Laboratory Enhancement Program HIV Laboratory, Public Health Ontario Updated analyses: January 2009 to December Background
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1 Laboratory Enhancement Program HIV Laboratory, Public Health Ontario Updated analyses: January 2009 to December 2012 Background To enhance laboratory-based HIV surveillance data and to better understand trends in the HIV epidemic in Ontario, we initiated the Laboratory Enhancement Program (LEP) in October The objectives were: 1) to obtain complete and valid risk factor information among persons testing positive and negative for HIV in Ontario; 2) to collect accurate and more complete information on HIV testing history to better quantity the number of HIV-infected persons who have been diagnosed and; 3) to perform HIV incidence testing to detect recent infections and, in turn, to estimate HIV incidence. We send the LEP questionnaire to all physicians prescribing an HIV test with a positive result and a 1 in 200 random sample of HIV-negative tests. The completed questionnaire is returned to us by mail and fax. In January 2009, the questionnaire was modified to add questions on race/ethnicity, country of birth and year of arrival Canada if born outside Canada. Trends in race/ethnicity In the tables below, we analyzed HIV-positive diagnoses by exposure category, race/ethnicity and year of diagnoses from January 2009 to December Analyses by health region are forthcoming. In the four-year period examined, among HIV-positive diagnoses in Ontario, the proportion of cases classified as White decreased, from 56.6% in to 48.7% in (p=0.0003). The proportion of Latin-American persons diagnosed with HIV also decreased, from 7.6% in to 4.4% in 2012 (p=0.01). In contrast, the proportion comprised by Black cases significantly increased, from 22.5% in to 29.4% in (p=0.0003); in 2012, 31.1% of diagnoses were among Black persons. The proportion of South-Asian persons increased slightly, from 3.4% in to 5.0% in 2012 but this was not statistically significant (p=0.10). Among male cases, trends similar to those seen overall were observed. The proportion of HIV diagnoses among White and Latin-American males significantly decreased while the proportion of cases among Black and East/Southeast Asian persons significantly increased. Among females, the proportion comprised by Black cases significantly increased, from 54.7% in to 67.1% in (p=0.009) while the proportion of East/Southeast Asian persons decreased from 5.2% in to 0.5% in (p=0.003). No obvious trends were observed in other race/ethnicities. Trends in exposure category and race/ethnicity Among MSM diagnosed with HIV, the proportion Black increased from 8.9% in to 13.7% in (p=0.009) and the proportion East/Southeast Asian increased from 4.9% in to 7.6% in (p=0.053). However, the proportion White decreased, from 68.2% in to 61.3% in (p=0.01). Among IDU and MSM-IDU together, the proportion Black increased from 4.3% in to 12.5% in 2012 (p=0.064). Among male IDUs, the proportion Aboriginal increased from 9.6% in to 35.3% in 2012 (p=0.01). Among female IDUs, the proportion Black increased significantly, from 0.0% in to 21.7% in (p=0.02). 1
2 Among low-risk heterosexual cases, the proportion Latin-American decreased, from 10.0% in to 3.7% in (p=0.09), mainly due to a decrease among men (11.0% in to 2.0% in , p=0.08). 2
3 Table 1a HIV-positive diagnoses by race/ethnicity and exposure category - both sexes Laboratory Enhancement Program, Ontario, 2009 White % % % 0 0.0% % % % % 0 0.0% % % Black % 1 7.1% 1 2.2% % 0 0.0% % 0 0.0% 0 0.0% % 2 7.4% % Aboriginal 1 0.3% % 4 8.9% 1 1.0% 0 0.0% 1 1.7% 0 0.0% 0 0.0% 0 0.0% 1 3.7% % East/Southeast Asian % 0 0.0% 0 0.0% 4 3.9% % 3 5.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % South Asian % 1 7.1% 0 0.0% 0 0.0% 0 0.0% 5 8.3% % 0 0.0% 0 0.0% % % Latin American % 1 7.1% 1 2.2% 2 2.0% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Arab/West Asian 6 2.1% 0 0.0% 0 0.0% 1 1.0% 0 0.0% 1 1.7% 0 0.0% 0 0.0% 0 0.0% 2 7.4% % Other 5 1.7% 0 0.0% 1 2.2% 2 2.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 8 1.4% Unknown Total % % % % % % % % % % % Table 1b HIV-positive diagnoses by race/ethnicity and exposure category - male Ontario, Laboratory Enhancement Program, 2009 White % % % 0 0.0% % % % % 0 0.0% % % Black % 1 7.1% 1 3.2% % 0 0.0% % 0 0.0% 0 0.0% % 1 4.3% % Aboriginal 1 0.3% % 2 6.5% 1 2.9% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 4.3% 7 1.6% East/Southeast Asian % 0 0.0% 0 0.0% 1 2.9% 0 0.0% 1 2.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % South Asian % 1 7.1% 0 0.0% 0 0.0% 0 0.0% % % 0 0.0% 0 0.0% % % Latin American % 1 7.1% 0 0.0% 2 5.7% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Arab/West Asian 6 2.1% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 2.7% 0 0.0% 0 0.0% 0 0.0% 2 8.7% 9 2.1% Other 5 1.7% 0 0.0% 1 3.2% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 6 1.4% Unknown Total % % % % % % % % % % % 3
