end the syndemic...2020/04/27  · amber coyne, mph end the syndemic coordinator ending the hiv...

END THE SYNDEMICTENNESSEE

endthesyndemictn.org

An Integrated HIV, Sexually Transmitted Infections, Substance Use Disorder, and Viral Hepatitis Plan for TN

Amber Coyne, MPHEnd the Syndemic Coordinator

ENDING THE HIV EPIDEMIC ACROSS THE U.S.

EHE plans across the

nation

Phase one jurisdictions identified by the federal EHE plan

THE STORY OF SCOTT COUNTY, INDIANA

THE STORY OF SCOTT COUNTY, INDIANA

HIV AND HCV RAPID TRANSMISSION VULNERABILITY

Federal assessment showing the 220 counties most

vulnerable counties

• 31 vulnerable counties• 53 moderately vulnerable counties • 11 highly vulnerable counties

TN assessment of

vulnerability

WHAT IS A SYNDEMIC?

THREE CRITERIA OF A SYNDEMIC FRAMEWORK

THE HEART OF THE FRAMEWORK

THE HEART OF THE FRAMEWORK

HOW TENNESSEE RANKS NATIONALLY

QUICK FACTS ON THE SYNDEMIC – NATIONAL DATA

QUICK FACTS ON THE SYNDEMIC – TENNESSEE DATA, 2018

HIV & HCV VULNERABILITY ASSESSMENT FOR TN, 2019

• % of populat ion 20-44 years old• % of homes w ith > 1 vehicle• % of populat ion unemployed• Per capita income

• Primary care prov ider rate• Mental health prov ider rate• % of clients in treatment for

OUD

• Syphil is case rate• Teen birth rate• Number of premature deaths• HIV prevalence rate

• Mult iple prov ider episodes• Morphine Mill igram equivalent

“ MME”

ACCESS TO HEALTHCARE

HEALTH OUTCOMESOPIOID USE

SOCIOECONOMIC FACTORS

NUMBER OF REPORTED CASES OF STIs TN, 2013-2017

30,493 35,088

7,406

12,425

990

1,456

-

200

400

600

800

1,000

1,200

1,400

1,600

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2013 2014 2015 2016 2017

CHLA

MYD

IA&

GO

NO

RRHE

A

*Syphilis includes all stages of disease.

Chlamydia ↑ 15%

Gonorrhea ↑ 68%

Syphilis ↑ 47%

STD/HIV REPORTED CO-INFECTIONS TN, 2014-2017

87

176189

244

101

178

239

354

225

367

344

380

0

50

100

150

200

250

300

350

400

2014 2015 2016 2017

Num

ber

of C

o-In

fect

ed R

epor

ted

Case

s

CHL/HIV GC/HIV Syphil is/HIV

PrEP REFERRALS AMONG SYPHILIS CASES TN, 2018

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Only Syphilis (N=2,496) Eligible for PREP (N=895) Referred for PREP(N=367)

STD/HIV REPORTED CO-INFECTIONS BY AGE TN, 2017

36 45 9540 57

5693 148

163

75 104 660 0 0

% O

F CO

-INFE

CTED

CASE

S RE

PORT

ED

45+ 35-44 25-34

Case Counts of Newly Reported Confirmed and Probable Chronic HCV infection by Age and Sex, Tennessee 2014-218

STD/HIV CO-INFECTIONS BY METRO REGION TN, 2017

0

20

40

60

80

100

120

140

160

180

Davidson Hamilton Knox Madison Shelby Sull ivan

Num

ber

of C

o-In

fect

ed C

ases

Rep

orte

d

CHL/HIV GC/HIV Syphilis/HIV

STD/HIV CO-INFECTIONS BY RURAL REGION TN, 2017

8

13

7

3

7

37

7

0

5

10

15

20

25

30

35

40

Northeast East Southeast UpperCumberland

South Central MidCumberland

West

umbe

r of

Co-

Infe

cted

Cas

es R

epor

ted

CHL/HIV GC/HIV Syphil is/HIV

REALTIONSHIP BETWEEN VIRAL HEPATITIS AND HIV

HEPATITIS C AND HIV CO-INFECTION DATA

37%

28%

10%

9%

16%

HIV/ HCV & HIV/HBV/HCV Co-infections by HIV Expsosure Category - 2019 Year-to-date

