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Yang Z, Wei L, Xu Z, Li S, Xing Y, Zhang Y, Yuan Y, Liu S, Xie W, Tan W, Ye W, Tan J, Shi X, Yan X, Feng T, Jia Z, Zhao J. HIV risk and influence factors among MSM who had sought sexual partners in core venues: a continuous sentinel surveillance in 2010-2022. Front Public Health 2024; 12:1476642. [PMID: 39737462 PMCID: PMC11683098 DOI: 10.3389/fpubh.2024.1476642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 11/14/2024] [Indexed: 01/01/2025] Open
Abstract
Background Seeking sexual partners in men who have sex with men (MSM) venues has been regarded as a high-risk behavior for HIV among MSM. Nevertheless, with the implementation of venue-based interventions and the change in the way MSM seek sexual partners, the continued status of MSM venues as the HIV risk factor remains inconclusive. This study endeavors to delve into this ambiguity by examining the MSM sexual contact network (SCN) as a foundation. Methods A series of cross-sectional surveys were conducted in Shenzhen in the period 2010-2022. MSM sexual contact network and venue network were acquired, and network metrics were employed to identify core MSM and core venues. We compared the risk of HIV and risk behaviors between MSM who sought sexual partners in core venues and those who did not, with subgroup analyses based on different time periods. Results The overall HIV prevalence among the 4,408 MSM surveyed in this study was 14.6%. Notably, 17 core venues were identified out of the 68 reported MSM venues, with 1,486 MSM who had sought sexual partners in core venues. These MSM had significantly higher risk of HIV and were more likely to take HIV testing and receive intervention services. Subgroup analyses showed that the heightened HIV risk associated with seeking partners in core venues was specific to the period 2010-2014, while HIV testing and service access remained consistently higher across all-period subgroups. Multiple sexual partners, seeking partners in core venues, receptive or both sexual roles, drug abuse, absence of HIV test, unprotected anal intercourse (UAI), and lower education levels were associated with elevated HIV risk among MSM. Conclusion Following the implementation of differentiated venue-based interventions, the risk of HIV among MSM who had sought sexual partners in core venues decreased to a level comparable to that of MSM who had not. The accessibility of HIV testing and intervention services remains uneven between MSM who had sought sexual partners in core venues and those who had not. As the Internet sex-seeking behavior gains prevalence among MSM, strategic adjustments of public health resource allocation may be necessary to address this imbalance.
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Affiliation(s)
- Zijie Yang
- School of Public Health, Peking University, Beijing, China
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lan Wei
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhongliang Xu
- Nanshan Center for Disease Control and Prevention, Shenzhen, China
| | - Simei Li
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yiwen Xing
- School of Public Health, Peking University, Beijing, China
| | - Yan Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yuan Yuan
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Shaochu Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Xie
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Tan
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Ye
- Nanshan Center for Disease Control and Prevention, Shenzhen, China
| | - Jingguang Tan
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiangdong Shi
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiangyu Yan
- School of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Tiejian Feng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Williams LD, van Heerden A, Friedman SR, Chibi B, Memela P, Rodriguez WA, Joseph P. Comparison of a novel expanded social network recruitment intervention with risk network recruitment to HIV testing: locating undiagnosed cases in South Africa. AIDS 2024; 38:1861-1865. [PMID: 38959096 DOI: 10.1097/qad.0000000000003976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To ascertain whether a novel expanded social network recruitment to HIV testing (E-SNRHT) intervention recruits men and individuals with previously undiagnosed HIV at higher rates than risk network recruitment. DESIGN Initial "seed" participants were prospectively randomly assigned to the E-SNRHT intervention or to risk network recruitment. Their network members were included in the study arm of their recruiter. SETTING Three Department of Health clinics and two drug treatment centers (DTCs) in the Msunduzi municipality of KwaZulu-Natal, South Africa. PARTICIPANTS Clinics and DTCs referred 110 newly HIV-diagnosed adult "seeds" to the study from June 2022 to February 2023. E-SNRHT seeds were asked to recruit network members as described below; risk network recruitment arm seeds were asked to recruit recent sex and/or injection partners. Presenting a recruitment coupon (from clinic/DTC staff or another participant) was required for eligibility. INTERVENTION E-SNRHT seeds were shown educational material about HIV transmission risks and then asked to recruit anyone they know (e.g., friends, family) whom they thought could benefit from HIV testing. MAIN OUTCOME MEASURES Rates of recruiting men to HIV testing and locating individuals with previously undiagnosed HIV. RESULTS E-SNRHT recruited significantly higher proportions of men to HIV testing (70.3 vs. 40.4%; χ2 = 16.33; P < 0.0005) and located significantly more previously undiagnosed cases of HIV per seed than risk network recruitment (rate ratio = 9.40; P < 0.0001). E-SNRHT also recruited significantly higher proportions of women with previously undiagnosed HIV (29.0 vs. 10.7%; χ2 = 3.87; P = 0.049). CONCLUSION E-SNRHT is an important strategy to expand the reach of HIV testing among men and undiagnosed cases of HIV in KwaZulu-Natal.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, Illinois, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Buyisile Chibi