4 Table 1c HIV-positive diagnoses by race/ethnicity and exposure category - female Ontario, Laboratory Enhancement Program, 2009 IDU HIV-end HR hetero LR hetero Transfsd CF MTC Unknown Total No. % No. % No. % No. % No. % No. % No. % No. % No. % White % 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% % % Black 0 0.0% % 0 0.0% % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal % 0 0.0% 0 0.0% 1 4.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 3 2.6% East/Southeast Asian 0 0.0% 3 4.5% % 2 8.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 8 7.0% South Asian 0 0.0% 0 0.0% 0 0.0% 1 4.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.9% Latin American 1 7.1% 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 6 5.2% Arab/West Asian 0 0.0% 1 1.5% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.9% Other 0 0.0% 2 3.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 1.7% Unknown Total % % % % 0 0.0% 0 0.0% 0 0.0% % % Note: Male and female tables exclude two cases with unknown sex Proportion expressed as percentage of cases with known race/ethnicity 4
5 Table 2a HIV-positive diagnoses by race/ethnicity and exposure category - both sexes Laboratory Enhancement Program, Ontario, 2010 White % % % 1 1.4% % % % % 0 0.0% % % Black % 0 0.0% 2 5.3% % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 3 1.0% 1 7.1% % 0 0.0% % 4 6.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % East/Southeast Asian % 0 0.0% 0 0.0% 0 0.0% 1 4.0% % 0 0.0% 0 0.0% 0 0.0% 1 4.8% % South Asian 8 2.8% 0 0.0% 0 0.0% 2 2.9% 1 4.0% 4 6.7% 0 0.0% 0 0.0% 0 0.0% 1 4.8% % Latin American % 0 0.0% 0 0.0% 1 1.4% % 4 6.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Arab/West Asian 6 2.1% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 6 1.2% Other 6 2.1% 0 0.0% 1 2.6% 0 0.0% 1 4.0% 1 1.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 9 1.7% Unknown Total % % % % % % % % 0 0.0% % % Table 2b HIV-positive diagnoses by race/ethnicity and exposure category - male Laboratory Enhancement Program, Ontario, 2010 White % % % 0 0.0% % % % % 0 0.0% % % Black % 0 0.0% 2 7.1% % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 3 1.0% 1 7.1% % 0 0.0% 0 0.0% 1 2.8% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 9 2.1% East/Southeast Asian % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% 0 0.0% 1 6.3% % South Asian 8 2.8% 0 0.0% 0 0.0% 1 4.2% 1 8.3% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Latin American % 0 0.0% 0 0.0% 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Arab/West Asian 6 2.1% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 6 1.4% Other 6 2.1% 0 0.0% 1 3.6% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 7 1.7% Unknown Total % % % % % % % % 0 0.0% % % 5
6 Table 2c HIV-positive diagnoses by race/ethnicity and exposure category - female Laboratory Enhancement Program, Ontario, 2010 IDU HIV-end HR hetero LR hetero Transfsd CF MTC Unknown Total No. % No. % No. % No. % No. % No. % No. % No. % No. % White % 1 2.2% % % 0 0.0% 0 0.0% 0 0.0% % % Black 0 0.0% % 0 0.0% % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal % 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 9 9.3% East/Southeast Asian 0 0.0% 0 0.0% 1 7.7% 2 8.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 3 3.1% South Asian 0 0.0% 1 2.2% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % 2 2.1% Latin American 0 0.0% 1 2.2% 1 7.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 2.1% Arab/West Asian 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 0 0.0% 0 0.0% 1 7.7% 1 4.2% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 2.1% Unknown Total % % % % 0 0.0% 0 0.0% 0 0.0% % % Note: Male and female tables exclude one case with unknown sex Proportion expressed as percentage of cases with known race/ethnicity 6
