STOP HIV/AIDS Quarterly Monitoring Report

STOP HIV/AIDS Quarterly Monitoring Report Quarter 2, 2012 April 1, 2012 June 30, 2012 Lauren MacDonald 1, Dr. Reka Gustafson 2, Tim Chu 1, Dr. Jat Sandhu 1 1 Public Health Surveillance Unit 2 Communicable Disease Control FINAL VERSION: September 20th, 2012

Acknowledgements We would like to acknowledge the contributions of our many partners. Without their support this report would not have been possible. Microbiology & Virology at Providence Health Care - Willson Jang, Technical Leader Public Health Microbiology and Reference Laboratory - Yin Chang, Laboratory Surveillance and Outbreak Coordinator & Rob MacDougall, Laboratory Information Management Coordinator Vancouver Coastal Health STOP Outreach Team - Meaghan Thumath, Clinical Practice Initiatives Lead and the STOP Outreach Team BC Centre for Excellence in HIV/AIDS - Benita Yip & William Chau, Analysts and Dr. Kate Heath, Epidemiologist Vancouver Coastal Health Communicable Disease Control - Margot Smythe, Communicable Disease Nurse Educator; Logan Chinski, HIV Communicable Disease Control Nurse & the Communicable Disease Control Nurses Vancouver Coastal Health STOP HIV/AIDS Project Team - Danielle Papineau, Program Evaluator & Lynn Tran, Health Planner

Table of Contents Table of Abbreviations... 1 Section 1. Population Monitoring Report Overview...2 Population Level Monitoring Indicators....3 Summary Table Results......6 Monitoring Indicators Summary Table.... 8 Section 2: Testing Indicators Graphs, Maps and Tables.....11 Figure 1. Number of POC Tests, Percent Positivity of POC tests..... 14 Table 1. Number of HIV Lab Tests by LHA of Testing Clinic 15 Map 1. Mean Monthly Rate of HIV Lab Tests per 10,000 population Historical Period....16 Map 2. Mean Monthly Rate of HIV Lab Tests per 10,000 population STOP HIV/AIDS Period....16 Figure 2. Number of HIV Lab Tests, Percent Positivity among VCH residents......17 Figure 3. Number of HIV Lab Tests, Percent Positivity among Vancouver HSDA residents..18 Figure 4. Proportion of New HIV Positives by Sex and Ratio of Males to Females by Year....19 Table 2. Percent Positivity Among Males by Age Group.... 20 Table 3. Percent Positivity Among Females by Age Group...... 20 Table 4. Monthly Average HIV Testing Numbers, Rate, Positives and Percent Positivity by LHA....21 Table 5. Proportion of HIV Positive Males by Exposure and Year of Diagnosis....22 Table 6. Proportion of HIV Positive Females by Exposure and Year of Diagnosis...22 Figure 5a. Proportion of Diagnoses by CD4 Cell Count and Year of Diagnosis. 23 Figure 5b. Number of Diagnoses by CD4 Cell Count and Year of Diagnosis.... 24 Figure 6. Proportion and Trend of Diagnoses by Disease Stage and Year of Diagnosis 25 Map 3. Mean CD4 Cell Count by LHA Historical Period....26 Map 4. Mean CD4 Cell Count by LHA STOP HIV/AIDS Period...26 Section 3. Public Health Management Indicators Graphs, Maps and Tables... 27 Figure 7. Total Number of Contacts Elicited, Contacts per Case and Contacts Notified.....29 Figure 8. Number of Contacts Notified and Tested, Percent Positivity due to Contact Tracing... 30 Section 4. Treatment Indicators Graphs, Maps and Tables.... 31 Table 7. Proportion of Males Linked to Care by Exposure and Year of Diagnosis 34 Table 8. Proportion of Females Linked to Care by Exposure and Year of Diagnosis.. 34 Table 9. Proportion of Males Engaged in Care by Exposure and Year of Care..35 Table 10. Proportion of Females Engaged in Care by Exposure and Year of Care.... 35 Table 11. Proportion of Males Prescribed ARVs by Exposure and Year of Care....36 Table 12. Proportion of Females Prescribed ARVs by Exposure and Year of Care...36 Figure 9. Mean Community Viral Load, Proportion of HIV Positive Individuals Not Fully Suppressed.37 Table 13. Mean Community Viral Load, Proportion of HIV Positive Individuals Not Fully Suppressed...38 Map 5. Mean Community Viral Load by FSA Historical Period 39

Map 6. Mean Community Viral Load by FSA STOP HIV/AIDS Period..39 Appendix A. Indicator Definitions and Rationale.. 40 Appendix B. Population Monitoring Data Sources 67

Table of Abbreviations AIDS ARVs BC BC CfE CD4 DTES FSA H +/- HIV HSDA LHA ml POC PHSU Q +/- S +/- STOP VCH vl Y +/- Acquired Immune Deficiency Syndrome Antiretroviral Therapy (can also be abbreviated as ART) British Columbia British Columbia Centre for Excellence Cluster of Differentiation 4, is a marker to identify a type of human T helper cell Downtown Eastside Forward Sortation Area (corresponds to the first 3 digits of Postal Code) An increase or decrease in a particular indicator for current time period compared to the historical time period (2008-2009) Human Immunodeficiency Virus Health Service Delivery Area Local Health Area Milliliter Point of Care HIV Test Public Health Surveillance Unit An increase or decrease in a particular indicator for current time period compared to previous quarters An increase or decrease in a particular indicator for current time period compared to STOP period HIV/AIDS Seek and Treat for Optimal Prevention of HIV/AIDS Vancouver Coastal Health (Authority) Viral Load An increase or decrease, for a particular indicator, in current year-to-date values compared to the previous year-to-date 1

