Kathleen Brady Philadelphia HIV Epidemiologic Update 2015

KATHLEEN A . BRADY, MDMEDICAL DIRECTOR/MEDICAL EPIDEMIOLOGIST

PHILADELPHIA DEPARTMENT OF PUBLIC HEALTHAIDS ACTIVITIES COORDINATING OFFICE

FEBRUARY 9 , 2015

WHOWHATWHENWHEREWHYHOW spells Epidemiology!

The HIV Care Continuum

HIV Care Continuum

Adapted from Eldred et al AIDS Patient Care STDs 2007;21(Suppl1):S1-S2Cheever LW Clin Infect Dis 2007;44:1500-2

Not in HIV Care Engaged in HIV Care

Unaware of HIV infection

Aware of HIV infection (not in care)

Receiving some medical care but

not HIV care

Entered HIV care but lost to

follow-up

Cyclical or intermittent user

of HIV care

Fully engaged in HIV care

Who is Aware?

Persons Living with Diagnosed HIV Infection HIV Care Continuum Outcomes, 2009, 2010 and

2011United States and Puerto Rico

2009 2010 20110

10

20

30

40

50

60

70

53.1 53.8 56.4

47.1 48.6 52.0

38.0 39.8 42.6

Received HIV medical care* Prescribed ART Viral Suppression

Perc

enta

ge (%

)

National HIV Surveillance System: Estimated number of persons aged ≥18 years diagnosed with HIV infection by the end of the year preceding the specified year (2008, 2009, 2010) and alive at the end of he specified year (2009, 2010, 2011)—United States and Puerto Rico.Medical Monitoring Project: Estimated number of persons aged ≥18 years who received medical care January to April of the specified year, were prescribed antiretroviral therapy, or whose most recent VL was undetectable or <200 copies/mL—United States and Puerto Rico.

Definitions – Surveillance Only Methods

Persons living with diagnosed HIV infection Definition – Number of persons who have lived with

diagnosed HIV infection for at least 12 months by a specified time point. This is the primary population (denominator) for the continuum analysis.

Philadelphia has used the person’s current address for this indicator.

Retention in continuous HIV medical care Definition – Receipt of 2 or more CD4 or viral load test

results at least 3 months apart during a 12 month period

Definitions – Surveillance Only Methods

Antiretroviral Therapy (ART) Prescriptions This indicator is not available with use of surveillance

only methodsViral Suppression

Definition – Viral load <200 copies/mL at the most recent test

Philadelphia Engagement in Care, 2011-2013Surveillance Method

HIV-Diagnosed In Care Suppressed viral load

0%10%20%30%40%50%60%70%80%90%

100%100%

42% 40%

100%

44% 44%

100%

45% 45% 201120122013

Philadelphia Engagement in Care, 2013

All MSM of Color

White MSM

IDU Male

IDU Female

HET Male

Het Female

0%10%20%30%40%50%60%70%80%90%

100%

Diagnosed Linked Retained Suppressed

Philadelphia Engagement in Care, 2013Incarcerated Individuals

HIV Diagnosed Linked to HIV Care

Retained in HIV Care

Virally Suppressed

0%10%20%30%40%50%60%70%80%90%

100%100%

80%

64%54%

Linkage to HIV Medical Care within 3 Months after HIV diagnosis during 2012, among persons

aged ≥13 years 17 States and the District of Columbia

Total Male-to-male sexual contact

Blacks/African Americans

Hispanics/Latinos

0102030405060708090

100

80.8 80.6 77.1 80.8

Perc

enta

ge (%

)

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage to HIV medical care was defined as having CD4 or VL test ≤3 months after HIV diagnosis. Hispanics/Latinos can be of any race.

