Diabetes Among People With Tuberculosis, HIV Infection, Viral Hepatitis B and C, and STDs in New York City, 2006-2010.

Matching infectious disease surveillance data has become a routine activity for many health departments. With the increasing focus on chronic disease, it is also useful to explore opportunities to match infectious and chronic disease surveillance data. To understand the burden of diabetes in New York City (NYC), adults with select infectious diseases (tuberculosis, HIV infection, hepatitis B, hepatitis C, chlamydial infection, gonorrhea, and syphilis) reported between 2006 and 2010 were matched with hemoglobin A1c results reported in the same period. Persons were considered to have diabetes with 2 or more hemoglobin A1c test results of 6.5% or higher. The analysis was restricted to persons who were 18 years or older at the time of first report, either A1c or infectious disease. Overall age-adjusted diabetes prevalence was 8.1%, and diabetes prevalence was associated with increasing age; among NYC residents, prevalence ranged from 0.6% among 18- to 29-year-olds to 22.4% among those 65 years and older. This association was also observed in each infectious disease. Diabetes prevalence was significantly higher among persons with tuberculosis born in Mexico, Jamaica, Honduras, Guyana, Bangladesh, Dominican Republic, the Philippines, and Haiti compared with those born in the United States after adjusting for age and sex. Hepatitis C virus-infected women had higher age-adjusted prevalence of diabetes compared with the NYC population as a whole. Recognizing associations between diabetes and infectious diseases can assist early diagnosis and management of these conditions. Matching chronic disease and infectious disease surveillance data has important implications for local health departments and large health system practices, including increasing opportunities for integrated work both internal to systems and with the local community. Large health systems may consider opportunities for increased collaboration across infectious and chronic disease programs facilitated through data linkages of routinely collected surveillance data.

Factors Associated With Hepatitis C Infection Among HIV-Infected Men Who Have Sex With Men With No Reported Injection Drug Use in New York City, 2000-2010.

BACKGROUND: Hepatitis C (HCV) infection is a major source of morbidity and mortality among HIV-infected patients. Despite decreasing HCV incidence in the United States, the proportion of cases among men who have sex with men (MSM) without history of injection drug use (IDU) in New York City has more than tripled between 2000 and 2010. METHODS: Using matched surveillance data, we identified non-IDU HIV-infected MSM with and without diagnosed HCV. Differences in continuous variables were assessed with Mann-Whitney U tests, and Pearson χ tests were used for categorical variables. Poisson regression was used to compare HCV diagnosis rates by race/ethnicity and sexual transmitted disease history. RESULTS: There were 41,303 non-IDU MSM diagnosed as having HIV before 2010 alive as of 2000, of whom 2016 (4.9%) were diagnosed as having HCV after HIV diagnosis. The HCV diagnosis rate was 605/100,000 person-years. Adjusting for birth year and age at HIV diagnosis, Hispanics (rate ratio [RR], 1.4; 95% confidence interval [CI], 1.2-1.5) and non-Hispanic blacks (RR, 1.6; 95% CI, 1.4-1.8) had higher HCV diagnosis rates than did non-Hispanic whites. Adjusting for race/ethnicity, birth year, and age at HIV diagnosis, MSM diagnosed as having syphilis (RR, 2.5; 95% CI, 2.3-2.8) had higher HCV diagnosis rates than did those without syphilis. CONCLUSIONS: We found a racial/ethnic disparity in HCV diagnosis rates and an association between HCV and syphilis, which is consistent with sexual transmission of HCV. With curative HCV treatment available, emphasis should be placed on adherence to guidelines recommending annual HCV screening for HIV-infected MSM, and education and outreach to MSM to prevent sexually transmitted HCV infections.

Legal and policy barriers to sharing data between public health programs in New York City: a case study.