Section 1. Population Monitoring Report Overview 2

SUMMARY Population Level Monitoring Indicators Quarter 2, 2012 (April 1 to June 30) Introduction The Seek and Treat for Optimal Prevention (STOP) of HIV/AIDS Project is a 3 year pilot (Feb 2010 Mar 2013) funded by the Ministry of Health Services to expand HIV testing, treatment and support with the goal of reducing HIV transmission in British Columbia. Funding was provided to: Vancouver Coastal Health (VCH), Providence Health Care (PHC), Northern Health (NH), the Provincial Health Services Authority (PHSA), and BC Centre for Excellence in HIV/AIDS (BCCfE). The Provincial project goals are to: 1. Reduce the number of new HIV/AIDS diagnoses in Vancouver (in the long term) 2. Reduce the impact of HIV/AIDS through effective screening and early detection 3. Ensure timely access to high quality and safe HIV/AIDS care and treatment 4. Improve the patient experience in every step of the HIV/AIDS journey 5. Demonstrate system and cost optimization. Provincial level monitoring and evaluation is being conducted by BC CfE using provincial testing data from BC Centre for Disease Control (BCCDC) and provincial treatment data from the provincial drug treatment program at the BCCfE. Quarterly population level indicator reports are produced by the BCCDC and BCCfE for monitoring and evaluation purposes. The STOP Vancouver HIV/AIDS Project Quarterly Monitoring Report was developed to enable VCH and PHC (Vancouver STOP partners) to report on overall changes in the project s targeted activities and results at a population level within Vancouver HSDA and across VCH. This report will provide data to support informed decision making regarding: project implementation resource allocation post-project sustainability planning Further, the report will be used to inform internal and external stakeholder groups about the Vancouver STOP project s impacts. VCH Quarterly Monitoring Report Overview The VCH STOP Evaluation Task Group approved a complete set of monitoring indicators in April 2011, to be monitored over the course of STOP until March-2013. In general these indicators report data from across the HIV patient journey, but more specifically they evaluate important components of the core testing, public health management and treatment objectives of the STOP HIV/AIDS pilot project. A rationale and definition of each indicator is provided in Appendix A. The VCH Monitoring Report presents both a summary table and a series of associated figures, maps and tables. Unless otherwise indicated, the data within this report is for Vancouver HSDA. 3

Summary Table The summary table reports on all* approved monitoring indicators, organized by testing, public health management and treatment phase of the patient journey. This table presents data from the current quarter for each indicator, and compares to data from previous quarters, the entire STOP HIV/AIDS pilot project period (July 1, 2010 to current), and to a historical baseline period (January 1, 2008 December 31, 2009). Also reported in this table: Counts (or proportions) for the current year (2012) to date Counts (or proportions) for the previous year (2011) to the end of the same quarter in that year Significant differences compared to previous quarters (Q+/-), the STOP HIV/AIDS period (S+/-), historical baseline period (H+/-), and year-to-date (Y+/-) were noted in the far right column. Where possible, statistically significant differences (p<0.05) were determined; however for some indicators significant differences were determined to be values with an increase or decrease of 10%. *In some cases, where the counts for a particular indicator were very small or the indicator was no longer considered useful, these indicators were dropped from the summary table. Those indicators dropped are noted in the subtext below the summary table. Additional Figures, Maps and Tables Graphs, maps and tables, were prepared to examine the data across different sociodemographic and clinical stratifications. Such graphs are not prepared for every indicator, but rather for a selection with important trends during the current quarter. Data Sources The data sources collected and compiled for this report, are described in Appendix B. Individual HIV public health surveillance records were linked using deterministic methods to the BC Centre for Excellence in HIV/AIDS clinical monitoring and drug treatment program data, creating a unique longitudinal dataset of the HIV continuum within Vancouver. Of all known HIV positive diagnoses reported in Vancouver since May 2003, 70% were linked to clinical monitoring and drug treatment records. The remaining 30% are diagnoses who participated in non-nominal testing and are therefore unable to be linked, but may yet be engaged in care. Those individuals from the BC CfE database who did not link to HIV surveillance records were primarily (88%) diagnosed before May 2003, the remaining 12% are likely the population of non-nominal testers. Comparative analyses of unlinked individuals to the linked population verify that the linked dataset is representative of the greater population of all known HIV positive individuals across VCH on a number of sociodemographic, clinical and epidemiological characteristics. For more detailed information please refer to the Q1 2012 report. Cautions/Interpretations The data sources used for this report are of a dynamic nature, and subject to changes on a frequent basis. The results reported herein are current as of July 15, 2012. A number of indicators are susceptible to the longitudinal dynamic nature of the data used for this report, and their values reported for the current time period are expected to change in the next reporting period. For this reason, significant differences should be interpreted with this in mind. Therefore, always refer to the most recent report. Through individual-level data linkage this report is able to describe select measures at the populationlevel for a specific dataset of linked individuals with nearly complete information. Extrapolation of 4

these results to the entire population receiving treatment within VCH, should take this into consideration. For this reason, absolute numbers in particular should be interpreted with caution. Updates from Previous Reports The Monitoring Report was presented to the VCH STOP HIV/AIDS Core Team, and the results have been used to inform strategic decision making and resource allocation. The following outlines actions, decisions, or further analyses that have come from the contents of these reports. Q1 2012 There are no updates to report. 5