Philadelphia Linkage to Care

2009 2010 2011 2012 20130%

10%20%30%40%50%60%70%80%90%

100%

76%82% 82% 82% 78%

Linked to Care

US* Philadelphia**

Number

100 Diagnosed

81 Are linked to HIV care

56 Stay in HIV care

52 Get antiretroviral therapy

43Have a very low amount of virus in their body

Number

100 Diagnosed

78 Are linked to HIV care

45 Stay in HIV care

N/A Get antiretroviral therapy

45Have a very low amount of virus in their body

For every 100 people living with HIV:

*2011 Data **2013 Data

Philadelphia EMA HIV Care Continuum, 2013

HIV di-agnosed

Linked to care

Retained in care

Prescribed ART

Suppressed viral load

0%10%20%30%40%50%60%70%80%90% 82.4%

64.7%

36.8% 40.0% 36.7%

27,830

21,847

13,516 12,412

12,44012,440

12,440

HIV-Infected – 33,789

Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2012—United States and

6 Dependent AreasN = 48,651 Total Rate = 18.4

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

Rates of Adults and Adolescents Living with Diagnosed HIV Infection, Year-end 2011—United

States and 6 Dependent Areas

N = 896,621 Total Rate = 342.1

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

HIV Prevalence in the Philadelphia EMA(reported thru 6/30/2014)

27,084 PLWHA (aware) 15,526 AIDS cases 11,558 HIV cases

5,959 estimated to be living with HIV and unaware

1.3% Philadelphia residents known to be HIV+

Rates (known) vary by race 1.4% of blacks 0.9% of Latinos 0.2% of whites

Rates vary by sex 0.8% of males 0.3% of females

Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year

Philadelphia, 2008-2013

2008 2009 2010 2011 2012 20130

200400600800

100012001400160018002000

1500015500160001650017000175001800018500190001950020000

928 897734 676 750 674

457 417 440 371 315

18640

1923719525

19157

1983219564

Newly Diagnosed Deaths Living HIV Cases

Proportion of EMA Residents LWHA by Race/Ethnicity and Sex, 2013

Black Males

Hispanic Males

Black Females

White Males

Hispanic Females

White Females-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

2.1%

1.3%

0.9%

0.3%0.5%

0.1%

2.9%

2.2%

1.1% 1.1%0.8%

0.2%

1.0%0.8%

0.5%

0.2%

0.4%

0.0%

0.9%

0.5% 0.5% 0.5%0.2%

0.0%

Overall Prevalence 0.5%

Epidemic Level 1.0%

20

HIV/AIDS Cases by Date of Diagnosis

11781302

1177

1001898

1200

894 895 907 861 821712 756

652

453

940 918 928 899

730 675 730 674

1308

0200

400600

8001000

12001400

Year

Num

ber

of C

ases

AIDS HIV

21

HIV/AIDS Cases by Sex and Date of Diagnosis

0

100

200

300

400

500

600

700

2006 2007 2008 2009 2010 2011 2012 2013

Year

Num

ber

of C

ases

HIV Female HIV Male

22

HIV Cases by Race/Ethnicity and Date of Diagnosis

171143 125 107 104 96 71

575 597537

481 476 501 500

133 147213

12386 112

810

100

200

300

400

500

600

700

2006 2007 2008 2009 2010 2011 2012 2013

Year

Num

ber

of C

ases

White AfrAm Hispanic

23

HIV Cases by Mode of Transmission and Date of Diagnosis

281305

150127

10375

51 6637

253

327

194

28 9 26 12

345300

276

302333

274

325

312

447457

2713

050

100150200250300350400450500

2006 2007 2008 2009 2010 2011 2012 2013

Year

Num

ber

of C

ases

MSM IDU HetSx NIR

24

HIV Cases by Age and Date of Diagnosis

68 65

251 256

306

223 218

261 248

199

149211

156 157 154126

155170

134 124110

133 120

403239

4346

139

149179194

232 233237

128

0

50

100

150

200

250

300

350

2006 2007 2008 2009 2010 2011 2012 2013

Year

Num

ber

of C

ases

13-19 20-29 30-39 40-49 50+

27

Summary

High HIV morbidity in PhiladelphiaPhiladelphia epidemic predominantly affects

minority populationsMSM and Heterosexual transmission

predominant modes of transmissionCases among MSM are increasingGrowing numbers of persons living with HIV

and AIDSFirst recent year to see an increase in AIDS

cases

Who is getting infected?

Incidence Surveillance

Collect and STARHS test the diagnostic blood specimens from all newly diagnosed HIV infections reported from public and private laboratories and providers to HIV Surveillance Unit.

Collect the HIV testing information needed for the statistical estimates of incidence.

Calculate population-based estimates of HIV incidence.

Use these estimates to identify emerging sub-epidemics, monitor trends, target prevention resources and interventions to areas and populations most heavily affected, and evaluate programs.

