Objective To provide the Ryan White Planning Council with information necessary for priority setting Topics Epidemiology The Indianapolis Transitional Grant Area TGA HIV incidence HIV mortalitydeaths ID: 779432
Download The PPT/PDF document "Epidemiology of HIV/AIDS in the Indianap..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Epidemiology of HIV/AIDS in the Indianapolis Transitional Grant Area: 2014
Slide2Objective
To provide the Ryan White Planning Council with information necessary for priority setting
Slide3Topics
EpidemiologyThe Indianapolis Transitional Grant Area (TGA)HIV incidence
HIV
mortality/deaths
HIV prevalence
Co-morbidities
Measures of HIV health outcomes
Slide4Epidemiology
Slide5Epidemiology – The study of:
Slide6Epidemiology - Terminology
IncidenceRate of new diagnoses per 100,000 people per yearPrevalenceProportion of people living with a disease/injury from among those at risk; reported as per 100,000 peopleMortality
Rate of death caused by a disease/injury per 100,000 people per year
Rate Ratio
Comparison of a rate among two or more groups
Slide7The Indianapolis Transitional Grant Area
(TGA)
Slide8TGA Location & Population
Ten Central Indiana counties with a 2014
estimated
population of just over 1.84 million
1
Slide9TGA Population 1990-2014
Source: U.S. Census Bureau1,2,3
5.7% increase since 2009
84% of TGA residents live in four counties
Slide10TGA Population Center
88% of the TGA population
4
Slide11TGA Demographics
Sex
Age
Slide12TGA Demographics
TGA Race/Ethnicity
The population of Marion County is more diverse than that of the TGA overall, with 26.9% Black, 9.7% Hispanic, and about the same percentage Asian/PI and Other
Slide13HIV I
ncidence
Slide14HIV/AIDS Incidence
Late diagnoses decreased from 27.4% in 2013 to 19.9% in 2014
New Diagnoses
Cases
*
Rate
TGA Rate (2013)
U.S.
Rate
**
(
2013)
5
HIV
241
13.2
13.2
15.0
AIDS
124
6.8
6.7
8.4
*N missing
≈
<5
**Includes
the TGA
A late HIV diagnosis occurs when an AIDS diagnosis is reported within 90 days of an initial HIV diagnosis
No significant change in HIV or AIDS incidence from 2013 to 2014
Slide15Annual HIV Incidence by Time to AIDS: 1982-2014
N missing
≈
<5
Slide16HIV Incidence by County
No significant change by county between 2013 to 2014
HIV incidence is 11.6 times higher in Marion County residents
County
Cases
% of Total
Rate
RR [95% CI
]:
to Others
Marion
216
89.6%
23.3
11.6 [6.5-20.8]
Hamilton
13
5.4%
4.4
NS
Others
*
12
5.0%
2.0
-
RR [95% CI]: = Rate ratio and 95% confidence interval
*N missing
≈
<5
NS = Not statistically significant
Slide17Morgan County data missing but thought to be <5 cases
Slide18HIV Incidence by Gender
No significant change by gender between 2013 to 2014
Men were diagnosed with HIV at a rate 4.4 times that of women
Gender
Cases
% of Total
Rate
RR [95% CI]:
to
Female
Female
<48
<19.9%
4.9
-
Male
194
80.5%
21.8
4.4 [3.2-6.1]
Transgender
<5
<2.1%
UNK
-
RR [95% CI]: = Rate ratio and 95% confidence
interval
N missing
≈
<5
Slide19HIV Incidence by Race/Ethnicity
No significant change by race/ethnicity 2013 to 2014
Racial/ethnic minorities, especially African Americans, experience increased risk of HIV infection
Race/ Ethnicity
Cases
% of Total
Rate
RR [95% CI]: to White
Asian/PI
6
2.5%
12.4
NS
Black
128
53.1%
46.2
8.3 [6.2-11.0]
Hispanic
26
10.8%
22.0
3.9 [2.5-6.1]
Other
6
2.5%
16.1
2.9 [1.3-3.6]
White
75
31.1%
5.6
-
RR [95% CI]: = Rate ratio and 95% confidence
interval N missing
≈
<5
NS = Not statistically
significant
Slide20HIV Incidence by Race/Ethnicity and Sex
N missing
≈
<5
Slide21HIV Incidence by Age
No significant change by age between 2013 and 2014
Young adults 20-34 continue to be at most risk of HIV, with rates at least double those of other age groups
Age (Yrs.)
