NYS Ending the Epidemic Metrics Where we were, where we are, and - PowerPoint PPT Presentation

NYS Ending the Epidemic Metrics Where we were, where we are, and where we need to be by the end of 2020 James Tesoriero, Ph.D Division of HIV/STI Epidemiology, Evaluation and Partner Services NYSDOH AIDS Institute

2 Objectives • Briefly Present – Update on core and supplemental ETE metrics through 2017 – Highlight areas of success and areas of challenge • Entertain Questions and Discussion

Ending the Epidemic Metrics Core March 20, 2019

4 New HIV Infections (Incidence) By the end of 2020, reduce the number of new HIV infections to 750. Year Target Actual – Old Actual – New Measure: Incidence estimates are Methodology Methodology calculated using CDC statistical methods. 2013 * 2,509 3,347 2014 * 2,497 3,273 2015 * 2,436 2,983 • 17% decrease 2016-2017 2016 2,050 2,115 2,732 • 32% decrease 2013-2017 2017 NA 2,269 1,750 2018 NA 1,410 2019 NA 1,060 2020 750 NA Data Sources: NYS HIV Surveillance System 2013 – 2015 data as of January 2017 to set target values. 2016 actual case data as of September 2017 and considered preliminary.

Bending the Curve (Ending AIDS) By the end of 2020, achieve fewer new HIV infections than deaths, resulting in the first ever decrease in HIV prevalence and the end of AIDS as an epidemic in NYS. Year HIV Infections Deaths among New Infections Measure: HIV Incidence (using CDC estimation method) minus all deaths among Persons Living (New Methodology) PLWDHI minus Deaths with Diagnosed HIV Infection (PLWDHI) 2013 3,347 2,108 1,239 2014 3,273 2,063 1,210 2015 2,983 1,955 1,028 2016 2,732 1,974 758 2017 2,269 1,545 724 2018 500 (Target) 2019 250 (Target) 2020 < 0 (Target) Data Sources: NYS HIV Surveillance System 2013 – 2015 data as of January 2017 to set target values. 2016 actual case data as of September 2017 and considered preliminary.

6 HIV Status Aware Increase the percentage of people living with HIV who know their serostatus to at least 98%. Year Target Actual Measure: Calculations are based 2013 * 92% on estimates from the CDC and seroprevalence studies. 2014 * 92% 2017 2015 * 92% Data Sources: NYS HIV Surveillance Target | 94% 2016 System. 2013 – 2015 data as of 93% 93% January 2017 to set target values. 2016 data as of September 2017. 2017 94% 91% Actual | 91% 2017 data as of June 2018. 2018 95% * 2019 96% * 2020 * 98%

7 New HIV Diagnoses By the end of 2020, reduce the number of new HIV diagnoses by 55%. Year Target Actual Data Sources: NYS HIV Surveillance Measure: Number of newly System. 2013 – 2015 data as of 2013 * 3,391 January 2017 to set target values. diagnosed HIV cases reported. 2016 actual case data as of September 2014 * 3,443 2017. 2017 actual case data as of July 2018. 2015 * 3,155 2016 2,911 2,881 • 4% decrease 2016-2017 • 2017 2,620 2,769 18% decrease 2013-2017 2018 2,253 * 2019 1,870 * 2020 * 1,515

8 Persons Newly Diagnosed with HIV by Residence at Diagnosis, 1 NYS, 2016-2017* 3,500 -3.9% Number of New Diagnoses 2,881 3,000 2,769 -3.8% 2,500 2,116 2,036 2,000 1,500 -4.2% 1,000 765 733 500 0 NYS NYC ROS 2016 2017 AI/DEEP/BHAE 1 Region of Residence at Diagnosis Year of HIV Diagnosis *Data as of June 2018

9 Case Rate for People Newly Diagnosed with HIV by Race/Ethnicity: NYS, 2007-2017* Non-Hispanic Black 72.6 80 71.8 (-51.9%) New diagnoses per 100,000 64.6 70 58.6 Hispanic (-42.4%) 53.8 60 45.4 44 43.2 50 39.9 39.3 38.7 36.9 Non-Hispanic White 35.8 34.9 40 (-45.7%) 30.7 30.7 30.6 27.3 27 26.5 23.9 23 30 Asian/PI (-26.0%) 20 8.1 7.6 7.1 6.7 6.9 6.5 6.1 6.2 5.4 4.7 4.4 10 7.3 7.1 0 6.4 6.3 5.6 5 5.3 5.4 4.8 4.5 4.5 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 *Data as of June 2018. Limited to racial/ethnic groups with at least 50 new HIV diagnoses per year Rate per 100,000 population. Rates are age adjusted to the Census Population.

