cascade the continuum of hiv care florida, 2013

Cascade The Continuum of HIV Care

Florida, 2013

Lorene Maddox, MPHKaralee Poschman, MPH

Living data through 2013, as of 06/30/2014

National HIV/AIDS Strategy•Goals–Reduce the number of people who become infected

with HIV–Increase access to care and improve health outcomes

for people living with HIV–Reduce HIV-related health disparities

•Vital to improve engagement at every stage in a continuum of care that includes:–HIV testing and subsequent diagnosis–Linkage to HIV medical care–Continuous engagement in HIV medical care (retention)–Initiation of antiretroviral therapy (ART)–Suppressed viral load (<200 copies/mL)

Definitions (part 1 of 2)• HIV-infected=HIV diagnosed cases divided by 84.2% (to account for 15.8%

national estimated unaware of their status in Florida). The 2011 indicator report (http://www.cdc.gov/hiv/pdf/2011_Monitoring_HIV_Indicators_HSSR_FINAL.pdf ) estimates that 15.8% are undiagnosed (Table 9a) – this report uses 2010 data and was published in October 2013.

• HIV Diagnosed=Number of cases known to be alive and living in Florida through 2013, regardless where diagnosed, as of 06/30/2014 (used for unmet need calculations).

• Linked to Care (Ever in Care) =86% of those cases were linked to care, based on persons living with HIV disease in Florida (regardless of where diagnosed) who ever had a CD4 or Viral load (VL) test in the electronic HIV/AIDS Reporting System (eHARS) (2010 National estimates are 79%*).

*Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html )

http://www.cdc.gov/hiv/pdf/2011_Monitoring_HIV_Indicators_HSSR_FINAL.pdf

http://www.cdc.gov/hiv/pdf/2011_Monitoring_HIV_Indicators_HSSR_FINAL.pdf

http://hab.hrsa.gov/data/reports/continuumofcare/index.html



Definitions (part 2 of 2)• In Care this Year=55% of cases were in care this year, based on Health Resources

and Services Administration (HRSA) unmet need definition, for persons living with HIV in Florida (regardless of where diagnosed) and having at least 1 HIV-related care service involving either a Viral Load or CD4 test or a refill of HIV-related prescription (2010 National estimates for in care are 56%*).

• On Antiretroviral Therapy (ART) =Estimated 90.6% of In care this year in Florida per 2011 Medical Monitoring Project (MMP) data (2010 National estimates are 80%*).

• Suppressed Viral Load (VL) =Estimated 78.0% on ART & a suppressed VL (<200 copies /mL)this year in Florida per 2011 MMP data (2010 National estimates are 70%*).

*Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html)




Limitations to the Data (part 1 of 2)• These data reflect the care status in the most recent year, for

those persons presumed alive and living in Florida following database matches with eHARS and the Careware and Medicaid datasets. • These data exclude cases from the Department of Corrections

(DOC).• The analysis of these data depends on:

– the completeness of laboratory reporting in eHARS, – maintaining timely reporting of deaths, and– maintaining accurate current addresses, accommodating for in and out

migration. • Although significant strides have been made in the past year to

address all three at both the state and local levels, continued efforts will be made to further improve the completeness of these data elements.

Limitations to the Data (part 2 of 2)• The first three bars in the HIV Continuum reflect actual data in

eHARS, including the results of matching with Careware and Medicaid for the linked to care data.

• However, the data for the ART and those with a suppressed viral load were estimated based on MMP data. Estimates were not available below the state level, therefore the statewide estimates for these two bars will be applied to each of the local areas. In the upcoming year, we will evaluate the use of the patient care databases along with eHARS to get a more accurate estimate for the state and local areas.

Number and Percentage of HIV-Diagnosed PersonsEngaged in Selected Stages of

The Continuum of HIV Care — Florida, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

86%

55%50%

35%

(1) HIV Diagnosed

(2) Linked to Care

(3) In Care this Year

(4) On ART

(5) Suppressed Viral Load (<200 copies/mL on ART)

Continuum of HIV Care

Perc

ent o

f Cas

es

HIV-infected = 121,387102,208

87,664

56,14750,869

35,965

86% of those diagnosed with HIV were linked to care.

64% of those linked to care were in care this year.

91% of those in care this year were on ART.

71% of those on ART have a suppressed VL.

