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HIV Epidemiology Program: Epidemiology of HIV and AIDS in Los Angeles County

HIV Epidemiology Program: Epidemiology of HIV and AIDS in Los Angeles County. Presentation to Public Health Commission October 28, 2010. Douglas M. Frye, MD, MPH Director, HIV Epidemiology Program. Mission Statement.

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HIV Epidemiology Program: Epidemiology of HIV and AIDS in Los Angeles County

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  1. HIV Epidemiology Program: Epidemiology of HIV and AIDS in Los Angeles County Presentation to Public Health Commission October 28, 2010 Douglas M. Frye, MD, MPH Director, HIV Epidemiology Program

  2. Mission Statement Collect, analyze, and disseminate HIV/AIDS surveillance and epidemiologic study data essential for the planning, implementation, and evaluation of programs and policies involving HIV care, prevention, education, and research in Los Angeles County

  3. HIV EPI PROGRAM STAFFING • Staff positions (49 total): • 38 County employees • 11 Temporary contract employees • Lead Surveillance/Research Staff: • 1 Medical Epidemiologist • 3 Doctoral Level Epidemiologists • 9 Masters Level Epidemiologists and Research Analysts • 4 Public Health Nurses • 1 PHN Supervisor

  4. L.A. County Board of Supervisors Department of Public Health Jonathan E. Fielding Director and Health Officer Jonathan E. Freedman Chief Deputy Director for Department of Public Health Mario J. Pérez Director, Office of AIDS Programsand Policy Robert Kim-Farley Division Director Communicable Disease Control and Prevention Sexually Transmitted Disease Control & Tuberculosis Control Douglas Frye Director HIV Epidemiology Program Acute Communicable Disease Control & Public Health Laboratory Department of Public Health

  5. HIV EPI Organizational Chart DIRECTOR ADMINISTRATION Data Acquisition Data Analysis Special Projects Behavioral Epidemiology Surveillance Units Research Units

  6. Current Program Surveillance and Epidemiologic Research Projects • HIV Surveillance units • Data Acquisition Unit collects case reports • Data Analysis Unit enters data, analyzes it, distributes it to stakeholders • Enhanced Perinatal Surveillance Project • Behavioral Epidemiology Unit • HIV Incidence and Resistant Strains Surveillance • National HIV Behavioral Surveillance • Special Projects Unit • Medical Morbidity Monitoring Project

  7. HIV and AIDS Reporting • 1982: physicians and hospitals required to report confirmed and suspected cases of AIDS to local health department • 2002: laboratories and providers required to report all non-AIDS HIV infections by code • 2006: SB-699 signed into law; report by name • 2008: AB-1045 signed into law; CD4 reporting by laboratories required • 2009: CDC implements evaluation-HARS • 2010: AB-2541 signed into law; HIV reporting allowed by secured electronic means for providers, labs and local health jurisdictions • 2011: more changes in eHARS

  8. Importance of Reporting HIV and AIDS for L.A. County • HIV/AIDS epidemic in Los Angeles differs from the rest of the United States by gender, race/ethnicity, mode of exposure, • Number of cases reported translates into state and federal dollars for prevention, education, care services for persons living with HIV in LA County • Second highest (to NYC) morbidity for among urban areas in nation • 5% of US and 35% of California cases

  9. How Data Are Collected • Active Reporting • HIV EPI personnel contact health care practitioners and review medical records in hospitals and clinics • Passive reporting • health care practitioners, hospitals, and clinics report cases of AIDS without being reminded or contacted • Electronic reporting • Labs and large providers report via secured network or by CD-ROM

  10. Persons Living with HIV and AIDS in L.A. County

  11. Estimated Number of Persons Living with HIV and AIDS in LAC 13,500 4,150 4,500 16,000 24,650 Estimate ~ 62,800 living with HIV & AIDS in LAC (3) Source: LAC HIV Epidemiology Program, reported as of 12/31/2009. (1) Estimate that 21.5% of HIV+ in LA County are unaware of their infection; modified from CDC estimate. (2) Of 6,700 notifications pending investigation, estimate >4,000 to be cases. (3) Estimate based on a 1:1 ratio of HIV (non-AIDS) to living AIDS cases and includes reported, named, coded, pending and unaware HIV and AIDS cases.

  12. Number of Persons Living with HIV/AIDS, by Gender and Year, LAC, 2002-08 88% 12% *Data is provisional due to reporting delay (2006-2008) Source: HIV Epidemiology Program, LAC-DPH; data as of May 31, 2009

  13. Proportion of LAC PLWHA Cases by Race/ Ethnicity* & Diagnosis Year, 1997-07 White Hispanic 39% 36% 22% Black Asian/PI 3% *American Indian and Alaska Native are not presented here but consistently comprise <1% of cases. *Data are provisional due to reporting delay. Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

  14. <1% 3% 35% 39% 21% Persons living with HIV and AIDS in LAC, by Race/Ethnicity (N=44,450), 12/31/2009 Source: HIV/AIDS Surveillance Summary, data as of 9/30/2010.

  15. Persons Living with HIV and AIDS in LAC per 100,000 population by Race/Ethnicity* *Sometimes called “Prevalence Rate”; it is really a proportion. Source: HIV/AIDS Surveillance Summary, data as of Dec. 2009.

  16. Current Age of Reported Persons Living with HIV and AIDS in LAC, 2010 (N=43,829) Age (years) Source: HIV/AIDS Surveillance Summary, data as of 9/30/2010.

  17. Proportion of LAC PLWHA by Mode of Exposure and Calendar Year, 1997-2007* 64% Men who have sex with men MSM IDU IDU 17% NRR** 6% 5% 7% Heterosexual **NRR = no reported risk. *Data are provisional due to reporting delay. Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

  18. Persons living with HIV and AIDS in LAC, 2007, by Mode of Exposure, Adjusted (N=40,000) Source: HIV/AIDS Surveillance Summary, data as of Sept. 2008.

  19. Adjusted Mode of Exposure for Persons Living with HIV/AIDS by Gender in LAC, December 2007 Male (n=35,035) Female (n=4,968) *Persons who had no reported risk for HIV infection had been redistributed to a valid mode of exposure category based on the CDC method for distribution of reclassified cases. Source: HIV/AIDS Surveillance Summary, data as of September 2008.

  20. Persons Living with HIV and AIDS by Zip Code and Service Planning Area (SPA) in Los Angeles County, as of Dec. 31, 2009 (N=44,450) Source: HIV/AIDS Surveillance Summary.

  21. Number, Percent, and Rate of Persons Living with HIV and AIDS by Service Planning Area (SPA) in Los Angeles County, as of Dec. 31, 2009(N=44,450) Source: HIV/AIDS Surveillance Summary.

  22. Percent of Newly Diagnosed Severe HIV Disease (AIDS) Cases Among Persons 50 Years and Older, by Year of Diagnosis 1984-2006 17% Percent (%) 11% Source: HIV Epidemiology Program, LAC-DPH; data as of December 31, 2009

  23. Percent Perinatal HIV Transmission by Birth Year, Los Angeles County, 1996 – 2009 20 SB889 15 AB1676 Percent 10 AB682 5 0 96 97 98 99 00 01 02 03 04 05 06 07 08 09 Year of Birth

  24. Contact Information Douglas M. Frye (213) 351-8190 HIV Epidemiology Program Phone: (213) 351 – 8196 www.publichealth.lacounty.gov/hiv

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