Cases
% of Total
Rate
<15
<5
0.4%
<1.0
15-19
18
7.5%
14.9
20-24
57
23.7%
48.4
25-34
86
35.7%
32.9
35-44
38
15.8%
15.3
45-64
39
16.2%
8.3
65+
<5
0.8%
<1.0
N missing
≈
<5
Slide22Annual
HIV Incidence
by Age
(Yrs.) at Diagnosis:
1982-2014
N missing
≈
<5
Slide23HIV Incidence by Age and Sex
N missing
≈
<5
Slide24HIV Incidence by Exposure/Risk
No significant change by exposure/risk 2013 to 2014
Men who have sex with men (MSM) bear the greatest burden of HIV in the TGA
Exposure/Risk Category
Cases
% of Total
Rate
Male-to-Male Sexual Contact
*
141
58.5%
362.6
Injection Drug Use
9
3.7%
0.5
Heterosexual Contact
70
29.0%
3.9
Not Reported/Identified
21
8.7%
0.6
* Rate based on estimate of men with a lifetime history of sexual contact
with another man of 4.6% Black and 5.8% other men 15+ years of
age
6
N
missing
≈
<5
Slide25HIV Incidence by U.S. Nativity Status
Foreign-born residents of the TGA experience a risk approximately 3.3 times that of native-born residents
U.S. Nativity Status
Cases
% of Total
Rate
RR [95% CI]: to
Native- Born
Foreign-Born
39
16.2%
35.7
3.3 [2.3-4.7]
Native
178
73.9%
10.8
-
Unknown
24
10.0%
UNK
-
RR [95% CI]: = Rate ratio and 95% confidence
interval
N missing
≈
<5
Slide26HIV
Mortality
Slide272013 HIV Mortality & All Deaths of People Living with HIV/AIDS during 2014
- HIV deaths are directly attributable to HIV/AIDS
- All deaths are those of PLWH/A regardless of cause
Area
HIV Deaths
(2013)
All Deaths (2014)
N
Rate
N
Rate
Marion County
23
2.5
35
3.8
TGA
-
-
50
2.7
Indiana (excl. TGA)
54
1.0
-
-
U.S.
6,955
2.2
-
-
Morgan County deaths missing
Reported deaths are subject to revision as it is standard practice to report 18 months behind any given period to allow
for reporting lag
Slide28HIV
Prevalence
Slide29HIV/AIDS Prevalence
No significant change in HIV or AIDS prevalence 2013 to 2014
Status
Cases
*
Rate
TGA Rate (2013)
U.S.
