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Engsig FN, Kronborg G. Pre-exposure prophylaxis against HIV infection. Ugeskr Laeger 2024; 186:V10230672. [PMID: 38808765 DOI: 10.61409/v10230672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Pre-exposure prophylaxis (PrEP) decreases the risk for HIV transmission in high-risk populations. PrEP has been available in Denmark since 2019 and consists of antiretroviral drugs in a combination tablet taken daily or on demand. The effect of this prophylaxis in Denmark is summarized in the review. PrEP is indicated in men and transgender persons with unprotected anal intercourse with multiple male partners in the latest 12 weeks or recent diagnoses of syphilis, chlamydia, or gonorrhoea. PrEP is provided by infectious disease specialists. Continued implementation could significantly reduce HIV transmission and potentially end the epidemic in Denmark.
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Affiliation(s)
| | - Gitte Kronborg
- Infektionsmedicinsk Afdeling, Københavns Universitetshospital - Hvidovre Hospital
- AIDS-Fondet
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Garcia R, Warming PE, Hansen CJ, Rajan D, Torp-Pedersen C, Benfield T, Folke F, Tfelt-Hansen J. Out-of-Hospital Cardiac Arrest in Individuals With Human Immunodeficiency Virus: A Nationwide Population-Based Cohort Study. Clin Infect Dis 2023; 77:1578-1584. [PMID: 37448334 DOI: 10.1093/cid/ciad422] [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: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Little data exist on the risk and outcomes of out-of-hospital cardiac arrest (OHCA) in people with HIV (PWH). We aimed to describe OHCA in PWH as compared with the general population in terms of incidence, characteristics, and survival. METHODS This nationwide study assessed all individuals aged 18-85 years between 2001 and 2019 in Denmark. The cumulative incidence of OHCA was computed using cause-specific Cox models accounting for competing risk of death. RESULTS Among 6 565 309 individuals, 6 925 (median age: 36; interquartile range [IQR]: 28-44 y; 74% males) were infected at some point with HIV. The incidence of OHCA was 149 (95% CI: 123-180)/100 000 person-years in PWH versus 64 (95% CI: 64-65)/100 000 person-years in people without HIV (P < .001). Age at the time of cardiac arrest was 52 (IQR: 44-61) years in PWH versus 69 (IQR: 59-77) years in individuals without HIV (P < .001). In a multivariable model adjusted for age, sex, hypertension, diabetes, heart failure, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, cancer, and renal failure, PWH had a 2-fold higher risk of OHCA (hazard ratio: 2.84; 95% CI: 2.36-3.43; P < .001). Thirty-day mortality (89% vs 88%; P = .80) was comparable to individuals without HIV. CONCLUSIONS HIV is an independent risk factor for OHCA, and those who experience OHCA with HIV are much younger than those without HIV. Almost 90% of PWH died 1 month after OHCA. Further research should strive to find out how to reduce OHCA occurrence in this population.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402, University Hospital of Poitiers, Poitiers, France
| | - Peder Emil Warming
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Carl Johann Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Deepthi Rajan
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Center of Research and Disruption of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
- Copenhagen University Hospital-Emergency Medical Services Copenhagen, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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Callander D, McManus H, Gray RT, Grulich AE, Carr A, Hoy J, Donovan B, Fairley CK, Holt M, Templeton DJ, Liaw ST, McMahon JH, Asselin J, Petoumenos K, Hellard M, Pedrana A, Elliott J, Keen P, Costello J, Keane R, Kaldor J, Stoové M, Guy R. HIV treatment-as-prevention and its effect on incidence of HIV among cisgender gay, bisexual, and other men who have sex with men in Australia: a 10-year longitudinal cohort study. Lancet HIV 2023; 10:e385-e393. [PMID: 37068498 DOI: 10.1016/s2352-3018(23)00050-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Although HIV treatment-as-prevention reduces individual-level HIV transmission, population-level effects are unclear. We aimed to investigate whether treatment-as-prevention could achieve population-level reductions in HIV incidence among gay, bisexual, and other men who have sex with men (GBM) in Australia's most populous states, New South Wales and Victoria. METHODS TAIPAN was a longitudinal cohort study using routine health record data extracted from 69 health services that provide HIV diagnosis and