(1) Number of cases known to be alive and living in Florida through 2013, regardless where diagnosed, as of 06/30/2014 (used for unmet need calculations). (2) Ever in Care = 86% of those cases were linked to care, based on persons living with HIV disease in Florida (regardless of where diagnosed) who ever had a CD4 or Viral load (VL) test in the electronic HIV/AIDS Reporting System (eHARS). (2010 National estimates are 79%*). (3) 55% of cases were in care this year, based on HRSA unmet need definition, for persons living with HIV in Florida (regardless of where diagnosed) and having at least 1 HIV-related care service involving either a VL or CD4 test or a refill of HIV-related RX. (2010 National estimates for in care are 56%*). (4) Estimated 90.6% of In care and on ART this year in Florida per 2011 MMP data (2010 National estimates are 80%*).(5) Estimated 78.0% on ART & the viral load is <200 this year in Florida per 2011 MMP data (2010 National estimates are 70%*). *Continuum of HIV care among Ryan White HIV/AIDS Program clients, U.S., 2010 (http://hab.hrsa.gov/data/reports/continuumofcare/index.html) For additional information please refer to the Florida Continuum of Care slide set accessible at http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html



http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html


Number and Percentage of HIV-Infected bySelected Demographic and Transmission Groups

Engaged in Selected Stages of The Continuum of HIV Care

Florida, 2013 (part 1 of 2)

• By Geographical Area/Population Density• By Sex–Male, Female

• By Race–White, Black, Hispanic

• By Current Age Group–13-24, 25-49, 50+

Number and Percentage of HIV-Infected bySelected Demographic and Transmission Groups

Engaged in Selected Stages of The Continuum of HIV Care

Florida, 2013 (part 2 or 2)• By Transmission Groups*–IDU

–MSM–White MSM–Black MSM–Hispanic MSM

–Heterosexual–Heterosexual Males–Heterosexual Females–White Heterosexual–Hispanic Heterosexual–Black Heterosexual–Black Heterosexual Males–Black Heterosexual Females

*Note: MSM=MSM and MSM/IDU cases, IDU=IDU and MSM/IDU cases, therefore these two groups are NOT mutually exclusive

Number and Percentage of HIV-Infected PersonsEngaged in Selected Stages of

The Continuum of HIV Care — Rural Area, 2013


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

94%

68%62%

48%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 4,7934,0363,782

2,7572,498

1,948

94% of those di-agnosed with HIV were linked to care.









The Continuum of HIV Care — Urban Area, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

77%

45%41%

32%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 30,42625,619

19,737

11,51410,432

8,137

77% of those di-agnosed with HIV were linked to care. 58% of those

linked to care were in care this year.








Number and Percentage of HIV-Infected Among MALES Engaged in Selected Stages of The Continuum of HIV Care — Florida, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

86%

54%42%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


61,400

38,536

30,25124,322










Number and Percentage of HIV-Infected Among FEMALES Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

86%

58%51%

36%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


26,255

17,61115,586

11,097










Number and Percentage of HIV-Infected Among WHITES Engaged in Selected Stages of The Continuum of HIV Care — Florida, 2013


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

90%

56% 53%46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


27,630

17,277 16,08514,026









Number and Percentage of HIV-Infected Among BLACKS Engaged in Selected Stages of The Continuum of HIV Care — Florida, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

84%

56% 51%

36%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


40,061

26,49824,378

17,284










Number and Percentage of HIV-Infected Among HISPANICS Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

83%

51%43%

32%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


18,218

11,2359,505

7,024










Number and Percentage of HIV-Infected Persons Aged 13-24 Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

82%

58% 58%

39%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


3,224

2,284 2,284

1,539










Number and Percentage of HIV-Infected Persons Aged 25-49 Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

84%

54% 49%

37%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


44,191

28,25525,656

19,216










Number and Percentage of HIV-Infected Persons Aged 50 and older Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

88%

56% 50%41%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


40,049

25,47622,954

18,707










Number and Percentage of HIV-Infected Among IDU Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

89%

58% 53%

37%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


11,131

7,3346,645

4,698










Number and Percentage of HIV-Infected Among MSM Engaged in Selected Stages of The Continuum of HIV Care — Florida, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

86%

54% 49%43%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


44,770

28,052 25,69

6 22,175










Number and Percentage of HIV-Infected Among WHITE MSM Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

90%

56%52%

47%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


21,296

13,120 12,17

5 10,994










Number and Percentage of HIV-Infected Among BLACK MSM Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

82%

54% 54%46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


11,200

7,391 7,391628










Number and Percentage of HIV-Infected Among HISPANIC MSM Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

82%

50%41%

30%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


11,329

6,9445,639

4,195










Number and Percentage of HIV-Infected Among HETEROSEXUAL Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

85%

55%50%

35%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


33,404

21,891 19,70

213,969










Number and Percentage of HIV-Infected Among HETEROSEXUAL MALES Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

83%

53%48%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


11,580

7,3246,621

4,654










Number and Percentage of HIV-Infected Among HETEROSEXUAL FEMALES

Engaged in Selected Stages of The Continuum of HIV Care — Florida, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

85%

57%51%

36%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


21,827

14,567 13,05

29,319










Number and Percentage of HIV-Infected Among WHITE HETEROSEXUALS


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

89%

59% 57%

42%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


4,021

2,638 2,551

1,895










Number and Percentage of HIV-Infected Among HISPANIC HETEROSEXUALS


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

85%

54%47%

35%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


5,020

3,1962,777

2,064










Number and Percentage of HIV-Infected Among BLACK HETEROSEXUALSEngaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