7 Table 3a HIV-positive diagnoses by race/ethnicity and exposure category - both sexes Laboratory Enhancement Program, Ontario, 2011 White % % % 0 0.0% % % % 0 0.0% 0 0.0% % % Black % 1 6.7% 2 5.6% % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 3 1.1% % % 0 0.0% % 2 5.4% % 0 0.0% 0 0.0% 1 4.3% % East/Southeast Asian % 1 6.7% 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % South Asian 7 2.5% 0 0.0% 0 0.0% 1 1.0% % 2 5.4% 0 0.0% 0 0.0% 0 0.0% % % Latin American % 1 6.7% 0 0.0% 4 3.9% 1 6.7% 2 5.4% 0 0.0% 0 0.0% 0 0.0% 2 8.7% % Arab/West Asian 5 1.8% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 4.3% 6 1.2% Other 8 2.8% 0 0.0% 2 5.6% 2 2.0% 0 0.0% 2 5.4% 0 0.0% 0 0.0% 0 0.0% 1 4.3% % Unknown Total % % % % % % % 0 0.0% 0 0.0% % % Table 3b HIV-positive diagnoses by race/ethnicity and exposure category - male Laboratory Enhancement Program, Ontario, 2011 White % % % 0 0.0% % % % 0 0.0% 0 0.0% % % Black % 1 6.7% 0 0.0% % 0 0.0% 2 9.1% 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 3 1.1% % 2 8.3% 0 0.0% % 1 4.5% % 0 0.0% 0 0.0% 0 0.0% % East/Southeast Asian % 1 6.7% 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % South Asian 7 2.5% 0 0.0% 0 0.0% 1 2.4% % 1 4.5% 0 0.0% 0 0.0% 0 0.0% % % Latin American % 1 6.7% 0 0.0% 2 4.8% 0 0.0% 1 4.5% 0 0.0% 0 0.0% 0 0.0% % % Arab/West Asian 5 1.8% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 5.6% 6 1.5% Other 8 2.8% 0 0.0% 2 8.3% 0 0.0% 0 0.0% 2 9.1% 0 0.0% 0 0.0% 0 0.0% 1 5.6% % Unknown Total % % % % % % % 0 0.0% 0 0.0% % % 7
8 Table 3c HIV-positive diagnoses by race/ethnicity and exposure category - female Laboratory Enhancement Program, Ontario, 2011 IDU HIV-end HR hetero LR hetero Transfsd CF MTC Unknown Total No. % No. % No. % No. % No. % No. % No. % No. % No. % White % 0 0.0% % % % 0 0.0% 0 0.0% % % Black % % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal % 0 0.0% 1 9.1% 1 6.7% 0 0.0% 0 0.0% 0 0.0% % 5 4.8% East/Southeast Asian 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% South Asian 0 0.0% 0 0.0% 0 0.0% 1 6.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 1.0% Latin American 0 0.0% 2 3.3% 1 9.1% 1 6.7% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 4 3.8% Arab/West Asian 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 0 0.0% 2 3.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 1.9% Unknown Total % % % % % 0 0.0% 0 0.0% % % Note: Proportion expressed as percentage of cases with known race/ethnicity 8
9 Table 4a HIV-positive diagnoses by race/ethnicity and exposure category - both sexes Laboratory Enhancement Program, Ontario, 2012 White % % % 1 1.0% % % 0 0.0% 0 0.0% 0 0.0% % % Black % % % % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 1 0.3% % % 0 0.0% 0 0.0% 3 6.7% 0 0.0% 0 0.0% 0 0.0% 1 3.7% % East/Southeast Asian % 0 0.0% 0 0.0% 1 1.0% 0 0.0% 2 4.4% 0 0.0% 0 0.0% 0 0.0% 2 7.4% % South Asian % 0 0.0% 0 0.0% 0 0.0% % 4 8.9% 0 0.0% 0 0.0% % % % Latin American % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 2.2% 0 0.0% 0 0.0% 0 0.0% 1 3.7% % Arab/West Asian 3 1.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 4 8.9% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 7 1.3% Other 8 2.6% 0 0.0% 0 0.0% 1 1.0% 0 0.0% 2 4.4% % 0 0.0% 0 0.0% 0 0.0% % Unknown Total % % % % % % % 0 0.0% % % % Table 4b HIV-positive diagnoses by race/ethnicity and exposure category - male Laboratory Enhancement Program, Ontario, 2012 White % % % 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% % % Black % % 0 0.0% % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 1 0.3% % % 0 0.0% 0 0.0% 1 3.6% 0 0.0% 0 0.0% 0 0.0% 1 4.0% % East/Southeast Asian % 0 0.0% 0 0.0% 1 3.3% 0 0.0% 1 3.6% 0 0.0% 0 0.0% 0 0.0% 2 8.0% % South Asian % 0 0.0% 0 0.0% 0 0.0% % % 0 0.0% 0 0.0% 0 0.0% % % Latin American % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 4.0% % Arab/West Asian 3 1.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 7 1.6% Other 8 2.6% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 3.6% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 9 2.1% Unknown Total % % % % % % 0 0.0% 0 0.0% 0 0.0% % % 9
10 Table 4c HIV-positive diagnoses by race/ethnicity and exposure category - female Laboratory Enhancement Program, Ontario, 2012 IDU HIV-end HR hetero LR hetero Transfsd CF MTC Unknown Total No. % No. % No. % No. % No. % No. % No. % No. % No. % White % 1 1.4% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Black % % % % 0 0.0% 0 0.0% 0 0.0% % % Aboriginal 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 1.8% East/Southeast Asian 0 0.0% 0 0.0% 0 0.0% 1 5.9% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.9% South Asian 0 0.0% 0 0.0% % 1 5.9% 0 0.0% 0 0.0% % 0 0.0% 3 2.7% Latin American 0 0.0% 0 0.0% 0 0.0% 1 5.9% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.9% Arab/West Asian 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 0 0.0% 1 1.4% 0 0.0% 1 5.9% % 0 0.0% 0 0.0% 0 0.0% 3 2.7% Unknown Total % % % % % 0 0.0% % % % Note: Male and female tables exclude one case with unknown sex Proportion expressed as percentage of cases with known race/ethnicity 10
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