care to GBM in New South Wales and Victoria, Australia. Data from Jan 1, 2010, to Dec 31, 2019, were linked within and between services and over time. TAIPAN collected data from all cisgender GBM who attended participating services, resided in New South Wales or Victoria, and were 16 years or older. Two cohorts were established: one included HIV-positive patients, and the other included HIV-negative patients. Population prevalence of viral suppression (plasma HIV viral load <200 RNA copies per μL) was calculated by combining direct measures of viral load among the HIV-positive cohort with estimates for undiagnosed GBM. The primary outcome of HIV incidence was measured directly via repeat testing in the HIV-negative cohort. Poisson regression analyses with generalised estimating equations assessed temporal associations between population prevalence of viral suppression and HIV incidence among the subsample of HIV-negative GBM with multiple instances of HIV testing. FINDINGS At baseline, the final sample (n=101 772) included 90 304 HIV-negative and 11 468 HIV-positive GBM. 59 234 patients in the HIV-negative cohort had two or more instances of HIV testing and were included in the primary analysis. Over the study period, population prevalence of viral suppression increased from 69·27% (95% CI 66·41-71·96) to 88·31% (86·37-90·35), while HIV incidence decreased from 0·64 per 100 person-years (95% CI 0·55-0·76) to 0·22 per 100 person-years (0·17-0·28). Adjusting for sociodemographic characteristics and HIV pre-exposure prophylaxis (PrEP) use, treatment-as-prevention achieved significant population-level reductions in HIV incidence among GBM: a 1% increase in population prevalence of viral suppression corresponded with a 6% decrease in HIV incidence (incidence rate ratio [IRR] 0·94, 95% CI 0·93-0·96; p<0·0001). PrEP was introduced in 2016 with 17·60% uptake among GBM that year, which increased to 36·38% in 2019. The relationship between population prevalence of viral suppression and HIV incidence was observed before the availability of PrEP (IRR 0·98, 95% CI 0·96-0·99; p<0·0001) and was even stronger after the introduction of PrEP (0·80, 0·70-0·93; p=0·0030). INTERPRETATION Our results suggest that further investment in HIV treatment, especially alongside PrEP, can improve public health by reducing HIV incidence among GBM. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Hamish McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Richard T Gray
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Carr
- HIV and Immunology Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Christopher K Fairley
- Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Positive Life New South Wales, Sydney, NSW, Australia
| | - Siaw-Teng Liaw
- School of Population Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James H McMahon
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | | | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Hellard
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; The Burnet Institute, Melbourne, VIC, Australia
| | | | - Julian Elliott
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Phillip Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jane Costello
- Positive Life New South Wales, Sydney, NSW, Australia
| | | | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark Stoové
- The Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Borchmann O, Omland LH, Gerstoft J, Larsen CS, Johansen IS, Lunding S, Jensen J, Obel N, Hansen ABE. Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904057 PMCID: PMC9336168 DOI: 10.2807/1560-7917.es.2022.27.30.2100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundMigrants face an increased risk of HIV infection and late presentation for HIV care.AimTo examine delays in HIV diagnosis, linkage to care (LTC), and risk of late presentation for migrants living with HIV in Denmark.MethodsWe conducted a population-based, nationwide study of adult migrants (n = 2,166) presenting for HIV care between 1 January 1995 and 31 December 2020 in Denmark. Time from immigration to HIV diagnosis and from diagnosis to LTC, and late presentation were assessed, stratified by migrants' geographical regions of origin, using descriptive statistics.ResultsThe demographics of the migrant population changed over time. Overall, migrants diagnosed with HIV after immigration to Denmark resided a median of 3.7 (IQR: 0.8-10.2) years in Denmark before diagnosis. Median time from HIV diagnosis to LTC was 6 (IQR: 0-24) days. Migrants diagnosed with HIV infection before immigration had a median of 38 (IQR: 0-105) days from arrival in Denmark to LTC. The corresponding median times for 2015-20 alone were 4.1 (IQR: 0.9-13.1) years, 0 (IQR: 0-8) days, and 62 (IQR: 25-152) days, respectively. The overall proportion of late presentation among migrants diagnosed with HIV after immigration was 60%, and highest among migrants from sub-Saharan Africa and East and South Asia.ConclusionHIV diagnosis is still substantially delayed in Danish migrants, while LTC is timely. The proportions with late presentation are high. These results call for targeted interventions to reduce the number of migrants with undiagnosed HIV infections and of late presenters.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Suzanne Lunding