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Phumlani Memela
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Wendy Avila Rodriguez
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, Illinois, USA
| | - Phillip Joseph
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
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3
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Williams LD, van Heerden A, Friedman SR, Chibi B, Rodriguez WA, Memela P. Changes in Stigma and Social Support among Participants in a Randomized Trial of a Novel Expanded Social Network-based HIV Testing Intervention in KwaZulu-Natal, South Africa. AIDS Behav 2024; 28:2619-2629. [PMID: 38833064 DOI: 10.1007/s10461-024-04379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
HIV-related stigma is a well-documented barrier to HIV testing in South Africa, and may be particularly likely to create reluctance to test among South African men, who have reported feeling blamed for HIV by their partners and communities. The present study presents a novel expanded social network recruitment to HIV testing (E-SNRHT) intervention explicitly designed to reduce stigma as a barrier to testing by asking people to recruit anyone they know to testing, thus allowing them to avoid the potential for increased stigma and/or blame associated with direct risk partner recruitment, and helping to normalize openly discussing HIV among social networks. We examined baseline and 6-10-week follow-up data from a 2022-2023 randomized trial in KwaZulu-Natal, South Africa that recruited 110 individuals who had been newly diagnosed with HIV and randomly assigned them to recruit people to HIV testing either via the E-SNRHT intervention or via risk network recruitment. Participants in the E-SNRHT intervention reported significant decreases in anticipated and enacted HIV-related stigma between baseline and follow-up; and the E-SNRHT intervention was more effective at decreasing enacted HIV-related stigma than was risk network recruitment. Individuals newly diagnosed with HIV by the E-SNRHT intervention reported significant increases in social support between intervention enrollment and follow-up, and all of these individuals reported participating in positive conversations about HIV services with peers in the 6-10 weeks after intervention enrollment. These findings suggest that E-SNRHT is a potentially important strategy to reduce HIV-related stigma as a barrier to HIV testing among peer networks in KwaZulu-Natal.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA.
| | - Alastair van Heerden
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel R Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Buyisile Chibi
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
| | - Wendy Avila Rodriguez
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Phumlani Memela
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Sweetwaters, KwaZulu-Natal, South Africa
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Williams LD, van Heerden A, Ntinga X, Nikolopoulos GK, Paraskevis D, Friedman SR. Pilot Testing Two Versions of a Social Network Intervention to Increase HIV Testing and Case-finding among Men in South Africa's Generalized HIV Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:54. [PMID: 38248519 PMCID: PMC10815189 DOI: 10.3390/ijerph21010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
Locating undiagnosed HIV infections is important for limiting transmission. However, there is limited evidence about how best to do so. In South Africa, men have been particularly challenging to reach for HIV testing due, in part, to stigma. We pilot-tested two versions of a network-based case-finding and care-linkage intervention. The first, TRIP, asked "seeds" (original participants) to recruit their sexual and/or injection partners. The second, TRIPLE, aimed to circumvent some stigma-related issues by asking seeds to recruit anyone they know who might be at risk of being HIV-positive-unaware. We recruited 11 (18% male) newly diagnosed HIV-positive (NDP) seeds from two clinics in KwaZulu-Natal, South Africa and randomly assigned them to either TRIP or TRIPLE. Network members were recruited two steps from each seed. The TRIP arm recruited 12 network members; the TRIPLE arm recruited 62. Both arms recruited NDPs at higher rates than local clinic testing, with TRIP (50.0%) outperforming (p = 0.012) TRIPLE (14.5%). However, TRIPLE (53.2%) was far superior to clinics (27.8%) and to TRIP (25.0%) at recruiting men. Given challenges around testing and treating men for HIV in this context, these findings suggest that the TRIPLE expanded network-tracing approach should be tested formally among larger samples in multiple settings.
