Analysis of Newly Diagnosed HIV Trends in Virginia, 2013-2018

This report analyzes the trends in newly diagnosed HIV cases among Ryan White clients in Virginia from 2013 to 2018. The data shows changes in incidence rates, gender distribution, racial/ethnic demographics, transmission risks, and regional distribution. The report includes insights into the shifting landscape of HIV diagnosis and highlights the need for tailored interventions to address different affected populations.

• HIV
• Virginia
• Trends
• Ryan White
• Diagnosis

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1. Ryan White Cross Parts: Six Year Trends Carrie Walker, MPH HIV Care Services Analyst Virginia Department of Health November 7, 2019 QMAC Meeting 1

2. RYAN WHITE INCIDENCE TRENDS, 2013-2018 2

3. Newly Diagnosed HIV Disease Cases: 2013-2018 1200 All Virginia RW Clients 982 975 1000 932 918 886 883 800 600 400 446 413 200 394 376 358 339 0 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 3

4. Newly Diagnosed HIV Cases by Gender, 2013-2018 Male RW Male Female RW Female 100% 17% 18% 18% 18% 19% 19% 19% 90% 21% 22% 22% 24% 24% 80% 70% 60% 50% 83% 82% 82% 82% 81% 81% 81% 40% 79% 78% 78% 76% 76% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 4

5. Newly Diagnosed RW Clients by Race/Ethnicity, 2013-2018 Black White Hispanic 350 296 300 260 248 243 250 212 196 200 140 150 134 131 129 127 106 100 64 60 48 46 39 35 50 0 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 5

6. Newly Diagnosed RW Clients by Transmission Risk, 2013 vs 2018 2013 N=355* 2018 N=355* MSM & IDU 1% IDU 2% IDU 2% MSM & IDU 1% Other 3% Other 1% MSM 58% Heterosexual 38% Heterosexual 36% MSM 58% Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. MSM= Men who have sex with men; IDU= Injection drug use; Other= Perinatal and blood product exposure. *Denominator (N) only includes those that did report or identify a risk for transmission. NIR 2013=3; NIR 2018=39 6

7. Newly Diagnosed RW Clients by Region, 2013-2018 100% 8% Southwest 9% 11% 13% 15% 17% 10% 11% Northern 13% 80% 13% 11% 13% Northwest 17% 23% 22% Central 24% 25% 18% 60% Eastern 32% 24% 16% 40% 18% 25% 29% 20% 39% 35% 31% 31% 27% 21% 0% 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. Region is based on Provider location. 7

8. RYAN WHITE PREVALENCE TRENDS, 2013 - 2018 8

9. People living with HIV in Virginia: 2013-2018 30,000 PLWH RW Clients 24,865 24,288 25,000 23,655 23,062 22,375 21,775 20,000 15,000 10,000 5,000 9,353 9,103 9,023 8,853 7,637 7,144 0 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 9

10. RW Clients Living with HIV by Gender, 2013-2018 Male Female Transgender 1% 1% 1% 2% 2% 2% 100% 90% 31% 31% 31% 31% 32% 31% 80% 70% 60% 50% 40% 68% 68% 68% 68% 67% 67% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 10

11. RW Clients Living with HIV by Race/Ethnicity, 2013-2018 Black White Hispanic/Latino 7000 6128 5967 5745 6000 5586 5000 4662 4278 4000 2972 2943 2915 2822 3000 2689 2583 2000 961 889 850 794 719 1000 702 0 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 11

12. RW Clients Living with HIV by Transmission Risk, 2013 vs 2018 2013 N=6,999* 2018 N=8,597* Other 3% Other 4% MSM & IDU 1% MSM & IDU 1% IDU 5% IDU 6% MSM 46% Heterosexual 45% Heterosexual 45% MSM 43% Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. MSM= Men who have sex with men; IDU= Injection drug use; Other= Perinatal and blood product exposure. *Denominator (N) only includes those that did report or identify a risk for transmission. NIR 2013=145; NIR 2018=256 12