- Department of Internal Medicine, Herlev University Hospital, Herlev, Denmark
| | - Janne Jensen
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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5
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Mbita G, Komba AN, Casalini C, Bazant E, Curran K, Christensen A, Nyato D, Kim YM, Reed J, Makyao N, Kategile U, Conserve DF, Faini D, van Roosmalen J, van den Akker T. Predictors of HIV Among 1 Million Clients in High-Risk Male Populations in Tanzania. AIDS Behav 2022; 26:3185-3198. [PMID: 35362905 PMCID: PMC9474353 DOI: 10.1007/s10461-022-03667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 12/01/2022]
Abstract
The World Health Organization identified men as an essential group to target with HIV testing and treatment strategies;: men who have sex with men (MSM) and male clients of female sex workers (CFSW) account for 35% of new HIV infections globally. Using a cross-sectional design from a community-based HIV prevention project in Tanzania (October 2015-September 2018) and multivariable logistic regression, we identified predictors of HIV seropositivity among men. Of 1,041,343 men on their initial visit to the project, 36,905 (3.5%) were MSM; 567,005 (54.5%) were CFSW; and 437,343 (42.0%) were other men living near hotspots (OMHA). Three predictors of HIV seropositivity emerged across all three groups: being uncircumcised, having sexually transmitted infection symptoms, and harmful drinking of alcohol before sex. Any reported form of gender-based violence among MSM and OMHA and inconsistent condom use among CFSW were associated with HIV seropositivity. These findings may inform community HIV strategies like self-testing, delivery of pre-exposure prophylaxis and antiretroviral therapy, and behavioral change communication targeting men at higher risk of infection.
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Affiliation(s)
- Gaspar Mbita
- Jhpiego, Dar-es-Salaam, Tanzania.
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
- Jhpiego, Monrovia, Liberia.
| | | | | | - Eva Bazant
- The Task Force for Global Health, Decatur, GA, USA
| | | | | | - Daniel Nyato
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | | | - Neema Makyao
- Ministry of Health Community Development, Gender, Elderly, and Children, National AIDS Control Program, Dodoma, Tanzania
| | | | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Diana Faini
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
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6
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Saxton PJW, Azariah S, Cavadino A, Forster RF, Jenkins R, Werder SF, Southey K, Rich JG. Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities. AIDS Behav 2022; 26:2723-2737. [PMID: 35167038 PMCID: PMC8853116 DOI: 10.1007/s10461-022-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Abstract
Inequities in pre-exposure prophylaxis (PrEP) experiences will impede HIV epidemic elimination among gay and bisexual men (GBM). Ethnicity is a strong marker of inequity in the United States, but evidence from other countries is lacking. We investigated experiences on-PrEP to 12 months follow-up in a prospective cohort of 150 GBM in Auckland, New Zealand with an equity quota of 50% non-Europeans. Retention at 12 months was 85.9%, lower among Māori/Pacific (75.6%) than non-Māori/Pacific participants (90.1%). Missed pills increased over time and were higher among Māori/Pacific. PrEP breaks increased, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had done so. Condomless receptive anal intercourse partners were stable over time. STIs were common but chlamydia declined; 12-month incidence was 8.7% for syphilis, 36.0% gonorrhoea, 46.0% chlamydia, 44.7% rectal STI, 64.0% any STI. Structural interventions and delivery innovations are needed to ensure ethnic minority GBM gain equal benefit from PrEP. Clinical trial number ACTRN12616001387415.
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Affiliation(s)
- Peter J W Saxton
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand.