10 Linkage to Care After Diagnosis By the end of 2020, increase the percentage of newly diagnosed persons linked to HIV medical care within 30 days of diagnosis to at least 90% Data Sources: NYS HIV Surveillance Year Target Actual System. Measure: Any CD4, VL or 2013 – 2015 data as of January 2017 to 2013 * 69% genotype test in NYSDOH set target values. 2016 actual case data HIV Surveillance system. as of September 2017. 2017 actual case 2014 * 72% data as of July 2018. • 2015 * 73% 6 percentage point 2016 78% 75% increase 2016-2017 • 12 percentage point 2017 81% 81% increase 2013-2017 2018 * 84% 2019 * 87% 2020 90% *

11 Time to AIDS By the end of 2020, reduce the rate at which persons newly diagnosed with HIV progress to AIDS by 50%. Year Target Actual Data Sources: NYS HIV Surveillance System. 2013 – 2015 data as of January 2012 * 10.4% 2017 to set target values. 2014 actual Measure: CD4 <200 (Stage 3 HIV) data as of September 2017. 2015 actual within two years of diagnosis. 2013 * 6.9% data as of June 2018. 2014 8.9% 7.1% * Two year lag built into indicator definition. 2015 8.2% 6.9% • 0.2 percentage point 2016 decrease 2016-2017 7.6% * • 3.5 percentage point 2017 * 7.0% decrease 2013-2017 2018 * 6.4% 2019 * 5.8% 2020 5.1% *

12 Receiving Any Care By the end of 2020, increase the percentage of persons living with diagnosed HIV infection who receive any care to 90%. Year Target Actual Measure: Any VL, CD4 or genotype 2013 * 81% test in NYSDOH HIV Surveillance system in calendar year. 2014 * 81% 2015 * 81% 2017 Data Sources: NYS HIV Surveillance 2016 84% 80% System. 2013 – 2015 data as of January Target | 86% 2017 to set target values. 2016 actual case 2017 83% 86% data as of September 2017. 2017 actual Actual | 83% case data as of July 2018. 2018 * 88% 2019 * 89% 2020 90% *

13 Viral Suppression – Receiving Any Care By the end of 2020, increase the percentage of individuals living with diagnosed HIV infection and receiving any care with suppressed viral load to 95%. Year Target Actual Data Sources: NYS HIV Surveillance System. Measure: Last VL test in calendar 2013 – 2015 data as of January 2017 to set year is non detectable or <200 2013 * 81% target values. 2016 actual case data as of copies/ml in NYSDOH HIV September 2017. 2017 actual case data as of 2014 * 84% Surveillance system. July 2018. 2015 * 85% • 0 percentage point 2016 87% 87% change 2016-2017 • 2017 89% 87% 6 percentage point increase 2013-2017 2018 91% * 2019 93% * 2020 95% *

14 Viral Suppression - PLWDHI By the end of 2020, increase the percentage of individuals living with diagnosed HIV infection with suppressed viral load to 85%. Year Target Actual Measure: Last VL test in calendar 2013 * year is non detectable or <200 66% copies/ml in NYSDOH HIV 2014 * 68% Surveillance system. 2015 * 67% 2017 Data Sources: NYS HIV Surveillance System. 2013 – 2015 data as of January 2016 73% 70% Target | 76% 2017 to set target values. 2016 actual case data as of September 2017. 2017 actual 2017 76% 72% Actual | 72% case data as of July 2018. 2018 79% * 2019 82% * 2020 * 85%

15 Concurrent AIDS Diagnosis By the end of 2020, reduce the proportion of persons with a diagnosis of AIDS within 30 days of HIV diagnosis to 15%. Year Target Actual n % n % Measure: CD4 <200 (Stage 3 HIV) w/ in 30 days of dx. 2013 * 736 21.7 2014 * 674 19.6 Data Sources: NYS HIV Surveillance • 2015 * 612 19.4 1.0 Percentage point System. 2013 – 2015 data as of January 2017 to set target values. increase 2016-2017 2016 536 18.4 541 18.8 2016 data as of September 2017. 2017 data as of July 2018. • 1.9 percentage point 2017 461 17.6 547 19.8 decrease 2013-2017 2018 * 376 16.7 2019 * 295 15.8 2020 225 15.0 *

March 20, 2019 16 Concurrent Diagnoses among Newly Diagnosed Persons by NYS Region: 2017* 40% 35% 30% 25.2% Percent Concurrent 25% 20% 17.8% 15% 10% 5% 0% NYC NYS Excluding NYC Diagnosing Region *Data as of June 2018

March 20, 2019 17 Concurrent Diagnosis among Newly Diagnosed Persons by Race/Ethnicity and Region of NYS: 2017* 50% 40% Percent Concurrent 30% 26.4% 26.2% 25.8% 25.6% 19.3% 18.8% 20% 17.4% 16.3% 14.2% 11.1% 10% 0% n=848 n=86 n=48 n=267 n=208 n=256 n=741 n=203 n=93 n=18 White Black Hispanic Asian/PI Multi-Race NYC ROS *Data as of June 2018

March 20, 2019 18 Concurrent Diagnoses among Newly Diagnosed Persons Over Time by NYS Region: 2013-2017* 40% Percent Concurrent 30% 25.2% 24.3% 24.5% 22.5% 20.1% 20% 20.5% 18.4% 18.2% 17.8% 17.2% 10% 2013 2014 2015 2016 2017 NYC ROS *Data as of June 2018

Ending the Epidemic Metrics Supplemental March 20, 2019

20 Stigma Measure Medical Monitoring Project By the end of 2020, decrease stigma experienced among persons living with diagnosed HIV by at least 25 percent. Actual Target MMP Definition: Based on results of Baseline: 2015 33.9% 10 question scale looking at four 2016 34.7% dimensions of stigma; personalized stigma, disclosure concerns, negative 2017 31.4% self-image, perceived public attitudes 2018 29.6% about people with HIV. Goal is to 2019 27.5% reduce the median score of these Target: 2020 25.4% questions by 25%. Source: Medical Monitoring Project