Summary Table Results Quarter 2, 2012 (April 1 June 30, 2011) Testing Indicators The number of POC tests from sites engaged in STOP HIV/AIDS activities has decreased compared to Q1 2012 and Q4 2011. Compared to the same period of 2011, POC test volumes are 20% higher in 2012 [VCH1]. The number of new HIV positive POC tests has not noticeably changed compared to previous quarters or historical period [VCH4a], though year-to-date numbers have increased 28% [VCH4a]. Overall HIV lab testing volumes from VCH residents, or those who tested in VCH, continue to increase over the course of the STOP HIV/AIDS pilot project. In Q2 2012, volumes have increased more than 20% compared to average testing numbers over STOP, and almost 50% higher than average volumes reported between 2008-2009 [VCH8a]. Compared to 2011, the first two quarters of 2012 saw 13,377 more HIV tests. HIV lab test volumes from clinics in VCH and Vancouver HSDA has increased compared to the average volume since STOP and also in comparison to historical volumes [VCH8b, VCH8c]. Year to date testing numbers in Vancouver HSDA clinics increased by 11,810 HIV tests in the first two quarters of 2012 alone, compared to 2011. HIV lab tests from VCH residents [VCH11a] also remains higher than volumes observed over the STOP period (21%) and historical baseline, 2008-2009 (50%). The number of HIV lab tests from residents of Vancouver HSDA increased this quarter compared to the average since STOP (22%) and compared to historical (47%) [VCH11b]. Similarly the number of HIV lab tests from residents of Richmond and Coastal Garibaldi HSDAs has also increased this quarter compared to volumes over the course of STOP HIV/AIDS, historical period and year-to-date [VCH11C]. This quarter, the number of new HIV positive cases from VCH has dropped in comparison to previous quarters, the quarterly average since STOP and the historical baseline period [VCH13a]. Year-to-date cases in 2012 are slightly lower than that observed over the same period of 2011. New HIV positive cases among Vancouver HSDA residents has decreased compared to all time periods [VCH13b]. However new diagnoses from Richmond and Coastal HSDAs increased in Q2 2012 in comparison to most previous quarters, as well as the STOP average, historical period and year-to-date counts [VCH13c]. Percent positivity of HIV dropped by 33% for VCH residents [VCH14a] compared to the average since STOP and 49% compared to historical values. This change may be attributed to the broader testing strategy that is generating greater number of HIV tests in low risk settings and the sustained increase in testing volumes. The proportion of new positives diagnosed with early stage HIV [VCH45a] was slightly lower than previous quarters but not noticeably different compared to other periods. The proportion of new positives diagnosed with late stage HIV [VCH45b] was slightly higher than previous quarters, and slightly higher than the STOP period and historical counts, however this change is not significant. It should be noted that data for these indicators was based on available CD4 data for only 50% of new cases diagnosed in the current quarter and these numbers are expected to be refreshed with updated data linkage. Public Health Management Indicators These indicators were established to measure public health management activities augmented for STOP HIV/AIDS. Data are collected by public health practitioners using a contact tracing form developed for this purpose. As a result, baseline data prior to STOP HIV/AIDS are not of reliable quality. The number of contacts elicited this quarter was between 16-68% lower than previous quarters. It was also lower than the average since STOP HIV/AIDS and year to date values. The number of 6

contacts elicited per positive case has also decreased compared to the STOP period and year to date [VCH17a]. The proportion of contacts notified this quarter was 72%, which is higher than previous quarters, the average over the STOP project and compared to year to date [VCH19]. This quarter also saw an increase in the proportion of contacts tested for HIV compared to almost all previous quarters, with a significant increase compared to year to date rates [VCH23a]. The number of new HIV positives found through public health follow-up decreased compared to previous quarters, however there was no significant difference compared to average number of positives found since STOP [VCH23b]. While lower this quarter compared to Q1 2012, percent positivity due to contact tracing efforts was not significantly different compared to all time periods [VCH23c]. Treatment Indicators The proportion of new diagnoses linked to care within 30 days of treatment was not significantly different compared to previous quarters, although these data are subject to lag times in complete data capture [VCH41]. Time to linkage to HIV care was significantly lower this quarter compared to all time periods, with year to date times lower by 43% [VCH44b]. The proportion of patients not found in care did not change significantly compared to previous quarters, since STOP or compared to historical baseline period. The same trend is also true when this measure is examined among individuals in the dataset who had sufficient identifying information to link them to care records available through BC CfE data [VCH47a, VCH47b]. Compared to the STOP period, the historical period and year to date, the proportion of patients currently prescribed ARVs has significantly increased, it was 48% higher than the historical quarterly average [VCH48]. Conversely, the proportion of patients who have discontinued and not restarted ARVs significantly decreased compared to previous quarters, the STOP time period, and compared to historical baseline [VCH49]. The proportion of individuals on ARVs who achieve viral suppression significantly decreased compared to all time periods, with the current quarter rates between 12% -23% lower than previous quarters. However the value of this indicator is likely to change due to lag in data reporting [VCH52]. The mean community viral load of all known HIV positive individuals (as identified through public health HIV testing records), significantly decreased compared to the quarterly average since STOP (22%) and historical baseline (76%). Notably, the year to date mean community viral load for the first two quarters of 2012 was also substantially lower than that observed over the first two quarters of 2011 [VCH53]. Compared to quarterly average since STOP and over the historical period, the proportion of individuals with a viral load greater than 1000 copies/ml (not suppressed) significantly decreased [VCH54]. 7

