HIV/AIDS unmet needs, Georgia, 2011

HIV/AIDS Unmet Needs, Georgia, 2011
D.M Rane, MBBS, MPH; J.M Kelly, MD; D Hughes, BS; A. Pennisi, MA, MPH; C.L Drenzek, DVM, MS Georgia Department of Public Health (GDPH), Division of Health Protection, Epidemiology Program, HIV/AIDS Epidemiology Section

Results

Results

Background
Georgia ranks sixth highest in the nation for total number of adults and adolescents living with diagnosed HIV infection in 20101
As of December 31, 2011 the Georgia Department of Public Health reports 45,527 people living with HIV/AIDS; 44% with HIV (not AIDS) and 56% with AIDS
Sixty-three percent of these live in the Atlanta Eligible Metropolitan Area (EMA)
GDPH estimates the unmet primary medical care services of persons living with HIV infection in Georgia as required by the Ryan White Treatment and Modernization Act
The analysis identifies the number, behavior, and demographics of persons living with HIV infection and not receiving HIV related medical services
The estimates inform community planning groups and other stakeholders to respond to the primary medical care needs of emerging underserved HIV/AIDS populations and reduce disparities in access to care
Methods
The Enhanced HIV/AIDS Reporting System (eHARS) is a
web-based surveillance system that gathers clinical and behavioral HIV infection data via documents such as case reports, electronic and paper-based laboratory reports, and birth and death certificates
Cases with complete information on last name soundex, state identification number, date of birth, race/ethnicity, birth sex, HIV/AIDS diagnosis information and vital status are termed eligible and are reported to the Centers for Disease Control and Prevention(CDC)
Unmet needs for Georgia, Atlanta EMA and Georgia nonEMA were estimated by analyzing CDC eligible HIV infection data reported in the Georgia eHARS based on a framework developed by the University of California, San Francisco2 using SAS programming
All persons living with HIV infection reported in the Georgia eHARS were assumed to be aware of their status
For the purpose of this analysis, population sizes were determined for persons living with AIDS(PLWA) and persons living with HIV/non-AIDS(PLWH non-AIDS) as of December 31, 2011 for Georgia statewide, the Atlanta EMA, and Georgia non-EMA
Primary medical care `met needs' were estimated for PLWA and PLWH(non-AIDS) for Georgia as a whole, the Atlanta EMA and Georgia non-EMA as evidenced by viral load testing and/or CD4 count for a 12 month period from January 01 to December 31, 2011
Unmet needs for HIV infection primary medical care were defined as no evidence of either of the two measures described above during the specified 12-month time frame
Persons living with HIV infection who are not identified to be `in care' were assumed to be `out of care'
Acknowledgements
Analysis of unmet primary care needs of HIV positive people of Georgia would not have been possible without the hard work and contributions of the Core Surveillance Unit, HIV Epidemiology Section, GPDH in the collection and integration of population based HIV/AIDS data. We would like to thank Marguerite Camp, Raimi Ewetola, Thelma Fannin, Rodriques Lambert, Sheila Maxwell, Mildred McGainey, Latoya Moss, Akilah Spratling and Eina Walker.

Figure 1: Estimates of unmet primary medical care needs among persons living
with HIV infection* in Georgia , Atlanta EMA and Georgia non-EMA, January 01 to
December 31, 2011
Pickens

Bartow

Cherokee

Forsyth

Paulding

Cobb

Gwinnett

Barrow

Carroll

Douglas

Fulton

DeKalb Rockdale

Clayton

Newton

Coweta

Fayette

Henry

Spalding

Number with unmet needs:
Georgia : 20,627 Atlanta EMA: 12,285 Georgia non-EMA : 8,342

*Persons living with HIV infection include PLWH(non-AIDS) and PLWA Atlanta EMA consists of Barrow, Bartow, Carroll, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Newton, Paulding, Pickens, Rockdale, Spalding and Walton counties

The total number of persons living with HIV infection in the Atlanta EMA (28,683) was almost twice that of those living in the Georgia non-EMA(16,844)
Estimates of unmet primary care needs of persons living with HIV infection were 20,627 (45%) for Georgia statewide, 12,285(43%) for the Atlanta EMA and 8,342(50%) for Georgia, non-EMA [Figure 1]
Proportions of unmet needs were highest in the Georgia non-EMA among PLWH (non-AIDS)(54%) and PLWA (46%) compared to Atlanta EMA (43% for both PLWH non-AIDS and PLWA)
Males living with HIV infection in the Atlanta EMA (9,805;44%), Georgia non-EMA (5,772;51%) and Georgia statewide (15,577;46%) had higher unmet needs than females in the Atlanta EMA (2,475;40%), Georgia non-EMA (2,562;46%) and Georgia statewide (5,037,43%) [Figure 4]
Among adults and adolescents (13 years of age and greater), higher unmet needs were seen among those 45 to 59 years of age in the Atlanta EMA, Georgia non-EMA and Georgia statewide [Figure 5]. However, by proportion higher unmet needs were seen in among those 60 years and greater in Georgia and its regions