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Affiliation(s)
- Leslie D. Williams
- Division of Community Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL 60612, USA
| | - Alastair van Heerden
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg 3201, South Africa
| | - Xolani Ntinga
- Sweetwaters Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg 3201, South Africa
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Samuel R. Friedman
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA
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Zhou Y, Cui M, Hong Z, Huang S, Zhou S, Lyu H, Li J, Lin Y, Huang H, Tang W, Sun C, Huang W. High Genetic Diversity of HIV-1 and Active Transmission Clusters among Male-to-Male Sexual Contacts (MMSCs) in Zhuhai, China. Viruses 2023; 15:1947. [PMID: 37766353 PMCID: PMC10535991 DOI: 10.3390/v15091947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Monitoring genetic diversity and recent HIV infections (RHIs) is critical for understanding HIV epidemiology. Here, we report HIV-1 genetic diversity and RHIs in blood samples from 190 HIV-positive MMSCs in Zhuhai, China. MMSCs with newly reported HIV were enrolled from January 2020 to June 2022. A nested PCR was performed to amplify the HIV polymerase gene fragments at HXB2 positions 2604-3606. We constructed genetic transmission network at both 0.5% and 1.5% distance thresholds using the Tamura-Nei93 model. RHIs were identified using a recent infection testing algorithm (RITA) combining limiting antigen avidity enzyme immunoassay (LAg-EIA) assay with clinical data. The results revealed that 19.5% (37/190) were RHIs and 48.4% (92/190) were CRF07_BC. Two clusters were identified at a 0.5% distance threshold. Among them, one was infected with CRF07_BC for the long term, and the other was infected with CRF55_01B recently. We identified a total of 15 clusters at a 1.5% distance threshold. Among them, nine were infected with CRF07_BC subtype, and RHIs were found in 38.8% (19/49) distributed in eight genetic clusters. We identified a large active transmission cluster (n = 10) infected with a genetic variant, CRF79_0107. The multivariable logistic regression model showed that clusters were more likely to be RHIs (adjusted OR: 3.64, 95% CI: 1.51~9.01). The RHI algorithm can help to identify recent or ongoing transmission clusters where the prevention tools are mostly needed. Prompt public health measures are needed to contain the further spread of active transmission clusters.
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Affiliation(s)
- Yi Zhou
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China;
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
| | - Mingting Cui
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China;
| | - Zhongsi Hong
- Department of Infectious Diseases, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519001, China
| | - Shaoli Huang
- School of Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | - Shuntai Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hang Lyu
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
| | - Jiarun Li
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
| | - Yixiong Lin
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
| | - Huitao Huang
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou 510315, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou 510315, China
- University of North Carolina Project-China, Guangzhou 510315, China
| | - Caijun Sun
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China;
- Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
| | - Wenyan Huang
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai 519060, China; (H.L.); (H.H.)
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Garcia M, Devlin S, Kerman J, Fujimoto K, Hirschhorn LR, Phillips II G, Schneider J, McNulty MC. Ending the HIV Epidemic: Identifying Barriers and Facilitators to Implement Molecular HIV Surveillance to Develop Real-Time Cluster Detection and Response Interventions for Local Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3269. [PMID: 36833963 PMCID: PMC9964218 DOI: 10.3390/ijerph20043269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The rapid implementation of molecular HIV surveillance (MHS) has resulted in significant challenges for local health departments to develop real-time cluster detection and response (CDR) interventions for priority populations impacted by HIV. This study is among the first to explore professionals' strategies to implement MHS and develop CDR interventions in real-world public health settings. Methods: Semi-structured qualitative interviews were completed by 21 public health stakeholders in the United States' southern and midwestern regions throughout 2020-2022 to identify themes related to the implementation and development of MHS and CDR. Results for the thematic analysis revealed (1) strengths and limitations in utilizing HIV surveillance data for real-time CDR; (2) limitations of MHS data due to medical provider and staff concerns related to CDR; (3) divergent perspectives on the effectiveness of partner services; (4) optimism, but reluctance about the social network strategy; and (5) enhanced partnerships with community stakeholders to address MHS-related concerns. Conclusions: Enhancing MHS and CDR efforts requires a centralized system for staff to access public health data from multiple databases to develop CDR interventions; designating staff dedicated to CDR interventions; and establishing equitable meaningful partnerships with local community stakeholders to address MHS concerns and develop culturally informed CDR interventions.
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Affiliation(s)
- Moctezuma Garcia
- Department of Social Work, College of Health & Sciences, San José State University, San Jose, CA 95112, USA
| | - Samantha Devlin
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Jared Kerman
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX 77030, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gregory Phillips II
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Moira C. McNulty
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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Nikolopoulos GK, Tsantes AG. Recent HIV Infection: Diagnosis and Public Health Implications. Diagnostics (Basel) 2022; 12:2657. [PMID: 36359500 PMCID: PMC9689622 DOI: 10.3390/diagnostics12112657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 08/15/2024] Open
Abstract
The early period of infection with human immunodeficiency virus (HIV) has been associated with higher infectiousness and, consequently, with more transmission events. Over the last 30 years, assays have been developed that can detect viral and immune biomarkers during the first months of HIV infection. Some of them depend on the functional properties of antibodies including their changing titers or the increasing strength of binding with antigens over time. There have been efforts to estimate HIV incidence using antibody-based assays that detect recent HIV infection along with other laboratory and clinical information. Moreover, some interventions are based on the identification of people who were recently infected by HIV. This review summarizes the evolution of efforts to develop assays for the detection of recent HIV infection and to use these assays for the cross-sectional estimation of HIV incidence or for prevention purposes.