Rate
**
(2012)
5
HIV
2,589
142.0
139.0
129.4
AIDS
2,863
157.0
154.5
162.1
Total
5,452
299.0
293.5
291.5
*N missing
≈
53
**Includes
the TGA
Slide30HIV/AIDS Prevalence: 2000-2014
Morgan County data missing since 2011. Prevalence in Morgan County at EOY 2014 thought to be
53 total
Slide31HIV Prevalence by County
County
Cases
% of
Total
Rate
Marion
4,751
87.1%
511.8
Putnam
67
1.2%
178.6
Brown
21
0.4%
139.8
Johnson
141
2.6%
96.9
Hendricks
135
2.5%
87.7
Morgan
*
*
*
Hancock
54
1.0%
75.4
Hamilton
214
3.9%
72.1
Boone
41
0.8%
67.8
Shelby
28
0.5%
62.6
No significant change by county between 2013 and 2014
More than 87% of TGA residents living with HIV reside in Marion County
*Morgan County data missing but thought to be N=53 (76 per 100,000)
Slide32HIV Prevalence by County
*
*Morgan County data missing but thought to total
53 for a rate of 76.0 per 100,000
Slide33*Morgan
County data is missing but prevalence was estimated using RISE and ISDH data and is estimated to total 53
Slide34HIV Prevalence by Gender
No significant change by gender between 2013 to 2014
Men have a risk 4-5 times that of women in the TGA
Gender
Cases
% of Total
Rate
RR [95% CI]:
to
Female
Female
1,018
18.7%
109.1
-
Male
4,370
80.2%
490.8
4.5 [4.2-4.8]
Transwomen
47
0.9%
UNK
-
Transmen
17
0.3%
UNK
-
RR [95% CI]: = Rate ratio and 95% confidence
interval N missing
≈
53
Slide35HIV Prevalence by Race/Ethnicity
No significant change by race/ethnicity 2013 to 2014
Racial/ethnic minorities, especially African Americans, experience increased risk of HIV
Race/ Ethnicity
Cases
% of Total
Rate
RR [95% CI]: to White
Asian
113
2.1%
233.1
1.3 [1.1-1.6]
Black
2,343
43.0%
845.6
4.7 [4.4-4.9]
Hispanic
396
7.3%
334.9
1.8 [1.7-2.1]
Other
165
3.0%
441.5
2.4 [2.1-2.8]
White
2,435
44.7%
181.4
-
RR [95% CI]: = Rate ratio and 95% confidence
interval N missing
≈
53
Slide36HIV Prevalence by Race/Ethnicity and Sex
N missing
≈
117 (53 from Morgan County and 64 transgender PLWH/A)
Slide37HIV Prevalence by Current Age
No significant change by age between 2013 and 2014
Adults 35-64 account for most PLWH/A in the TGA
Age (Yrs.)
Cases
% of Total
Rate
<15
31
0.6%
7.9
15-19
33
0.6%
27.4
20-24
243
4.5%
206.1
25-34
940
17.2%
359.9
35-44
1,246
22.9%
502.6
45-64
2,727
50.0%
578.3
65+
228
4.2%
106.9
N missing
≈
53
A significant increase in prevalence among those 20-44 years of age has occurred since 2010
(r = .
95, p < .
05,)
Slide38HIV Prevalence by Age and Sex
N missing
≈
117 (53 from Morgan County and 64 transgender PLWH/A)
Slide39Exposure/Risk Category
Cases
% of Total
Rate
Male-to-Male Sexual Contact*
3,143
57.6%
8,082.4
Injection Drug Use
565
10.4%
31.0
Heterosexual Contact
1,056
19.4%
59.2
Other
75
1.4%
4.1
Not Reported/Identified
613
11.2%
33.6
*Rate
based on estimate of men with a lifetime history of sexual contact
with another man of 4.6% Black and 5.8% other men 15+ years of
age
6
N missing
≈
53
HIV Prevalence by Exposure/Risk
No significant change from last year
MSM bear the greatest burden of HIV in the TGA with a known prevalence of about 8.1%
Based on CDC estimates, about 18% of MSM are
HIV-positive. Moreover, while
14% of PLWH/A are unaware of their status overall, 34% of HIV-positive MSM are unaware of their
status.