Incidence vs. Prevalence

HIV Prevalence = the total number of HIV cases that exist at a specific time within a specific population.

HIV Incidence = the number of individuals newly infected with HIV within a given period of time (6 - 12 months).

20061981 2007

20061981 2007

Serologic

Testing

Algorithm for

Recent

HIV

Seroconversion

What is STARHS?

Remnant HIV+ Serum

Supplemental Data

STARHS Testing using BED

Assay

Includes:•Race, sex, mode of transmission•Testing history & reasons for testing (Calculating weights)•Any exclusionary info (AIDS diagnosis, prior recent ART)•Adjust for LFU, QNSHIV Incidence Estimation

Requirements for HIV Incidence Surveillance

CDC STARHS Test Results

(+) standard test and (+) STARHS test

= long-standing HIV infection

(+) standard test and (-) STARHS test = recent HIV infection

National Incidence Data

Estimated 47,500 HIV infections in 2010 in adults and adolescents (95% CI, 42,000 – 53,000)

Estimated incidence 19.0 infections per 100,000 population

44% among blacks, 21% Latinos51% among MSM, 38% heterosexual26% among 13-24 year olds

2012 Local Estimate of HIV Incidence

Local estimate of 761 new HIV infections in 2012 in adults and adolescents (95% CI, 480-1,043)

Rate is 3 times that of the US estimate

Philadelphia HIV Incidence Estimates

47%

8%

45%

2012 Incidence Estimate

MSM IDU HET

2006

2007

2008

2009

2011

2012

0

100

200

300

400

500

MSM HIV IncidenceMSMHIV Diagnosis

Estimated 761 infections

Data Source: PDPH/AACO HIV Incidence Surveillance Program

HIV Incidence Trends by Demographic Groups

0

200

400

600

800

1000

1200

2006 2007 2008 2009 2011 2012

TotalAge 13-24MaleBlackMSM

Estimated Incidence Rates - 2012

Population Population in 2010 (13 +)ESTIMATED

Incidence Estimate, 2012

EstimatedCase Rate per 100,000

95% CI lower bound

95% CI upper bound

MSM 27,841 357 1,200.5 652 1,749IDU 37,378 58 155.2 0 318HET 254,200* 346 117.4 51 185

*Includes persons >13 living in poverty

Data Source: PDPH/AACO HIV Incidence Surveillance Program

HIV in MSM in Philadelphia

HIV Incidence Estimates

• Estimated that 1.2% of MSM in Philadelphia became infected with HIV in 2012.– 54.5% estimated increase in HIV

incidence in MSM between 2006 and 2009 (driven by new infections in 13-24 AA MSM).

– 19.0% increase in the number of MSM newly diagnosed with HIV between 2006 and 2012.

– Suggests an increasing number of MSM are unaware they are infected.

HIV Prevalence (aware) among MSM, 12/31/2013

Pop size >age 13

MSM estimate

MSM LWHA

% HIV infected

Black 229,698 11,485 3,706 32.3%

White 244,551 12,228 2,094 17.1%

Latino 69,252 3,463 680 19.6%

Data Source: PDPH/AACO HIV Incidence Surveillance Program and Philadelphia eHARS data

Incidence Summary

Includes people unaware of their status. Overall, HIV incidence in Philadelphia is stable

Trends - ???

Who is unaware?

Concurrent HIV/AIDS

Definition – An AIDS diagnosis within 90 days of an HIV diagnosis

Philadelphia EMA Concurrent HIV/AIDS, 2013

Non-Concurrent

Concurrent HIV/AIDS Total

N Row % N Row % N Col % Total 736 72.9% 269 26.6% 1,010 100% Sex Male 585 68.6% 199 25.5% 781 77.2% Female 157 74.9% 70 30.6% 229 22.7% Race/Ethnicity Black 501 76.5% 152 23.2% 655 64.9% Hispanic 95 75.4% 30 23.8% 126 12.5% White 114 60.6% 72 38.3% 188 18.6% Other 26 63.4% 15 36.6% 41 4.1%