STOP HIV/AIDS Monitoring Indicators Quarterly Summary Report Quarter 2 2012 (April 1 - Jun 30, 2012) Indicator Number Indicator Name Current Quarter Counts by Quarter Jan-Mar 2012 Oct-Dec 2011 Jul-Sep 2011 STOP HIV/AIDS (July 1, 2010 to date) 2-year Historical Baseline (Jan 1, 2008 to Dec 31, 2009) Avg Min Max Avg Min Max Year to Date Cases Year 2012 Year 2011 Significance VCH1 Number of POC tests 1219 1398 1803 5443 2008 949 5443 N/A N/A N/A 2617 2183 Q-S-Y+ VCH4a Number of new true positive POC tests 15 17 12 35 17 8 35 N/A N/A N/A 32 25 Y+ VCH4b VCH8a VCH8b Number of previous positives identified by POC tests Overall number of HIV lab tests (either from VCH residents or those who tested at a VCH clinic) Number of HIV lab tests from all clinics in VCH 0 1 0 19 5 0 19 N/A N/A N/A 1 9 S-Y- 26427 26560 22877 21094 21916 19086 26560 18309 17539 19366 52987 39610 S+H+Y+ 25244 25400 21706 20234 20903 18223 25400 17074 16168 18061 50644 37766 S+H+Y+ Testing Indicators VCH8c VCH11a VCH11b* VCH11c VCH11d VCH13a VCH13b* VCH13c Number of HIV lab tests from all Vancouver HSDA clinics Number of HIV lab tests from residents of VCH (only those with known VCH residence) Number of HIV lab tests from residents of Vancouver HSDA Number of HIV lab tests from residents of Richmond and Coastal HSDAs Number of HIV lab tests from nonresidents of VCH, who tested in VCH Number of positive HIV diagnoses for VCH residents Number of positive HIV diagnoses for Vancouver HSDA Residents Number of positive HIV diagnoses for Richmond and Coastal HSDAs 21249 21126 17880 16661 17161.38 14669 21249 13702 12927 14556 42375 30565 S+H+Y+ 16758 16966 15078 13280 13813 11800 16966 11143 10607 11886 33724 24650 S+H+Y+ 16375 16183 14135 12894 13390 11354 16375 11177 10604 11931 32558 23866 S+H+Y+ 4287 4633 4176 3583 3824.625 3363 4633 3182 3045 3324 8920 7051 S+H+Y+ 9624 9630 7845 7822 8112 7119 9630 7165 6762 7566 19254 14971 S+H+Y+ 34 43 40 58 42 31 58 44 36 57 77 79 Q-S-H- 30 42 36 51 38 29 51 41 34 54 72 75 Q-S-H- 4 1 4 7 4 1 7 3 1 6 5 4 Q+S+H+Y+ VCH14a Percent positivity (%) of VCH residents 0.20 0.25 0.27 0.44 0.30 0.20 0.44 0.39 0.32 0.54 0.23 0.32 H-Y- VCH14b* Percent positivity (%) of Vancouver HSDA residents 0.18 0.26 0.25 0.40 0.29 0.18 0.41 0.36 0.30 0.50 0.22 0.31 H-Y- VCH14c Percent positivity (%) of Richmond & Coastal HSDA residents 0.09 0.02 0.10 0.20 0.09 0.02 0.21 0.10 0.03 0.18 0.06 0.06 VCH45a Proportion of HIV patients that have CD4 count > 500 cells/mm3 at diagnosis 36 38 40 40 38 36 41 38 25 54 38 36 (%) VCH45b Proportion of HIV patients that have CD4 count < 200 cells/mm3 at diagnosis 27 24 10 11 21 10 32 23 10 32 25 23 (%) Notes *This includes testers or positives who have a known Vancouver HSDA address and those who test in Vancouver HSDA but do not have an address available. Data used for this report is logitudinal and of a dynamic nature, with many indicators being subject to a lag in time to reporting. Therefore indicator values are likely to change with continual data updating. Interpretation Q +/- represents an increase or decrease for current time period compared to previous quarters S +/- represents an increase or decrease for current time period compared to STOP Period (July 1, 2010 to current) H +/- represents an increase or decrease for current time period compared to historical time period (2008-2009) Y +/- represents an increase or decrease for current year-to-date compared to previous year-to-date STOP HIV/AIDS quarterly average is the average of all quarters since Q3 2010 (start date of July 1 2010), with the quarterly minimum is the minimum count or proportion for all quarters since STOP, and the quarterly maximum is the maximum count or proportion for all quarters since STOP. This also applies to historical baseline quarterly average, min and max determinations for all quarters during the baseline two year period betwen 2008-2009. Indicators Omitted VCH4c. Number of false positive POC tests VCH16. Number of HIV positive diagnoses who were previously positive 8

STOP HIV/AIDS Monitoring Indicators Quarterly Summary Report Quarter 2 2012 (April 1 - Jun 30, 2012) STOP HIV/AIDS 2-year Historical Baseline Counts by Quarter Year to Date Cases (July 1, 2010 to date) (Jan 1, 2008 to Dec 31, 2009) Indicator Number Indicator Name Significance Current Jan-Mar Oct-Dec Jul-Sep Year Year Avg Min Max Avg Min Max Quarter 2012 2011 2011 2012 2011 Public Health Management Indicators VCH17 Number of contacts elicited 72 86 214 222 118 72 222 N/A N/A N/A 158 328 Q-S-Y- VCH17a Average number of contacts elicited per positive case 3 3 5 4 4 3 5 N/A N/A N/A 3 6 S-Y- VCH19 Proportion of contacts notified (%) 72 59 55 57 51 55 72 N/A N/A N/A 65 37 S+Y+ VCH24 VCH23a VCH23b Proportion of contacts who were known to be previously HIV positive (%) Proportion of notified contacts tested for HIV (%) Number of contacts who tested HIV positive 10 29 18 13 17 10 29 N/A N/A N/A 19 19 Q- 70 53 74 28 50 28 74 N/A N/A N/A 63 43 Y+ 2 4 3 5 2 2 5 N/A N/A N/A 6 4 Q-Y+ Percent positivity (%) due to Contact VCH23c 6 21 4 16 9 4 21 N/A N/A N/A 12 10 Tracing Notes Data used for this report is logitudinal and of a dynamic nature, with many indicators being subject to a lag in time to reporting. Therefore indicator values are likely to change with continual data updating. In cases where the values reported previously have changed by more than 10%, the values from the previous report are found in brackets below the most recent update. Interpretation Q +/- represents an increase or decrease for current time period compared to previous quarters S +/- represents an increase or decrease for current time period compared to STOP Period (July 1, 2010 to current) H +/- represents an increase or decrease for current time period compared to historical time period (2008-2009) Y +/- represents an increase or decrease for current year-to-date compared to previous year-to-date STOP HIV/AIDS quarterly average is the average of all quarters since Q3 2010 (start date of July 1 2010), with the quarterly minimum is the minimum count or proportion for all quarters since STOP, and the quarterly maximum is the maximum count or proportion for all quarters since STOP. This also applies to historical baseline quarterly average, min and max determinations for all quarters during the baseline two year period betwen 2008-2009. Indicators Omitted VCH26 - VCH39: Social Networking Public Health Management Indicators 9