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Affiliation(s)
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece
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Spillover benefit of pre-exposure prophylaxis for HIV prevention: evaluating the importance of effect modification using an agent-based model. Epidemiol Infect 2022; 150:e192. [PMID: 36305040 PMCID: PMC9723998 DOI: 10.1017/s0950268822001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We developed an agent-based model using a trial emulation approach to quantify effect measure modification of spillover effects of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) in the Atlanta-Sandy Springs-Roswell metropolitan area, Georgia. PrEP may impact not only the individual prescribed, but also their partners and beyond, known as spillover. We simulated a two-stage randomised trial with eligible components (≥3 agents with ≥1 HIV+ agent) first randomised to intervention or control (no PrEP). Within intervention components, agents were randomised to PrEP with coverage of 70%, providing insight into a high PrEP coverage strategy. We evaluated effect modification by component-level characteristics and estimated spillover effects on HIV incidence using an extension of randomisation-based estimators. We observed an attenuation of the spillover effect when agents were in components with a higher prevalence of either drug use or bridging potential (if an agent acts as a mediator between ≥2 connected groups of agents). The estimated spillover effects were larger in magnitude among components with either higher HIV prevalence or greater density (number of existing partnerships compared to all possible partnerships). Consideration of effect modification is important when evaluating the spillover of PrEP among MSM.
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Schneider JA, Hayford C, Hotton A, Tabidze I, Wertheim JO, Ramani S, Hallmark C, Morgan E, Janulis P, Khanna A, Ozik J, Fujimoto K, Flores R, D'aquila R, Benbow N. Do partner services linked to molecular clusters yield people with viremia or new HIV? AIDS 2022; 36:845-852. [PMID: 34873085 PMCID: PMC9397139 DOI: 10.1097/qad.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago. DESIGN Historical cohort study. METHODS We matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012-2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0.5% and identified clusters exhibiting recent and rapid growth according to the Centers for Disease Control and Prevention definition (three new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression. RESULTS There were 5208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% MSM. Of the 537 named partners, 191 (35.6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster [adjusted relative risk 1.82, (0.81-4.06)]. CONCLUSION Partner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.
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Affiliation(s)
- John A Schneider
- University of Chicago Medicine
- Chicago Center for HIV Elimination
| | | | | | | | - Joel O Wertheim
- Department of Medicine, University of California, San Diego, La Jolla, California
| | | | | | - Ethan Morgan
- College of Public Health, Ohio State University, Columbus, Ohio
| | | | - Aditya Khanna
- School of Public Health, Brown University, Providence, Rhode Island
| | - Jonathan Ozik
- Chicago Center for HIV Elimination
- Department of Public Health Science, University of Chicago, Chicago, Illinois
| | - Kayo Fujimoto
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rey Flores
- University of Chicago Medicine
- Chicago Center for HIV Elimination
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10
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Dangerfield DT, Ober AJ, Anderson JN, Gorbach P, Bluthenthal RN. Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men. Public Health Nurs 2022; 39:153-160. [PMID: 34403517 PMCID: PMC8766864 DOI: 10.1111/phn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. METHODS Go-alongs with two virally suppressed BSMM LWHIV supplemented 27 in-depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go-alongs involved accompanying participants' follow-up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient-provider interactions. RESULTS We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient-provider interactions, and personal motivations to achieve viral suppression. CONCLUSION Clinic accessibility, co-located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV.
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Affiliation(s)
| | - Allison J. Ober
- Policy and Behavioral Science Researcher, RAND Corporation, Los Angeles, CA, USA
| | - Janeane N. Anderson
- Assitant Professor, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamina Gorbach
- Professor, University of California Los Angeles, Los Angeles, CA, USA
| | - Ricky N. Bluthenthal
- Professor, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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11
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Improving HIV Self-Testing Social Network Interventions: The Role of Sexual Behavior Disclosure Among Chinese Men Who Have Sex with Men. AIDS Behav 2021; 25:1984-1992. [PMID: 33471242 DOI: 10.1007/s10461-020-03128-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
We assessed if same-sex sexual behavior disclosure of index men who have sex with men (MSM) was related to number of HIV self-testing (HIVST) kits requested by index participants, and number of test results successfully uploaded by alters in a network-based HIVST intervention. Index participants are men who accessed and distributed HIVST kits and alters are index's social contacts who received kits. We analyzed treatment arm data [N = 106, mean age = 27 (SD = 5.3)] of an intervention conducted among MSM in Guangzhou, China, May 2019-December 2019. Index MSM who disclosed sexual behavior to their family tended to request more kits [adjusted incidence rate ratio (aIRR) 1.42, 95% CI 1.06, 1.90, p < .05]. Index men who disclosed sexual behavior to their family (aIRR 2.47, 95% CI 1.17, 5.24, p < .05) tended to yield an increase in number of alter test results uploaded. Findings have implications for the development of network-based interventions for key populations.
