NYC study determines true HIV prevalence
NYC study determines true HIV prevalence
Study puts number to untested, unreported
Name-based reporting of HIV infection has been successful in New York City since it was begun in June 2000, but holes still remain in the surveillance system in which thousands of HIV-infected individuals are lost, according to recent research.
"Name-based reporting has worked pretty well, but there are a lot of people who are not tested to begin with, and without their getting tested there’s no way surveillance will pick them up," says Yussef Bennani, MPH, research scientist with the New York City Department of Health and Mental Hygiene.
Another gap in the HIV reporting system involves people who had been tested before 2000 but who have fallen out of medical care, he says.
"They may have no provider, and their viral load may be sufficiently suppressed that they don’t have any reportable events, like a diagnostic antibody test or CD4 cell counts below 500," Bennani says.
"The law does not require HIV doctors to list all HIV patients," Bennani notes. "From this analysis, it seems the majority of folks who are not part of the 90,000."
He participated in a study that analyzed data to arrive at a more accurate number of HIV-infected individuals in New York City. The study reports a total of 88,479 people diagnosed with HIV or AIDS as of Dec. 31, 2003, with an estimate range of 11,336-45,914 people who have HIV/AIDS but who are not diagnosed. Also, between 5,151-8,216 people have been diagnosed but are not reportable, the study states.1
Based on this analysis, the prevalence of HIV in New York City is 22% to 44% greater than what the surveillance system has measured.1
Few cities have gone through this extensive of an analysis to obtain a better estimate of undiagnosed, unreported HIV cases than by using the CDC’s estimate that 25% of people infected with HIV are undiagnosed, says Judith Sackoff, PhD, director of HIV/AIDS surveillance at the New York City Department of Health and Mental Hygiene.
"We’ve had a lot of special studies in high-risk populations that have allowed us to make those kinds of estimates," Sackoff notes.
Investigators calculated the number of unreported persons with HIV infection by dividing the city’s population into subpopulations by risk and demographic characteristics and estimating the untested population and multiplying that number by a high- and low-prevalence estimate.
New York sends the CDC its new diagnoses for HIV and AIDS each month, Sackoff says.
"We’re quite confident about the quality and accuracy of the data," she reports.
Although there were some concerns raised about the impact name-based reporting would have on voluntary HIV testing in New York City prior to its implementation in 2000, subsequent surveys have shown that the HIV reporting law has not had an impact on testing, Sackoff says.
Nonetheless, New York City has about 4,000 new HIV diagnoses each year, and it takes time for a new surveillance system to mature, so the new diagnoses data cannot be used to determine new infections, she explains.
Also, it’s too soon to say whether the data show any trends, such as an increase in HIV diagnoses, in the past few years, Sackoff says.
The new analysis of suspected undiagnosed and unreported HIV infection prevalence shows how it’s important for governments to continue promoting HIV testing, Bennani notes.
"I don’t know if the analysis had any surprises," he says. "But it strengthens our thoughts about the problem of undiagnosed HIV in New York City."
For this reason, the city’s health department has begun a new campaign, called Take Care New York," which stresses the importance of people knowing their HIV status, Bennani says.
"The campaign is fairly visible throughout the city to anyone who takes the subway," he says.
"The analysis does reinforce the importance of HIV testing because undiagnosed people can be unwittingly spreading HIV over the course of many years as well as missing out on the opportunity to get care for themselves that would improve the quality of their lives," Sackoff says.
Reference
- Torian LV, Bennani Y, Frieden T. What is the true prevalence of HIV in New York City? Estimating the number of undiagnosed and unreported persons living with HIV and AIDS, 2003. Poster presented at the 12th Conference on Retroviruses and Opportunistic Infections. Abstract 970. Boston; Feb. 22-25, 2005.
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