| | - Sunita Azariah
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand
| | - Rose F Forster
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Renee Jenkins
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Suzanne F Werder
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
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Nkambule R, Philip NM, Reid G, Mnisi Z, Nuwagaba-Biribonwoha H, Ao TT, Ginindza C, Duong YT, Patel H, Saito S, Solmo C, Brown K, Moore CS, Voetsch AC, Bicego G, Bock N, Mhlanga F, Dlamini T, Mabuza K, Zwane A, Sahabo R, Dobbs T, Parekh BS, El-Sadr W, Ryan C, Justman J. HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys. PLoS One 2021; 16:e0260892. [PMID: 34855890 PMCID: PMC8639055 DOI: 10.1371/journal.pone.0260892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/18/2021] [Indexed: 01/01/2023] Open
Abstract
With the highest HIV incidence and prevalence globally, the government of Eswatini started a substantial scale-up of HIV treatment and prevention services in 2011. Two sequential large population-based surveys were conducted before and after service expansion to assess the impact of the national response. Cross-sectional, household-based, nationally representative samples of adults, ages 18 to 49 years, were sampled in 2011 and 2016. We measured HIV prevalence, incidence (recent infection based on limiting antigen ≤1.5 optical density units and HIV RNA ≥1000 copies/mL), viral load suppression (HIV RNA <1000 copies/mL among all seropositive adults) and unsuppressed viremia (HIV RNA ≥1000 copies/mL among all, regardless of HIV status) and assessed for temporal changes by conducting a trend analysis of the log ratio of proportions, using a Z statistic distribution. HIV prevalence remained stable from 2011 to 2016 [32% versus 30%, p = 0.10]. HIV incidence significantly declined 48% [2.48% versus 1.30%, p = 0.01]. Incidence remained higher among women than men [2011: 3.16% versus 1.83%; 2016: 1.76% versus 0.86%], with a smaller but significant relative reduction among women [44%; p = 0.04] than men [53%; p = 0.09]. The proportion of seropositive adults with viral load suppression significantly increased from 35% to 71% [p < .001]. The proportion of the total adult population with unsuppressed viremia decreased from 21% to 9% [p < .001]. National HIV incidence in Eswatini decreased by nearly half and viral load suppression doubled over a five-year period. Unsuppressed viremia in the total population decreased 58%. These population-based findings demonstrate the national impact of expanded HIV services in a hyperendemic country.
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Affiliation(s)
| | - Neena M. Philip
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Giles Reid
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | | | - Harriet Nuwagaba-Biribonwoha
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
- ICAP at Columbia University, Mailman School of Public Health, Mbabane, Eswatini
| | - Tony T. Ao
- U.S. Centers for Disease Control and Prevention Eswatini, Mbabane, Eswatini
| | | | - Yen T. Duong
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Hetal Patel
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Suzue Saito
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Chelsea Solmo
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Kristin Brown
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Chiara S. Moore
- PHI/CDC Global Health Fellowship Program, Oakland, CA, United States of America
| | - Andrew C. Voetsch
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - George Bicego
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Naomi Bock
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | | | - Tengetile Dlamini
- National Emergency Response Council on HIV/AIDS (NERCHA), Mbabane, Eswatini
| | - Khanya Mabuza
- National Emergency Response Council on HIV/AIDS (NERCHA), Mbabane, Eswatini
| | - Amos Zwane
- Central Statistics Office, Mbabane, Eswatini
| | - Ruben Sahabo
- ICAP at Columbia University, Mailman School of Public Health, Mbabane, Eswatini
| | - Trudy Dobbs
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Bharat S. Parekh
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Wafaa El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention Eswatini, Mbabane, Eswatini
| | - Jessica Justman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
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Dramatic decline in new HIV diagnoses in persons born in France in a large nationwide HIV cohort. Public Health 2021; 196:129-134. [PMID: 34192605 DOI: 10.1016/j.puhe.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. STUDY DESIGN We performed a retrospective cohort study using data from the mainland French Dat'AIDS cohort. METHODS Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. RESULTS Between 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat'AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (-38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (-43.6%), P < 0.01, than in those born abroad (-23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was -46.7% among men who have sex with men (MSM), -43.5% for heterosexual women and -33.3% for heterosexual men. CONCLUSION Our findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention.
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9
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Smith DK, Sullivan PS, Cadwell B, Waller LA, Siddiqi A, Mera-Giler R, Hu X, Hoover KW, Harris NS, McCallister S. Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016. Clin Infect Dis 2021; 71:3144-3151. [PMID: 32097453 DOI: 10.1093/cid/ciz1229] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. METHODS We used 2012-2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. RESULTS From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], -5.2% to -2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, -1.77% to -.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, -2.12% to -.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. CONCLUSIONS We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections.