13. RW Clients Living with HIV by Age, 2013 - 2018 100% 55+ 20% 22% 45-54 24% 26% 29% 31% 80% 25-44 18-24 60% 33% 32% 31% 29% 28% 27% 40% 19% 20% 20% 19% 20% 19% 19% 7% 6% 6% 5% 4% 4% 0% 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. Age is as-of December 31 of the specific year. 13

14. RW Clients Living with HIV by FPL, 2013 - 2018 100% 2% 1% 2% 1% 2% 1% 2% 1% 2% 2% Over 500% FPL 2% 2% 6% 6% 6% 6% 6% 7% 401 thru 500% FPL 12% 12% 12% 12% 13% 13% 80% 301 to 400% FPL 14% 15% 15% 15% 15% 15% 201 to 300% FPL 60% 13% 13% 14% 15% 139 to 200% FPL 15% 15% 40% 51% 51% 50% 49% 47% 47% 20% 0% 2013 2014 2015 2016 2017 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 14

15. RW Clients Living with HIV by Housing Status, 2013 - 2018 100% Unstable Temporary Stable/Permanent 1.6% 1.7% 1.8% 1.8% 99% 2.0% 2.1% 98% 1.7% 1.9% 1.8% 2.1% 97% 2.3% 2.4% 96% 95% 96.7% 96.4% 96.4% 96.1% 95.7% 95.4% 94% 93% 2013 2014 2015 2016 2016 2018 *Data for 2018 is preliminary and may be subject to change due to reporting delays; Data are as of December 31, 2018; accessed October 2019. 15

16. RYAN WHITE HIV CARE CONTINUUM, 2018 16

17. Base Definitions 17

18. National HIV/AIDS Strategy Goals for the HIV Continuum of Care HIV Continuum of Care Measure 2020 Goal Linkage to HIV care within 30 days Retention in care 85% 90% Viral suppression 80% 18

19. HIV Continuum of Care in Virginia, 2018 RW Clients (n=8,853) All Virginia (n=24,865) 100% 99% 100% 100% 92% N=394 85% 90% N=883 80% 75% 80% 68% 70% 56% 60% 54% 50% 40% 30% 20% 10% 0% People diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 19

20. Ryan White HIV Continuum of Care by Gender, 2018 Male Female Transgender 100% 100% 100% 99% 100% 100% 93% 91% 91% 89% 87% 90% 81% 81% 82% 80% 67% 70% 60% 53% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 20

21. Ryan White HIV Continuum of Care by Race/Ethnicity, 2018 Black White Hispanic 100% 100% 100% 99% 99% 99% 100% 94% 93% 92% 92% 88% 90% 83% 83% 83% 79% 80% 70% 60% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 21

22. Ryan White HIV Continuum of Care by Risk, 2018 MSM IDU Other Heterosexual MSM & IDU 100% 100% 100% 100% 100% 100% 100% 100% 99% 100% 99% 98% 100% 93% 93% 92% 92% 87% 90% 85% 85% 85% 82% 81% 81% 80% 69% 70% 67% 60% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. MSM=Men who have sex with men; IDU=Injection Drug Use; Other=Perinatal and blood product exposure 22

23. Ryan White HIV Continuum of Care by Age, 2018 18-24 years 25-44 years 45-54 years 55 + years 100% 100% 100% 100% 99% 99% 99% 99% 100% 94% 94% 93% 90% 86% 90% 86% 84% 83% 85% 82% 75% 80% 68% 70% 60% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Age is calculated as-of December 31 of the specific year. 23

24. Ryan White HIV Continuum of Care by Region, 2018 Northwest Northern Southwest Central Eastern 100% 100% 100% 100% 100% 99% 99% 99% 99% 99% 100% 95% 94% 93% 91% 89% 90% 87% 90% 85% 84% 82% 82% 80% 79% 79% 79% 80% 70% 60% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Region is determined by provider location. 24

25. Ryan White HIV Continuum of Care by Housing Status, 2018 Stable/Permanent Temporary Unstable 100% 100% 100% 100% 99% 99% 100% 93% 90% 86% 90% 85% 81% 82% 80% 68% 67% 67% 70% 60% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker in 2018 Retained in care in 2018 Virally suppressed in 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 25