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Dennis AM, Cressman A, Pasquale D, Frost SDW, Kelly E, Guy J, Mobley V, Samoff E, Hurt CB, Mcneil C, Hightow-Weidman L, Carry M, Hogben M, Seña AC. Intersection of Syphilis and HIV Networks to Identify Opportunities to Enhance HIV Prevention. Clin Infect Dis 2021; 74:498-506. [PMID: 33978757 DOI: 10.1093/cid/ciab431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV and syphilis infection continue at disproportionate rates among minority men who have sex with men (MSM) in the United States. The integration of HIV genetic clustering with partner services can provide important insight into local epidemic trends to guide interventions and control efforts. METHODS We evaluated contact networks of index persons defined as minority men and transgender women diagnosed with early syphilis and/or HIV infection between 2018-2020 in two North Carolina regions. HIV clusters were constructed from pol sequences collected through statewide surveillance. A combined "HIV-risk" network, which included persons with any links (genetic or sexual contact) to HIV-positive persons, was evaluated by component size, demographic factors, and HIV viral suppression. RESULTS In total, 1,289 index persons were identified and 55% named 1,153 contacts. Most index persons were Black (88%) and young (median age 30 years); 70% had early syphilis and 43% had prevalent HIV infection. Most people with HIV (65%) appeared in an HIV cluster. The combined HIV-risk network (1,590 contact network and 1,500 cluster members) included 287 distinct components; however, 1,586 (51%) were in a single component. Fifty-five percent of network members with HIV had no evidence of viral suppression. Overall, fewer index persons needed to be interviewed to identify one HIV-positive member without viral suppression (1.3 versus 4.0 for contact tracing). CONCLUSIONS Integration of HIV clusters and viral loads illuminate networks with high HIV prevalence, indicating recent and ongoing transmission. Interventions intensified towards these networks may efficiently reach persons for HIV prevention and care re-engagement.
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Affiliation(s)
- Ann M Dennis
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Cressman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dana Pasquale
- Department of Sociology, Duke University, Durham, NC, USA
| | - Simon D W Frost
- Microsoft Research, Redmond, WA, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Kelly
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jalila Guy
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victoria Mobley
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Erika Samoff
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Christopher B Hurt
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Candice Mcneil
- Section of Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Monique Carry
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Hogben
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Arlene C Seña
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
BACKGROUND Sexual network degree, a count of ongoing partnerships, plays a critical role in the transmission dynamics of human immunodeficiency virus and other sexually transmitted infections. Researchers often quantify degree using self-reported cross-sectional data on the day of survey, which may result in bias because of uncertainty about future sexual activity. METHODS We evaluated the bias of a cross-sectional degree measure with a prospective cohort study of men who have sex with men (MSM). At baseline, we asked men about whether recent sexual partnerships were ongoing. We confirmed the true, ongoing status of those partnerships at baseline at follow-up. With logistic regression, we estimated the partnership-level predictors of baseline measure accuracy. With Poisson regression, we estimated the longitudinally confirmed degree as a function of baseline predicted degree. RESULTS Across partnership types, the baseline ongoing status measure was 70% accurate, with higher negative predictive value (91%) than positive predictive value (39%). Partnership exclusivity and racial pairing were associated with higher accuracy. Baseline degree generally overestimated confirmed degree. Bias, or number of ongoing partners different than predicted at baseline, was -0.28 overall, ranging from -1.91 to -0.41 for MSM with any ongoing partnerships at baseline. Comparing MSM of the same baseline degree, the level of bias was stronger for black compared with white MSM, and for younger compared with older MSM. CONCLUSIONS Research studies may overestimate degree when it is quantified cross-sectionally. Adjustment and structured sensitivity analyses may account for bias in studies of human immunodeficiency virus or sexually transmitted infection prevention interventions.