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Affiliation(s)
- Dawn K Smith
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Betsy Cadwell
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Azfar Siddiqi
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Xiaohong Hu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Norma S Harris
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Lima VD, Zhu J, Card KG, Lachowsky NJ, Chowell-Puente G, Wu Z, Montaner JSG. Can the combination of TasP and PrEP eliminate HIV among MSM in British Columbia, Canada? Epidemics 2021; 35:100461. [PMID: 33984688 DOI: 10.1016/j.epidem.2021.100461] [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: 02/26/2020] [Revised: 03/09/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In British Columbia (BC), the HIV epidemic continues to disproportionally affect the gay, bisexual and other men who have sex with men (MSM). In this study, we aimed to evaluate how Treatment as Prevention (TasP) and pre-exposure prophylaxis (PrEP), if used in combination, could lead to HIV elimination in BC among MSM. METHODS Considering the heterogeneity in HIV transmission risk, we developed a compartmental model stratified by age and risk-taking behaviour for the HIV epidemic among MSM in BC, informed by clinical, behavioural and epidemiological data. Key outcome measures included the World Health Organization (WHO) threshold for disease elimination as a public health concern and the effective reproduction number (Re). Model interventions focused on the optimization of different TasP and PrEP components. Sensitivity analysis was done to evaluate the impact of sexual mixing patterns, PrEP effectiveness and increasing risk-taking behaviour. RESULTS The incidence rate was estimated to be 1.2 (0.9-1.9) per 1000 susceptible MSM under the Status Quo scenario by the end of 2029. Optimizing all aspects of TasP and the simultaneous provision of PrEP to high-risk MSM resulted in an HIV incidence rate as low as 0.4 (0.3-0.6) per 1000 susceptible MSM, and an Re as low as 0.7 (0.6-0.9), indicating that disease elimination was possible when TasP and PrEP were combined. Provision of PrEP to younger MSM or high-risk and younger MSM resulted in a similar HIV incidence rate, but an Re with credible intervals that crossed one. CONCLUSION Further optimizing all aspects of TasP and prioritizing PrEP to high-risk MSM can achieve the goal of disease elimination in BC. These results should inform public health policy development and intervention programs that address the HIV epidemic in BC and in other similar settings where MSM are disproportionately affected.
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Affiliation(s)
- Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Jielin Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gerardo Chowell-Puente
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Zunyou Wu
- Division of HIV Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Doshi RK. Bending the Curve on Human Immunodeficiency Virus Transmission. Clin Infect Dis 2021; 71:301-303. [PMID: 31420643 DOI: 10.1093/cid/ciz805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rupali Kotwal Doshi
- Department of Epidemiology and Department of Medicine, George Washington University.,District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration
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12
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Duthely LM, Sanchez-Covarrubias AP. Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice. FRONTIERS IN COMMUNICATION 2020; 5:530164. [PMID: 33644162 PMCID: PMC7909469 DOI: 10.3389/fcomm.2020.530164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mobile health technologies (mHealth) are efficacious along the continuum of HIV/AIDS-from prevention of HIV transmission to those at the highest risk of acquiring infection, to adherence to HIV medical care, for those living with the disease-decreasing the public health burden of the disease. HIV/AIDS is a complex condition, as certain population subgroups are disproportionately affected. Furthermore, barriers experienced at the individual level (e.g., HIV stigma) and at the systems level (i.e., access to care) contribute to these disparities. Low cost, high penetration rates and ease of use mean mHealth SMS/texting solutions hold the biggest promise for curbing the global HIV/AIDS epidemic; yet these technologies have their own challenges. Our primary objective was to assess interventions that promote adherence, which are delivered via SMS/texting, and important design and ethical considerations of these technologies. Specifically, we evaluated the underlying frameworks underpinning intervention design, strategies to safeguard privacy and confidentiality, and measures taken to ensure equity and equitable access across different subgroups of persons living with HIV (PLWH). We also synthesized study outcomes, barriers/facilitators to adherence, and barriers/facilitators of technology to support HIV adherence. METHODS A scoping review methodology was utilized, searching the Medline database for recently published articles (January 2017 to June 2019). Two reviewers independently screened titles and abstracts for relevancy using the following eligibility criteria: (a) original research or protocol; (b) inclusion of persons living with HIV; (c) intervention delivery via SMS/text messaging; and, (d) intervention included HIV care adherence. RESULTS Seven (7) of the 134 articles met full criteria. The great majority (n = 6) did not report whether the interventions were developed under established behavioral change models or frameworks. Strategies to address privacy, confidentiality and equity/equitable access were taken in four (n = 4) studies. CONCLUSION Our mixed methods review determined that privacy and confidentiality remain a concern for PLWH. Provisions to accommodate literacy, infrastructure, technology and other challenges (e.g., access to smartphones and Wifi) are important ethical considerations that guarantee equity and equitable access. Further investigation will determine the contexts within which theoretical models and frameworks remain relevant in the rapidly evolving field of digitized interventions that support adherence.