26. RYAN WHITE HIV CARE CONTINUUM: BY MEASURE, 2013-2018 26

27. Overall Ryan White HIV Continuum of Care, 2013 - 2018 2013 2014 2015 2016 2017 2018 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 100% 92% 91% 91% 91% 90% 88% 86% 90% 85% 87% 85% 84% 81% 80% 76% 80% 75% 70% 57% 60% 48% 46% 50% 40% 30% 20% 10% 0% RW Clients diagnosed and living with HIV Newly diagnosed with HIV and linked to care within 30 days Evidence of a care marker Retained in care Virally suppressed Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 27

28. Linkage to HIV Care within 30 days Those newly diagnosed with HIV who had a care marker within 30 days of diagnosis date All those newly diagnosed with HIV Ineligible: Those not newly diagnosed in the specific timeframe 28

29. Linkage to Care for Ryan White Clients, by Gender, 2013-2018 Male Female Transgender 100% 100% 100% 100% 100% 92% 87% 87% 89% 87% 90% 86% 85% 85% 83% 83% 84% 82% 81% 80% 67% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 29

30. Linkage to Care for Ryan White Clients, by Race/Ethnicity, 2013-2018 Black White Hispanic/Latino Asian 100% 95% 93% 92% 91% 89% 88% 88% 88% 87% 88% 90% 86% 85% 84% 84% 83% 83% 83% 80% 81% 77% 77% 80% 71% 70% 70% 60% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 30

31. Linkage to Care for Ryan White Clients, By Risk, 2013-2018 MSM IDU Heterosexual Contact 100% 100% 94% 89% 88% 87% 87% 90% 85% 85% 85% 83% 83% 83% 82% 80% 78% 80% 67% 70% 60% 57% 50% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. MSM= Men who have sex with men; IDU=Injection Drug Use 31

32. Linkage to Care for Ryan White Clients, by Region, 2013-2018 Northwest Northern Southwest Central Eastern 100% 95% 94% 92% 92% 90% 90% 91% 89% 89% 88% 88% 87% 87% 90% 86% 85% 85% 85% 84% 84% 84% 83% 82% 82% 81% 80% 79% 79% 80% 78% 77% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Region is determined by provider location. 32

33. Linkage to Care for Ryan White Clients, By Housing Status, 2013-2018 Stable/Permanent Temporary Unstable 100% 100% 100% 100% 100% 92% 88% 87% 86% 86% 90% 86% 84% 83% 83% 82% 82% 80% 75% 71% 67% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 33

34. Retention in HIV Care Those who received a Ryan White service and had at least two care markers in the respective timeframe that were at least 90 days apart Those who received a Ryan White service and had at least one care marker in the respective timeframe Ineligible: Those without a care marker in the respective timeframe or those newly diagnosed with HIV during the timeframe 34

35. Retention in HIV Care for Ryan White Clients by Gender, 2013-2018 Male Female Transgender 100% 93% 92% 92% 92% 91% 91% 90% 90% 91% 90% 89% 88% 88% 90% 84% 83% 82% 81% 79% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 35

36. Retention in HIV Care for Ryan White Clients by Race/Ethnicity, 2013-2018 Black White Hispanic/Latino Asian 100% 99% 97% 98% 96% 94% 94% 94% 94% 94% 93% 93% 94% 93% 92% 92% 92% 92% 92% 92% 92% 91% 91% 91% 90% 90% 90% 90% 88% 88% 88% 86% 84% 82% 80% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 36

37. Retention in HIV Care for Ryan White Clients by Risk, 2013-2018 MSM IDU Other Heterosexual Contact MSM/IDU 100% 93% 93% 93% 93% 93% 93% 92% 92% 92% 92% 92% 91% 91% 90% 91% 90% 89% 89% 89% 90% 88% 87% 86% 86% 90% 87% 85% 84% 83% 82% 82% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. MSM= Men who have sex with men; IDU=Injection Drug Use; Other= Perinatal and Blood Product Exposures. 37