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14
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Popovich KJ, Snitkin ES, Zawitz C, Aroutcheva A, Payne D, Thiede SN, Schoeny M, Green SJ, Hayden MK, Hota B, Weinstein RA. Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks. Clin Infect Dis 2021; 71:323-331. [PMID: 31425575 DOI: 10.1093/cid/ciz818] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. METHODS Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks.We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. RESULTS There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001). CONCLUSIONS A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Chad Zawitz
- Clinical Coordinator of HIV and Infectious Disease Services, Cermak Health Services, Cook County Health, Chicago, Illinois, USA
| | - Alla Aroutcheva
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Darjai Payne
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Stephanie N Thiede
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Stefan J Green
- Sequencing Core and Associate Director, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Bala Hota
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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15
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Popovich KJ. Using Genomic Sequencing to Delineate Community Networks of Methicillin-Resistant Staphylococcus aureus Transmission Among Men Who Have Sex With Men. J Infect Dis 2021; 223:543-546. [PMID: 33057661 PMCID: PMC7904285 DOI: 10.1093/infdis/jiaa652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Chicago, Illinois, USA
- Cook County Health, Chicago, Illinois, USA
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16
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Pagkas-Bather J, Young LE, Chen YT, Schneider JA. Social Network Interventions for HIV Transmission Elimination. Curr HIV/AIDS Rep 2021; 17:450-457. [PMID: 32720253 PMCID: PMC7497372 DOI: 10.1007/s11904-020-00524-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of Review Network interventions for HIV prevention represent a potential area for growth in a globalizing world, where persons are more easily connected to one another through social media and networking applications. The basic tenets of network interventions such as (1) selection of a change agent, (2) segmentation, (3) induction, and (4) alteration represent myriad ways to structure network interventions for HIV prevention with the potential for large public health impact. Recent Findings Recent studies have employed the use of social networking websites such as Facebook to identify key persons to recruit others and disseminate information aimed at decreasing HIV transmission and improving safe sex practices among groups who are more vulnerable to HIV acquisition. Many of these interventions have successfully decreased HIV risk behaviors as well as decreased the spread of HIV among intervention cohorts. Summary Network interventions for HIV prevention provide more opportunities to reach populations who have not been reached through typical efforts employed in clinical and public health settings, though they are not currently widely employed by the public health community and other stakeholders.
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Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA. .,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
| | - Lindsay E Young
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - Yen-Tyng Chen
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Chicago Center for HIV Elimination, 5841 South Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, 60637, USA
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17
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Palmer S, Dijkstra M, Ket JCF, Wahome EW, Walimbwa J, Gichuru E, van der Elst EM, Schim van der Loeff MF, de Bree GJ, Sanders EJ. Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis. J Int AIDS Soc 2020; 23 Suppl 6:e25590. [PMID: 33000916 PMCID: PMC7527764 DOI: 10.1002/jia2.25590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. METHODS We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). RESULTS Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. CONCLUSIONS Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
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Affiliation(s)
- Shaun Palmer
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- International AIDS Vaccine InitiativeAmsterdamthe Netherlands
| | - Maartje Dijkstra
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Johannes CF Ket
- Medical LibraryVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elizabeth W Wahome
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | | | - Evanson Gichuru
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Elise M van der Elst
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Godelieve J de Bree
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- Department of Global Health, and Amsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
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18
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Korobchuk A, Davtyan H, Denisiuk O, Zachariah R, Nikolopoulos GK, Paraskevis D, Skaathun B, Schneider J, Vasylyeva TI, Williams LD, Smyrnov P, Friedman SR. People with high HIV viral load within risk networks: who are these people and who refers them best? J Infect Dev Ctries 2020; 13:103S-110S. [PMID: 31592313 PMCID: PMC6779172 DOI: 10.3855/jidc.11273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Viral load is one of the most important determinants for HIV transmission. Identification of people with high viral load (PHVL) can be effective in limiting onward HIV transmission. In order to improve the identification of these individuals within risk networks, we determined a) the number of PHVL recruited through risk networks b) their socio-demographic, behavioural and clinical characteristics and c) the characteristics of individuals who referred these PHVL to the study. Methodology: From November 2013 to March 2016, in Odessa, Ukraine, Transmission Reduction Intervention Project (TRIP) was implemented to identify people recently infected with HIV within the risk networks of “seeds” and “venues” where they engaged in risk behaviour. Results: TRIP identified 53 PHVL, of whom 32 (60%) injected drugs; 42 (79%) were unaware of their HIV status; 25 (47%) had more than one sex partner, and only 14 (26%) were using condoms. There were 164 people who referred individuals into the study; 33 of them (20%) referred PHVL. In terms of referrers, those with lower than secondary level of education, not living with a sex partner, and reporting regular condom use were significantly more likely (p < 0.05) to refer PHVL. Most PHVL (38, 72%) and their referrers (27, 82%) were found through venues. Conclusions: In Odessa city, PHVL are at high risk of transmitting HIV as the majority inject drugs, do not know their HIV status, and have unprotected sex and/or multiple partners. Targeting these individuals for HIV prevention, harm reduction and initiation of antiretroviral treatment (ART) is urgent.