8
Slide40HIV Prevalence by U.S. Nativity Status
The proportion of foreign-born TGA residents infected with HIV is about twice that of native-born residents
U.S. Nativity Status
Cases
% of Total
Rate
RR [95% CI]: to
Native- Born
Foreign-Born
603
11.1%
552.1
2.0 [1.8-2.2]
Native
4,553
83.5%
275.8
-
Unknown
296
5.4%
UNK
-
RR [95% CI]: = Rate ratio and 95% confidence
interval
N missing
≈
53
Slide41Co-morbidities
Slide42Foreign-Born
Almost
1 in 6
newly diagnosed with HIV in the TGA during 2014 was foreign-born and this group had
3.3 times
the risk of native-born residents
More than
1 in 10
PLWH/A in the TGA are foreign-born, a prevalence
twice as high
as among the native-born
Special
considerations
Linguistic services
Health insurance
Social support structure
Cultural stigma/beliefs
Fear
Slide43Aging
Better therapies Longer lives
54%
of PLWH/A in the TGA are 45+ years of age
People living with AIDS at 50+ have needs as complicated as a geriatric patient
Special considerations
9
Weakened immune system
Increased risk of adverse events and drug interactions
Slide44Photo credit: Jeremy Swain,
Ending Homelessness in London
Among PLWH/A,
347 were homeless or insecurely housed
at some point during 2013
10,11,12
Research suggests that
10
%-16%
of all
PLWH/A
in some communities are homeless at any given
time
13
Special considerations
Case finding
Public assistance
Permanent housing
Priority of medical care
Homelessness
Slide45Recent Incarceration
157
PLWH/A have a known history of incarceration
Special considerations
Employment and housing
Retention in care throughout and after the transition
Substance abuse
Trouble navigating the health care system
Slide46Mental Health & Substance Abuse
Approximately 2,726 PLWH/A suffer from mental health issues according to the
50% estimate
found in the National HIV/AIDS Strategy
16
40%
of PLWH/A are estimated to have substance abuse issues and
13%
are thought to experience both substance abuse and mental health issues
16
To complicate matters…
Marion County, home to 4,751 PLWH/A, is an underserved area for mental health services (population-to-provider ratio is only about two-thirds the average mental health staffing capacity in the state)
17
Slide47Food Insecurity
50% of PLWH/A are thought to struggle with food insecurityFood insecurity is a risk factor for mortality among people on HAART, especially those who are underweight
18
Slide48Mycobacterium tuberculosis (TB)
During 2014, 59 TGA residents were diagnosed with active TB, of these six were HIV positive
PLWH/A in the TGA were
at least 8 times
more likely to be diagnosed with active TB than HIV-negative
residents (RR 20.7, 95% CI: 8.2-52.0)
Special considerations
Screening
Diagnostic
Treatment
Slide49Viral Hepatitis
Approximately
545
PLWH/A are thought to be co-infected with hepatitis B based on the
10% estimate
of the U.S. Department of Health and Human Services
14
1,363-1,636
PLWH/A are thought to be co-infected with hepatitis C based on the
25%-30
%
estimate
of the National
Alliance of State and Territorial AIDS
Directors
15
Slide50Chlamydia
11,581 chlamydia diagnoses were reported in the TGA during 2014
At least
129
diagnoses were among HIV-positive residents for a rate of 2,265.9 per 100,000 [95% CI: 1,910.4-2,685.9]
HIV-positive residents were about
3.6 times more
likely
[95% CI: 3.0-4.3] to
receive a chlamydia diagnosis than HIV-negative residents
HIV-chlamydia co-infection is thought to be grossly underestimated due to low screening rates – PLEASE screen, diagnose and treat PLWH/A and their partner(s) for chlamydia