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Affiliation(s)
- Lunthita M. Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
- Correspondence: Lunthita M. Duthely,
| | - Alex P. Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
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13
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Nguyen LH, Nguyen HLT, Larsson M, Tran BX, L Stein M, Rocha LEC, Strömdahl S. An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam. BMC Public Health 2020; 20:1387. [PMID: 32917157 PMCID: PMC7488431 DOI: 10.1186/s12889-020-09449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) interventions are promising in HIV and sexually transmitted infections (STIs) prevention among men who have sex with men (MSM), given a high rate of the Internet use in this population. This study determined the preferences for eHealth interventions to prevent HIV and STIs among MSM in Hanoi, Vietnam to guide the development of future eHealth interventions. METHODS Five focus group discussions (FGD) were conducted with 35 MSM recruited by purposive sampling in January 2018 in Hanoi, Vietnam. The FGDs addressed attitudes towards the feasibility and uptake of HIV/STI interventions via online modalities such as smartphone applications (apps, social network sites, or emails); preferences and concerns regarding an online HIV/STI intervention. FGDs were audio-recorded and transcribed verbatim. Content analysis was used to determine themes. RESULTS MSM reported that they commonly searched for information regarding HIV/STI and sexual health on Facebook and a variety of mobile apps. They perceived a lack of reliable online sources, a high need, and interest for an online intervention. Most of them preferred short and concise messages without perceived sensitive words such as "HIV" or "STI". Diversity of online modalities were preferred with information from credible sources about HIV/STI symptoms, testing and treatment, safe sex practices and testing locations with a focus on safe MSM-friendly clinics. Concerns about the need to trust the organization behind the online information and interventions, and the importance of confidentiality when participating in online interventions were raised. CONCLUSION High acceptance and perceived need for an online HIV/STI intervention were reported. The importance of establishing trust within the MSM community as a reliable source of information was emphasized, as well as the importance of confidentiality.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
| | | | - Mattias Larsson
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mart L Stein
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Susanne Strömdahl
- Department of Global Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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14
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Kostaki EG, Hodges-Mameletzis I, Magiorkinis G, Adamis G, Xylomenos G, Nikolopoulos G, Lazanas M, Chini M, Mangafas N, Skoutelis A, Papastamopoulos V, Antoniadou A, Papadopoulos A, Protopapas K, Psichogiou M, Basoulis D, Chrysos G, Paraskeva D, Paparizos V, Kourkounti S, Sambatakou H, Sipsas NV, Lada M, Panagopoulos P, Maltezos E, Hatzakis A, Paraskevis D. Earlier treatment initiation is associated with a decreased number of HIV-1 subtype A1 transmissions in Greece. Sex Transm Infect 2020; 97:232-237. [PMID: 32561553 DOI: 10.1136/sextrans-2020-054509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Subtypes A1 and B are the most prevalent HIV-1 clades in Greece. Subtype A1 epidemic is highly monophyletic and corresponds to transmissions that occurred locally. Our aim in this molecular epidemiology analysis was to investigate the role of early treatment in preventing new HIV-1 transmissions. METHODS Our analysis focused on 791 subtype A1 sequences from treatment-naïve individuals in Greece. Estimation of infection dates was performed by molecular clock calculations using Bayesian methods. We estimated the time interval between (1) the infection and sampling dates (linkage to care window), (2) the sampling dates and antiretroviral therapy (ART) initiation (treatment window), and (3) the infection dates and ART initiation (transmissibility window) for the study population. We also inferred the putative source of HIV infections between individuals of different groups divided according to the length of treatment, linkage to care or transmissibility window. RESULTS A significant decline was detected for the treatment window during 2014-2015 versus the 2 previous years (p=0.0273), while the linkage to care interval remained unchanged during the study period. Inference of the putative source of HIV infections suggested that individuals with a recent diagnosis or narrow transmissibility window (time period between HIV infection and ART initiation) were not sources of HIV infections to other groups. Contrarily, a significant number of HIV infections originated from individuals with longer transmissibility window interval. CONCLUSIONS Our findings showed that the treatment window is decreasing over time, presumably due to the updated treatment guidelines. Our study also demonstrates that people treated earlier after infection do not transmit at high rates, thus documenting the benefits of early ART initiation in preventing ongoing HIV-1 transmission.