Non-Concurrent


N Row % N Row % N Col % Total 736 72.9% 269 26.6% 1,010 100% Age Group at HIV Diagnosis <13 * 100.0% 0 0.0% * 0.2% 13-24 201 87.0% 30 13.0% 231 22.9% 25-44 329 72.5% 123 27.1% 454 45.0% 45+ 210 65.0% 116 35.9% 323 32.0% Transmission Risk Men who have sex with men (MSM) 366 78.5% 100 21.5% 466 46.1% Injection drug use (IDU) 32 68.1% 15 31.9% 47 4.7% MSM/IDU 11 91.7% * 8.3% 12 1.2% Heterosexual 287 68.5% 134 32.0% 419 41.5% No identified risk 43 68.3% 19 30.2% 63 6.2% Pediatric exposures * 100.0% 0 0.0% * 0.3%


Non-Concurrent


N Row % N Row % N Col % Total 736 72.9% 269 26.6% 1,010 100% Geographic Area Philadelphia 514 76.4% 159 23.6% 673 66.6% PA Counties 132 66.8% 68 33.2% 205 20.3% NJ Counties 90 68.2% 42 31.8% 132 13.1%

Concurrent HIV/AIDS Summary

26.6% of EMA residents diagnosed with HIV in 2013 had an AIDS diagnosis within 3 months

Females, whites, persons >25 years of age (but much higher among those 45+), IDU, heterosexuals, and persons living in the suburban counties are more likely to be diagnosed with concurrent HIV/AIDS

Significant decline in concurrent HIV/AIDS in 2013 in Philadelphia compared to 2012

Retention in care

Definition: Met Need for Primary Care

Met Need for Primary Care defined as measurement of at least one CD4 count and/or one Viral Load and/or receipt of antiretroviral therapy during a specified time period

Framework

Input Population sizes of those with HIV and AIDS within

the service area Care Patterns of those with HIV and AIDS

Calculated Result Number of persons with HIV and AIDS with unmet

need

Population Sizes Value

Data Source(s)Row A. Number of persons living

with AIDS (PLWA), for the period of 12/31/2013 in the EMA

15,526 Local eHARS data

Row B. Number of persons living with HIV (PLWH)/non-AIDS/aware, for the period of 12/31/2013 in the EMA


Row C. Total number of HIV+/aware for the period of 12/31/2013 in the EMA


Population Sizes

Care Patterns Value Data Source(s)Row D. Number of PLWA

who received the specified HIV primary medical care during the 12-month period of 2012 in the EMA

13,616 Surveillance Data (Lab Data)

CAREWare

Row E. Number of PLWH/non-AIDS who received the specified HIV primary medical care during the 12-month period of 2012 in the EMA

8,380 Surveillance Data (Lab Data)

CAREWare

Row F. Total number of HIV+/aware who received the specified HIV primary medical care during the 12-month period of 2012 in the EMA

21,996

Calculated Results Value CalculationRow G. Number of PLWA who

did not receive primary medical services during the 12-month period of 2011 in the EMA

1,910(12.0%)

= A – D

Row H. Number of PLWH/non-AIDS who did not receive primary medical services during the 12-month period of 2011 in the EMA

3,178(28%)

= B – E

Row I. Total of HIV+/aware not receiving specified primary medical care services (quantified estimate of unmet need in the EMA

5,088(19%)

= G + H

Philadelphia EMA Unmet Need Estimates, 2009-2013

2009 2010 2011 2012 20130%5%

10%15%20%25%30%35%40%45%

19%16% 14% 12% 12%

39%35%

32%27% 28%27%

24%21%

18% 19%

PLWA with unmet need PLWH with unmet needPLWHA with unmet need

Demographic Characteristics and Insurance Status of PLWHA with

Unmet Need, 2013Demographic Group % of PLWH

not in care Demographic Group % of PLWHnot in care

Race/Ethnicity AgeBlack 18.4% 13-19 years 16.1%White 18.3% 20-29 years 23.9%

Hispanic 19.8% 30-39 years 22.0%Multi-race 11.6% 40-49 years 16.7%

Other 21.4% 50+ years 17.1%Mode of Transmission Insurance Status

MSM 17.3% Medicaid 15.1%IDU 17.7% Medicare 15.6%

Heterosexual 19.3% None 26.8%MSM/IDU 22.0% Other/unknown 31.6%NIR/NRR 26.1% Private 14.0%

Other 23.5% Missing 28.4%Perinatal 18.0%

SexMale 19.7%

Female 17.0%

Care Patterns of Persons with Unmet Need, 2013

Never Linked – Person with confirmed HIV infection without evidence of a subsequent CD4 and/or viral load after HIV diagnosis

Sporadic Care – CD4 and/or viral load in either 2011 or 2012

Lost to Care – Evidence of a CD4 and/or viral load after diagnosis but no evidence of care in the previous 2 years (2011 and 2012)

Care Patterns of PLWHA with Unmet Need, 2013

42%

21%

37%Never LinkedSporadic CareLost to Care

Unmet Need Summary

Unmet Need for HIV related primary care remains stable in the Philadelphia EMA.