84%

55%50%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


23,756

15,673 14,09

09,638










Number and Percentage of HIV-Infected Among BLACK HETERO MALES Engaged in Selected Stages of


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

82%

53%47%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


8,347

5,3634,816

3,405










Number and Percentage of HIV-Infected Among BLACK HETERO FEMALES


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

85%

57%51%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


15,409

10,309 9,278

6,170











The Continuum of HIV Care — Partnership 1, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

93%

65%59%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,2001,8521,730

1,1981,085

847











The Continuum of HIV Care — Partnership 2a, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

92%

69%63%

49%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 1,025863796

597541

422











The Continuum of HIV Care — Partnership 2b, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

89%

65%59%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,1561,8151,617

1,1841,073

837













Series10%

10%20%30%40%50%60%70%80%90%

100%100%

93%

68%62%

48%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,3341,9651,825

1,3421,216

948











Series10%

10%20%30%40%50%60%70%80%90%

100%100%

94%

68%62%

48%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,4602,0711,956

1,4151,282

1,000











The Continuum of HIV Care — Consortium Partnerships 3/13 , 2013


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

94%

68%62%

48%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 4,7934,0363,782

2,7572,498

1,948











Series10%

10%20%30%40%50%60%70%80%90%

100%100%

91%

65%59%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 7,7406,5175,917

4,2103,814

2,975











The Continuum of HIV Care — Jacksonville EMA, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

91%

65%58%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


5,830

4,1473,757

2,931













Series10%

10%20%30%40%50%60%70%80%90%

100%100%

94%

68%61%

48%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 5,9054,9724,652

3,3573,041

2,372












Series10%

10%20%30%40%50%60%70%80%90%

100%100%

91%

63%57%

44%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 9,0557,6246,974

4,7934,342

3,387










The Continuum of HIV Care — Tampa/St. Pete EMA, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

92%

65%58%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 13,81211,63010,734

7,5076,801

5,305













Series10%

10%20%30%40%50%60%70%80%90%

100%100%

91%

66%60%

47%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,6852,2612,066

1,4891,349

1,052










The Continuum of HIV Care — Consortium Partnerships 5/6/14, 2013


Series10%

10%20%30%40%50%60%70%80%90%

100%100%

92%

65%59%

46%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 17,64514,85713,694

9,6398,733

6,812












Series10%

10%20%30%40%50%60%70%80%90%

100%100%

87%

54%49%

38%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


9,759

6,1105,536

4,318










The Continuum of HIV Care — Orlando EMA, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

86%

54%49%

38%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


9,148

5,7075,171

4,033













Series10%

10%20%30%40%50%60%70%80%90%

100%100%

92%

64%58%

45%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 5,1314,3203,969

2,7612,501

1,951










The Continuum of HIV Care – Partnership 9, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

81%

48%43%

34%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


6,454

3,7923,436

2,680












Series10%

10%20%30%40%50%60%70%80%90%

100%100%

87%

52%47%

37%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


15,923

9,5918,689

6,778

87% of those di-agnosed with HIV were linked to care. 60% of

those linked to care were in care this year.









The Continuum of HIV Care — Partnership 11a, 2013

Series10%

10%20%30%40%50%60%70%80%90%

100%100%

77%

45%41%

32%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


19,737

11,51410,432

8,137











The Continuum of HIV Care — Partnership 11b, 2013


Series10%

10%20%30%40%50%60%70%80%90%

100%100% 95%

54%49%

38%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 779656622

352319

249












Series10%

10%20%30%40%50%60%70%80%90%

100%100%

88%

63%57%

44%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es


1,512

1,079978












Series10%

10%20%30%40%50%60%70%80%90%

100%100%

91%

58%52%

41%

(1) HIV Diagnosed

(2) Linked to Care


(4) On ART



Perc

ent o

f Cas

es

HIV-infected = 2,8002,3582,155

1,3641,236

964









For Florida HIV/AIDS Surveillance DataContact: (850) 245-4444

Lorene Maddox, MPH Ext. 2613 Tracina Bush, BSW Ext. 2612 Madgene Moise, MPH Ext. 2373

Visit Florida’s internet site for:Monthly Surveillance Reports

Slide Sets and Fact SheetsAnnual Reports and Epi Profiles

http://www.doh.state.fl.us/disease_ctrl/aids/trends/trends.html

Visit CDC’s HIV/AIDS internet site for:Surveillance Reports, fact sheets and slide sets

http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm

cascade the continuum of hiv care florida, 2013

Documents

continuum of hiv care

continuum of care

hiv testing

lorene maddox

mphkaralee poschman

number of people

health outcomes

mphliving data