Integration of public health surveillance data within health departments is important for public health activities and cost-efficient coordination of care. Access to and use of surveillance data are governed by public health law and by agency confidentiality and security policies. In New York City, we examined public health laws and agency policies for data sharing across HIV, sexually transmitted disease, tuberculosis, and viral hepatitis surveillance programs. We found that recent changes to state laws provide greater opportunities for data sharing but that agency policies must be updated because they limit increased data integration. Our case study can help other health departments conduct similar reviews of laws and policies to increase data sharing and integration of surveillance data.

Deaths among people with hepatitis C in New York City, 2000-2011.

BACKGROUND: Infection with hepatitis C virus (HCV) increases the risk of death from liver and nonliver-related diseases. Coinfection with human immunodeficiency virus (HIV) further increases this risk. METHODS: Surveillance data (2000-2010) and mortality data (2000-2011) maintained by the New York City Department of Health and Mental Hygiene (DOHMH) were deterministically cross-matched. Factors associated with and causes of death among HCV-infected adult decedents were analyzed. RESULTS: Between 2000 and 2011, 13 307 HCV-monoinfected adults died, and 5475 adults coinfected with HCV/HIV died. Decedents with HCV monoinfection were more likely to have died of liver cancer (odds ratio [OR] = 9.2), drug-related causes (OR = 4.3), and cirrhosis (OR = 3.7), compared with persons with neither infection. HCV/HIV-coinfected decedents were more likely to have died of liver cancer (OR = 2.2) and drug-related causes (OR = 3.1), compared with persons with neither infection. Among coinfected decedents, 53.6% of deaths were attributed to HIV/AIDS, and 94% of deaths occurred prematurely (before age 65). Among persons with HCV who died, more than half died within 3 years of an HCV report to DOHMH. CONCLUSIONS: HCV-infected adults were at increased risk of dying and of dying prematurely, particularly from conditions associated with HCV, such as HIV/AIDS or drug use. The short interval between HCV report and death suggests a need for earlier testing and improved treatment.

Matching HIV, tuberculosis, viral hepatitis, and sexually transmitted diseases surveillance data, 2000-2010: identification of infectious disease syndemics in New York City.

CONTEXT: In 2012, the New York City Department of Health and Mental Hygiene matched HIV, tuberculosis, viral hepatitis, and sexually transmitted disease surveillance data to identify the burden of infection with multiple diseases. METHODS: HIV, tuberculosis, hepatitis B, hepatitis C, chlamydia, gonorrhea, and syphilis surveillance data from 2000 to 2010 were matched using a deterministic method. Data on deaths from the Department of Health and Mental Hygiene's Office of Vital Statistics were also matched. RESULTS: The final data set contained 840,248 people; 13% had 2 or more diseases. People with a report of syphilis had the highest proportion of matches with other diseases (64%), followed by gonorrhea (52%), HIV (31%), tuberculosis (23%), hepatitis C (20%), chlamydia (16%), and hepatitis B (11%). CONCLUSIONS: The findings indicate several possible infectious disease syndemics in New York City and highlight the need to integrate surveillance data from different infectious disease programs. Conducting the match brought surveillance programs together to work collaboratively and has resulted in ongoing partnerships on programmatic activities that address multiple diseases.

Public health implications of rapid hepatitis C screening with an oral swab for community-based organizations serving high-risk populations.

OBJECTIVES: Between April and September of 2009 we evaluated the accuracy of the OraQuick HCV rapid antibody test and assessed its feasibility for use by community-based organizations (CBOs) serving populations at high risk for HCV in New York City. METHODS: We compared the results of screening by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw). We performed ribonucleic acid polymerase chain reaction testing for discordant results. We also assessed research staff perceptions through a survey and focus group. RESULTS: Overall, 97.5% of OraQuick and EIA results matched. Testing of discordant samples indicated that the rapid test was more likely than the EIA to provide a correct diagnosis. Research staff preferred the rapid test and identified challenges that would be overcome with its use. CBOs could benefit from increased testing capacity, and clients might benefit from more rapid access to education, counseling, and referrals. CONCLUSIONS: OraQuick's accuracy is comparable to the EIA. The oral swab rapid test could help HCV screening programs reach individuals unaware of their status and expand testing into nonclinical settings such as mobile units.