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Affiliation(s)
| | - Hayk Davtyan
- TB Research and Prevention Center, Yerevan, Armenia
| | | | - Rony Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | | | - Dimitrios Paraskevis
- Department of Hygiene Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Britt Skaathun
- Division of Global Public Health, University of California, San Diego, California, United States
| | - John Schneider
- Department of Medicine and Center for HIV Elimination, University of Chicago, Chicago, United States
| | | | - Leslie D Williams
- National Development and Research Institutes, Department of Population Health, NYU Medical School, New York, United States
| | | | - Samuel R Friedman
- National Development and Research Institutes, Department of Population Health, NYU Medical School, New York, United States
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19
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Popovich KJ. Intersection of HIV and community-associated methicillin-resistant Staphylococcus aureus. Future Virol 2020. [DOI: 10.2217/fvl-2019-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has evolved over the past approximately 20 years, with certain populations appearing to have disproportionate risk. Of concern is the potential worsening of S. aureus infections in light of the continued opioid crisis. This review will discuss how CA-MRSA has significantly impacted HIV-infected individuals and address additional factors and populations that are associated with increased risk for MRSA. It will review therapeutic options and infection control strategies as well as highlight how whole genome sequencing can be used to extend traditional epidemiologic analysis and ultimately, inform infection prevention efforts. Continued work identifying those at the highest risk for MRSA, what the best infection prevention settings are in community settings and how to effectively implement and target these strategies is needed. Ultimately, infection control efforts will likely need to extend beyond healthcare settings to effectively and sustainably reduce MRSA infections.
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Affiliation(s)
- Kyle J Popovich
- Associate Professor, Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina St. Suite 143, Chicago, IL 60612, USA
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20
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Individual and Network Factors Associated With Racial Disparities in HIV Among Young Men Who Have Sex With Men: Results From the RADAR Cohort Study. J Acquir Immune Defic Syndr 2019; 80:24-30. [PMID: 30365451 DOI: 10.1097/qai.0000000000001886] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed differences across individual, network, and social determinants. METHODS Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16-29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM. RESULTS Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001). CONCLUSIONS Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.
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21
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The social network context of HIV stigma: Population-based, sociocentric network study in rural Uganda. Soc Sci Med 2019; 233:229-236. [PMID: 31229909 DOI: 10.1016/j.socscimed.2019.05.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE HIV-related stigma profoundly affects the physical and social wellbeing of people living with HIV, as well as the community's engagement with testing, treatment, and prevention. Based on theories of stigma elaborating how it arises from the relationships between the stigmatized and the stigmatizer as well as within the general community, we hypothesized that social networks can shape HIV-related stigma. OBJECTIVE To estimate social network correlates of HIV-related stigma. METHODS During 2011-2012, we collected complete social network data from a community of 1669 adults ("egos") in Mbarara, Uganda using six culturally-adapted name generators to elicit different types of social ties ("alters"). We measured HIV-related stigma using the 9-item AIDS-Related Stigma Scale. HIV serostatus was based on self-report. We fitted linear regression models that account for network autocorrelation to estimate the association between egos' HIV-related stigma, alters' HIV-related stigma and alters' self-reported HIV serostatus, while adjusting for egos' HIV serostatus, network centrality, village size, perceived HIV prevalence, and sociodemographic characteristics. RESULTS The average AIDS-Related Stigma Score was 0.79 (Standard Deviation = 0.50). In the population 116 (7%) egos reported being HIV-positive, and 757 (46%) reported an HIV-positive alter. In the multivariable model, we found that egos' own HIV-related stigma was positively correlated with their alters' average stigma score (b=0.53; 95% confidence interval [CI] 0.42-0.63) and negatively correlated with having one or more HIV-positive alters (b=-0.05; 95% CI -0.10 to -0.003). CONCLUSION Stigma-reduction interventions should be targeted not only at the level of the individual but also at the level of the network. Directed and meaningful contact with people living with HIV may also reduce HIV-related stigma.