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Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G Gennimatas GH, Athens, Greece
| | | | | | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases, Evaggelismos GH, Athens, Greece
| | | | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vasileios Paparizos
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Sofia Kourkounti
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion GH, Athens, Greece
| | - Periklis Panagopoulos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, 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
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15
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Abstract
Four of the largest HIV prevention trials have been conducted in sub-Saharan Africa, enrolling hundreds of thousands of participants in catchment areas of millions of people. The trials have focused on community-level interventions to increase diagnosis and initiation of antiretroviral therapy (ART) to improve health and reduce HIV transmission. Universal test-and-treat strategies are deployed to achieve viral suppression thereby reducing risk to uninfected persons, known as treatment as prevention (TasP).
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Abstract
The HIV Prevention Trials Network 052 study (HPTN 052) was a clinical trial designed to determine whether early treatment for HIV infection prevented transmission of the virus in couples where one partner was infected with HIV and the other was not, referred to as HIV serodiscordant or serodifferent couples. The study enrolled 1,763 couples at 13 sites in 9 countries in Asia, Africa, and the Americas. HPTN 052 demonstrated a minimum of 96% reduction of HIV in heterosexual couples ascribed to antiretroviral treatment; early treatment of HIV significantly reduced other infections in the HIV-infected subjects. This study, in conjunction with similar research, led to significant changes in international HIV treatment guidelines and the concept of treatment as prevention (TasP). This article provides the scientific background and history of how HPTN 052 came into being, the challenges it faced, and the ultimate impact it had on the fields of HIV treatment and prevention.
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Affiliation(s)
- Myron S Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina 27516, USA;
- Science Facilitation Department, HIV Prevention Trials Network (HPTN) Leadership and Operations Center, FHI 360, Durham, North Carolina 27701, USA; ,
| | - Theresa Gamble
- Science Facilitation Department, HIV Prevention Trials Network (HPTN) Leadership and Operations Center, FHI 360, Durham, North Carolina 27701, USA; ,
| | - Marybeth McCauley
- Science Facilitation Department, HIV Prevention Trials Network (HPTN) Leadership and Operations Center, FHI 360, Durham, North Carolina 27701, USA; ,
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17
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Ma Y, Dou Z, Guo W, Mao Y, Zhang F, McGoogan JM, Zhao Y, Zhao D, Wu Y, Liu Z, Wu Z. The Human Immunodeficiency Virus Care Continuum in China: 1985-2015. Clin Infect Dis 2019; 66:833-839. [PMID: 29216405 DOI: 10.1093/cid/cix911] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) care continuum attrition is a major global public health challenge. Few studies have examined this problem in resource-limited settings. We aimed to assess cumulative, current, and historical achievement along China's HIV continuum of care. Methods A nationwide, serial cross-sectional study of all individuals with HIV infection diagnosed in China between 1 January 1985 and 31 December 2015 was conducted using data from China's HIV/AIDS information systems. Biennial estimates of the number of persons living with HIV were also used. We defined 7 steps in HIV care continuum as infected (estimated), diagnosed, linked, retained, enrolled, receiving antiretroviral therapy (ART), and virally suppressed. Cumulative, 30-year performance, and biennial performance during the most recent 10 years were examined. Results A total of 573529 persons diagnosed with HIV infection were included. Cumulatively, 94% were linked, 88% were retained, 73% were enrolled, 67% were receiving ART, and 44% were suppressed. Greatest attrition was observed for adolescents, minorities, and those who reported injecting drug use as their route of infection. Improvement was observed from 2005 to 2015. As of the end of 2015, 68% among those infected were diagnosed, 67% among diagnosed were receiving ART, and 65% among those receiving ART were virally suppressed. After adjusting for those without viral load testing, the proportion suppressed increased to 89%. Conclusions Despite dramatic improvements, China faces serious challenges in achieving the Joint United Nations Programme on HIV/AIDS 90-90-90 targets, because of substantial attrition along its continuum of HIV care.