MSM IDU MSM & IDU

Heterosexual Other

HEPATITIS B AND HIV DATA CO-INFECTION DATA

48%

9%9%

12%

22%

HIV/ HCV & HIV/HBV/HCV Co-infections by HIV

Expsosure Category - 2019 Year-to-date

MSM IDU MSM & IDU Heterosexual Other

THE RELATIONSHIP BETWEEN SUD AND HIV, STIS, & VH

DIVISION OF SUBSTANCE ABUSE OPIOID USE PATTERNS

Substance Use Rate Increases by Region, FY 2012 – FY 2019

Percentage Increase, Opioid Use Rate

Percentage Increase, Methamphetamine Use Rate

Percentage Increase, Use of Both Opioids and

Methamphetamine

Tennessee 27% 219% 286%

Region 1 6% 361% 398%

Region 2 -1% 448% 405%

Region 3 13% 141% 141%

Region 4 122% 303% 683%

Region 5 49% 198% 321%

Region 6 18% 122% 190%

Region 7 89% 162% 307%

WANT TO MAKE A DIFFERENCE? INTEGRATE & COLLABORATE

WANT TO MAKE A DIFFERENCE? JOIN END THE SYNDEMIC

COMMUNITY ENGAGEMENT PROCESS

COMMUNITY ENGAGEMENT PROCESS

ANATOMY OF THE PLAN

LINKS TO MORE INFORMATION • Syringe Services Programs- https://www.tn.gov/health/health-program-areas/std/std/syringe-services-

program.html• Ryan White Program- https://www.tn.gov/health/health-program-areas/std/std/ryanwhite.html• Viral Hepatitis Case Navigators:

https://www.nastad.org/sites/default/files/HD_Success_Stories/successstories_july2019_tennessee.pdf• PrEP Navigators: https://getpreptn.com/• Overdose dashboard: https://www.tn.gov/health/health-program-areas/pdo/pdo/data-dashboard.html• Regional Overdose Prevention Specialists: https://www.tn.gov/behavioral-health/substance-abuse-

services/prevention/rops.html• Medication-Assisted Treatment: https://www.tn.gov/behavioral-health/substance-abuse-services/treatment--

-recovery/treatment---recovery/opioid-treatment-programs.html• Behavioral Health Safety Net of TN: https://www.tn.gov/behavioral-health/mental-health-services/mental-

health-services-for-adults0/behavioral-health-safety-net-.html• Tennessee Recovery Navigators: https://www.tn.gov/behavioral-health/substance-abuse-services/treatment--

-recovery/treatment---recovery/tennessee-recovery-navigators.html• Substance Abuse and Mental Health Services Administration: https://www.tn.gov/behavioral-health.html• HIV surveillance Reports https://www.tn.gov/health/health-program-areas/statistics/health-data/hiv-

data.html• Viral Hepatitis Epidemiological Profile https://www.tn.gov/content/dam/tn/health/documents/viral-

hepatitis/2018%20Epi%20Profile_Final.pdf

A BIG THANK YOU TO THE FOLLOWING:

• The End the Syndemic Internal work group at TDH and TDMHSAS

• The HIV Prevention Team – especially Meredith Brantley • The Viral Hepatitis Team – especially Lindsey Sizemore,

Heather Wingate, and Jennifer Black• The STI Team – especially Leo Parker, Dyanne Herrera-Vasquez • The Office of Informatics and Analytics – especially Charlotte

Cherry and Ben Tyndall• The TDMHSAS – especially Anthony Jackson • Opioid Response Coordinator – Kristen Zak

END THE SYNDEMICTENNESSEE

endthesyndemictn.org

Thank you!Have questions or feedback?

Email: Endthesyndemic.tn@tn.gov