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Williams LD, Korobchuk A, Pavlitina E, Nikolopoulos GK, Skaathun B, Schneider J, Kostaki EG, Smyrnov P, Vasylyeva TI, Psichogiou M, Paraskevis D, Morgan E, Hadjikou A, Downing MJ, Hatzakis A, Friedman SR. Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois. AIDS Behav 2019; 23:1210-1224. [PMID: 30680540 PMCID: PMC6511315 DOI: 10.1007/s10461-019-02402-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A growing body of evidence suggests that network-based interventions to reduce HIV transmission and/or improve HIV-related health outcomes have an important place in public health efforts to move towards 90-90-90 goals. However, the social processes involved in network-based recruitment may pose a risk to participants of increasing HIV-related stigma if network recruitment causes HIV status to be assumed, inferred, or disclosed. On the other hand, the social processes involved in network-based recruitment to HIV testing may also encourage HIV-related social support. Yet despite the relevance of these processes to both network-based interventions and to other more common interventions (e.g., partner services), there is a dearth of literature that directly examines them among participants of such interventions. Furthermore, both HIV-related stigma and social support may influence participants' willingness and ability to recruit their network members to the study. This paper examines (1) the extent to which stigma and support were experienced by participants in the Transmission Reduction Intervention Project (TRIP), a risk network-tracing intervention aimed at locating recently HIV-infected and/or undiagnosed HIV-infected people and linking them to care in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois; and (2) whether stigma and support predicted participant engagement in the intervention. Overall, experiences of stigma were infrequent and experiences of support frequent, with significant variation between study sites. Experiences and perceptions of HIV-related stigma did not change significantly between baseline and six-month follow-up for the full TRIP sample, and significantly decreased during the course of the study at the Chicago site. Experiences of HIV-related support significantly increased among recently-HIV-infected participants at all sites, and among all participants at the Odessa site. Both stigma and support were found to predict participants' recruitment of network members to the study at the Athens site, and to predict participants' interviewer-rated enthusiasm for naming and recruiting their network members at both the Athens and Odessa sites. These findings suggest that network-based interventions like TRIP which aim to reduce HIV transmission likely do not increase stigma-related risks to participants, and may even encourage increased social support among network members. However, the present study is limited by its associational design and by some variation in implementation by study site. Future research should directly assess contextual differences to improve understanding of the implications of site-level variation in stigma and support for the implementation of network-based interventions, given the finding that these constructs predict participants' recruitment of network members and engagement in the intervention, and thereby could limit network-based interventions' abilities to reach those most in need of HIV testing and care.
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Affiliation(s)
- Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA.
| | - A Korobchuk
- The Alliance for Public Health, Kiev, Ukraine
| | - E Pavlitina
- Transmission Reduction Intervention Project, Athens, Greece
| | | | - B Skaathun
- University of California San Diego, San Diego, USA
| | - J Schneider
- Medical School, University of Chicago, Chicago, USA
| | - E-G Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - P Smyrnov
- The Alliance for Public Health, Kiev, Ukraine
| | - T I Vasylyeva
- Department of Zoology, University of Oxford, Oxford, UK
| | - M Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - E Morgan
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - A Hadjikou
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - M J Downing
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA
- Department of Psychology, Lehman College, Bronx, NY, USA
| | - A Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA
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Psichogiou M, Giallouros G, Pantavou K, Pavlitina E, Papadopoulou M, Williams LD, Hadjikou A, Kakalou E, Skoutelis A, Protopapas K, Antoniadou A, Boulmetis G, Paraskevis D, Hatzakis A, Friedman SR, Nikolopoulos GK. Identifying, linking, and treating people who inject drugs and were recently infected with HIV in the context of a network-based intervention. AIDS Care 2019; 31:1376-1383. [PMID: 30939897 DOI: 10.1080/09540121.2019.1601671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Identifying and linking people to care soon after HIV infection could limit viral transmission and protect their health. This work aims at describing the continuum of care among recently HIV-infected people who inject drugs (PWID) and participated in an intervention in the context of an HIV outbreak in Athens, Greece. The Transmission Reduction Intervention Project (TRIP) conducted risk network-based contact tracing and screened people for recent HIV infection. A comprehensive approach with a case management component that aimed to remove barriers to accessing care was adopted. Follow-up data on antiretroviral treatment (ART) and HIV-RNA levels were obtained from HIV clinics. TRIP enrolled 45 recently HIV-infected PWID (80% male) with a median viral load at recruitment of 5.43 log10 copies/mL. Of the recently infected persons in TRIP, 87% were linked to care; of these, 77% started ART; and of those on ART, 89% achieved viral load <200 copies/mL. TRIP and its public health allies managed to get most of the recently HIV-infected PWID who were identified by the program into care and many of them onto ART. This resulted in very low HIV-RNA levels. Treatment as prevention can work if individuals are aided in overcoming difficulties in entry to, or attrition from care.
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Affiliation(s)
- Mina Psichogiou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | | | | | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens site , Athens , Greece
| | - Martha Papadopoulou
- First Department of Internal Medicine, Medical School, "Laiko" General Hospital, National and Kapodistrian University of Athens , Athens , Greece
| | - Leslie D Williams
- National Development and Research Institutes , New York City , NY , USA
| | - Andria Hadjikou
- Medical School, University of Cyprus , Nicosia , Cyprus.,European University Cyprus , Nicosia , Cyprus
| | - Eleni Kakalou
- General Hospital of Athens "Evangelismos" , Athens , Greece
| | | | - Konstantinos Protopapas
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | - Anastasia Antoniadou
- Department of Internal Medicine, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens , Athens , Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Samuel R Friedman
- National Development and Research Institutes , New York City , NY , USA
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