The Australian HIV diagnosis and care cascde. Richard Gray NAPWHA AGM 30 October 2015

Transcription

1 The Australian HIV diagnosis and care cascde Richard Gray NAPWHA AGM 30 October 2015

2 HIV cascade estimates for 2014 (from 2015 ASR) 2

3 HIV Cascade Definitions Stage Number living with HIV Number living with diagnosed HIV Definition Estimated number of PLHIV in overall population Estimated number of people previously diagnosed with HIV Number taking ART Number of PLHIV who received antiretroviral drugs at some stage during previous 12 months Number with suppressed virus Proportion of people on ART who had a VL less than 400 copies/ml at last test (range between 50 and 1000 copies/ml) 3

4 Stakeholder consultation process Consultation process to review the HIV cascade and annually update estimates for the ASR Formed a reference group with representatives from: SA Health; QLD Health; NT Health; MSHC; Burnet; Melbourne University; ASHA; ARCSHS; The Kirby Institute; NAPWHA; AFAO; WA Health; ASHM; NSW Health; SAHMRI Met on June 16 to review HIV cascade structure, methodology, data sources, and insertion into the ASR This process is ongoing 4

5 HIV cascade estimates Methods & data sources Infected Diagnosed Treatment Supressed viral load 5

6 Calculating number of people living with diagnosed HIV Method based on de-duplicated notifications from start of the epidemic in 1980 Number living with diagnosed HIV = number of (unique) people diagnosed with HIV number of deaths overseas migration (+/- interstate migration for states) 6

7 Calculating number of people living with diagnosed HIV Data & Methods Notifications from National HIV Registry Remove duplicates (Law et al. ANZJPH 20; 2: 1996) ~8% overall, most early on Estimate mortality rate Linkage study up to 2003 (Nakhaee et al. Sexual Health 6; 129: 2009) Post-2003 AHOD mortality rates Estimate overseas migration rate Permanent departures and resident population from ABS (series , ) PLHIV rate between 0 and overall rate (<0.5%) For state cascades interstate migration rate Arrivals and departure numbers from ABS (series ) PLHIV rate assumed same as overall population 7

8 PLHIV Estimating undiagnosed infections Number living with HIV = Number living with diagnosed HIV (1- Proportion undiagnosed) Empirical: COUNT study: linked to Annual Gay Community Periodic Surveys 9% (6-14%) of HIV-positive were unaware No estimate for non-community attached MSM or non-msm Methods which use CD4 count or infection stage at diagnosis to estimate time since infection Generally align with empirical estimates for MSM 20% (12-23%) among non-msm Mallitt, K.A., et al., Sexual Health, (2): p Wand, H., et al., HIV Medicine, (6): p

9 Number on ART The reference group reviewed a number of approaches Decided to use data from a 10% Pharmaceutical Benefits Scheme (PBS) national sample provided by the company prospection This is a randomised patient level, de-identified PBS script claims dataset from 2006-present. Currently has 170m script claims and 3m patients. Includes all PBS listed drugs with HIV indications. At end of 2014: 17,470 people taking ART in Australia 9

10 Suppressed viral load Proportion of people on ART with suppressed virus in AHOD proportion of people who had < 400 copies per ml at their last viral load test Uncertainty range: proportion of people with <50 copies per ml / < 1000 copies per ml 10

11 Issues and ongoing work Number linked to care: Estimated number of people who underwent a CD4 test within 3 months of diagnosis From the HIV registry Issue: number ever linked < number currently on ART Dropped from cascade and report number linked annually instead Generally assumed nearly everyone is linked to care Number retained in care Number of PLHIV in 2013 who received at least one CD4 or VL test within the last 12 months Dropped from cascade because previous method using MBS and AHOD data produced contradictory results For NSW there is a discrepancy between PBS data on number receiving ART and other sources such as ipharmacies Continue to engage with stakeholders to address these issues 11

12 Acknowledgements David Wilson, Rebecca Guy, Skye McGregor, Hamish McManus, Jane Costello, James Jansson HIV care cascade reference group: Lea Narciso, SA Health; John Marquess, QLD Health; Jiunn-Yih Su, NT Health; Nick Medland, MSHC; Mark Stoové, Burnet; Jane Hocking, Melbourne University; David Lewis, ASHA; Graham Brown, ARCSHS; David Cooper, Andrew Grulich, Basil Donovan, Denton Callander, John Kaldor, Marlene Kong, Jenny Iversen, Kathy Petoumenos, Kirby; Aaron Cogle, NAPWHA; Simon Donohoe, AFAO; Donna Mak, WA Health; Levinia Crooks, ASHM; Heather-Marie Schmidt, NSW Health; James Ward, SAHMRI 12