“Continuing to Care”Continuing to CareUsing Data to Address Disparities

Charlotte “Charlee” Coggins Melissa Morrison Webb, M.A.Charlotte Charlee CogginsCDC Public Health AssociateIV P TN D t f H lth

,Director of HIV Prevention

HIV Program TN Dept of Health

Agenda

The Face of HIV in Tennessee

HIV Continuum of Care in Tennessee

Taking a Closer Look: Black MSM

Using Data to Address DisparitiesUsing Data to Address Disparities

New HIV Diagnoses in TN (2010)( / )(n=843, by sex and race/ethnicity)

Males (n=648, 77%) Females (n=195, 23%)0 0

7%

1%

( )

7%

2%

( )

31%16%

61%

31%

75%

lack White Hispanic Other Black White Hispanic Other

New HIV Diagnoses in TN (2010)(n=843 by gender and transmission category)(n=843, by gender and transmission category)

Males (n=648, 77%) Females (n=195, 23%)( )

2%

( )

25%

32%

62%10% 63%

3%

MSM Hetero IDU NIR Hetero IDU NIR Perinatal Exp

New HIV Diagnoses in TN (2010)(n=843 by gender and age category)(n=843, by gender and age category)

Males (Mdn=33.9 yrs) Females (Mdn=36.9 yrs)

174

167

( y )

53 54 53

50

60

( y )

160

167

35

30

40

ases

14720

30

# C

a

0

10

< 25 25-34 35-44 45+Age Category

< 25 25-34 35-44 45+Age Category

HIV Continuum of Care: HIV Continuum of Care: Tennessee

HIV Surveillance

M f HIV bidi d liMeasures of HIV morbidity and mortality

nfectionHIV diagnosis

(1st positive confirmatory

test)Linkage to

CareAIDS1st CD4 Count

1st Viral Load Test

1st Drug Resistance t t

AIDS1st CD4 Count

<200 or AIDS-OIRetention / Response to

Caretest CareCD4 or VL Death

Entry to care Retention in care and viral suppression

Data Sources & Populations

EHARS (Electronic HIV/AIDS Reporting System)l l ( )Cross‐sectional analysis (n=16,718):  All HIV‐infected 

persons diagnosed by Dec 31, 2009 and alive & living in TN as of Dec 31 2010as of Dec 31, 2010. 

o Diagnosedo Retained in Careo Achieved Suppressed Viral Load

Newly diagnosed cohort (n=843):  All HIV‐infected persons diagnosed between Jan 1 – Dec 31, 2010.

o Linked to Care

Laboratory Reporting: Challenges & Progress

Prior to Jan 1, 2012N CD4 & VL ti li i lNo CD4 & VL reporting policy in place

Effective Jan 1 2012Effective Jan 1, 2012Performing labs required to report all VLs & CD4s to the TDHto the TDH• Increasing % of labs received via ELR• Remaining labs (paper and ELR rejects) entered manually

Paper copies of VLs and CD4s from 2010 & 2011 entered retrospectivelyp y

DefinitionsDiagnosed: Number of individuals diagnosed with HIV by 31, 2009 who were alive and living in TN as of December 31, 2009 who were alive and living in TN as of December 2010

Linked* to Care: Individuals newly diagnosed with HIV in y g0 and having ≥ 1 CD4 and/or VL measurements reported hin 3 months of diagnosis

Retained in Care: Diagnosed individuals having > 2 CD4 /or VL measurements more than 3 months apart in 2010

Achieved Suppressed VL:  Diagnosed individuals having ≥ L measurement in 2010 & the last VL measure ≤ 200 ies/mLies/mL

Tennessee Continuum of Care: All Diagnosedg

64

29

37

Diagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

United States vs. Tennessee

US TN

80

64

45

64

3029

37

Diagnosed Linked to Care Retained in Care Achieved Suppressed VL

Tennessee Continuum of Care: Gender

All M l F l

64 6268

All Male Female

62

29

37

29

37

3035

Diagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

Tennessee Continuum of Care: Race/Ethnicity/ y

All Black White Hispanic

64

76

66

7

58

41

29

37

3033

28

21

31

Diagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

Tennessee Continuum of Care: Age Categoryg g y

15-24 25-34 35-44 45-54 >54

66

74

82

5457

4045

21 2127

302935

30

40

33

Diagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

Tennessee Continuum of Care: Transmission Categoryg y

All MSM Hetero IDU

6461

6972

3741

37

29

3731 31

37

2832

D d L k d C R d C A h d S d VLDiagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

Taking a Closer Look

Definitions: New DiagnosesDiagnosed: Number of individuals diagnosed with HIV by 31, 2009 who were alive and living in TN as of December 31, 2009 who were alive and living in TN as of December 2010

Linked to Care: Individuals newly diagnosed with HIV in y g0 and having ≥ 1 CD4 and/or VL measurement(s) reported hin 3 months of diagnosis

Retained in Care: For those linked to care, ≥ 2 CD4 and/or results reported ≥ 3 months apart within 12 months after al medical visital medical visit

Achieved Suppressed VL:  Diagnosed individuals having ≥ L measurement within 12 months of diagnosis & the lastL measurement within 12 months  of diagnosis & the lastmeasure ≤ 200 copies/mL

Tennessee Continuum of Care: Transmission Category (2010)g y ( )

6469

All MSM Hetero

6461

4135

2933

28

41

30

Diagnosed Linked to Care Retained in Care Achieved Suppressed VL

Tennessee Continuum of Care: MSM (2010)( )

All MSM Black MSM White MSM

61

76

61

51

40

332829

24

4035

Diagnosed Linked to Care Retained in Care Achieved Suppressed VLEngagement in HIV Care

How Have We How Have We Addressed These Disparities?

Using Data to Address DisparitiesAPUS Social Network Strategyemphisashvilleashville

APUS DIS Re-engagement Specialists

MSM T k FMSM Task Forcesed data from focus groups & cascadecorporated Cultural Competency training in HDsp p y grgeted media in Metro areas to Black MSM through CPGs

uture possibilitiesprgeted ARTAS RFPrtnership with Ryan White Part A in Memphis/Nashville

Questions?

Thank you!Carolyn Wester, MD, MPH

Medical Director, TN Dept of Health

Charlotte “Charlee” Coggins, BSCDC Public Health Associate, TN Dept of Health

Melissa Morrison Webb, MADirector of HIV Prevention, TN Dept of Health

Thom Shavor, MBA, MPHHIV/STD Surveillance Director, TN Dept of Healthp

Benn Daley, MS

Works CitedH. I., Frazier, E. L., Rhodes, P., Holtgrave, D. R., Furlow‐Parmley, Tang, T., . . . Skarbinski, J. (2013). Differences in human 

d fi i i d t t t b l timunodeficiency virus care and treatment among subpopulations the United States. JAMA Internal Medicine, e1‐e7. :10.1001/jamainternmed.2013.6841essee Department of Health. (2010a). Data from eHARS tabase. 

f l h (2010b) C bi d d fessee Department of Health. (2010b). Combined data from ARS and PRISM databases.