Georgia HIV Care Continuum Update Persons Living with

Georgia HIV Care Continuum Update: Persons Living with HIV, 2016, and Persons Diagnosed with HIV, 2015 HIV Epidemiology Section, Georgia Department of Public Health

Persons Living with HIV Care Continuum Methodology, Georgia, 2016 • Adults and adolescents are those aged >= 13 years • Diagnosed with HIV by 12/31/2015, living as of 12/31/2016, including those missing race, sex, and/or risk behavior • Current address within Georgia • Any care >= 1 CD 4 or VL in 2016 • Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 • Viral suppression (VS) = VL<200 copies/ml in most recent VL in 2016 • Each bar in the continuum is independent of those preceding it; all percentages are of the total number of persons (N) diagnosed with HIV in each category

Caveats and Clarifications • Missing laboratory data may result in underestimating care continuum outcomes • The number of individuals (N) in some subpopulations is small. Use caution in interpretation • Methodology for the care continuum and completeness of HIV data varies among jurisdictions, thus limiting direct comparisons with other states or the national continuum • Missing information about race, sex and/or transmission category reflects missing data on case report forms that remains unresolved

Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016 100% Percent 80% 64% 51% 49% 40% 20% 0% Any care N=53, 385 Retained in care Virally Suppressed (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016 by Sex 100% Percent 80% 64% 60% 63% 49% 52% 50% 49% 40% 20% N=40365 0% Male Any care Retained in care N=12293 Female Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016 Excludes 104 persons for whom sex is unknown

Percent Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016, by Race/Ethnicity 100% 80% 65% 49% 50% 59% 64% 49% 51% 56% 40% 31% 20% 0% N=35950 Black Any care 23% 28% N= 3285 N=10353 N=1388 Hispanic/Latino White Unknown Retained in care Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016, by Race/Ethnicity 100% Percent 80% 78% 65% 54% 60% 53% 42% 40% 38% 25% 20% 0% Any care 53% 62% 65% 35% N= 213 N= 24 N=17 N=2034 Asian AI/AN NHOPI Multiple races Retained in care Viral Suppression (VS) AI/AN = American Indian/Alaska Native NHOPI = Native Hawaiian or Other Pacific Islander Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

100% Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016, by Current Age (in Years) 80% 60% 71% 65% 62% 51% 45% 52% 47%46% 64% 63% 47%49% 63% 55% 50%53% 40% 20% 0% N= 228 N=1496 N=9806 N=11560 13 -19 20 -24 25 -34 35 -44 Any care Retained in care N=16697 N=13598 45 -54 Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care>= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016 55+

100% Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016, by Current Age (in Years) 80% 60% 71% 65% 62% 51% 45% 52% 47%46% 64% 63% 47%49% 63% 50%53% 55% 50% 40% 20% 0% N= 228 N=1496 N=9806 N=11560 13 -19 20 -24 25 -34 35 -44 Any care Retained in care N=16697 45 -54 Viral Suppression (VS) Trend line shown for viral suppression by age Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care>= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016 N=13598 55+

Transmission category definitions Multiple imputation was used to assign transmission category where missing • MSM = Male to male sexual contact • IDU = Injection drug use • MSM/IDU = Male to male sexual contact and injection drug use • HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection • Other = hemophilia, blood transfusion, perinatal exposure • NRR/NIR = no reported risk/no identified risk

Percent Adults and Adolescents Living with Diagnosed HIV, Georgia, 2016, by Transmission Category 100% 80% 66% 50%54% 58% 44%46% 47% 44% 65% 62% 51% 50% 42% 40% 32% 28% 24% 20% 0% N=31805 MSM Any care N=3802 N= 2266 N= 13519 N= 539 IDU MSM/IDU HET Other Retained in care N=1454 NRR/NIR Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2015, living as of 12/31/2016 Current address Georgia Any care>= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Viral suppression among adults and adolescents retained in care, Georgia, 2014 -2016 100% Percent 80% 82% 85% 2014 2015 N = 24, 544 N = 25, 900 85% 60% 40% 20% 0% 2016 N = 26, 094 N = number retained in care Adults and adolescents >= age 13 Diagnosed by 12/31 of previous year, living as of 12/31 of reporting year, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in reporting year Viral suppression (VS) = VL<200 copies/ml