After several years of consistent declines, the level of unmet need in the EMA has plateaued for PLWH, PLWA, and the combined population. The estimate reasonably demonstrates that these desirable declines are

the result of systematic, concentrated efforts to identify, inform, refer, link and retain persons in care

Unmet need is higher among Latinos, heterosexuals (and NIR), males, persons age 20-39 and those with no insurance

Local analysis suggests that improving linkage to care could have the greatest impact on reducing unmet need in the future.

clinicaloptions.com/hivStarting Antiretroviral Therapy in 2012: A Compendium of Interactive Cases

What Will It Take to Substantially Reduce HIV Transmission in an Entire Population?

• Answer: Treatment AND Prevention

•Gardner EM, et al. Clin Infect Dis. 2011;52:793-800.

•200,000

•600,000

•0

•800,000

•1,000,000

•1,200,000

•400,000

•19% •22%•34% •28% •21%

•66%

•N

umbe

r of I

ndiv

idua

ls

•Current •DX90%

•Engage90%

•Treat90%

•VL < 50 in 90%

• Dx, Engage, Tx, and VL < 50

in 90%

Undiagnosed HIVNot linked to careNot retained in careART not requiredART not utilizedViremic on ARTUndetectable HIV-1 RNA

Care Continuum of HIV-Infected People with Mental Illness in Philadelphia

Kathleen A. Brady, MD

Penn Mental Health AIDS Research Center

HIV and Mental Illness

HIV and mental illness are closely intertwined conditions:–5-23% of persons with mental illness

are infected with HIV, compared to 0.3-0.4% of the general population

–As many as half of PLWH have one or more psychiatric disorders

HIV and Mental Illness

Improving the care of PLWH and mental illness will be critical to–meeting the goals of the U.S.

National HIV/AIDS Strategy–accelerating improvements along

the HIV care continuum

Purpose of this Study

(1) Compare differences in retention in care, use of ART, and HIV suppression between PLWH with and without mental illness

(2) help identify gaps in HIV treatment cascade amenable to future intervention

Study Sample

• Philadelphia Medical Monitoring Project (MMP)- population-based sample representative of PLWH (2008-2010)

• Eligibility criteria: (1) known HIV diagnosis (2) age ≥ 18 years (3) enrollment in care at a medical facility (4) new to MMP

Outcome variablesOutcome Variable Definition

Retention in Care ≥ 2 HIV medical visits separated by ≥ 90 days in a 12-month period

Use of ART Prescribed 3 antiretroviral drugs (excluding ritonavir) at any point during a 12-month period

HIV Viral Suppression HIV-1 RNA ≤ 200 copies/mL at the last measure of the observation period

Exposure Variable DefinitionDiagnosis of Mental Illness*

Documented psychosis, bipolar, depression, anxiety disorder

*Severity of mental illness evaluated in secondary analyses

Statistical AnalysisMultivariable Logistic

RegressionDemographic Factors

AgeSex

Race/EthnicityInsurance Status

Behavioral FactorsAlcohol/ Drug use

HIV Disease Severity (CD4)

Mental IllnessAssociation

Prevalence of Mental Illness among MMP Participants

730 PLWH

358 with Mental Illness

49%

Depression orAnxiety

79%

Bipolar12%

Psychosis9%

372 without Mental Illness

51%

Factors Associated with Mental IllnessCharacteristics Mental Illness AOR

(95% CI)Sex Female

(Ref male)1.84 (1.31, 2.58)

Race/Ethnicity Black Hispanic

(Ref white)0.45 (0.29, 0.71)1.16 (0.64, .2.11)