STOP HIV/AIDS Monitoring Indicators Quarterly Summary Report Quarter 2 2012 (April 1 - Jun 30, 2012) STOP HIV/AIDS 2-year Historical Baseline Counts by Quarter Year to Date Cases (July 1, 2010 to date) (Jan 1, 2008 to Dec 31, 2009) Indicator Number Indicator Name Significance Current Jan-Mar Oct-Dec Jul-Sep Year Year Avg Min Max Avg Min Max Quarter 2012 2011 2011 2012 2011 VCH41 Proportion of new diagnoses linked to care within 30 days of diagnosis (%) 66 67 67 78 69 61 78 64 50 83 67 67 Treatment Indicators VCH44a VCH44b VCH46 VCH47a VCH47b VCH48 VCH49 Time to linkage to HIV care among those newly diagnosed with HIV (median days) who were linked within 30 days Time to linkage to HIV care among those newly diagnosed with HIV (median days) Proportion of HIV patients that are actively engaged in care (%) Proportion of all HIV patients not found in care (%) Proportion of matched HIV patients not found in care (%) Proportion of patients who are currently prescribed ARVs (%) Proportion of patients who have discontinued and not restarted ARVs (%) 3 6 9 8.5 9 3 13 12 8 13 6 10.5 Q-S-H-Y- 5 9 13 9 11 5 16 15 11 25 8 14 Q-S-H-Y- 75 75 75 75 75 75 76 75 75 76 75 76 26 27 27 26 26 25 27 27 27 28 26 26 16 16 17 16 16 15 17 18 18 19 16 16 65 63 63 61 61 55 65 44 38 50 65 60 S+H+Y+ 8 11 13 15 16 8 25 40 32 49 8 17 Q-S-H-Y- VCH51 VCH52 VCH53 Proportion of individuals newly taking ARVs who are virally suppressed within 9 months of treatment start (%) Proportion of all individuals on ARVs who are currently virally suppressed (%) Mean viral load (copies/ml) of all known HIV positive individuals 82 90 96 100 93 82 100 93 88 97 82 96 Y- 73 83 92 95 90 73 95 91 90 92 73 94 Q-S-H-Y- 100 100 111 132 129 100 188 418 256 759 100 123 S-H-Y- VCH54 Proportion of all individuals with viral load greater than 1000 copy per ml (%) 16 16 17 20 20 16 27 38 31 47 16 19 S-H- Notes The analyses for most treatment indicators are based on n=1694 individuals in a linked dataset of PHSU HIV Surveillance data and BC CfE Drug Treatment Program data. For those indicators that measure linkage to care or engaged in care, the full PHSU HIV Surveillance dataset was used as a denominator, as it is the best representation of all known HIV positive individuals in Vancouver HSDA. This indicator only examines linkage to care among individuals linked from public health surveillance data to the BC CfE clinical monitoring and drug treatment program database, as some individuals who tested non-noiminally or with very little identifying information may be linked to care but are not able to be linked to their medical records. Data used for this report is longitudinal and of a dynamic nature, with many indicators being subject to a lag in time to reporting. Therefore indicator values are likely to change with continual data updating. In cases where the values reported previously have changed by more than 10%, the values from the previous report are found in brackets below the most recent update. Interpretation Q +/- represents an increase or decrease for current time period compared to previous quarters S +/- represents an increase or decrease for current time period compared to STOP Period (July 1, 2010 to current) H +/- represents an increase or decrease for current time period compared to historical time period (2008-2009) Y +/- represents an increase or decrease for current year-to-date compared to previous year-to-date STOP HIV/AIDS quarterly average is the average of all quarters since Q3 2010 (start date of July 1 2010), with the quarterly minimum is the minimum count or proportion for all quarters since STOP, and the quarterly maximum is the maximum count or proportion for all quarters since STOP. This also applies to historical baseline quarterly average, min and max determinations for all quarters during the baseline two year period betwen 2008-2009. Indicators Omitted VCH50a, VCH50b - Proportion of new diagnoses eligible for tx and taking ARVs 10

Section 2. Testing Indicators Figures, Maps and Tables 11

Summary of Results Testing Indicators Figure 1. Number of HIV POC Tests and Percent Positivity of HIV POC Tests [VCH1, VCH4c] The number of POC tests dropped in Q2 2012 compared to recent quarters, while percent positivity remains steady. Table 1. Mean Monthly Rate of HIV Lab Tests for Vancouver HSDA residents per 10,000 population [VCH8c] Significant increases in HIV lab tests were seen across all Vancouver LHAs by clinic address. Clinics in LHA 1 City Centre increased HIV test volumes in the first two quarters of 2012 by 36% compared to the same period of 2011. Notably, South LHA clinics significantly increased test volumes compared to previous quarters by 15-51%. Maps 1,2. Mean Monthly Rate of HIV Lab Tests for Vancouver HSDA residents per 10,000 population [VCH11c] Average monthly HIV testing rates over the period of STOP HIV/AIDS to date noticeably increased for residents of City Centre and DTES LHAs (Map 2) compared to historical testing rates (Map 1). Testing rates from residents of Midtown and Westside LHAs also increased compared to historical rates. As was seen in previous quarters, testing rates among residents of South and Northeast LHAs have not noticeably changed for the time period of consideration. Figure 2. Number of HIV Lab Tests and Percent Positivity from Residents of VCH [VCH11a, 14a] The number of HIV lab tests from residents of VCH has been steadily increasing since the historical period, with Q2 2012 numbers slightly decreasing compared to Q1 2012. Along with this steady increase there continues to be a drop in percent positivity since Q3 2011. Figure 3. Number of HIV Lab Tests and Percent Positivity from Residents of Vancouver HSDA [VCH11b, 14b] The number of HIV lab tests among residents of Vancouver HSDA experienced a noticeable jump in Q1 2012 and this remained steady in Q2 2012. Percent positivity among residents of Vancouver HSDA continued to decline in Q2 2012, with rates dropping steadily since Q3 2011. Figure 4. Proportion of New HIV Positives by Sex and the Ratio of Males to Females by Year of Diagnosis [VCH13] In the first two quarters of 2012 the ratio of male to female diagnoses dropped compared to 2011. Noticeably less males were diagnosed compared to the number of females in 2012 (6 males to 1 female), than 2011 (11 males to 1 female). However, males continue to be the majority (85%) of new diagnoses in Vancouver. Table 2, 3. Percent Positivity among Male and Female Residents of Vancouver HSDA by Age Group [VCH11b, 13b, 14b] Compared to previous quarters, percent positivity increased among males age 20-29 (Table 2), however percent positivity amongst males of all other age groups noticeably decreased. Overall, percent positivity among males dropped by 36% in the first 2 quarters of 2012 compared to the same period of 2011 (Table 2). The highest percent positivity among females was observed among those age 40-49 in Q2 2012 (Table 3). Percent positivity among females overall has slightly decreased in the first 2 quarters 12