Slide51Gonorrhea
3,695
gonorrhea diagnoses were reported in the TGA during 2014
At least
162
diagnoses were among HIV-positive residents for a rate of
2,845.6 per
100,000 [95% CI
: 2,444.5-3,310.3]
HIV-positive residents were about
14.6
times more
likely
[95% CI: 12.5-17.1
]
to
receive a gonorrhea diagnosis than HIV-negative residents
HIV-gonorrhea co-infection is thought to be underestimated – Please screen, diagnose and treat PLWH/A and their partner(s) for gonorrhea
Slide52Early Syphilis
202 early syphilis diagnoses were reported in the TGA during 2014
At least
87
diagnoses were among HIV-positive residents for a rate of 1,528.2 per 100,000 [95% CI
:
1,240.7-1,881.1]
HIV-positive residents were
at least 183 times as likely
[95% CI:
183.1-318.7]
to
be diagnosed with early syphilis than HIV-negative residents
Early syphilis includes primary, secondary and early latent stages of infection
Slide53More on Sexually-Transmitted Infections
HIV and STIs are commonly co-morbid conditionsSpecial concerns
STDs can increase the likelihood of contracting HIV
As providers to residents with the highest risk, you can:
Include routine screening as a function of HIV primary care
Perform
risk analyses – Assess risk behaviors of your patients
Perform risk reduction - Alert your patients to the risks of STDs, especially when comorbid to HIV/AIDS, and offer periodic STD testing for each of your patients
Treat - Diagnose and treat patients and their partner(s)
Report – Provide thorough and accurate case reporting for better modeling of risk factors
Slide54Measures of HIV
Health Outcomes
Slide55HIV Treatment Cascade
Developed by Dr. Edward Gardner and colleagues19
in March 2011
Model for use in identifying unmet needs, as well as discovery of where, across the continuum of care, clients are lost to follow-up
“Improving control of HIV begins with enhanced detection and linkage to care” –
Gardner, et al.,
2011
19
“HIV
screening without linkage to care “confers little or no benefit to the patient” –
Branson, et al.,
2006
20
Slide56Benefits of Improving Linkage Into and Retention in Care
Delayed linkage and poor engagement in care are associated
with:
19,20
Delayed/no receipt of anti-retroviral therapy (ART)
Quicker progression to
AIDS
Drug resistance
Increased morbidity (hospitalizations, opportunistic infections, emergency department visits, etc.)
Increased mortality
Increased risk of HIV
transmission
Slide57Use of a Treatment Cascade, as Illustrated by the CDC21
Slide58Continuum of Care Definitions (TGA)
Measure
Denominator
Numerator
Estimated Prevalence
Estimated number of persons living with HIV on 31-Dec-2014, including those undiagnosed/unaware
2
Diagnosed
Persons living with HIV on 31-Dec-2014, including those undiagnosed/unaware
Number diagnosed
Linked to Care
Persons newly diagnosed with HIV during 2014
Number with ≥1 CD4 or viral load test within 90 days
Retained in Care
Persons with an HIV diagnosis and ≥1 CD4 or viral load test in the first six months of 2013
Number with ≥1 CD4 or viral load test in each 6-month period of 2013 and 2014, with ≥60 days between the first in a 6-month period and the last in the subsequent period
Prescribed ART
Persons with an HIV diagnosis and ≥1 CD4 or viral load test in 2014
Number prescribed HIV antiretroviral therapy
Suppressed Viral Load
Persons with an HIV diagnosis and ≥1 CD4 or viral load test in 2014
Number with HIV viral load <200 copies/mL at last 2014 HIV viral load test
Slide59Continuum of Care Definitions (U.S.)
