HIV Care Continuum Atlanta EMA Georgia 2014 HIV

HIV Care Continuum, Atlanta EMA, Georgia, 2014

HIV Care Continuum Methodology, Atlanta EMA, 2014 • Adults and adolescents are those aged >= 13 years • Diagnosed by 12/31/2013, living as of 12/31/2014, including those missing race, sex, and/or risk behavior • Current address Atlanta Eligible Metropolitan Areas (EMA) • Linked to care = CD 4 or viral load (VL) within 30 days of diagnosis date including the day of diagnosis for those diagnosed between 01/01/2014 and 12/31/2014, inclusively – This is consistent with the new NHAS 2020 measures and is a change from previous within 90 days measure • Any care >= 1 CD 4 or VL in 2014 • Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 • Viral suppression (VS) = VL<200 copies/ml in most recent VL in 2014 • 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 • The EMA consists of the following counties: Bartow, Paulding, Carroll, Coweta, Fayette, Spalding, Henry, Newton, Rockdale, Gwinnett, Walton, Barrow, Forsyth, Cherokee, Pickens, De. Kalb, Fulton, Clayton, Cobb and Douglas • Missing laboratory data may result in underestimating care continuum outcomes. • Persons who have only one doctor visit each year for monitoring of their HIV infection will not meet the criteria for “retained in care” but may be virally suppressed. • 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 Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014 100% Percent 80% 77% 61% 60% 47% 40% 20% 0% N=1725 Linked to care within 30 days Any care N=34593 Retained in care Virally Suppressed (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Methodology for Identifying Transgender Persons in Georgia HIV database • Traditionally, Georgia DPH has depicted the HIV care continuum by sex based on birth sex • The state enhanced HIV/AIDS Reporting System (e. HARS) database was reviewed to identify individuals with a birth sex/current gender mismatch in case report forms and/or laboratory reports and/or other databases • Caution should be used in interpretation of the HIV care continuum for transgender persons as data on transgender identity may be missing non-randomly

Adults and Adolescents Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014, by Sex 100% Percent 80% 60% 77% 64% 62% 60% 54% 48% 47% 47% 45% 40% 20% 0% N=1409 N=27375 N=316 Male Linked to care within 30 days N=7145 Female Any care Retained in care N<10 N=126 Transgender Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia Excludes 73 people for whom sex is unknown Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Adults and Adolescents Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014, by Race/Ethnicity 100% Percent 80% 60% 85% 74% 84% 74% 60% 51% 44% 63% 58% 46% 47% 49% 54% 48% 36% 40% 43% 20% 0% N=1113 N=22926 N=106 N= 764 N=216 N=3171 N=253 N=651 Black Hispanic/Latino White Unknown Linked to care within 30 days Any care Retained in care Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Adults and Adolescents Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014, by Race/Ethnicity 100% Percent 80% 91% 77% 72% 63%60% 69% 55% 60% 46% 40% 38% 46% 44% 38% 31% 20% 0% N=11 N= 157 Asian Linked to care within 30 days N= N<10 N=13 AI/AN Any care N<10 N=16 NHOPI Retained in care N=29 N=1255 Multiple races Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia AI/AN = American Indian/Alaska Native, NHOPI = Native Hawaiian or Other Pacific Islander Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Percent Adults and Adolescents Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014, 100% by Current Age (in Years) 80% 60% 73%75% 61% 72% 67% 57% 40% 40% 81% 76% 61% 43% 80% 61% 39% 46% 78% 61% 49% 50% 59% 49% 50% 20% 0% N=64 N=171 N=306 N=1023 N=575 N=6538 N=349 N=8438 N=289 N=11466 N=148 N=6946 13 -19 20 -24 25 -34 35 -44 45 -54 55+ Linked to care within 30 days Any care Retained in care Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

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 risk reported or no risk identified

Percent Adults and Adolescents Living with Diagnosed HIV, Atlanta EMA, Georgia, 2014, by Transmission Category 100% 80% 60% 76% 75% 48% 40% 20% 0% 74% 62% 45% 41% 40% 42% N=1071 N=21930 N=51 N=2277 N=28 N=1698 MSM IDU MSM/IDU Linked to care within 30 days Any care 66% 63% 56% 52% 84% 77% 55% 49% 47% N=329 N=7014 N<10 HET Retained in care N=316 Other 48% 43% 36% N=253 N=1357 NIR/NRR Viral Suppression (VS) Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address Atlanta EMA, Georgia Linked to care= CD 4 or VL within 30 days of diagnosis, among those diagnosed 01/01/14 -12/31/14 (N=1725) Any care>= 1 CD 4 or VL in 2014 Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Viral Suppression Among Those Retained in Care, Atlanta EMA, Georgia, 2014, by Sex 100% 84% 81% 78% N=12827 N=3483 N=57 Male Female Transgender Percent 80% 60% 40% 20% 0% Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address in Atlanta EMA, Georgia Excludes 5 people with unknown sex Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Viral Suppression Among Those Retained in Care, Atlanta EMA, Georgia, 2014, by Race/Ethnicity 100% Percent 80% 85% 91% 95% 60% 40% 20% 0% N=10498 N=1026 N=3405 N= 494 Black Hispanic White Unknown Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address in Atlanta EMA, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Viral Suppression Among Those Retained in Care, Atlanta EMA, Georgia 2014, by Race/Ethnicity 100% 92% 83% Percent 80% 60% 40% 20% 0% N=85 N<10 N=795 Asian AI/AN NHOPI Multiple races Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address in Atlanta EMA, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Viral Suppression Among Those Retained in Care, Atlanta EMA, Georgia, 2014, by Current Age (in Years) Percent 100% 81% 70% 83% 86% 89% N= 3914 N= 5621 N= 3386 N= 1990 25 -34 35 -44 45 -54 55+ 72% 60% 40% 20% 0% N= 101 13 -19 N=477 20 -24 Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address in Atlanta EMA, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014

Percent 100% Viral Suppression Among Retained in Care Atlanta EMA, Georgia, 2014, by Transmission Category 84% 80% 82% 80% N=932 N=766 81% 80% 60% 40% 20% 0% N=10493 MSM IDU MSM/IDU N=3463 HET Adults and adolescents >= age 13, diagnosed by 12/31/2013, living as of 12/31/2014 Current address in Atlanta EMA, Georgia Retained in care >= 2 CD 4 or VL at least 3 months apart in 2014 Viral suppression (VS) = VL<200 copies/ml on most recent viral load in 2014 N=172 Other