New HIV Diagnoses Care Continuum Methodology, Georgia, 2015 • Adults and adolescents are those aged >= 13 years • Diagnosed in 2015, living as of 12/31/2016, including those missing race, sex, and/or risk behavior • Address at HIV diagnosis within Georgia • Linked to care = CD 4 or viral load (VL) within 30 days of diagnosis date including the day of diagnosis for those diagnosed between 01/01/2015 and 12/31/2015, inclusively – This is consistent with the new National HIV/AIDS Strategy 2020 measures and is a change from previous “within 90 days” measure

New HIV Diagnoses Care Continuum Methodology, continued • Any care >= 1 CD 4 or VL in 2016 • Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 • Viral suppression (VS) = VL<200 copies/ml in most recent VL in 2016 • Each bar in the continuum is independent of those preceding it; all percentages are of the total number of persons (N) diagnosed with HIV in each category

Caveats and Clarifications • Missing laboratory data may result in underestimating care continuum outcomes • Because the “linked to care” measure has changed from within 90 to 30 days, use caution when comparing these data to earlier reports • The number of individuals (N) in some sub-populations is small. Use caution in interpretation • Methodology for the care continuum and completeness of HIV data varies among jurisdictions, thus limiting direct comparisons with other states or the national continuum • Missing information on race, sex and/or transmission category reflects missing data on case report forms that remains unresolved

Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015 100% Percent 80% 76% 65% 59% 60% 57% 40% 20% 0% Linked to care within 30 days N=2, 688 Any care Retained in care Virally Suppressed (VS) Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015 by Sex 100% Percent 80% 76% 65% 59% 60% 58% 67% 75% 57% 53% 40% 20% 0% N=515 N=2171 Male Linked to care within 30 days Any care Female Retained in care Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016 Excludes 2 persons for whom sex is unknown

Percent Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015, by Race/Ethnicity 100% 80% 60% 76% 62% 58%55% 77% 65% 62%60% 84% 76% 69%72% 40% 32% 24% 19% 20% 0% 72% Black N=1916 Linked to care within 30 days N=179 N=408 N=96 Hispanic/Latino White Unknown Any care Retained in care Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015, by Race/Ethnicity 100% Percent 80% 60% 90% 70% 82% 68% 65% 60% 65%65% 40% 20% 0% Asian N=20 Linked to care within 30 days N<10 N=68 AI/AN NHOPI Multiple races Any care Retained in care Viral Suppression (VS) AI/AN = American Indian/Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

100% 80% 60% Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015, by Current Age (in Years) 75% 48% 78% 63% 61% 59%57% 59% 57% 60% 54% 75% 71% 74%75% 57% 58% 61%61% 73%71% 55% 54% 40% 20% 0% N=138 13 -19 N=522 20 -24 Linked to care within 30 days N=915 25 -34 Any care 35 -44 N=473 Retained in care 45 -54 N=406 55+ Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016 N=234

Percent Adults and Adolescents Newly Diagnosed with HIV, Georgia, 2015, by Transmission Category 100% 80% 79% 65% 60% 62%61% 70% 62% 49% 44% 40% 73% 64% 57% 75% 66% 57% 72% 53% 32% 25% 19% 20% N=97 0% N=1782 N=81 MSM IDU Linked to care within 30 days Any care N=37 MSM/IDU Retained in care N=690 HET NRR/NIR Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed 01/01/15 -12/31/15, living as of 12/31/2016 Address at HIV diagnosis Georgia Linked to care = CD 4 or VL within 30 days of diagnosis Any care >= 1 CD 4 or VL in 2016 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2016 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2016

Viral suppression among newly diagnosed adults and adolescents retained in care, Georgia, 2014 -2016 100% Percent 80% 78% 82% 84% 2014 N = 1, 348 2015 N = 1, 465 2016 N = 1, 579 60% 40% 20% 0% N = number retained in care Adults and adolescents >= age 13 Diagnosed in reporting year, living as of 12/31 of following year, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in reporting year Viral suppression (VS) = VL<200 copies/ml