of 2012 compared to 2011, and current quarter percent positivity is noticeably lower than historical baseline. Table 4. Monthly Average Number, Rate (per 10,000), Positives and Percent Positivity (%) among Vancouver HSDA Residents by LHA [VCH11b, 13b, 14b] Monthly average HIV lab tests have again increased in City Centre since Q1 2012 (Table 4) and in comparison to historical numbers. Average monthly numbers also increased across all other LHAs compared to Q1 2012 and compared to historical. The rates per 10,000 population in Vancouver LHAs have also increased compared to the historical period, with rates in City Centre 20% higher than historical. New diagnoses continue to be highest in City Centre LHA, as well. Due to increased testing rates, percent positivity in City Centre and DTES LHAs has noticeably decreased compared to historical. Table 5, 6. Proportion of HIV positives among Males and Female Residents of Vancouver HSDA (and those who tested in Vancouver but have no residence information) by Exposure and Year of Diagnosis [VCH13b] Proportionally more new diagnoses were seen among males of MSM exposure in 2010-2012 compared to other exposure groups (Table 5). The proportion of new diagnosis of MSM exposure has been increasing since 2003-2005, while those of IDU exposure continue to decline. The proportion of new male diagnoses with unknown exposure has increased in recent years. The proportion of females with heterosexual exposure increased substantially in 2010-2012 compared to previous years, while females of IDU exposure have been decreasing (Table 6). Figure 5a,b. Proportion and Number of Patients by CD4 Cell Count at Diagnosis [VCH45] The proportion and number of HIV patients diagnosed with late stage disease (CD4 cell count <200 cells/mm 3 ) has been slightly increasing in 2012 compared to the most recent 3 years (Figures 5a). This may be due to the broader HIV testing strategy reaching individuals unaware of their infection who have progressed to late stage disease. In contrast, the proportion of new diagnoses diagnosed earlier in the course of disease has not drastically changed compared to previous years. The number of new diagnoses diagnosed with CD4>=500 cells/mm3 is slightly higher than other groups in 2012 (Figure 5b). Figure 6. Proportion and Trend of Patients by Disease Stage and Year of Diagnosis [VCH45] The trend in stage of disease at diagnosis continues into the first half of 2012, with the proportion of patients diagnosed with late stage disease (<200 cells/mm3) on the decline. The proportion of patients diagnosed early in the course of disease, with healthy CD4 counts (>500 cells/mm3), continues to exhibit an increasing trend. The first two quarters showed a 10% increase in the proportion of new positives diagnosed with late stage disease (<200 cells/mm3). Maps 3,4. Mean CD4 Cell Count (cells/mm 3 ) at diagnosis for all HIV positive individuals [VCH45] Compared to the historical period (Map 3), the mean CD4 cell count at diagnosis for residents of the City Centre did not changed (350-<500 cells/mm3), however mean CD4 at diagnosis improved in DTES, Westside, Midtown and North East LHAs (Map 4). Mean CD4 at diagnosis for residents of South LHA dropped from 500+ cells/mm3 during the historical period to 200-<350 cells/mm3. 13

Figure 1 Number of HIV POC Tests [VCH1] Percent Positivity of HIV POC Tests [VCH4c] 6000 3 5000 2.5 Number of HIV POC Tests 4000 3000 2000 2 1.5 1 Percent Positivity (%) 1000 0.5 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2008 2009 2010 2011 2012 Time 0 Number of POC Tests Percent Positivity STOP HIV/AIDS Pilot Project Activities Start POC test counts include only volumes reported from sites engaged in STOP HIV/AIDS activities. POC positive test counts include only positive tests reported to VCH CDC Department HIV Nurse. Source: HIV Point of Care (POC) Data. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012 14

Table 1. Number of HIV Lab Tests by LHA of Testing Clinic [VCH8c] Vancouver LHA Current Quarter Counts by Quarter STOP HIV/AIDS 2-year Historical Baseline Year to Date Cases Jan-Mar Oct-Dec Oct-Dec Avg Min Max Avg Min Max Year 2012 Year 2011 2012 2011 2011 Significance LHA 1 City Centre LHA 2 DTES LHA 3 North East LHA 4 Westside LHA 5 Midtown 11772 9568 9092 7986 9077 7986 11772 7405 6996 7845 11772 8614 Q+S+H+Y+ 2111 1882 1799 1498 1705 1453 2111 1338 1216 1581 2111 1685 Q+S+H+Y+ 1651 1310 1156 1027 1166 989 1651 1015 858 1179 1651 1028 Q+S+H+Y+ 2066 1927 1886 1601 1795 1601 2066 1446 1351 1552 2066 1830 S+H+Y+ 1670 1475 1427 1410 1447 1278 1670 1336 1202 1410 1670 1513 Q+S+H+Y+ LHA 6 South 1354 1172 1025 898 1065 898 1354 945 887 1027 1354 1006 Q+S+H+Y+ Total* 20624 17413 16385 14420 16266 14420 20624 13485 12784 14278 20624 15676 Q+S+H+Y+ *Total may not equal sum of lha due to missing value. Source: Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 15

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Figure 2 Number of HIV Lab Tests from Known Residents of VCH [VCH11a] Percent positivity of HIV Lab Tests from Known Residents of VCH [VCH14a] 18000 0.80 Number of HIV Lab Tests 16000 14000 12000 10000 8000 6000 4000 2000 0.70 0.60 0.50 0.40 0.30 0.20 0.10 Percent Positivity (%) 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2008 2009 2010 2011 2012 0.00 Time Number of HIV Lab Tests Percent Positivity STOP HIV/AIDS Pilot Project Activities Start Source: Public Health Surveillance Unit (HIV Surveillance Data); Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory Database. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 17