38. Retention in HIV Care for Ryan White Clients by Region, 2013-2018 Northwest Northern Southwest Central Eastern 100% 95% 95% 94% 94% 94% 95% 94% 94% 94% 94% 93% 93% 93% 93% 93% 92% 92% 92% 92% 91% 90% 89% 89% 90% 88% 88% 86% 86% 86% 85% 84% 84% 85% 80% 75% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Region is determined by provider location. 38

39. Retention in HIV Care for Ryan White Clients by Age, 2013-2018 18-24 25-44 45-54 55+ 100% 94% 94% 93% 93% 93% 93% 92% 92% 92% 92% 90% 90% 90% 89% 89% 89% 89% 87% 86% 86% 90% 87% 85% 83% 83% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Age is calculated as of December 31 of the specific year. 39

40. Retention in HIV Care for Ryan White Clients by Housing Status, 2013-2018 Stable/Permanent Temporary Unstable 100% 93% 93% 91% 91% 92% 90% 92% 90% 89% 89% 88% 88% 90% 87% 90% 85% 83% 83% 83% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 40

41. Viral Suppression Those who received a Ryan White service whose last viral load in the respective timeframe was under 200 copies/mL Persons served by Ryan White who had a care marker in the respective timeframe Ineligible: Those without a care marker in the respective timeframe. 41

42. Viral Suppression for Ryan White Clients by Gender, 2013-2018 100% Male Female Transgender 90% 81% 81% 76% 76% 80% 75% 76% 70% 58% 57% 56% 60% 53% 52% 49% 48% 47% 50% 45% 40% 30% 19% 20% 16% 15% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 42

43. Viral Suppression for Ryan White Clients by Race/Ethnicity, 2013-2018 Black or African American White Hispanic/Latino Asian 100% 88% 90% 83% 83% 81% 80% 80% 80% 80% 79% 79% 80% 74% 73% 67% 70% 65% 62% 60% 59% 57% 60% 56% 48% 48% 47% 47% 50% 45% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 43

44. Viral Suppression for Ryan White Clients by Risk, 2013-2018 MSM IDU Other Heterosexual Contact MSM/IDU 100% 90% 82% 81% 81% 78% 77% 77% 76% 76% 76% 80% 76% 75% 69% 67% 70% 62% 58% 58% 56% 60% 54% 52% 51% 48% 47% 46% 50% 45% 44% 43% 40% 38% 38% 40% 34% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. MSM= Men who have sex with men; IDU=Injection Drug Use; Other= Perinatal and Blood Product Exposures. 44

45. Viral Suppression for Ryan White Clients by Region, 2013-2018 Northwest Northern Southwest Central Eastern 100% 90% 83% 83% 84% 80% 82% 82% 80% 79% 79% 78% 77% 80% 76% 73% 72% 67% 67% 70% 66% 62% 60% 57% 60% 55% 50% 47% 50% 46% 44% 41% 38% 36% 40% 34% 34% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Region is determined by provider location. 45

46. Viral Suppression for Ryan White Clients by Age, 2013-2018 18-24 25-44 45-54 55+ 100% 86% 90% 83% 81% 79% 79% 79% 80% 75% 72% 72% 68% 70% 66% 64% 60% 60% 56% 60% 51% 51% 50% 47% 47% 50% 44% 45% 39% 36% 40% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. Age is calculated as of December 31 of the respective year. 46

47. Viral Suppression for Ryan White Clients by Housing Status, 2013-2018 Stable/Permanent Temporary Unstable 100% 90% 81% 77% 80% 77% 68% 67% 67% 70% 63% 58% 58% 57% 60% 50% 49% 47% 50% 45% 39% 38% 40% 36% 33% 30% 20% 10% 0% 2013 2014 2015 2016 2017 2018 Data derived from Care Markers Database, Virginia Department of Health, and are as of December 2018; Accessed October 2019. 47

48. Questions? Carrie Walker HIV Care Services Analyst Virginia Department of Health Carrie.Walker@vdh.virginia.gov 48