2019 Epidemiologic Profile Of HIV, STDs, TB And Viral .
2019 North DakotaHIV, STI, TB & Viral HepatitisEpidemiologic ProfileMarch 2021www.ndhealth.gov/hiv
This document was authored by the Division of Sexually Transmitted and Bloodborne Diseases:Lindsey VanderBusch, MPHDirector, Division of Sexually Transmitted and Blood Borne DiseaseDelora PritschetTB Prevention and Control CoordinatorSarah Weninger, MPHHIV/STI/Viral Hepatitis Prevention CoordinatorGordana CokrlicRyan White Program CoordinatorShari Renton, MPHHIV/STI/Viral Hepatitis Surveillance CoordinatorNathan Fix, MPHHIV & STI Outreach Coordinator, NDSU2019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile1
Table of ContentsIntroduction . 5Data Sources . 6Maven . 6HIV/AIDS Data Sources . 6STI Data Sources. 7Tuberculosis Surveillance Data . 7Viral Hepatitis Surveillance Data . 7Vital Statistics Data . 8Demographic Data . 8Guidelines to Interpretation of the Data . 8North Dakota Demographics . 9Age and Gender Distribution . 9Race Distribution . 10Social Characteristics . 10HIV Prevalence. 11Age . 11Race . 12Perinatal Exposures . 12Geography . 132019 HIV/AIDS Incidence . 13Gender. 13Age . 14Race . 14Country of Birth . 15Geography . 15Risk of Infection . 16HIV Care – Ryan White Part B Program . 18Gender. 19Age . 19Race . 192019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile2
Geography . 20Poverty Level. 21Housing Status . 21Insurance Status . 22Services . 23ADAP (AIDS Drug Assistance Program) . 24Disparities by Race . 27Disparities by Risk . 28Disparities by Geography. 28Hepatitis B Virus (HBV) . 30Acute HBV . 30Gender. 30Age . 30Race . 31Geography . 32Perinatal Follow-Up . 32Hepatitis C Virus (HCV). 33Acute HCV. 33Gender. 33Age . 34Race . 34Geography . 35Hepatitis C Enhanced Surveillance . 35HIV/AIDS Counseling, Testing and Referral Data . 36Gender Identity . 37Age . 37Race . 38Geography . 38Risk Factors. 39HIV Positives Identified at CTR Sites . 40HIV PrEP Referrals CTR Sites . 402019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile3
Gender. 40Age . 41Race . 41Geography . 42Risk Factors. 42HCV Positives Identified at CTR Sites . 43Chlamydia . 44Gender. 44Age . 45Race . 45Geography . 46Gonorrhea . 46Gender. 47Age . 47Race . 47Risk Factors. 48Geography . 48Syphilis . 49Gender. 49Age . 49Race . 50Risk Factors. 50Geography . 51Tuberculosis Disease . 52Gender. 52Age . 53Race . 53Geography . 54Tuberculosis Infection . 54Appendix A . 57Appendix B . 582019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile4
IntroductionThe HIV, STIs, TB and Viral Hepatitis Epidemiologic Profile describes the epidemiology ofHIV/AIDS; sexually transmitted infections (chlamydia, gonorrhea and syphilis); tuberculosis(latent and active); hepatitis B (HBV); and hepatitis C (HCV) in North Dakota during 2019. Thisprofile covers the general epidemiology of the above conditions in terms of gender, age, race,geography and associated casual factors. This profile was created to assist in developing aComprehensive Jurisdictional HIV and Viral Hepatitis Prevention and Care Plan. Information inthis report is used to characterize and predict the changing epidemic at the local level. NorthDakota data is summarized annually to help North Dakota’s Department of Health (NDDoH)answer questions about how to prevent these diseases in the population.Table 1. Common abbreviations/acronyms used throughout this profileABBREVIATION FULL DESCRIPTIONADAPAIDS Drug Assistance ProgramAIDSAcquired Immunodeficiency SyndromeARTAntiretroviral TherapyCDCCenters for Disease Control & PrEPPWIDRWSTITBCouncil of State and Territorial EpidemiologistsCounseling, Testing and ReferralElectronic HIV/AIDS Reporting SystemHepatitis B VirusHepatitis C VirusHuman Immunodeficiency VirusInjection Drug UseHuman Resources and Services AdministrationMen Who Have Sex with MenNorth Dakota Department of HealthPersons Living With HIV/AIDSPre-exposure prophylaxisPersons Who Inject DrugsRyan WhiteSexually Transmitted InfectionTuberculosis2019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile5
Data SourcesData was compiled from a number of sources to present the most complete picture of theepidemiology of diseases as possible. However, because few behavioral or supplementalsurveillance projects are available in North Dakota, core surveillance data is utilized extensively.Each data source has strengths and limitations. A brief description of each source follows.MavenThe North Dakota Electronic Disease Surveillance System, known as Maven, is an electronicdisease surveillance system that allows public health officials to receive, manage, process andanalyze disease and other condition-related data. Maven offers tools for automatic diseasereporting, case investigations, and case follow-up and management within the state of NorthDakota. It is an integrative system allowing easy sharing and connecting among the NDDoH,local public health, and providers.HIV/AIDS Data SourcesHIV/AIDS Case SurveillanceA diagnosis of HIV/AIDS is a mandatory reportable condition to the NDDoH according to NorthDakota Century Code Chapter 23-07-01 and North Dakota Administrative Code Chapter 33-0601. Reports of HIV/AIDS cases can be provided by physicians, hospitals, laboratories and otherinstitutions. The data is stored in the electronic HIV/AIDS Reporting System (eHARS) and Mavendatabases. Statistics and trends presented in this report were derived