Figure 3 Number of HIV Lab Tests from Known Residents of Vancouver HSDA [VCH11b] Percent positivity of HIV Lab Tests from Known Residents of Vancouver HSDA [VCH14b] 18000 0.80 Number of HIV Lab Tests 16000 14000 12000 10000 8000 6000 4000 2000 0.70 0.60 0.50 0.40 0.30 0.20 0.10 Percent Positivity (%) 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2008 2009 2010 2011 2012 0.00 Time Number of HIV Lab Tests Percent Positivity STOP HIV/AIDS Pilot Project Activities Start Source: Public Health Surveillance Unit (HIV Surveillance Data); Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory Database. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 18

Figure 4 Proportion of New HIV Positives by Sex and Ratio of Males to Females by Year of Diagnosis [VCH13] 100% 15 90% Proportion of New HIV Diagnoses 80% 70% 60% 50% 40% 30% 20% 12 9 6 3 Ratio [X Males: 1 Female] 10% 0% 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Male Female M:F Ratio Year of Diagnosis 0 Source: Public Health Surveillance Unit (HIV Surveillance Data). Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 19

Table 2. Percent Positivity Among Male Residents of known Vancouver HSDA by Age Group [VCH11b, 13b, 14b] Current Quarter Previous Quarters STOP HIV-AIDS Historical Baseline (2008-2009) Year to Date Age % Positivity Jan-Mar 2012 % Positivity Oct-Dec 2011 % Positivity July 2010 - Jun 2012 % Positivity % Positivity 2012 % Positivity 2011 % Positivity 0-9 0 0 0 0 0 0 0 10-19 0 0 0 0.19 0.25 0 0 20-29 0.62 0.49 0.75 0.54 0.82 0.56 0.41 30-39 0.31 0.53 0.50 0.80 1.11 0.42 0.76 40-49 0.28 0.73 1.04 0.85 1.51 0.51 0.99 50-59 0.33 0.61 0.30 0.61 0.90 0.46 0.65 60+ 0.00 0.22 0.40 0.27 0.40 0.10 0 Total* 0.30 0.51 0.61 0.64 1.02 0.41 0.64 *Total may not equal sum of all age groups due to missing data on patient age. Source: Public Health Surveillance Unit (HIV Surveillance Data), Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. Table 3. Percent Positivity Among Female Residents of Vancouver HSDA by Age Group [VCH11b, 13b, 14b] Current Quarter Previous Quarters STOP HIV-AIDS Historical Baseline (2008-2009) Year to Date Age % Positivity Jan-Mar 2012 % Positivity Oct-Dec 2011 % Positivity July 2010 - Jun 2012 % Positivity % Positivity 2012 % Positivity 2011 % Positivity 0-9 0 0 0 0 0 0 0 10-19 0 0 0 0 0.27 0 0 20-29 0.05 0 0.00 0.07 0.07 0.08 0.06 30-39 0.07 0.04 0.04 0.04 0.08 0.05 0 40-49 0.10 0 0 0.11 0.08 0.11 0 50-59 0 0 0 0 0.30 0 0 60+ 0 0 0 0.13 0.13 0 1.28 Total* 0.06 0.06 0.02 0.06 0.09 0.06 0.08 *Total may not equal sum of all age groups due to missing data on patient age. Source: Public Health Surveillance Unit (HIV Surveillance Data), Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 20

Table 4. The Monthly Average Number, Rate (per 10,000), Positives and Percent Positivity (%) among Vancouver HSDA Residents by LHA [VCH11b, 13b, 14b] HIV Lab Tests HIV Lab Tests (per 10,000 population) Positive HIV Lab Tests Percent Positivity LHA STOP HIV/AIDS (July 2010 to date) Monthly Avg Historical (2008-2009) Monthly Avg STOP HIV/AIDS (July 2010 to date) Monthly Avg Historical (2008-2009) Monthly Avg STOP HIV/AIDS (July 2010 to date) Monthly Avg Historical (2008-2009) Monthly Avg STOP HIV/AIDS (July 2010 to date) Monthly Avg Historical (2008-2009) Monthly Avg LHA 1 City Centre LHA 2 DTES LHA 3 North East LHA 4 Westside LHA 5 Midtown LHA 6 South 776 635 65 54 3 4 0.4 0.7 451 326 65 52 1 2 0.3 0.6 380 309 36 30 1 1 0.2 0.2 568 416 41 31 1 0 0.1 0.1 429 334 47 39 1 1 0.2 0.2 446 340 33 26 1 1 0.2 0.2 Total* 3050 2360 46 37 10 13 0.3 0.5 *Total may not equal to sum of all LHAs due to missing assignment of LHA coding in original data, on average 2 positives per month are missing LHA information. Source: Public Health Surveillance Unit (HIV Surveillance Data), Provincial Public Health Microbiology and Reference Laboratory (Misys Laboratory Database) & Providence Health Care Virology Laboratory. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 21

Table 5. Proportion of Male HIV Positive Diagnoses among Residents of Vancouver HSDA (and those who tested in Vancouver but have no residence information) by Exposure and Year of Diagnosis [VCH13b] Exposure Year of Diagnosis 2003/2005 2006/2009 2010/2012 MSM 62.6 69 76 MSM/IDU 5.6 4.1 3.3 IDU 17.3 12.4 6.8 Heterosexual 12.7 11.1 10.4 Other* 1.6 2 0.9 Unknown 0.2 1.3 2.7 *Other = blood/blood products, occupational, perinatal and other exposures Table 6. Proportion of Female HIV Positive Diagnoses among Residents of Vancouver HSDA (and those who tested in Vancouver but have no residence information) by Exposure and Year of Diagnosis [VCH13b] Exposure Year of Diagnosis 2003/2005 2006/2009 2010/2012 IDU 61.6 49.5 28.9 Heterosexual 34.9 46.2 64.4 Other* 3.5 3.3 2.2 Unknown 0 1.1 4.4 *Other = blood/blood products, occupational, perinatal and other exposures Source: Public Health Surveillance Unit (HIV Surveillance Data). Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 22