Insurance Medicaid Medicare Uninsured

(Ref Private)2.74 (1.61, 4.66)2.27 (1.26, 4.08)1.16 (0.51. 2.63)

Alcohol abuse Yes

(Ref no)2.20 (1.56, 3.10)

Injection Drug Use Yes

(Ref no)2.31 (1.37, 3.89)

Percent Retained, Using ART and Virally Suppressed

Characteristics Retained in CareAOR (95% CI)

Use of ARTAOR (95% CI)

Viral SuppressionAOR (95% CI)

Mental Illness, No Yes

(Ref)1.30 (0.63, 2.56)

(Ref)0.79 (0.49, 1.25)

(Ref)0.64 (0.46, 0.90)

Age (years), 18-29 30-39 40-49 >49

(Ref)0.86 (0.41, 1.83)1.46 (0.64, 3.34)1.93 (0.86, 4.35)

(Ref)3.70 (1.65, 8.31)2.26 (1.24, 4.11)3.79 (1.76, 8.16)

(Ref)2.05 (1.01, 4.15)3.26 (1.98, 5.38)4.06 (2.39, 6.90)

Sex, Male Female

(Ref)1.32 (0.68, 2.58)

(Ref)0.45 (0.30, 0.67)

(Ref)0.56 (0.329, 0.80)

Race, White Black Hispanic

(Ref)0.97 (0.45, 2.13)1.02 (0.27, 3.85)

(Ref)0.90 (0.45, 1.77)0.79 (0.29, 2.19)

(Ref)0.45 (0.22, 0.93)0.86 (0.39, 1.91)

CD4, <201 cell/mm3

201-350 cell/mm3

351-500 cell/mm3

>500 cell/mm3

(Ref)1.08 (0.51, 2.29)3.52 (1.23, 10.13)1.35 (0.59, 3.07)

(Ref)0.41 (0.15, 1.07)0.34 (0.14, 0.83)0.27 (0.11, 0.65)

(Ref)3.37 (1.89, 6.02)3.37 (1.95, 5.83)4.40 (2.47, 7.83)

Alcohol Abuse, No Yes

(Ref)0.72 (0.28, 1.85)

(Ref)0.76 (0.40, 1.45)

(Ref)0.75 (0.44, 1.27)

Injection Drugs, No Yes

(Ref)1.28 (0.48, 3.46)

(Ref)0.73 (0.35, 1.54)

(Ref)0.95 (0.53, 1.69)

Factors Associated With Retention, Use of ART and Viral Suppression

Mental Illness Severity

Characteristics Retained in CareAOR (95% CI)

Use of ARTAOR (95% CI)

Viral SuppressionAOR (95% CI)

Mental Illness No Psychosis Bipolar Depression/Anxiety

(Ref)1.28 (0.27, 5.98)0.86 (0.23, 3.20)1.38 (0.70, 2.73)

(Ref)0.44 (0.12, 1.67)1.28 (0.40, 4.05)0.81 (0.52, 1.25)

(Ref)0.38 (0.13, 1.07)0.95 (0.41, 2.21)0.65 (0.47, 0.91)

Alcohol abuse and IDU did not significantly modify the association of mental illness with any of the outcomes

Limitations

• Limited definition of mental illness• Treatment history not captured• The impact of mental illness on the early

steps of the HIV care continuum unknown

• High retention rates due to sampling bias• Observations limited to one year

Conclusion

• PLWH commonly experience mental illness

• People with a diagnosis of mental illness achieved similar rates of retention in HIV care and ART use but were less likely to be suppressed compared to those without mental illness

Implications of Study Findings

• These findings argue for the importance of identifying and treating mental illness in PLWH to optimize their HIV outcomes

• Model of care: integrating HIV and mental health• The relationship between drug/alcohol abuse on

ART adherence and viral suppression needs to be investigated further

• We need to understand why women do poorly

Acknowledgment

Funding This research was

supported by a grant from the Penn Mental Health AIDS Research Center (PMHARC), an NIH-funded program (P30 MH 097488)

CollaboratorsUniversity of Pennsylvania Baligh Yehia

Alisa Stephens Robert Gross

Karen GlanzBenoit Dube

Drexel UniversityFlorence Momplaisir

QUESTIONS?

The End

Health & Medicine

Kathleen Brady Philadelphia HIV Epidemiologic Update 2015