front 1 summary of HIV global epidemic 2020 | back 1
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front 2 Women covered for ART more than men US density distribution on AIDs view
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Est HIV incidence |
front 3 Est HIV incidence | back 3
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front 4 new HIV diagnoses in US for most affected subpopulations, 2019 | back 4 20,000 of 38,000 are MSM
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front 5 New HIV diagnoses in US by age | back 5 younger ppl dominate - most affected population (25-34 yrs) |
front 6 HIV diagnosis rate by county of residence | back 6
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front 7 elements that are critically important that we follow in HIV | back 7
pic shows linkage to care within 1 month of HIV diagnosis darker color = worse florida is actually better, but still not where want |
front 8 cont. from last: retention in care | back 8 ability to keep ppl in care at least 2x per year darker color = worse better in florida, midsection of US worse |
front 9 cont.: viral load suppression | back 9 viral suppression = 200 copies virus/ml (want ppl to be <20 copies now) darker colors worse florida not very good in this one (only 62-66% on ARV therapy are suppressed) some states are bad in all 3 |
front 10 ending the HIV epidemic a plan for the US | back 10 editorial talking abt plan for ending HIV epidemic
FOUND:
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front 11 US areas with highest burden of HIV diagnosis | back 11 wanna focus on these areas to make biggest impact how to do that? see next card |
front 12 -> came up with plan for ending HIV epidemic (plan for america) | back 12 75% in HIV infections in 5 years and at least 90% reduction in 10 years
sits on 4 pillars:
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front 13 change in criteria for initiating ART | back 13 1998 - right after started using combination ARV therapy used to treat ppl depending on their CD4 cell level, now, treat EVERY INFECTED PERSON POSSIBLE in 2012, started treating everyhing HIV+ who was willing to take treatment
this changed bc of 052 study that came out (next card) |
front 14 HPTN 052 study | back 14 prevention study looked at couples where 1 had HIV and 1 did not randomized control - treatment given to 1 partner
= suppression is critical to transmission (undetectable = untransmittable) = realized should treat ppl early to prevent transmission |
front 15 initiation of antirevtroviral therapy in early asynptomatic HIV infection (2011-2015 study) | back 15 to show whether if start therapy early, compare to started later, does this make better outcome for person? individual with higher CD4 count had better outcome primary event cane = death, heart attack, etc. treat ppl early = prevent time to the first primary event confirmed early treatment better than waiting (now know dont just prevent transmission, but allows individual to DO BETTER) |
front 16 ppl living with HIV (PLWH) in miami-dade county along HIV care continuum | back 16 88% ever in care drop 20% (difference) to 69% in care in care/retained = small difference (69 vs 64%) and can usually suppress - only 58% of all people living with HIV are virally suppressed where can make biggest impact? by retaining ppls + getting them into care |
front 17 caribbean countries - looking for mechanisms to get ppl into care | back 17 tried to get ppl treatment quickly after diagnosis results indicated that ppl able to be taken into care around same day were able to be suppressed san francisco did same thing
doing it early - can suppression quicker = great benefit so can decrease transmission |
front 18 implemented rapid testing at UM immediate initiation program in public/academic medical center in the US miami test and treat rapid response program | back 18 what did this mean for viral load suppression? and impact on our ability to keep them in care? traditional linkage to care pathway (L) high acceptability in 1st year 2016 Dr. Hansel worked to get infectious disease elimination act (IDEA) passed at state level
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front 19 rapid identification and investigation of an HIV risk network among ppl who inject drugs - miami Fl 2018 | back 19 cohort of individuals who tested positive none got it from eachother, but from other means important at this time:
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front 20 common btw all studies done: when rapid test + treat ppl, median time for viral suppression after start ARVS is | back 20 70 days |
front 21 even state did test + treat | back 21 also brought ppl who fell out of care back in |
front 22 # ppl who whas care reinitiated, suppressed viral load retained in care, retained in care, etc. | back 22 |
front 23 pre exposure prophylaxis (PrEP) | back 23
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front 24 study - pre exposure chemoprophylaxis for HIV prevention in men who have sex with men | back 24 used dual drug - gave in randomized control trial
found preexposure prophylaxis DOES prevent HIV aquisition blue = less aquisition (y axis) compared to placebo (almost 40% difference) |
front 25 2012 FDA approved 1st drug (dual combination) for use in preventing HIV infection WHO did the same | back 25 didnt know how to make it more effacacious |
front 26 why do we need PrEP demonstration projects? | back 26
= questions in 2012 |
front 27 implementing PrEP in the real world | back 27 US PrEP demonstration project
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front 28 demo project | back 28 NIAID funded PrEP demonstration project multi site prospective openlabel wanted to look at 500 at risk individuals in real world setting (MSM and trans women) offered up to 48 weeks of prEP in 3 places
methods
found: graph attached |
front 29 retention in demo project over time | back 29 last time gave meds was week 36 (dont count wek 48)
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front 30 clinical trial evidence for HIV prevention options | back 30 effectiveness/ability to prevent HIV varies a lot
figure:
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front 31 who should PrEP be offered to? | back 31 substantial risk of HIV infection
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front 32 coverage among perosns aged >16 years | back 32 darker = worse
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front 33 HIV PrEP is underutilized | back 33 1.1 million individuals in UN at risk for HIV and should be offered PrEP estimated number of PrEP users end 2018 = 269,000 being PrEPared
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front 34 how many in groups taking it? HIV prevention pill not reaching most who could potentially benefit - esp african american + latinos | back 34 44% ppl who could benefit are african american (500K) only 1% of those (7K) wre prescribed PrEP 25% ppl who could benefit from PrEP are latino (300K) only 3% of them (7600) prescribed it |
front 35 these problems = | back 35 overcoming prep adherence problems need to masintain good drug levels for protection prep presistence - do ppl stay on or get fatigued? |
front 36 made injectables, one for PrEP, yet to be approved for it | back 36 e |
front 37 ending aids epidemic | back 37 repeated goals again (75% in 5 years and 90% in 10 years) |