The Continuum of HIV Care in Orange County- 2014

The Continuum of HIV Care in Orange County -- 2014 Introduction The Centers for Disease Control and Prevention (CDC) released an analysis 1 showing that only one in every three of the 1.2 million Americans living with HIV have their infection under control. The Continuum of Care provides a visual “cascade” of individuals living with HIV disease. In Orange County, the stages of the continuum include: 1. Infected with HIV: This is the Centers for Disease Control and Prevention (CDC) estimate that includes those who know their HIV status and those who are HIV-positive but unaware of their HIV status; 2. Diagnosed with HIV: This is the percent of individuals who are HIV-positive and aware of their status compared to the estimate of all individuals living with HIV in Orange County; 3. Ever Linked to HIV care: This is the percent of HIV-positive individuals who have been linked to HIV medical care (as indicated by having at least one viral load and/or CD4 count blood test after the month and year of diagnosis); 4. Retained in HIV care: This is persons diagnosed with HIV and whose most current address was in Orange County as of December 31, 2014 who had at least two CD4 or viral load results with at least three months in-between the first and last result. For persons diagnosed prior to 2014, the two results occurred in 2013 and/or 2014. For persons diagnosed in 2014, the results occurred between January 2014 and August 2015.

5. Antiretroviral Therapy (ART) Estimate: This is the estimated percent of HIV-positive individuals who are taking antiretroviral medications. Because this data is not available for Orange County, a proxy measure has been used (persons with an undetectable viral load at their last test in 2014 and persons whose viral load has declined between the last test in 2014 and the previous test); and 6. HIV Viral Load Suppression: This is the percent of individuals with a HIV viral load of less than 200 copies/mL. Figure 1: The Continuum of HIV Care: Orange County, 2014 100.0%

Persons living with HIV (%)

100%

86.0% 79.7%

80%

66.5%

61.4%

59.3%

ART Estimate

Viral Load Suppression

60% 40% 20% 0% HIV Infected

HIV Diagnosed

Ever Linked to HIV Care

Retained in HIV Care

Stage of HIV Care



Of the 6,6982 estimated persons living with HIV in Orange County in 2014: o 5,340 (79.7%) were ever linked to HIV care. o 4,456 (66.5%) were retained in HIV care. o 4,115 (61.4%) were estimated to be receiving ART. o 3,975 (59.3%) achieved viral suppression.

1

CDC. HIV in the United States: Stages of Care. www.cdc.gov/nchhstp/newsroom/docs/HIV-Stages-of-Care-Factsheet-508.pdf Released November 2014. Accessed March 1, 2016.

2 The number of persons living with HIV in Orange County changes as individuals move in and out of the County. The 6,698 is estimated from the 5,760 diagnosed who were living in Orange County in 2014 from data extracted as of January 2015 and does not match previously reported numbers for 2013.

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2014 Highlights     

Of the 6,698 Orange County residents estimated to be living with HIV, 59.3 percent had achieved viral suppression (Figure 1).

Hispanics estimated to be living with HIV in Orange County are less likely to be retained in HIV care (61.4%) or virally suppressed (53.9%) than other race/ethnicity groups. (Figure 2).

Younger persons (13-24 years) estimated to be living with HIV are least likely to ever be linked to care (52.0%), retained in care (44.6%), and are also least likely to be virally suppressed (36.7%).

Women estimated to be living with HIV in Orange County are more likely to ever be linked to care (82.0%) and virally suppressed (60.5%), while men are equally as likely to be retained in care (67.3%).

Orange County’s 2014 Continuum shows improvements compared to 2013. This is due to lower estimates of people who are unaware of being infected with HIV as well as better information regarding persons currently living in Orange County.

The figures below provide an overview of Orange County data.

60.1%

61.5%

66.3%

74.2%

79.2%

100.0% 66.8%

68.5%

85.2%

73.8%

89.8%

100.0% 53.9%

56.5%

61.4%

77.0%

85.3%

100.0% 61.5%

58.8%

60%

66.7%

80%

82.0%

Persons Living with HIV (%)

100%

86.3%

100.0%

Figure 2: Continuum of HIV Care by Race/Ethnicity: Orange County, 2014

40%

20%

0% Black/African American (N=327)

Hispanic/Latino (N=3,156)

White (N=2,609)

Asian/Pacific Islander (N=496)

HIV Infected (Estimated)

HIV Diagnosed

Ever Linked to HIV Care

Retained in HIV Care

ART Estimate

Viral Load Suppression

Does not include 110 persons who are American Indian/Alaskan Native, more than on race, or of other/unknown race.

 

Race/Ethnicity Hispanics estimated to be living with HIV in Orange County have the lowest percentages of being retained in care (61.4%), on ART (56.5%), and virally suppressed (53.9%), while Asian/Pacific Islanders have the lowest percentage of ever being linked to care (74.2%).

Whites have the highest percentage in all stages of the continuum from 85.2% ever being linked to care to 66.8% being virally suppressed.

