Sue McAllister

AIDS Epidemiology Group

University of Otago, Dunedin

HIV Treatment Update Meeting

Auckland

17 September 2021

From diagnosis to quality of

life: The four “90’s”

Overview of presentation

Total

number

of people

with

HIV

Diagnosed

treatment

Undetect-

able viral

load

Good

quality

of life

90 – 90 – 90

– 90

Cascade of care

Number notified with HIV in New Zealand by place

of first diagnosis: 2001-2020

52%

Number of people diagnosed with HIV in New

Zealand, by main mode of acquisition: 2001-2020

56%

Men who have sex with men (MSM)

Number of MSM diagnosed in New Zealand, by country

of acquisition: 2001-2020

49%

Initial CD4 count of MSM diagnosed and HIV acquired

in New Zealand: 2016-2020

Age at time of diagnosis of MSM diagnosed and

HIV acquired in New Zealand: 2016-2020

MSM aged 30-49 years

Ethnicity of MSM diagnosed and HIV acquired in

New Zealand: 2016-2020

European MSM

Residence of MSM diagnosed and HIV acquired in

New Zealand: 2016-2020

MSM in the Northern/Auckland region

Men and women with heterosexually

acquired HIV

Annual number heterosexually acquired HIV diagnosed

in New Zealand, by place of infection: 1996-2020

.Includes HIV cases diagnosed by Western Blot antibody test and viral load testing

Heterosexual men and women: Initial CD4 count of those

diagnosed and HIV acquired in New Zealand (2011-15 and 2016-

20)

52% 52%

52%

33%

HIV from injecting drug use (IDU): 1996 – 2020

(Includes IDU only + MSM/IDU + Hetero/IDU)

Summary

Decline in HIV diagnosed in NZ

MSM:

- Acquired in NZ

- Aged 30-49

- European

- Living in Auckland region

v Heterosexual men and women – late diagnosis

HIV cascade of care

• To estimate the proportion of people notified with HIV from 2006 to 2017, and who

were alive at the end of 2017, who were on ART and had a suppressed viral load.

• UNAIDS 90-90-90 target.

Mortality

AEG

Ministry

of Health

Pharmaceutical

claims

Hospitalisations

Clinical

Teams

Viral load

laboratories

Matching on NHI

McAllister et al. Cascade of care of people diagnosed with HIV in New Zealand between

2006 and 2017. HIV Medicine 2021; 22: 122-130. doi:10.1111/hiv.12983

HIV reported

(2018 – 2019)

n=395

Alive in NZ

n=323

On ART

n=219 (96%)

• Overseas (n=64)

• Died (n=8)

Current ART

unknown

n=7 (3.1%)

Not on ART

n=2 (0.9%)

Suppressed VL

n=218 (99.5%)

VL not suppressed

n=1 (0.5%)

Clinical data not available

• Not yet returned (n=81; 25.1%)

• Current clinician unknown (n=3; 0.9%)

• Initial case report never returned (n=11; 3.4%)

Clinical data

available

n=228 (70.6%)

• Post-diagnosis

forms to clinicians

• Cases notified to the

AEG 2018-2019

Annual data collection

from MoH and laboratories

Quality of life (QoL)

Methods

§ Aotearoa New Zealand Stigma Index

o Meaningful involvement of people living with HIV and AIDS

(MIPA principle)

§ Convenience sample – participants living with HIV aged > 16

years (total participants = 188)

§ In-person interviews

§ AIM: To measure QoL and examine characteristics associated

with QoL in people living with HIV in Aotearoa New Zealand

PozQoL

Not at

all

Slightly

Mod-

erately

Very

Extremely

1. I worry about my health

2. I worry about the impact of HIV on my health

3. I fear the health effects of HIV as I get older

4. I am enjoying life

5. I feel in control of my life

6. I am optimistic about my future

7. I feel good about myself as a person

8. I feel that HIV limits my personal relationships

9. I lack a sense of belonging with people around me

10. I am afraid that people may reject me when they

learn I have HIV

11. I feel that HIV prevents me from doing as much as I

would like

12. Having HIV limits my opportunities in life

13. Managing HIV wears me out

§ PozQoL Scale: 13 questions

– summed score = 13 - 65

§ Low ( 36)

§ Moderate (37-45)

§ High (46-53)

§ Very high ( 54)

Brown G. et al. PozQoL Scale Implementation Kit June 2018 (Revised Sept 2019)

Australian Research Centre in Sex, Health and Society: La Trobe University, Melbourne, Australia:

https://pozqolhome.files.wordpress.com/2019/09/pozqol-implementation-kit-june-2018-revsept2019.pdf

