New HIV diagnoses in Ontario, 2014

Transcription

1 New HIV diagnoses in Ontario, 2014 Mark Gilbert, MD Applied Epidemiology Unit, Ontario HIV Treatment Network November 2015

2 What can you expect to learn? To understand what the trends are in new HIV diagnoses for Ontario up to 2014 To understand some of the limitations of this information

3 Where does this data come from?

4 Source of information 1. Person decides to get an HIV test 2. Health care provider completes a lab form 3. Specimen is collected and sent to Public Health Ontario Laboratory 4. If the result is HIV positive: Result reported back to health care provider to give result to the person, and to local public health unit Result is shared with the Laboratory Enhancement Program, which sends a data collection form to the health care provider Information on form Information on form 4

5 What is a new HIV diagnosis? Based on having a first positive HIV test in Ontario Not the same thing as a new HIV infection Includes people already diagnosed with HIV who have moved and tested for the first time in Ontario 5

6 William W. Watt 6

7 25% of new HIV diagnoses are missing information on risk factors 40% are missing information on ethnicity No option for documenting transgender identity 7

8 HIV diagnoses by Sex 8

9 Total HIV diagnoses, ,400 Number of HIV diagnoses 1,200 1, ,106 1,132 1,048 1, ,025 1, Data provided by Public Health Ontario Laboratory to OHESI ( 9

10 HIV diagnoses by sex, ,000 Number of HIV diagnoses Male Female Data provided by Public Health Ontario Laboratory to OHESI ( Cases with unknown sex excluded; no option for transgender 10

11 HIV diagnoses by Age group 11

12 25% HIV diagnoses by age group and sex, Percent of HIV diagnoses Male Female 20% 15% 10% 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( 12

13 Female HIV diagnoses by age group and time period, % 25% Percent of HIV diagnoses Time period: % 15% 10% 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( 13

14 Female HIV diagnoses by age group and time period, % 25% Percent of HIV diagnoses Time period: % 15% 10% 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( 14

15 Male HIV diagnoses by age group and time period, % 25% Percent of HIV diagnoses Time period: % 15% 10% 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( 15

16 Male HIV diagnoses by age group and time period, % 25% Percent of HIV diagnoses Time period: % 15% 10% c 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( 16

17 Male (not known to be MSM) HIV diagnoses by age group and time period, % 25% Percent of new HIV Time period: diagnoses % 15% 10% 5% 0% < Data provided by Public Health Ontario Laboratory to OHESI ( MSM=men who have sex with men 17

18 Male (known to be MSM) HIV diagnoses by age group and time period, % 25% 20% Percent of new HIV diagnoses Time period: % 10% c 5% 0% < Age group (years) Data provided by Public Health Ontario Laboratory to OHESI ( MSM=men who have sex with men 18

19 HIV diagnoses by Health Region 19

20 Health Regions

21 HIV diagnoses by Health Region, Number of HIV diagnoses Northern Ottawa Eastern Toronto Central East Central West Southwest Average Data provided by Public Health Ontario Laboratory to OHESI ( 21

22 Male HIV diagnoses by Health Region, Number of HIV diagnoses Northern Ottawa Eastern Toronto Central East Central West Southwest Average Data provided by Public Health Ontario Laboratory to OHESI ( 22

23 Female HIV diagnoses by Health Region, Number of HIV diagnoses <5 <5 Northern Ottawa Eastern Toronto Central East Central West Southwest Average Data provided by Public Health Ontario Laboratory to OHESI ( 23

24 HIV diagnoses by population (exposure category) 24

25 Missing information on exposure category 25% 75% 25

26 HIV diagnoses by exposure category (where known) 100% 90% 80% 70% 60% 50% 40% 30% Percent of HIV diagnoses 61% % 10% 0% 13% 14% 8% 4% 0% MSM MSM-PWID PWID HIV-Endemic Heterosexual Other Data provided by Public Health Ontario Laboratory to OHESI ( MSM=men who have sex with men, PWID=people who inject drugs 26

27 Male HIV diagnoses by exposure category (where known) 100% 90% 80% 70% 60% 50% 40% 30% Percent of HIV diagnoses 73% % 10% 0% 11% 5% 6% 5% 0% MSM MSM-PWID PWID HIV-Endemic Heterosexual Other Data provided by Public Health Ontario Laboratory to OHESI ( MSM=men who have sex with men, PWID=people who inject drugs 27

28 Female HIV diagnoses by exposure category (where known) 100% 90% 80% 70% % 50% 48% 40% 30% 33% 20% 10% 0% 18% PWID HIV-Endemic Heterosexual Other 1% Data provided by Public Health Ontario Laboratory to OHESI ( PWID=people who inject drugs 28

29 HIV diagnoses by ethnicity 29

30 Missing information on ethnicity 40% 60% 30

31 HIV diagnoses by ethnicity (where known) 70% Percent of HIV diagnoses % 50% 40% 52% % 20% 21% 10% 0% 2% 7% 4% 2% 9% 3% Data provided by Public Health Ontario Laboratory to OHESI ( 31

32 Male HIV diagnoses by ethnicity (where known) 70% 60% 50% Percent of HIV diagnoses % % 30% 20% 10% 0% 15% 2% 8% 4% 3% 10% 3% Data provided by Public Health Ontario Laboratory to OHESI ( 32

33 Female HIV diagnoses by ethnicity (where known) 70% 60% 50% 40% 30% Percent of HIV diagnoses % 51% % 10% 0% 4% 2% 4% 1% 4% 2% Data provided by Public Health Ontario Laboratory to OHESI ( 33

34 To summarize 34

35 Take-home messages for 2014 New HIV diagnoses by exposure category Consistent with long term trends Small changes in compared to previous two years, except among females who use injection drugs New HIV diagnoses by ethnicity Varying trends in compared to prior two-year periods Difficult to interpret due to missing data 35

36 Take-home messages for 2014 New HIV diagnoses in females: Peak age 30-34, with shift to older age at diagnosis over time Small increase in diagnoses in females compared to 2013 yet still lower than previous years Small increase in Northern, Eastern, and Central West Health Regions Small increase among females who use injection drugs Possible explanations? Small increases between years are not uncommon (usual variation)? Efforts to increase testing among females who use injection drugs? 36

37 Take-home messages for 2014 New HIV diagnoses in males: Stable number of new HIV diagnoses compared to 2013 Two trends by age: Cohort effect: men born in 1960 s have higher number of diagnoses compared to other generations (more pronounced in MSM) Shift towards younger age at diagnosis among MSM over past 10 years Explanations? Consistent with trends seen in other places Reflects generational differences, including underlying HIV prevalence? 37

38 What s next? Looking further into these trends Working to change lab form to reducing missing information Looking at ways to adjust for missing data Shifting from mutually exclusive exposure categories to overlapping priority populations 38

39 Thanks for For more information or to register for updates, please visit 39