Ending the Epidemic and Older Adults:
Case Counts and Care Data
December 9, 2015
Daniel Gordon, PhD
Bureau of HIV/AIDS Epidemiology
AIDS Institute
NYSDOH
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Today’s Presentation
• Newly Diagnosed Cases
• Persons Living with Diagnosed HIV Infection
(PLWDHI)
• Population Projection (2032)
• Measures of Linkage and Retention
• Observations
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New diagnoses
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Newly Diagnosed HIV Cases
New York State, 2002-2013*
Annual Newly Diagnosed Cases
7,000
6,070
6,000
5,000
4,000
3,512
3,000
42% drop in new HIV
diagnoses 2002-2013
2,000
1,000
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year of Diagnosis
*Data as of April 2015
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Newly Diagnosed HIV Cases
by Age at Diagnosis and Year of Diagnosis
New York State, 2002-2013*
32% drop in new HIV diagnoses
age 50+ 2002-2013.
Age 50+ has accounted for
15-18% of new diagnoses over
the last decade.
Number of Cases
2,000
1,500
30-39
40-49
25-29
20-24
50-59
60+
13-19
12 & under
1,000
500
0
2002
*Data as of April 2015
2004
2006
2008
2010
2012
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Age Distribution of Newly Diagnosed HIV* Cases
New York State, 2013**
1200
3,512 Total; 2,007 Male, 537 Female
Number of Cases
1000
Among new cases
age 50+, about a
third are women
800
600
Male
400
Female
200
0
<13
13-19
20-29
30-39
40-49
Age at Diagnosis
*Regardless of subsequent or concurrent AIDS diagnosis
**Data as of September 2015
50-59
60+
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Newly Diagnosed HIV Cases,
by Age and Race/Ethnicity,
New York State, 2013
N=2,818
N=391
N=201
40%
30%
White
Black
20%
Hispanic
All Others*
10%
0%
<50
50-59
Age at Diagnosis
60+
*Includes Asians, Pacific Islanders, Native Americans, Alaskan Natives and Multi-Race
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Percent Concurrent HIV/AIDS Diagnoses by Age Group
New York State, 2013
A large proportion of
persons diagnosed at
later ages have longstanding infections
As Percent of All HIV Diagnoses
50%
40%
30%
20%
10%
0%
<50
Concurrent HIV & AIDS Dx
50-59
60+
Other Late (AIDS within 12 mos.)
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Persons Living with Diagnosed
HIV Infection
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Persons Living with Diagnosed HIV Infection Residing in NYS†, December 2013*
by Age
16,000
14,000
N=113,049
Average age=47.3 yrs
46% of PLWDHI
are age 50+
12,000
10,000
Male
8,000
Female
6,000
4,000
2,000
0
0-12 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 65-69 70+
Age (years) in 2013
† Based on most recent address, regardless of where diagnosed. Excludes
persons with AIDS with no evidence of care for ≥5 years and persons with
diagnosed HIV (non-AIDS) with no evidence of care for ≥8 years.
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PLWDHI by Age Group and Race/Ethnicity,
New York State, 2013
N=60,647
N35,428
N=16,974
40%
30%
White
Black
20%
Hispanic
All Others*
10%
0%
<50
50-59
60+
*Includes Asians, Pacific Islanders, Native Americans, Alaskan Natives and Multi-Race
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HIV Incidence Estimates
NYS, 2013
NYSDOH uses a method developed by the
Centers for Disease Control, NYSDOH estimated
that in 2013 there were about 2,800 new HIV
infections in New York State.
Persons age 45 and over account for 22% of
estimated new infections in 2013
Age
group
13-14
25-34
35-44
45-54
55+
Total
Estimated
Incidence, 2013*
643
937
589
388
239
2,796
* Estimate of 12/2014 based on data as
of 10/2014
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Projection – PLWDH age 50+
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Population Projections
A population simulation model developed by the AIDS
Institute Bureau of HIV/AIDS Epidemiology projected that
if recent HIV diagnosis and death rates are maintained,
then between 2013 and 2032:
The number of PLWDHI age > 50 will rise by about 47%
age > 65 will rise by 360%
PLWDHI > 50 will rise from 47% to 59% of total PLWDHI
65+ will rise from 7% to 28% of total PLWDHI
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Measures of Care
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Measures of HIV Care by Age Group
New York State, 2013*
National HIV/AIDS Strategy (2010) Target
National HIV/AIDS Strategy (2015) Targets
80%
80%
60%
60%
40%
40%
20%
20%
0%
0%
<50
50-59
60+
Entry to Care within
3 Months of Diagnosis
*Data as of February, 2015
<50 50-59 60+
Continuity of Care (≥2 tests
in 2013, ≥3 months apart)
<50 50-59 60+
Viral Suppression at
Last Test in the Year
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Summary &
Discussion
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Observations/Discussion (1)
•Persons age 50+ accounted for 18% of the 3,500 new diagnoses in
NYS in 2013, and a roughly similar proportion of the estimated 2,800
new infections.
•Prevention services must be directed to older persons as well as
younger ones
•The high proportion (1/3) of concurrent HIV/AIDS diagnoses
indicate missed opportunities for diagnosis and need for outreach
• Currently, nearly half the 113,000 persons living with diagnosed HIV
infection in New York State are age 50+
•Over the coming 20 years this group will increase substantially
both in number and as proportion of total PLWDHI
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Observations/Discussion (2)
•Entry to care after diagnosis is similar across age groups
•The 2010 NHAS goal (85% within 3 months) is almost met, but
the 2015 NHAS goal (85% within 1 month) has not yet been met
• Continuity of care and viral suppression among those age 50+ are
higher than among younger ages, but the 2015 NHAS goals have not
yet been met.
•HIV in persons age 50+ presents a distinct challenge in terms of
• prevention,
•diagnosis outreach and
• coordination of HIV-specific care with the normal increasing care
needs of older persons in general
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Contact Information:
Bureau of HIV/AIDS Epidemiology
AIDS Institute
New York State Department of Health
Phone (518) 474-4284
Email [email protected]