Medical Director, East Bay AETC

Slides:



Advertisements
Similar presentations
MINNESOTAS HIV TREATMENT CASCADE. Introduction This slide set describes the continuum of HIV care in Minnesota. The slides rely on data from HIV/AIDS.
Advertisements

Quality Improvement Team Members
Coordinating Care Across Funded Providers to Support Retenion in Care: The In+Care Campaign in RI. Aadia Rana, MD Assistant Professor of Medicine Miriam.
HRSA Policy Updates NASTAD AIDS Drug Assistance Program (ADAP) Technical Assistance Meeting July 31, 2014 Heather Hauck, Director Division of State HIV/AIDS.
State of Texas HIV Planning &. Goals for the National HIV/AIDS Strategy 1.Reduce new HIV infections 2.Increase access to care and improve health outcomes.
Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County Shoshanna Nakelsky, MPH Division of HIV and.
The HIV Engagement in Care Cascade Edward Gardner, MD Associate Professor of Medicine Denver Public Health University of Colorado Denver.
National HIV Prevention Progress Report, 2013 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention.
The Future of the Ryan White CARE Act in the Post-ACA Era Jason King Advocacy & Legislative Affairs Manager AIDS Healthcare Foundation – Southern Bureau.
Illustrating the HIV Care Continuum in U.S. Cities
Implementing the National HIV/AIDS Strategy (NHAS) via the CDC Funding Announcement for SPG Meeting - August 17, 2011 Portland State Office Building.
“ Technical Assistance to those Beyond Bars: Linkages to care Post Incarceration ” Carmen Brown, MD, MPH, Tessa R. Brown, MPH, BSN, RN, CIC, Gwendolyn.
Disparities in Health Outcomes by Race Among HIV-Positive Clients of Los Angeles County Ryan White CARE Act-Funded Services in 2002 Ijeoma C. Nwachuku,
Illustrating the HIV Care Continuum in U.S. Cities Chicago, IL.
Illustrating the HIV Care Continuum in U.S. Cities New Orleans, LA.
Illustrating the HIV Care Continuum in U.S. Cities Atlanta, GA.
Illustrating the HIV Care Continuum in U.S. Cities Philadelphia, PA.
© 2005, Johns Hopkins University. All rights reserved. Department of Health, Behavior & Society David Holtgrave, PhD, Professor & Chair.
HIV & AIDS Cases in Alameda County Presentation to the CCPC August 24, 2011 Elaine Bautista & Alex Marr.
Community Feedback and Involvement in [Health Department’s] Proposed Data to Care Program [Name of Provider Session Date of Provider Session]
Michael J. Mugavero, M.D., MHSc, Jessica A. Davila, Ph.D., Christa R. Nevin, MSPH, and Thomas P. Giordano, M.D., M.P.H. Volume 24, Number 10, 2010 AIDS.
The Minority AIDS Initiative (MAI): Then and Now Edwin M. Craft, Dr. P
Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division.
HIV Care Continuum, Georgia, United States, 2011 Presented to American Public Health Association, Annual Meeting Presented by Deepali Rane, MBBS, MPH,
HIV Care Continuum New Diagnoses, 2011, Fulton County, Georgia.
Monitoring Indicators of the National HIV/AIDS Strategy Using Data for Public Health Action Irene Hall, PhD, FACE HIV Incidence and Case Surveillance Branch.
HIV Care Continuum Persons Living With HIV, Georgia, 2012.
Ryan White All Grantees Meeting Washington, DC November, 2012 Supporting National HIV/AIDS Strategies: the domestic experience and the AETCs.
Getting to Zero: Will San Francisco be the first city to succeed? Diane Havlir, MD, Professor of Medicine, UCSF, Chief HIV San Francisco General Hospital.
Michael J. Mugavero, MD, MHSc Associate Professor of Medicine University of Alabama at Birmingham Birmingham, Alabama Elements of the Care Continuum FORMATTED:
MINNESOTA’S HIV TREATMENT CASCADE April, Introduction.