from HIV/AIDS case datareported to the NDDoH cumulatively starting in 1984 through December 31, 2019.HIV/HCV Counseling and Testing DataThe NDDoH contracted with 22 Counseling, Testing and Referral (CTR) sites in 2019. CTR sitesoffer free, confidential HIV and HCV rapid and confirmatory testing and counseling in NorthDakota. Participants complete risk assessments as part of their visit. These risk assessmentsalong with demographics, testing history, test results and sexual health history information arereported to the NDDoH via Maven.HIV Care Data/Ryan White Part B ProgramThe North Dakota Ryan White Part B Program assists low-income North Dakota residents livingwith HIV or AIDS to access confidential health and supportive services. The program wasimplemented in 1991. In order to participate in the North Dakota Ryan White Part B Program,one must be a resident of North Dakota, have a gross income of less than 400 percent of thecurrent Federal Poverty Level and have proof of HIV infection.Part B services include core and supportive medical services. Core services includeoutpatient/ambulatory medical services, AIDS Drug Assistance Program (ADAP), oral health care,health insurance premium assistance, mental health services and medical case management.Supportive services include non-medical case management, housing services, medicaltransportation services and emergency financial assistance.2019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile6
The Ryan White Part B Program manages program information using Maven. This has allowedfor integration and sharing of information between HIV Prevention and Surveillance programs.This system ensures that required client-level data elements are collected and reported to HRSA.The “real time” nature of the networked system allows the Ryan White Part B Program tomonitor specific indicators (e.g., number of clients without medical insurance) in a more timelyfashion, and it gives case managers access to view lab work and medication so that clients canbe served more effectively.STI Data SourcesSTI Surveillance Case ReportingThe NDDoH STI Program conducts statewide surveillance to determine the number of reportedcases of STIs. The data is used to monitor trends and to offer voluntary partner counseling andpartner notification services. Chlamydia, gonorrhea and syphilis cases are mandatory reportableconditions in North Dakota. STI surveillance data can serve as surrogate markers for unsafesexual practices and may demonstrate changes in behavior among specific populations thatincrease their risk for HIV infection. Because of a shorter time from infection to symptomaticdisease, STI diagnoses may better indicate recent unsafe behavior and/or changes in communitynorms. In addition, certain STIs can facilitate the transmission of HIV infection.Tuberculosis Surveillance DataTuberculosis (Mycobacterium tuberculosis and Mycobacterium bovis) disease and tuberculosisinfection are mandatory reportable conditions and must be reported to the NDDoH accordingto North Dakota Administrative Code Chapter 33-06. The data are stored within Maven and areused to monitor ongoing treatment and management of tuberculosis disease and tuberculosisinfection. The Maven system also serves as a method of communication between the TBPrevention and Control program and the TB contract pharmacy to ensure timely medicationdispensing.Viral Hepatitis Surveillance DataThe Hepatitis Program receives reports of acute and chronic cases of HBV and HCV infections.HBV infections are investigated to determine if post-exposure immune-prophylaxis proceduresfor contacts were followed. Follow-up is conducted on females of child-bearing age (14 to 49years) who are HBV positive to determine if they are pregnant. Pregnant females who are HBVpositive are then followed by the perinatal HBV prevention coordinator in the immunizationprogram. The coordinator ensures the hospital has HBV immune globulin (HBIG) foradministration to the baby at time of delivery. The coordinator also confirms the baby is giventhe HBV vaccine series and ensures serology testing is done at completion of the vaccine seriesto ensure the child is not infected and is immune to the HBV virus.Cases of HCV that are reported as acute are followed by a case investigation. Cases of HCV thatare determined to be chronic HCV are not routinely investigated. There is no partner notification2019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile7
conducted by the NDDoH. Under-reporting of both acute and chronic HCV infections in NorthDakota is likely. Data reported here does not distinguish between resolved and active infections.Vital Statistics DataBirth and Death DataThe NDDoH Division of Vital Statistics collects information on all births and deaths in NorthDakota. The birth certificate form includes demographic information on the newborn infant andthe parents, prenatal care, maternal medical history, mode of delivery, events of labor andabnormal conditions of the infant. Death certificates include demographics, underlying cause ofdeath and factors contributing to the death. The surveillance program reviews death certificateson a weekly basis to ascertain deaths of HIV-positive persons. The surveillance program alsoelectronically matches data with death and birth databases annually to ascertain deaths ofpersons with HIV/AIDS and births to HIV-infected females.Demographic