api hiv epidemiology, disparities, the hidden hiv epidemic · 2018. 10. 16. · 10/15/2018 2 asia...
TRANSCRIPT
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APIs & the HIV Epidemic: Getting to Zero Health Disparities
and Zero New HIV Infections
Sophy Shiahua Wong, MD, AAHIVSMedical Director, Bay Area AIDS Education Training Center (AETC) & HIV ACCESS
Internal Medicine/HIV/hepatitis primary care provider, Asian Health Services
Associate Clinical Professor of Medicine, UCSF
Objective:HIV, APIs, and Getting to Zero
API HIV epidemiology
PrEP, U=U, rapid ART
resources
API HIV epidemiology,disparities,
the hidden HIV epidemic
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Asia is behind Africa in access to HIV treatment & prevention:
In 2017: • 36.9 million people living
with HIV worldwide• 1 million deaths• No longer a top 10 cause of
death worldwide (but is #4 in low‐
income countries)
WHO data, updated May 2018
US HIV prevalence, 2016
US CDC data, updated March 2018
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www.cdc.gov/hiv/pdf/programresources/cdc‐hiv‐npep‐guidelines.pdf
Lifetime HIV risk: 1 in 2 Af Am MSM
API Wellness Center
US HIV testing guidelinesEveryone 13‐65! It’s covered!
USPSTF Grade A, 2013: ages 15‐65
CA HIV testing laws, 2013No written consent neededMandatory testing in primary care
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API Wellness Center
x
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Most APIs with HIV get it through sex:
CDC: HIV Among Asians, 2018
New HIV diagnoses are rising among APIs…
CDC: HIV Among Asians, 2018
…and APIs in Alameda County have the lowest median CD4 at the time of diagnosis:
"Alameda County HIV Surveillance Report, 2014‐2016," published March 2018.
But when in care, APIs in Alameda County have high rates of viral load suppression:
"Alameda County HIV Surveillance Report, 2014‐2016," published March 2018.
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The role of primary care in ending the HIV epidemic:
Creative Commons license photosby Ali Yahya on Unsplashby Walt Stoneburner on Flickr
HIV testingPEPPrEP
& linkages!4th generation HIV testing!‐combined antigen‐antibody test‐shortens window period: 45 to 14 days‐can pick up acute HIV infection
Whom do you test for HIV?
John, a 20 year old Vietnamese pre‐med drops in for “a check‐up”
Hdwallpapersarena.com
If John is HIV‐negative, what can you do to reduce his risk of getting HIV?
Hdwallpapersarena.com
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>99% effective if taken daily
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The Stigma Project
PleasePrEPme.org
PrEP: in one page!
Whom do you test for HIV?
Mrs. Cruz,
a 65 year‐old grandmother comes in for diabetes follow‐up and needs to get her labs checked.
Photo: CC0 license
Mrs. Cruz’s 4th gen HIV test result:HIV Ag/Ab+
Multispot Differentiation Ab+
Photo: CC0 license
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What is HIV?
We’ve come a long way…
From this & many side effects…
We’ve come a long way…
…to 10 single‐tablet regimens& 6 classes of drugs
Treatment reduces HIV transmission by how much?
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treatment reduces transmission by
96%HPTN 052 study: Cohen MS et al, NEJM 2011: 365 HIV Plus Magazine, October 2017
Rapid ART ART
retention viral suppression
survival
Koenig, AIDS 2016; Lifson 2017; Rosen 2016; Bacon 2018; Pilcher, JAIDS 2016 and 2017; Photo by Zun Zun from Pexels CDC, HIV Surveillance Report, 2015; vol. 27. Pub 11/2016; data updated 7/2018
37,600+ new HIV diagnoses each year
in the US
PrEP test treat
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APHA: “The Nation’s Health”
The Stigma Project
CDC: Act Against AIDS
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ZERO new infectionsZERO AIDS‐related deathsZERO discrimination
New York State
You can help us test, rapidly link people with HIV and offer PrEP!
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Key points:APIs getting to zero new HIV infections!
• 1 in 5 APIs with HIV don’t know they have it.
• Test everyone for HIV once, and some annually.
• Offer Rapid linkage/ART: treatment reduces transmission by 96%!
• Offer PrEP! It’s >99% effective when taken daily.
• Collective impact makes a difference!
test PrEP treat
Resources
1. HIV Clinical Essentials one‐page PDF
2. Clinical questions: HIV Warmline– nccc.ucsf.edu
– Call 1‐800‐933‐3413
3. Training and technical assistance: AETC– www.paetc.org
– call 415‐476‐6153
– Email: [email protected]