Mean HIV viral load among resident cases and undiagnosed in Oregon Jeff Capizzi, Epidemiologist Sean Schafer, HIV/STD/TB Medical Epidemiologist Lea Bush,
HIV/AIDS Bureau Update Ryan White HIV/AIDS Program Clinical Conference New Orleans, LA December 15, 2015 Laura Cheever, MD, ScM Associate Administrator.
The HIV Care Continuum: A Tool for Driving Systematic Change to Support Better Engagement in Care Jeffrey S. Crowley Distinguished Scholar/ Program Director.
California Department of Public Health Office of AIDS HIV CARE and PREVENTION 2009: You Need to Know.
H. Dawn Fukuda Director, Office of HIV/AIDS Massachusetts Department of Public Health United States Conference on AIDS Washington, D.C. September 10-13,
HIV Care Continuum New Diagnoses, 2011, Georgia. Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States Percent
Epidemiology of HIV in California: Hot spots, cold spots, and program improvement Juliana Grant, MD MPH Chief, Surveillance, Research, and Evaluation Branch.
Prevention of HIV Transmission Treatment as Prevention or Behavior Change Interventions? Moderator Victoria A Cargill, M.D., M.S.C.E. Office of AIDS Research,
HIV Prevention: A Winnable Battle Centers for Disease Control and Prevention.
Using Data to Optimize the HIV Care and Prevention Continua in San Francisco The views expressed herein do not necessarily reflect the official policies.
Janet Heitgerd, PhD Program Evaluation Branch, Associate Chief for Science American Evaluation Association Annual Meeting November 2010 Improving the Design,
HRSA Talk: HIV From the Inside USCA 2016 – September 17, 2016 Harold Phillips, Director Office of Domestic & Global HIV Training & Capacity Development.
Integrating Program Innovation to Improve Prevention and Care Services USCA 2016 – September 17, 2016 April Stubbs-Smith, MPH Director, Division of Domestic.
Harry Lampiris, MD, Moderator Chief, ID Section, Medical Service, SFVAMC Professor of Clinical Medicine, UCSF.
Quick Review This presentation is the first in a series of presentations intended to familiarize you with disparities calculation Part I: YOU ARE HERE!
State Office of AIDS Update
Report Back: 21st International AIDS Conference (Durban, South Africa)
Kathleen Brady, MD; Coleman Terrell; Marlene Matosky, MPH, RN
Illustrating the HIV Care Continuum in U.S. Cities
Lowering Barriers to Engage Hard to Find Communities in PrEP
Strategies for Linkage to and Engagement in Care
Entry into care Failure to initiate timely HIV care after diagnosis is common ~75% of newly diagnosed link to care within 6-12 months Delayed entry into.
Illustrating the HIV Care Continuum in U.S. Cities
Melanie L. Fritza Ronald J. Lubelchek, MD a, b, c*
East Bay HIV Update Conference
Illustrating the HIV Care Continuum in U.S. Cities
Illustrating the HIV Care Continuum in U.S. Cities
Elements of the Care Continuum
Let’s end aids, long island.
Community Consortium Harry Lampiris Moderator IAS Report Back, August 30, 2017 Chief, ID Section, Medical Service, SFVA Health Care System Professor of.
HIV Treatment: What Can You Do to Get and Keep Patients in Care?
Community Based Dental Partnership Program
Illustrating the HIV Care Continuum in U.S. Cities
Needs Assessment Slides for Module 4
Sustaining Primary Care-Public Health Partnerships for Engagement in Care – The Partnerships for Care Demonstration Project Sue Lin, PhD, MS Director,
Core Medical Services Waiver
Medical Management of HIV Among Transgender Adults
Baltimore Eligible Metropolitan Area (EMA) Planning Council Meeting
HIV Treatment Cascade and the Ryan White HIV/AIDS Program
Presentation transcript:

Medical Director, East Bay AETC The Missing Link in Test-and-Treat identifying and improving gaps in care test treat Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist and HIV specialist, Asian Health Services Assistant Clinical Professor of Medicine, UCSF

disclosures None! I have no financial arrangements or affiliations with commercial interests. Commercial support was not received for this activity. I will not discuss off-label uses of drugs or products in my presentation.

objectives Describe the impact of using clinical data, especially linkage rates, retention rates and viral loads on test-and-treat outcomes. Identify and analyze gaps in linkage to and retention in care. Propose a work plan to implement at least one strategy for identifying and/or improving linkage and retention rates.

workshop format Gardner & CDC test-link-treat cascades Case Definitions of linkage, retention, and viral load suppression The Alameda County experience How to use this data to improve care Your experience and way forward!

80% 62% 41% 36% 28% * HIV-infected, N = 1,178,350; HIV-diagnosed, n=941,950. Source: CDC. HIV surveillance—United States, 1981–2008. MMWR 2011;60:689–93. † Calculated as estimated number diagnosed (941,950) × estimated percentage linked to care (77%); n = 725,302. Sources: Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS 2010;24:2665–78; Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS 2011;25:79–88. § Calculated as estimated number diagnosed (941,950) × estimated percentage retained in care (51%); n = 480,395. Sources: Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS 2010;24:2665–78; Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS 2011;25:79–88; Hall IH, Mahle KC, Tang T, Li J, Johnson AS, Shouse L. Retention in care of HIV-infected adults and adolescents in 13 U.S. areas. Presented at the National HIV Prevention Conference, Atlanta, GA, August 14–17, 2011; Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses 2011;27:751–8. ¶ Calculated as estimated number retained in HIV care (480,395) × percentage prescribed ART in MMP (88.8%); n = 426,590. Source: Data from the Medical Monitoring Project. ** Calculated as estimated number on ART (426,590) × percentage with suppressed viral load in MMP (77.0%); n = 328,475 (28% of the estimated 1,178,350 persons in the United States who are infected with HIV). Source: Data from the Medical Monitoring Project. 2011-11-29 MMWR 60

New HIV infections Access to care: test & treat!  HIV health disparities

treatment reduces transmission by 96% HIV Treatment Is Prevention: The Results of HPTN 052 Among HIV-serodiscordant couples, treatment of the infected partner  decreased the risk for transmission to the uninfected partner by 96%. Combination antiretroviral therapy (ART) has long been known to drive viral replication to levels below the limit of detection, leading to significant  improvements in patients' health. Given that ART also decreases the amount  of HIV present in genital secretions, experts have speculated that it  should also reduce sexual transmission of HIV. Several observational  studies -- most recently, the Partners in Prevention HSV/HIV Transmission  Study (JW AIDS Clin Care Jun 7 2010) -- have supported this hypothesis, but only a randomized, controlled trial could provide definitive proof. Enter  the HPTN 052 study. The results of this trial were released in May 2011, after the data and  safety monitoring board (DSMB) concluded that the study had demonstrated  its goal (JW AIDS Clin Care May 16 2011). Now, they are being published in  the New England Journal of Medicine and simultaneously presented at this  year's International AIDS Society meeting in Rome. The HPTN 052 study involved 1763 HIV-serodiscordant couples in nine  countries (5 in Africa, 2 in Asia, and 2 in the Americas). Per inclusion  criteria, all the HIV-infected partners had baseline CD4 counts between 350 and 550 cells/mm{super 3}, and all were treatment naive (except for  possible ART to prevent perinatal transmission). They were randomized 1:1  to receive early ART at enrollment or to delay therapy until their CD4  counts were <=250 cells/mm{super 3} on two consecutive measurements or they developed an AIDS-related illness. Nearly all the couples were heterosexual (97%), and half the HIV-infected participants were men. The median baseline CD4 count was 442 cells/mm{super 3} in the early-therapy group and 428  cells/mm{super 3} in the delayed-therapy group. AZT/3TC/efavirenz was the  most commonly used antiretroviral regimen in the study. At the time of the DSMB review, 90% of couples remained in the study, with  a median follow-up of 1.7 years; 89% of participants in the early-therapy  group had viral loads below 400 copies/mL. A total of 39 HIV transmission  events occurred during follow-up: 4 in the early-therapy group and 35 in  the delayed-therapy group. In 28 of these cases, genetic testing confirmed  that the HIV-infected partner in the study was the source of infection:  Only 1 of these cases was in the early-therapy group versus 27 in the  delayed-therapy group, which translated to a 96% risk reduction with early  ART. Of interest, 17 of the 28 linked infections occurred when the infected  partner had a CD4 count >350 cells/mm{super 3}, and 23 were among African  couples. A high plasma viral load at baseline increased the likelihood of  transmission, whereas consistent condom use decreased the likelihood. The clinical benefits of early ART were also evident, with the  delayed-therapy group experiencing significantly more clinical events  (primarily, extrapulmonary tuberculosis). Comment: This study conclusively demonstrates that treatment of HIV  infection decreases the risk for sexual transmission and improves the lives of those infected, regardless of CD4-cell count. Clearly, the study has  important policy implications. Is it time to recommend treatment for  HIV-infected individuals in stable serodiscordant couples in order to  prevent infection of their partners? I think the evidence is now quite  strong (AI evidence) and we should therefore move in that direction. I also think it is probably time to stop guiding ART by CD4-cell count and just  treat anyone who is willing to be treated -- not only for their own health  but also for the larger public health benefit. -- Carlos del Rio, MD Published in Journal Watch HIV/AIDS Clinical Care July 19, 2011  Citation(s): Cohen MS et al. Prevention of HIV-1 infection with early antiretroviral  therapy. New Engl J Med 2011 Jul 18; [e-pub ahead of print].  (http://dx.doi.org/10.1056/NEJMoa1105243) Hammer SM. Antiretroviral treatment as prevention. New Engl J Med 2011 Jul  18; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMe1107487)