Participants characteristics

188 participants

§ Mean age 47 years

§ 65% men

§ 56% European, 20% Māori; 24% Asian,

African, Pacific and other ethnicities

§ 65% tertiary education

§ 65% employed

§ 75% living in a major urban area

§ 61% living with HIV >10 years

Quality of life PozQoL score

Low

18%

Moderate

22%

High

26%

Very high

34%

Mean summary

score

46.16

Australia

44.62*

Brown G. et al. PozQoL Scale Implementation Kit June 2018 (Revised Sept 2019)

Australian Research Centre in Sex, Health and Society: La Trobe University, Melbourne, Australia:

https://pozqolhome.files.wordpress.com/2019/09/pozqol-implementation-kit-june-2018-revsept2019.pdf

Characteristics associated with lower

mean PozQoL score

Characteristics Co-efficient (95% CI)

Unemployed or on a government benefit -5.02 (-8.48, -1.55)

Unable to meet basic needs -7.47 (-10.56, -4.38)

Diagnosed with HIV within last 5 years -5.48 (-9.54, -1.43)

Poor physical health status -5.43 (-8.96, -1.90)

Mental health condition -5.74 (-8.92, -2.56)

Decided not to have sex in past 12 months -9.03 (-11.98, -6.09)

No support from close people on disclosure

of HIV

-4.71 (-8.00, -1.42)

Experienced stigma or discrimination in the

past 12 months

-5.03 (-8.16, -1.91)

Internalised stigma -2.81 (-3.49, -2.12)

Socio-

demographic

Social

connected

ness

Health-

Stigma

Characteristics associated with lower

mean PozQoL score

Characteristics Co-efficient (95% CI)

Unemployed or on a government benefit -5.02 (-8.48, -1.55)

Unable to meet basic needs -7.47 (-10.56, -4.38)

Diagnosed with HIV within last 5 years -5.48 (-9.54, -1.43)

Poor physical health status -5.43 (-8.96, -1.90)

Mental health condition -5.74 (-8.92, -2.56)

Decided not to have sex in past 12 months -9.03 (-11.98, -6.09)

No support from close people on disclosure

of HIV

-4.71 (-8.00, -1.42)

Experienced stigma or discrimination in the

past 12 months

-5.03 (-8.16, -1.91)

Internalised stigma -2.81 (-3.49, -2.12)

Socio-

demographic

Social

connected

ness

Health-

Stigma

Characteristics associated with lower

mean PozQoL score

Characteristics Co-efficient (95% CI)

Unemployed or on a government benefit -5.02 (-8.48, -1.55)

Unable to meet basic needs -7.47 (-10.56, -4.38)

Diagnosed with HIV within last 5 years -5.48 (-9.54, -1.43)

Poor physical health status -5.43 (-8.96, -1.90)

Mental health condition -5.74 (-8.92, -2.56)

Decided not to have sex in past 12 months -9.03 (-11.98, -6.09)

No support from close people on disclosure

of HIV

-4.71 (-8.00, -1.42)

Experienced stigma or discrimination in the

past 12 months

-5.03 (-8.16, -1.91)

Internalised stigma -2.81 (-3.49, -2.12)

Socio-

demographic

Social

connected

ness

Health-

Stigma

Characteristics associated with lower

mean PozQoL score

Characteristics Co-efficient (95% CI)

Unemployed or on a government benefit -5.02 (-8.48, -1.55)

Unable to meet basic needs -7.47 (-10.56, -4.38)

Diagnosed with HIV within last 5 years -5.48 (-9.54, -1.43)

Poor physical health status -5.43 (-8.96, -1.90)

Mental health condition -5.74 (-8.92, -2.56)

Decided not to have sex in past 12 months -9.03 (-11.98, -6.09)

No support from close people on disclosure

of HIV

-4.71 (-8.00, -1.42)

Experienced stigma or discrimination in the

past 12 months

-5.03 (-8.16, -1.91)

Internalised stigma -2.81 (-3.49, -2.12)

Socio-

demographic

Social

connected

ness

Health-

Stigma

QoL conclusions

§ Greater investment in peer support, and

community welfare programmes to better support

people living with HIV, particularly if they have

poorer health and are unable to work.

§ Stigma reduction campaigns targeting the

broader community

§ Broad and multi-factorial responses required

through cross-sector collaboration.

Total

number

of people

with

HIV

Diagnosed

treatment

Undetect-

able viral

load

Good

quality

of life

90 – 90 – 90

– 90

Cascade of care

Acknowledgements

• Organisers and sponsors of today’s meeting

• Ministry of Health

• Healthcare providers and their support staff

• Miss Ashleigh de Gouw & Dr Jerram Batemen - AIDS Epidemiology Group