Clusters of HIV in Texas Analise Monterosso, MPH Epidemiologist - PowerPoint PPT Presentation

Rapidly Growing Molecular Clusters of HIV in Texas Analise Monterosso, MPH Epidemiologist Molecular HIV Surveillance Coordinator

Outline • HIV in Texas • HIV Drug Resistance testing (genotyping) in Texas • Molecular Clusters in Texas • Cluster Case Study • Continuing Efforts 2

New HIV Diagnoses, Persons Living with HIV , and Deaths in Texas since 1980 6,000 90,000 New HIV Diagnoses 5,000 75,000 New Diagnoses/Deaths People Living with HIV 4,000 60,000 Persons Living with HIV 3,000 45,000 2,000 30,000 1,000 15,000 Deaths in Persons Living with HIV* 0 0 1980 1984 1988 1992 1996 2000 2004 2008 2012 2016 3

People Living With HIV by County, 2016 4

Hispanic Persons in Texas HIV Treatment Cascade, 2016 100% 100% 18,000 16,000 80% 76% 14,000 71% 12,000 62% 60% 10,000 18,663 8,000 40% 14,262 13,185 6,000 11,538 4,000 20% 2,000 0 0% HIV+ Individuals At Least One Retained In Care Achieved Viral Living at end of Visit/Lab Suppression 2016 5

HIV Incidence In Texas, 2010-2015 2000 1800 1600 1400 1200 Estimated new HIV 1000 infections 800 600 400 200 0 2010 2011 2012 2013 2014 2015 Black\ African American Hispanic\ Latino White 6

HIV Genotype Testing in Texas 7

Genotyping Completeness by Texas Ending the Epidemic Priority Populations*, 2010-2016 Hispanic MSM White MSM 37% 43% 57% 63% Genotyped Ever Not Genotyped Black MSM Black Women 41% 44% 56% 59% *Data on Trans-PLWH cannot be displayed at this time

HIV Genotype Testing by County, 2010-2016* *Counties with less than 30 diagnoses in timeframe have been suppressed for clarity *Counties with less than 30 diagnoses in the time period are suppressed for clarity

Genotype testing among those linked to care • In 2016: • Of Persons linked to HIV care within 3 months of diagnosis- 55.7% received genotype testing • Of Persons linked to HIV care within 6 months of diagnosis- 55.5% received genotype testing • In 2015: • Of Persons linked to HIV care within 3 months of diagnosis- 53.4% received genotype testing • Of Persons linked to HIV care within 6 months of diagnosis- 53.1% received genotype testing

Molecular clusters in Texas 11

Age distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters Texas Diagnoses 2016 7% 7% 21% 23% 51% 18% 35% 38% 15-24 25-34 35-44 45+ 15-24 25-34 35-44 45+

Race distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters Texas Diagnoses 2016 5% 4% 16% 21% 39% 18% 62% 36% Hispanic White Hispanic Black Black Other White Other

Transmission Risk distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters Texas 2016 Diagnoses 1% 2% 11% 6% 20% 2% 6% 80% 72% MSM MSM\PWID MSM PWID Heterosexual PWID MSM\PWID Heterosexual NIR

Texas Cluster Case Study 15

Public Health Follow Up and Contact Tracing 16

Molecular Cluster Cases Molecular Cluster Case Named Partner Relationship 17

Network diagram showing partner services links between molecular cluster members and other suspected members of transmission cluster 18

Timing of exposure and infectiousness among molecular cluster members

Re-linkage to Care outcomes 11% 12% 4% 16% 40% 17% Located, Linked to Medical Care Located, Confirmed already in care Located, Refused Services Unable to Locate 20 Open Case Deceased, Incarcerated, Moved

Major Findings from Cluster Investigation • Low availability of PrEP in the area • HIV diagnostic\testing algorithm was not used correctly\completely • Acute HIV cases often missed without the diagnostic algorithm completed • Clusters are not contained to one geographic region or jurisdicition 21

Actions Taken to Address Community Factors • Released a Health Advisory • Sent to medical providers and stakeholders statewide • Details the need to use diagnostic algorithm to identify acute HIV cases • Recommends HIV genotype testing to identify these clusters • Available on the Texas DSHS Website: https://www.dshs.texas.gov/hivstd/ • Increase in Prevention funding • More testing • Additional PrEP clinics

Continuing efforts 23

Prevention Opportunities • Speak with providers locally about the importance of the CDC\APHL recommended diagnostic testing algorithm • Advocate for routine HIV testing in Emergency Rooms\Urgent Care Centers every patient who gets blood tests also gets an • HIV test • Offer PrEP • Work with local Health Department to link high-risk persons to PrEP services - make sure the Health Department knows they can refer to your facility • Work with local Emergency rooms to advocate for PrEP referral for high risk persons

Clusters Intervention and CDC funding • Cluster detection, intervention and use for high impact prevention is a major goal for integrated funding for HIV Prevention and Surveillance • Texas and Houston received supplemental funding to investigate and intervene on clusters identified using molecular methods that have Latino\Hispanic MSM • 7 Field Health Advocate staff in Dallas (2), San Antonio (1) and statewide(4) • 3 PrEP navigators- Dallas, Houston and San Antonio • 1 Public Health Detailing staff dedicated to clusters and drug resistance testing education • 2 staff to help coordinate the functions around the state

Thank you Analise Monterosso Analise.Monterosso@dshs.texas. gov 26

HIV Treatment Cascade in Texas, 2016 100% 100% 80,000 70,000 80% 77% 70% 60,000 60% 59% 50,000 86,669 40,000 40% 66,680 60,993 30,000 51,329 20,000 20% 10,000 0 0% HIV+ Individuals At Least One Retained In Care Achieved Viral Living at end of Visit/Lab Suppression 2016 27

New HIV Diagnoses by County, 2016 28