Measure
Denominator
Numerator
Estimated Prevalence
Estimated number of persons living in the U.S. with HIV on 31-Dec-2011, including those undiagnosed/unaware
Diagnosed
Persons living in the U.S. with HIV on 31-Dec-2011, including those undiagnosed/ unaware
Number diagnosed
Linked to Care
Persons ≥13 in any of 18 U.S. states or District of Columbia (D.C.) that require reporting of all CD4 and viral load tests and newly diagnosed with HIV during 2011
Number with ≥1 CD4 or viral load test within 90 days of diagnosis
Retained in Care
Persons ≥13 in any of 18 U.S. states or D.C. that require reporting of all CD4 and viral load tests and diagnosed with HIV by year-end 2009 and alive at year-end 2010
Number with ≥2 CD4 or viral load tests ≥90 days apart during 2010
Prescribed ART
Persons living in the U.S. with HIV on 31-Dec-2010
Number prescribed HIV antiretroviral therapy
Suppressed Viral Load
Persons ≥13 in any of 18 U.S. states or D.C. that require reporting of all CD4 and viral load tests and HIV diagnosed by year-end 2009, alive at year-end 2010, and ≥1 CD4 or viral load test during 2010
Number with HIV viral load <200 copies/mL at last 2010 HIV viral load test
Slide60National HIV/AIDS Strategy Objectives
90% of HIV-positive residents diagnosed and aware of their status85% of newly diagnosed individuals linked to care within 90 days
80%
retained in care
20%
increase in the number of PLWH/A with suppressed viral loads
Slide61Estimated Number of Undiagnosed/Unaware PLWH/A
Current estimated proportion of PLWH/A while undiagnosed/unaware is 14.0% of known prevalence22
HIV/AIDS Prevalence
5,452
HIV Prevalence
2,589
AIDS Prevalence
2,863
Undiagnosed/Unaware
894
Estimated Total PLWH/A
6,346
Slide62Continuum of Care
Slide63Community Viral Load
Mean HIV viral load is based on the last test result during each year analyzed for all PLWH/A who had at least one viral load testResults reported as <20 or >10,000,000 copies/mL were set to 20 and 10,000,000 copies/mL, respectively, to reflect the detectable range of lab
instruments
Community viral load =
CVL
Slide64Mean Community Viral Load, Indianapolis TGA: 2010-2014
Analysis of variance between CVLs during 2010-2014 was
not
significant, F(4,17850) = 1.04, p = .3836, ηp
2
= .
0002
Slide65Morgan County data are missing
Slide66Slide67Mean Community Viral Load by County, Indianapolis TGA: 2014
Analysis of variance for the effect of residence county on mean CVLs during 2010-2014 was not
significant F(8, 17850) = .77, p = .6318, ηp
2
= .
0003
Morgan County data are missing
Slide68Improving Retention in the Cascade
Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel23
Close monitoring and individualized care
Systematic monitoring of retention in care for all PLWH/A
Intensive outreach for PLWH/A who are not engaged in care within six months
Use of peer or paraprofessional patient navigators
Summary of recommendations included. See appendix.
Full
published
article at:
http://
annals.org/article.aspx?articleid=1170890
Slide69Vision for the National HIV/AIDS Strategy16
“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and
discrimination.”
Slide70Slide71Slide72Slide73Tammie L. Nelson, MPH, CPH
Epidemiologist
Health & Hospital Corporation
Marion County Public Health Department
3901
Meadows
Drive, H108
Indianapolis, IN
46205
Office: 317-221-3556
Fax: 317-221-4404
Tnelson@MarionHealth.org
Slide74References
1 U.S. Census Bureau. (2015).
Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014
. U.S. Census Bureau, Population Division. Release dates: For the United States, regions, divisions, states, and Puerto Rico Commonwealth, December 2014; For counties and Puerto Rico municipios, March 2015.
2
U.S. Census Bureau. (2002).
Time series of Indiana intercensal population estimates by county: April 1, 1990 to April 1, 2000
. Table CO-EST2001-12-18. Release date April 17, 2002
.
3
U.S. Census Bureau. (2011).
Intercensal estimates of the resident population for counties of Indiana: April 1, 2000 to July 1, 2010
. Table CO-EST00INT-01-18
.
4
Glenn, R. (2011).
Demographics & trends: Indianapolis, Marion County & the Indianapolis region
. Department of Metropolitan Development: City of Indianapolis.
5
Centers for Disease Control and Prevention. (2015).
HIV surveillance report, 2013
. Retrieved from
http://
www.cdc.gov/hiv/pdf/g-l/hiv_surveillance_report_vol_25.pdf#Page=21
6
Purcell et al. (2012). Estimating the population size of MSM in the U.S. to obtain HIV and syphilis rates.
Open AIDS Journal; 6
(S1: M6) 98-107
.