Figure 5a Proportion of Patients by CD4 Cell Count at Diagnosis and Year of Diagnosis [VCH45] 100% Proportion of New HIV Diagnoses 75% 50% 25% 0% 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 CD4 Cell Count (cells/mm3) Year of Diagnosis <200 [200,350) [350,500) 500+ Source: Public Health Surveillance Unit (HIV Surveillance Data) & BC CfE Drug Treatment Program Data. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 23

Figure 5b Number of Patients by CD4 Cell Count at Diagnosis and Year of Diagnosis [VCH45] 200 180 160 Number of New HIV Diagnoses 140 120 100 80 60 40 20 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 CD4 Cell Count (cells/mm3) <200 [200,350) [350,500) 500+ Year of Diagnosis Source: Public Health Surveillance Unit (HIV Surveillance Data) & BC CfE Drug Treatment Program Data. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 24

Figure 6. Proportion of Patients by CD4 Cell Count at Diagnosis and Year of Diagnosis [VCH45] 50 Proportion of New HIV Diagnoses 40 30 20 10 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 CD4 Cell Count (cells/mm3) <200 500+ Linear Trend (<200) Linear Trend (500+) Year of Diagnosis Source: Public Health Surveillance Unit (HIV Surveillance Data) & BC CfE Drug Treatment Program Data. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 25

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Section 3. Public Health Management Indicators Figures, Maps and Tables 27

Summary of Results Public Health Management Indicators Figure 7. Total Number of Contacts Elicited, Number per HIV Case and Notified [VCH17, 17a, 19] Since the start of 2012, there has been a noticeable decline in the total number of contacts elicited from HIV index cases. There has also been a significant decline in the average number of contacts elicited per case (Figure 7). In Q2 2012, the proportion of all contacts that were notified from public health follow-up was slightly higher than observed in previous quarters. The number of previous positive contacts identified and notified dropped in Q2 2012 compared to previous time periods. Figure 8. Number of contacts notified and tested for HIV and Percent Positivity due to Contact Tracing [VCH23a, 23c] The total number of contacts that were tested for HIV as a result of public health follow-up increased in Q2 2012 compared to Q1 2012. However, percent positivity dropped compared to Q1 2012 (Figure 8). 28

Figure 7 Total Number of Contacts Elicited [VCH17] Number of Contacts Elicited per Case [VCH17a] Number of Contacts Notified [VCH19] 240 8 Number of Contacts 180 120 60 * Reliable data not available pre-stop HIV/AIDS 6 4 2 Number of Contacts per Positive Case 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 0 2008 2009 2010 2011 2012 Number of Contacts Elicited and Notified Time Number of Contacts Elicited and Not Notified Number of Previous Positive Contacts Elicited and Notified Number of Previous Positive Contacts Elicited but Not Notified Contacts per Positive Case STOP HIV/AIDS Pilot Project Activities Start Source: Enhanced HIV Contact Tracing Form Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 29

Figure 8 Number of contacts notified and tested for HIV [VCH23a] Percent Positivity due to Contact Tracing [VCH23c] 120 30 100 25 Number of Contacts 80 60 40 20 15 10 Percent Positivity (%) 20 5 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 2008 2009 2010 2011 2012 0 Number of Contacts Notified and Tested Number of Contacts Notified but Not Tested Percent Positivity Time STOP HIV/AIDS Pilot Project Activities Start Source: Enhanced HIV Contact Tracing Form Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. August 27, 2012. 30

Section 4. Treatment Indicators Figures, Maps and Tables 31

Summary of Results Treatment Indicators Table 7,8. Proportion of Male and Female Patients Linked to Care within 30 days by Exposure and Year of Diagnosis [VCH41] The proportion of males of heterosexual exposure linked to care within 30 days of diagnosis substantially increased in 2010-2012 compared to previous years and compared to other exposure groups (Table 7). Again this quarter, time to linkage to care was longest among MSM/IDU males, although median days improved in this group compared to previous years. The proportion of females of IDU exposure linked to care within 30 days increased in 2010-2012 compared to previous years (Table 8). The time to linkage to care was noticeably shorter among the IDU exposure group compared to heterosexual exposure. Table 9,10. Proportion of Male and Female Patients Engaged in Care by Exposure and Year of Care [VCH46] Proportionally more males of MSM/IDU exposure are engaged in care compared to other risk groups, a 5%-10% increase compared to 2008-2009 rates (Table 9). Males of Other exposure were least likely to be engaged in care compared to other exposure groups. To date in 2012 females of heterosexual and other exposure were more likely to be engaged in care than other exposure groups. However, compared to 2008 and 2009, proportionally more females of IDU exposure were engaged in care in 2012 (Table 10). Overall, there is a trend in an increasing proportion of females engaged in care since 2003. Table 11,12. Proportion of Male and Female Patients Prescribed ARVs by Exposure and Year of Care [VCH48] Compared to 2008 and 2009, the proportion of males of all exposure groups who were prescribed ARVs had increased in 2012. Among these exposure groups, males of MSM/IDU and heterosexual exposures had the greatest proportion of individuals prescribed ARVs in 2012, which has been the trend since 2009 (Table 11). As well for females, the proportion of all exposure groups who were prescribed ARVs had increased in 2012 compared to 2008 and 2009 (Table 12). Figure 9. Mean Community Viral Load (copies/ml) and Proportion of HIV positive Individuals not Fully Suppressed or Monitored [VCH53] From 2008 to current the mean community viral load (copies/ml) has been steadily on the decline (Figure 9). This trend is similarly observed in the proportion of those with unsuppressed viral loads. The mean community viral load appears to be below detectable levels (<200 copies/ml) since the initiation of STOP HIV/AIDS, and the proportion of individuals not fully suppressed has dropped from 25% in 2011, to 15% in the first quarter of 2012. Table 13. Mean Community Viral Load and Proportion of HIV Positive Individuals Not Fully Suppressed by those on ARVs and Not on ARVs [VCH53, 54] Similar to Figure 9, this table shows a steady decline in mean community viral load (copies/ml) since 2008. This corresponds with a steady increase in the proportion of HIV positive individuals with a prescription for antiretroviral therapy, and a decrease in the proportion not on ARVs. The inverse relationship was observed for indicator VCH54, with both the proportion and absolute number of virally unsuppressed individuals decreasing over time. 32