HIV/AIDS in Austin/Travis County

and Our Local Response

Philip Huang, MD, MPH

Health Authority/Medical Director
Austin Public Health

SIGNING OF THE PARIS DECLARATION ON FAST-TRACK CITIES

CENTRAL AUSTIN LIBRARY
JUNE 20, 2018
 Travis County Residents Living with Diagnosed HIV
Infections, New Diagnoses and Deaths, 1980-2017
500 5000

450 PLWH
4500 – Rising 4-6% per year

400 4000

People Living with HIV
350 3500
New Dx & Deaths due to HIV

1995: ART Introduced
300 3000

250 2500

200 New
2000 Dx ~ 200-250/year

150 1500

100 1000

50 Deaths*
500 – Low and stable
0 0

*Two-year lag on death data;

New Dx Deaths PLWH deaths to persons living with
HIV
HIV in Travis County by Gender

Number of People Living with HIV in Number of New HIV Dx in

Travis County by Gender, 2016 Travis County, by Gender, 2016

Female
Female 27
654 11%
14%

Male
Male
4062
215
86%
89%

Gender - Men make up the majority of PLWH and the majority of new diagnoses.
HIV in Travis County by Race/Ethnicity

Number of People Living with HIV in Travis Number of New HIV Dx in Travis County
County by Race/Ethnicity, 2016 by Race/Ethnicity, 2016

Other Unknown
Other Unknown 6
148 3
64 2%
3% 1%
1%

NH-White
NH-White 86
Hispanic/Latinx 1871 36%
40% Hispanic/Latinx
1585
99
34%
41%

NH-Black NH-Black
1048 48
22% 20%
HIV in Travis County by Transmission

Number of People Living with HIV in Travis County

by Transmission Category, 2016 Number of New HIV Dx in Travis County
by Transmission Category, 2016
Pediatric Adult Other
40 1 MSM/IDU
0.8% 0.0% 10
4%
Heterosexual
IDU 26
Heterosexual
12 11%
MSM/IDU 676
5%
329 14.3%
7.0%

IDU
397 MSM
8.4% 195
80%
MSM
3273
69.4%

Mode of Exposure - MSM makes up the primary mode of exposure among PLWH and among new diagnoses.
 HIV in Travis County by Age Group

Number of People Living with HIV in Travis County Number of New HIV Dx in Travis County
by Age Group, 2016 by Age Group, 2016

13-24 years 55+ years

182 22
4% 9%
45-54 years
55+ years 23
1131 25-34 years
10%
24% 912
13-24 years
19%
47
19%

35-44 years
45-54 years 1071
35-44 years
1413 23%
48
30%
20%
25-34 years
102
42%

Age - The majority of PLWH are 45 and older; the majority of new diagnoses are among people 25-45.
Economic Benefits of Getting to Zero

 CDC estimates the Texas total lifetime treatment cost of each new
HIV diagnosis is $379,668 (in 2010 dollars).
 In Travis County, this means approximately $95 million in lifetime
treatments costs each year.
 250 new Dx x $379,668/Dx = $94,917,000
 If there is no change, after 10 years of new diagnoses, Travis
County would see almost $1 billion in lifetime treatment costs.
 This is money that can be saved if we achieve zero new diagnoses.
Top Diagnosing Providers
Austin HSDA, 2014-2016

Austin HSDA Counties: Bastrop, Blanco, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson
Met Need Outside of Ryan White Funding
Austin HSDA

Austin HSDA Counties: Bastrop, Blanco, Caldwell, Fayette, Hays, Lee, Llano, Travis, and Williamson
Proposed Austin Fast Track
Cities/Getting to Zero 2020 Goals

 Goal 1 - 90% of all people living with HIV will know their HIV
status;
 Goal 2 - 90% of all people with diagnosed HIV infection will
receive sustained antiretroviral therapy; and
 Goal 3 - 90% of all people receiving antiretroviral therapy
will have viral suppression.
 Goal 4 – 50% reduction in New Infections
 Goal 5 - End stigma related to HIV
 Number of People Living with HIV in Travis County
4,800
4,716
4,700

4,600
4535

4,500

4396
4,400
4,335

4,300

4,196
4,200

4,100

4,000

3,900
2012 2013 2014 2015 2016
 Goal 1: Current Status

 Goal 1 - 90% of all people living with HIV will know their HIV status
 At the end of 2016, there were 4,716 residents living with HIV infection in
the Travis County. An additional 987 HIV cases are estimated to be
undiagnosed, making the percentage of persons infected with HIV
that know their status to be 4,716/5,703 = 82.7%
 According to the CDC, persons unaware of their human
immunodeficiency virus (HIV) infection account for nearly one third of
ongoing transmission in the United States.
 Travis County HIV Population Treatment
Cascade, 2016
100% 1
4500
85%
4000 80%
0.8
72%
3500

3000
0.6

2500
90% of Retained in
4716 Care
2000 4016 3754 0.4

1500
3389

1000 0.2

500

0 0

HIV+ Individuals Living at At Least One Visit/Lab Retained In Care Achieved Viral Suppression
end of 2016
 Current Status of 90-90-90 Goals in Travis
County

GOAL CURRENT STATUS GAP

Goal 1: 90% of all people living with Estimated 83% of Travis County residents living with 7%
HIV will know their HIV status. HIV know their status

Goal 2: 90% of all people with 80% of people diagnosed with HIV are retained in 10%
diagnosed HIV infection will receive care
sustained antiretroviral therapy.

Goal 3: 90% of all people receiving 90% of people who are retained in care are virally Goal Met
antiretroviral therapy will have viral suppressed
suppression.
Getting to Zero Goals by 2030

 Zero new cases of HIV

 Zero deaths due to HIV/AIDS
 Zero Stigma
 Number of New HIV Diagnoses in Travis County
350

300 287

251
250 239 242

219

200

150

100

50

0
2012 2013 2014 2015 2016
 Number of HIV Deaths* in Travis County
30

26

25
23

20
18

15 14 14

10

0
2012 2013 2014 2015 2016

*Deaths with ICD-10 codes B20-B24

Austin/Travis County Getting to
Zero/Fast Track Cities Initiative
Infrastructure

Prevention
Executive Committee
Planning Taskforce
Agency CEO’s and/or
Nicholas Yagoda, Scott decision makers
Lyle, Brandon Wollerson,
Valerie Agee, Akeshia Testing & Rapid
Johnson Smothers, Laura Linkage
Still, Paul Scott, Mark Erwin,
Janice Savengrith, Virginia
Brown, Parker Hudson,
Adrienne Sturrup, Philip Consortium Retention,
Huang
Workgroups Reengagement &
Viral Suppression

Ending Stigma
Why Now?

 We are at a defining moment to turn around the HIV epidemic in Travis County
 PrEP
 Effective Antiretroviral Treatment
 Dramatic improvement in quality of life and life expectancy (almost equal to general
population)
 People treated with ART with undetectable viral loads CANNOT transmit the virus
 RAPID start
 Expanded Linkage/Retention
 Anti-Stigma Campaigns
 Timeline and Next Steps

 Community organizing to launch local initiative

 Task Force Created and Continues to meet - Ongoing
 Executive Committee Established and Meets – First Meeting Held May 15, 2018
 First Community Forum - June 20, 2018
 Mayor and County Judge sign Paris Agreement on Fast-Track Cities - June 20,
2018
 Workgroups convene and begin work – Beginning in August 2018
 World AIDS Day December 1, 2018 - Celebration Day
 Consortium is established, action plan developed and has community buy-in
and started implementation
Logistics

 Signing of the Paris Declaration

 Photo Ops
 Community Input