NHAS Goals 79%  90% 65%  85% 73%  80% 28%  48%

case A 28 year old African American bisexual man tests positive at a community-based rapid testing project…

HIV-infected, N = 1,178,350; HIV-diagnosed, n=941,950. Source: CDC * HIV-infected, N = 1,178,350; HIV-diagnosed, n=941,950. Source: CDC. HIV surveillance—United States, 1981–2008. MMWR 2011;60:689–93. † Calculated as estimated number diagnosed (941,950) × estimated percentage linked to care (77%); n = 725,302. Sources: Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS 2010;24:2665–78; Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS 2011;25:79–88. § Calculated as estimated number diagnosed (941,950) × estimated percentage retained in care (51%); n = 480,395. Sources: Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS 2010;24:2665–78; Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS Patient Care STDS 2011;25:79–88; Hall IH, Mahle KC, Tang T, Li J, Johnson AS, Shouse L. Retention in care of HIV-infected adults and adolescents in 13 U.S. areas. Presented at the National HIV Prevention Conference, Atlanta, GA, August 14–17, 2011; Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses 2011;27:751–8. ¶ Calculated as estimated number retained in HIV care (480,395) × percentage prescribed ART in MMP (88.8%); n = 426,590. Source: Data from the Medical Monitoring Project. ** Calculated as estimated number on ART (426,590) × percentage with suppressed viral load in MMP (77.0%); n = 328,475 (28% of the estimated 1,178,350 persons in the United States who are infected with HIV). Source: Data from the Medical Monitoring Project. 2011-11-29 MMWR 60

Definitions Linkage: how does the CDC define linkage to care? Retention: how does HRSA define retention in care?

Definitions Viral load suppression: how does the CDC define viral load suppression?

The Missing Link in Test-and-Treat

The Missing Link: Linkage & retention is our weakest point.

So what?

What will it take to substantially reduce HIV transmission in an entire population? Answer: Treatment AND Prevention Gardner, CID 2011

Questions?

CME / CE credits If you would like to receive continuing education credit for this activity, visit: http://www.pesgce.com/RyanWhite2012

thanks! AETC: Kathleen Clanon East Bay AETC team OAA/DPH HIV data team: Lorenzo Hinojosa Neena Murgai Kate Buchacz Elaine Bautista Alex Marr Kaiser: Leo Hurley Highland: Doug White AHS: Koji Sakakibara EBAC Downtown Youth Clinic HIV ACCESS: Lois Lindsey Dan Clanon Jose Reyes Brianna Rogan Alameda County DPH: Damon Francis Office of AIDS: Kabir Hypolite CA State: Mark Damesyn Matt Facer