DataU.S. Census BureauThe Census Bureau collects and provides timely information about the people and economy ofthe United States. The Census Bureau website (http://www.census.gov) includes data ondemographic characteristics (e.g., age, race, ethnicity and sex) of the population, familystructure, educational and income level, housing status and the proportion of persons who liveat or below the poverty line. Summaries of the most requested information for states andcounties are provided, as well as analytical reports on population changes, age, race, familystructure and apportionment. State- and county-specific data are easily accessible and links toother web sites with census information are included. For this report, 2019 population estimatesare used unless otherwise noted.Guidelines to Interpretation of the DataDecisions about how to allocate limited resources for prevention and care services depend, inpart, on appropriate interpretation of epidemiological data. The following guidelines areintended to facilitate proper interpretation of the tables and figures presented in this profile.The data has certain limitations. This report will not specifically differentiate, unless indicated,whether an individual is or is not at the stage of AIDS for HIV infections. The first AIDS casereported in North Dakota was diagnosed in 1984. Reporting of HIV-infected persons in NorthDakota began in 1984. HIV surveillance reports may not be representative of all infectedpersons, because not all infected persons have been tested or reported. Data are collected forthe entire state of North Dakota, which include data for patients who are diagnosed for the firsttime in North Dakota, as well as patients who move to North Dakota after they have beendiagnosed. Data do not necessarily consider emigration out of North Dakota, although effortsare made to account for this in HIV prevalence data. State and county of diagnosis do notchange even if a person moves to a different county or out of state.2019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile8
The data presented in this profile only includes cases that met the current case definitiondocumented by CSTE and CDC. This report does not include cases that have not beendiagnosed by laboratory methods or a healthcare provider.Rates have been calculated for 12-month periods per 100,000 persons. The denominator forcalculating rates, unless otherwise noted, is based on 2019 population estimates from the U.S.Bureau of Census. The numerator is the number of cases reported during the 12-month period.This number is divided by the population estimate and multiplied by 100,000. For example, racespecific rates are the number of cases reported for a racial/ethnic group during the preceding12-month period divided by the estimated population for that race/ethnicity and multiplied by100,000. Those categorized as white are white, alone. Hispanic ethnicity can be of any race. If arace is not included in a graph, it is due to small numbers.The data presented in this report are current as of time of publication. However, thedata may be variable as new information is received and may differ from other reports.North Dakota DemographicsNorth Dakota is a rural state that covers 70,704 square miles and in 2019 had an estimatedpopulation of 762,062, according to the U.S. Census Bureau. North Dakota ranks 47th in thenation by population. It contains 53 incorporated counties and 357 cities. Nine cities havepopulations of more than 10,000, and 20 cities have populations of more than 2,500. Countypopulations in North Dakota range from 750 to 181,923 people. The six counties along theeastern border with Minnesota account for more than one-third of the state’s population.Age and Gender DistributionAt the time of the most current U.S. Census estimates for gender and age (2019), North Dakota’spopulation was 51 percent male and 49 percent female. More than one quarter (28.1%) of NorthDakota’s population is over the age of 55. Of the remaining 71.9 percent, adults ages 20 to 24are disproportionately represented. Within that group, there are 13 percent more males thanfemales. The most considerable discrepancy between males and females is between the ages of25 and 29, where there are nearly 13.3 percent more males than females.Figure 1. North Dakota population by age group and gender, 20192019 North Dakota HIV.STI.TB.Viral Hepatitis Epidemiological Profile9
0085 30-3425-2920-2415-1910-145-9 50Age GroupMaleFemaleSource: U.S Census Data 2019Race DistributionThe majority of North Dakota’s population (89.0%) reports white as their race. The largestminority group is American Indian and Alaskan Native, accounting for 6.9 percent, most ofwhom reside in Rolette and Sioux counties. The African American/Black population follows,accounting for an estimated 3.9 percent of the total population which increased from 2.9percent the previous year.2019Figure 2. North Dakota population by race, 20190%10%20%30%40%50%60%70%80%90%100%White, aloneBlack/African AmericanAmerican Indian/A
It is an integrative system allowing easy sharing and connecting among the NDDoH, local public health, and providers. HIV/AIDS Data Sources HIV/AIDS Case Surveillance A diagnosis of HIV/AIDS is a mandatory reportable condition to the NDDoH according to North Dakota Century Code Chapter 23-07-01 and North Dako
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