Figure 2: Estimates of unmet primary care needs among persons living with HIV(non-AIDS) , Georgia and its regions,
Figure 2: Estimates of unmet primary care needs among persons living with HIV(non-AIDS)
, January 01 to Georgia and its regions, January D01 teo cDeecemmbebr 3e1,r203111, 2011

Figure 3: Estimates of unmet primary care needs among persons living with AIDS, Georgia and its regions, January 01 to December 31, 2011

Hispanic/Latinos had the lowest number of persons but highest proportion with unmet needs compared to all other racial/ethnic groups in the Atlanta EMA(720,48%) and Georgia non-EMA (374,56%)[Figures 6,7]

Number of cases 25,000

Total Population In Care Out-of-Care

Figure 3: Estimates of unmet primary care needs among persons living with AIDS , Georgia and its regions, January 01 to December 31, 2011
Number of cases

Conclusions

20,000

19,818

15,000 10,000

10,506 9,312

5,000

12,058
6,915 5,413

7,760 3,591 4,169

30,000 25,000 20,000 15,000 10,000
5,000

25,709

Total Population In Care Out-of-Care

14,394 11,315

16,625
9,483 7,142

9,084 4,911 4,173

Quantified estimates of unmet primary medical care needs among persons living with HIV infection in the Atlanta EMA assists Ryan White program A grantees to monitor and ensure that persons living with HIV infection in the Atlanta EMA have access to primary medical care.

0 Georgia

0

Atlanta EMA

Georgia non-EMA

Georgia

Atlanta EMA

Georgia non-EMA

Total population refers to PLWH(non-AIDS) [Figure 2] or PLWA [Figure 3] as of December 31, 2011 In care refers to PLWH(non-AIDS) [Figure 2] or PLWA[Figure 3] as of December 31, 2011 with an evidence of viral load and/or CD4 count between January 01 to December 31, 2011 Out-of-Care = Total Population In Care

Figure 4: Estimates of unmet primary care needs among persons living with HIV infection by sex, Georgia and its regions, January 01 to December 31, 2011

Figure 5: Estimates of unmet primary care needs among persons living with HIV infection by age (13 years and greater), Georgia and its regions, January 01 to December 31, 2011

Estimates of unmet primary medical care needs in Georgia statewide and in Georgia non-EMA guide stakeholders in decision-making to improve primary care access for all HIV positive Georgians
It is important to consider both numbers of persons and proportions of populations to measure unmet needs so we can identify disparities in provision of care
Ongoing efforts to estimate unmet needs for Georgia statewide, the Atlanta EMA and Georgia non-EMA in the future will allow comparative and trend analysis of unmet needs

Number of cases 20,000

15,000

15,577

10,000 5,000

5,037

0 Georgia

Male Female

9,805 2,475
Atlanta EMA

5,772 2,562
Georgia non-EMA

Number of cases 10,000

8,873

8,000

7,098

13-29 30-44 45-59 60+

6,000 4,000 2,000
0

2,461

2,075

Georgia

5,407 4,154

1,439

1,240

Atlanta EMA

3,466 2,944

1,022

835

Georgia non-EMA

Figure 6: Estimates of unmet primary care needs among persons living with HIV infection by race/ ethnicity, Georgia and its regions, January 01 to December 31, 2011

Figure 7: Proportion of unmet primary care needs among persons living with HIV infection by race/ ethnicity, Georgia and its regions, January 01 to December 31, 2011

Number of cases

16,000 14,000

14,108

Black, NH* White,NH* Hispanic/Latino Other

Proportion of Prcoapsoertsion of 80cases

Black, NH* White, NH* Hispanic/Latino Other

12,000 10,000
8,000 6,000 4,000 2,000
0

4,494 1,094 931
Georgia

8,447
2,580 720 538
Atlanta EMA

5,661
1,914 374 393
Georgia non-EMA

60 47 47 50
40 26
20
0 Georgia

45 45 48 21
Atlanta EMA

56 49 52
40
Georgia non-EMA

*NH (non-Hispanic) Other Includes Asian, Hawaiian/Pacific Islander, Multiracial, American Indian, Alaskan Native and Unknown

Limitations
The burden of HIV infection in Georgia may be underestimated due to limitations in reporting
Evidence of one viral load or CD4 laboratory test may not be indicative of comprehensive primary medical care for persons living with HIV infection
Utility of unmet need estimates by transmission category is limited by the large number of individuals with unspecified transmission category in the Georgia surveillance data
Additional studies are needed to identify barriers to access to care and unmet needs that may differ for the Atlanta EMA and non-EMA populations
References
1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2011; vol. 23. http://www.cdc.gov/hiv/topics/ surveillance/resources/reports/. Published February 2013. Accessed April 2013.
2. A practical guide to measuring unmet need for HIV related primary medical care: Using the unmet need framework; Institute of Health Policy Studies, University of California, San Francisco, May 2003