7
Centers for Disease Control and Prevention. (2015). Deaths: Final data for 2013.
National Vital Statistics Report, 64
(2).
Retrieved from
http://
www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
8
Centers for Disease Control and Prevention. (2015). HIV among gay and bisexual men: Fact sheet. Retrieved from
http://www.cdc.gov/hiv/risk/gender/msm/facts
/
9
U.S.
Department
of Health and Human Services. (2013). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved from http://aidsinfo.nih.gov/guidelines10 Indiana University Public Policy Institute. (2013). 2013 Point-in-time count: Identifying the most vulnerable homeless in Indianapolis. Retrieved from http://policyinstitute.iu.edu/uploads/PublicationFiles/HomelessCount_2013_WEB.pdf
Slide75References
11 U.S. Department of Housing and Urban Development.
(2014).
HOPWA performance profile - Formula grantee: City of Indianapolis
.
Retrieved from
https://
www.hudexchange.info/resource/reportmanagement/published/HOPWA_Perf_GranteeForm_00_INDI-IN_IN_2013.pdf
12
Marion County Public Health Department.
(2014). Ryan White Information Services Enterprise (RISE). Indianapolis:
Ryan White Services Program.
13
Shubert, G. (2012).
Mobilizing knowledge: Housing is HIV prevention and care
. Available from
https://
www.slideserve.com/sibley/mobilizing-knowledge-housing-is-hiv-prevention-and-care-summary-of-research-presented-at-the-housing-and-hiv
14
U.S. Department of Health and Human Services. (2014).
Staying healthy with HIV/AIDS: Potential related health problems: Hepatitis
. Retrieved from
http://www.aids.gov/hiv-aids-basics/staying-healthy-with-hiv-aids/potential-related-health-problems/hepatitis
/
15
National Alliance of State and Territorial AIDS Directors. (2011).
HIV and viral hepatitis co-infection
. Retrieved from
http://www.nastad.org/Docs/031236_HIV%20VH%20CoInfection%20Final.pdf
16
The
White House Office of National AIDS Policy. (2010).
National HIV/AIDS strategy for the United States
.
Retrieved from
http://
www.cdc.gov/hiv/strategy/pdf/nhas.pdf
17
Marion County Public Health Department. (2014). Community health assessment of Marion County: 2014. Retrieved from
http://health.mchd.com
/
18
Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., . . . Hogg, R. S
. (2009). The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr, 52(3): 342-349. doi: 10.1097/QAI.0b013e3181b627c2. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740738/
Slide76References
19 Gardner, E.M., McLees
, M.P., Steiner, J.F., del Rio, C., and
Burman
, W.J. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection.
Clin
Infect Dis. 2011;52
(6): 793-800.
doi
: 10
.1093/cid/ciq243
20
Branson, B.M., Handsfield, H.H., Lampe, M.A., Janssen, R.S., Taylor, A.W., Lyss, S.B., and Clark, J.E. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Centers for Disease Control and Prevention: Atlanta.
MMWR. 2006; 55
(RR14): 1-17.
Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm
21
Centers for Disease Control and Prevention. (2013).
Linkage to and retention in HIV medical care
.
Retrieved from
http://
www.cdc.gov/hiv/prevention/programs/pwp/linkage.html
22
Centers
for Disease Control and Prevention. (2014). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data - United States and 6 dependent areas - 2012.
HIV Surveillance Supplemental Report, 19
(3).
Retrieved from
http://
www.cdc.gov/hiv/pdf/surveillance_Report_vol_19_no_3.pdf
23
Thompson, M. A., Mugavero, M. J., Amico, K. R., Cargill, V. A., Chang, L. W., Gross, R., . . . Nachega, J. B. (2012). Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: Evidence-based recommendations from an international association of physicians in AIDS care panel.
Ann Intern Med. 2012;156
(11): 817-833. doi:
10.7326/0003-4819-156-11-201206050-00419