Transcript Slide 1

TB, STDs, HIV, HEPATITIS C
and SUBSTANCE ABUSE:
A Local Perspective
Paula Kriner, MPH
Imperial County Public Health Department
Management of TB, STDs, HIV, Substance Abuse and
Hepatitis C on the Border: Focus on Testing
June 20-21, 2014
Management of TB, STDs, HIV, Hepatitis C and
Substance Abuse on the Border

I do not have any financial arrangements or affiliations with
commercial sponsors which have direct interest in the subject
matter:
Management of TB, STDs, HIV, Hepatitis C and
Substance Abuse on the Border
Objectives
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Describe epidemiological trends for
HIV/AIDS, sexually transmitted
diseases, tuberculosis, hepatitis C, and
substance abuse in Imperial County
Discuss challenges to identifying,
testing, and treating diseases
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Demographics
Estimated 2014 population:
180,672
 Predominantly Latino (>80%)
 Younger population than California
 Higher rates of poverty than state
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Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
TUBERCULOSIS
Tuberculosis
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In California, tuberculosis (TB) rates
have declined since 1992
In Imperial County, TB case rates
have fluctuated and are now on rise
IC has highest TB rates in California
– 15.2 cases per 100,000 population in IC
compared to 6.1 cases/100,000 statewide
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Tuberculosis
Tuberculosis Rates, Imperial County and
California, 2004-2013
Rate per 100,000
25
20
15
10
5
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Imperial County
California
Healthy People Objective
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Tuberculosis
Nearly all cases are Latino
 Many are foreign-born
 Diabetes and HIV/AIDS are
increasingly common
co-morbidities in persons infected
with TB
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Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
TB Challenges
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Homelessness and drug use are risk
factors
Binational cases: cross-border travel
and contacts
Latent TB Infection (LTBI) cases not
adequately followed by local healthcare providers
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse: Focus on Testing
Sexually
Transmitted
Diseases (STDs)
STD Highlights
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Chlamydia is the most common STD
reported
IC Public Health participated in
statewide enhanced gonorrhea
surveillance project
County has improved local surveillance
for all STDs
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Rate per 100,000
Chlamydia
700
600
500
400
300
200
100
0
Chlamydia Rates by Year of Diagnosis,
Imperial County, 2001-2013
Female
Male
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Chlamydia
Chlamydia Rates by Age Group
Imperial County, 2012
Rate per 100,000
3000
Female
Male
2500
2000
1500
1000
500
0
10-14
15-19
20-24
25-29
30-34
35-44
Age Group
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
45+
Gonorrhea
Rate per 100,000
60
Gonorrhea Rates by Year of Diagnosis,
Imperial County, 2001-2013
FEMALE
MALE
50
40
30
20
10
0
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Gonorrhea
Gonorrhea Rates by Age Group,
Imperial County, 2012
Female
Rate per 100,000
80
Male
60
40
20
0
10-14
15-19
20-24
25-29
30-34
35-44
Age Group
Management of TB, STDs, HIV, Hepatitis C and
Substance Abuse on the Border: Focus on Testing
45+
Syphilis
Rate per 100,000
Primary and Secondary Syphilis Rates,
Imperial County, 2001-2013
14
12
10
8
6
4
2
0
FEMALE
MALE
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
STD Challenges
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Diagnosis and treatment of partners
– Limited use of Expedited Partner Therapy
– Out-of-jurisdiction including Mexico
– Other factors (drug use, co-morbidities)
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Limited services for counseling and
testing
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse: Focus on Testing
HIV / AIDS
HIV/AIDS
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AIDS: 266 cases since 1983
–106 (40%) deaths reported
HIV: 87 cases reported by name
since April 2006.
–Three (3%) deceased
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
AIDS
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Nearly all cases (90%) are male
Most (76%) are Latino
More than half (55%) identified risk as
men who have sex with men (MSM)
12% reported risk as injection drug
use (IDU)
7% reported risk as MSM/IDU
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
HIV
Most cases are Latino (76%) and
male (80%)
 Most are MSM (57%)
 IDUs (14%)
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Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
HIV/AIDS Cases
Number of Cases
30
25
HIV and AIDS Cases by Year of
Diagnosis,
Imperial County
HIV
AIDS
20
15
10
5
0
Management of TB, STDs, HIV, Hepatitis C
and Substance Focus on Testing
HIV/AIDS Challenges
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Stigma
Many cases test out of jurisdiction -often in Mexico -- and don’t seek care
until very sick
Limited counseling and testing services
available
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse : Focus on Testing
HEPATITIS C
Hepatitis C
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In 2011, one acute case and 178
newly reported non-acute HCV cases
were identified countywide
Many of the reported cases are
incarcerated
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C: Focus on Testing
Hepatitis C
Rate per 100,000
Chronic Hepatitis C ∙ Rate of New Cases by
Age Group, Imperial County, 2011
450
400
350
300
250
200
150
100
50
0
Female
18-24
25-34
Male
35-44
45-54
Age Group
55-64
Management of TB, STDs, HIV, Hepatitis C and
Substance Abuse on the Border: Focus on Testing
65+
Hepatitis C ∙ Challenges
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Injection drug users
Small percentage share needles for
vitamins and medicines
Many older people are not aware that
they may have been exposed
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse: Focus on Testing
SUBSTANCE ABUSE
Substance Abuse
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Admission rates to treatment facilities in
Imperial County have increased since 2000
In 2000, IC reported 417 admissions per
100,000 compared to 790 admissions per
100,000 in 2008
IC’s alcohol and drug admission rate was
higher than the state overall each year
since 2000
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Substance Abuse
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Marijuana use accounted for 29% of
all treatment admissions in 2008
Heroin = 27%
Methamphetamine = 24%
Alcohol = 19%
Crack/cocaine = 1%
Highest rate in 25 to 34 year olds
Management of TB, STDs, HIV, Hepatitis C and
Substance Abuse on the Border: Focus on Testing
Substance Abuse
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Death rates due to alcohol and drug
use increased slightly between 2000
and 2007
Death rate due to alcohol use
increased nominally
Death rate due to drug use increased
from 7.65 per 100,000 to 10.29 per
100,000
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse: Focus on Testing
Substance Abuse Challenges
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Substance abuse is a risk factor for
sexually transmitted diseases
Lack of local treatment facilities
Homelessness and other risk factors
makes it difficult to follow up and
ensure completion of treatment
Management of TB, STDs, HIV, Hepatitis C
and Substance Abuse : Focus on Testing
Summary
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Imperial County has highest rate of TB
in California
High number of chronic hepatitis C
reported annually
Increasing rates of HIV and other
STDs due in part to increased testing,
improved surveillance and provider
reporting
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing
Questions?
Paula Kriner, MPH
Imperial County Public Health Dept.
(760) 482-4904
[email protected]
Management of TB, STDs, HIV, Substance Abuse
and Hepatitis C on the Border: Focus on Testing