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100.0% 94.0% 85.6% 73.2% 68.0% 66.8%

100.0% 96.7% 86.6% 73.3% 71.0% 70.7%

100.0%

100.0% 92.1% 85.6% 72.3% 66.5% 64.3%

40%

61.1% 58.5%

60%

73.7% 69.0% 57.8% 51.7% 48.8%

80%

55.8% 52.0% 44.6% 38.3% 36.7%

Persons Living with HIV (%)

100%

86.8% 81.3% 64.8%

100.0%

100.0%

Figure 3: Continuum of HIV Care by Age Group – Orange County, 2014

45-54 (N=2,130)

55-64 (N=1,136)

65+ (N=346)

20%

0% 13-24 (N=314)

25-34 (N=1,140)

35-44 (N=1,574)

HIV Infected (Estimated)

HIV Diagnosed

Ever Linked to HIV Care

ART Estimate

Viral Load Suppression

Retained in HIV Care

Does not include 58 persons under the age of 13.

 

Age Group Persons age 13-24 years estimated to be living with HIV in Orange County are least likely to be diagnosed (55.8%), ever be linked to care (52.0%), be retained in care (44.6%), be on ART (38.3%), or be virally suppressed (36.7%).

Viral load suppression increases with age, with persons age 65 years and over having the highest rate of viral load suppression (70.7%).

60.5%

63.9%

67.3%

82.0%

88.6%

100.0% 60.1%

62.0%

80%

67.3%

80.4%

Persons Living with HIV (%)

100%

86.7%

100.0%

Figure 4: Continuum of HIV Care by Gender – Orange County, 2014

60%

40%

20%

0% Male (N=5,742)

Female (N=835)

HIV Infected (Estimated)

HIV Diagnosed

Ever Linked to HIV Care

Retained in HIV Care

ART Estimate

Viral Load Suppression

Does not include 121 persons who identify as transgender.



Gender Women estimated to be living with HIV in Orange County have higher percentages than males at all stages of the continuum except retention in care, where both genders are equally retained (67.3%). Transgender percentages are not shown due to the lack of an estimate regarding how many are diagnosed.

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Heterosexual Male (N=129)

100.0% 86.7% 82.6% 68.3% 65.0% 61.8%

100.0% 83.6% 78.2%

MSM/IDU (N=322)

57.3% 52.6% 50.3%

100.0% 93.6% 89.6% 74.0% 65.6% 61.3%

100.0%

94.0% 80.9% 63.8%

59.2% 53.2%

60%

61.1% 54.8% 52.1%

80%

100.0% 95.0% 82.1%

Persons Living with HIV (%)

100%

100.0% 85.2% 79.8% 67.7% 62.5% 60.8%

Figure 5: Continuum of HIV Care by Risk Group – Orange County, 2014

40% 20% 0% MSM (N=4,849)

Male IDU (N=334)

Female IDU (N=152)

Heterosexual Female (N=603)

HIV Infected (Estimated)

HIV Diagnosed

Ever Linked to HIV Care

Retained in HIV Care

ART Estimate

Viral Load Suppression

Note: MSM=men who have sex with men. IDU=injection drug users.

Does not include 309 people infected as children, infected through a blood transfusion, are hemophiliacs, or are of unknown transmission source.

 

Risk Group Heterosexual males estimated to be living with HIV in Orange County have the lowest percentages at all stages of the continuum, with only 57.3% being retained in care and 50.3% being virally suppressed.

MSM/IDU have the highest percentages at all stages of the continuum except viral suppression, where heterosexual females have the highest percentage at 61.8%.

Closing the Gaps HIV testing is a critical step in HIV prevention and is the only way to identify Orange County residents with HIV who do not know they are infected (14 percent of the number of persons living with HIV who know they are infected).

In addition, ensuring that people have access to care, stay in care, and remain on antiretroviral treatment will increase the percentage of HIV-infected individuals who achieve and maintain viral suppression, which is important for improving their health and for preventing HIV transmission.

To reduce the impact of HIV in Orange County, improvements are needed at each stage of the Continuum of HIV Care, with particular efforts aimed to reduce disparities by race, age, and risk group.

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Data Sources, Methods, and Additional Resources Data Sources  The data were extracted from the Orange County HIV Case Registry, as reported January 2015.  The estimated percentages of persons living with undiagnosed HIV are based on national figures obtained from the CDC.3 Definitions  Persons living and diagnosed with HIV were defined as current Orange County residents diagnosed with HIV by December 31, 2014 who had their case reported to the Orange County HIV/AIDS Surveillance and Monitoring Program by January 31, 2015.

Additional Resources  National HIV/AIDS Strategy: https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhasupdate.pdf.  California’s Office of AIDS Integrated HIV Surveillance, Prevention, and Care Plan: http://www.cdph.ca.gov/programs/aids/Pages/StatewideIntegratedPlan-2016.aspx.

Acknowledgements Orange County Health Care Agency would like to thank all Orange County providers and laboratories whose work made this report possible.

3

Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and six U.S. dependent areas— 2013. HIV Surveillance Supplemental Report 2015;20 (No 2). http://www.cdc.gov/hiv/library/reports/surveillance/. Published July 2015.

Accessed March 1, 2016.

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