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Affiliation(s)
- Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhihui Dou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Fujie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Beijing Ditan Hospital, Capital Medical University, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yasong Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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18
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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19
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Cohen MS, Council OD, Chen JS. Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy. J Int AIDS Soc 2019; 22 Suppl 6:e25355. [PMID: 31468737 PMCID: PMC6715951 DOI: 10.1002/jia2.25355] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION HIV is a unique sexually transmitted infection (STI) that is greatly affected by other concomitant "classical" bacterial and viral STIs that cause genital ulcers and/or mucosal inflammation. STIs also serve as a marker for risky sexual behaviours. STIs increase infectiousness of people living with HIV by increasing the viral concentration in the genital tract, and by increasing the potential for HIV acquisition in people at risk for HIV. In addition, some STIs can increase blood HIV concentration and promote progression of disease. This review is designed to investigate the complex relationship between HIV and classical STIs. DISCUSSION Treatment of STIs with appropriate antibiotics reduces HIV in blood, semen and female genital secretions. However, community-based trials could not reliably reduce the spread of HIV by mass treatment of STIs. Introduction of antiretroviral agents for the treatment and prevention of HIV has led to renewed interest in the complex relationship between STIs and HIV. Antiretroviral treatment (ART) reduces the infectiousness of HIV and virtually eliminates the transmission of HIV in spite of concomitant or acquired STIs. However, while ART interrupts HIV transmission, it does not stop intermittent shedding of HIV in genital secretions. Such shedding of HIV is increased by STIs, although the viral copies are not likely replication competent or infectious. Pre-exposure prophylaxis (PrEP) of HIV with the combination of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) prevents HIV acquisition in spite of concomitant STIs. CONCLUSIONS STIs remain pandemic, and the availability of ART may have led to an increase in STIs, as fear of HIV has diminished. Classical STIs present a huge worldwide health burden that cannot be separated from HIV, and they deserve far more attention than they currently receive.
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Affiliation(s)
- Myron S Cohen
- UNC School of MedicineInstitute for Global Health & Infectious DiseasesChapel HillNCUSA
| | | | - Jane S Chen
- Department of EpidemiologyGillings School of Global Public HealthUNCChapel HillNCUSA
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20
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Martin-Iguacel R, Pedersen C, Llibre JM, Søndergaard J, Jensen J, Omland LH, Johansen IS, Obel N, Rasmussen LD. Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection. HIV Med 2019; 20:404-417. [PMID: 31016849 DOI: 10.1111/hiv.12735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. METHODS We used data from national registries to conduct a population-based nested case-control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. RESULTS We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. CONCLUSIONS For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.
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Affiliation(s)
- R Martin-Iguacel
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - J M Llibre
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - J Søndergaard
- Department of Public Health, The Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - J Jensen
- Department of Internal Medicine, Kolding Sygehus, Kolding, Denmark
| | - L H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
| | - N Obel
- Fight AIDS Foundation, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark
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21
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Vinken L, Fransen K, Cuypers L, Alexiev I, Balotta C, Debaisieux L, Seguin-Devaux C, García Ribas S, Gomes P, Incardona F, Kaiser R, Ruelle J, Sayan M, Paraschiv S, Paredes R, Peeters M, Sönnerborg A, Vancutsem E, Vandamme AM, Van den Wijngaert S, Van Ranst M, Verhofstede C, Stadler T, Lemey P, Van Laethem K. Earlier Initiation of Antiretroviral Treatment Coincides With an Initial Control of the HIV-1 Sub-Subtype F1 Outbreak Among Men-Having-Sex-With-Men in Flanders, Belgium. Front Microbiol 2019; 10:613. [PMID: 30972053 PMCID: PMC6443750 DOI: 10.3389/fmicb.2019.00613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) non-B subtype infections occurred in Belgium since the 1980s, mainly amongst migrants and heterosexuals, whereas subtype B predominated in men-having-sex-with-men (MSM). In the last decade, the diagnosis of F1 sub-subtype in particular has increased substantially, which prompted us to perform a detailed reconstruction of its epidemiological history. To this purpose, the Belgian AIDS Reference Laboratories collected HIV-1 pol sequences from all sub-subtype F1-infected patients for whom genotypic drug resistance testing was requested as part of routine clinical follow-up. This data was complemented with HIV-1 pol sequences from countries with a high burden of F1 infections or a potential role in the global origin of sub-subtype F1. The molecular epidemiology of the Belgian subtype F1 epidemic was investigated using Bayesian phylogenetic inference and transmission dynamics were characterized based on birth-death models. F1 sequences were retained from 297 patients diagnosed and linked to care in Belgium between 1988 and 2015. Phylogenetic inference indicated that among the 297 Belgian F1 sequences, 191 belonged to a monophyletic group that mainly contained sequences from people likely infected in Belgium (OR 26.67, 95% CI 9.59–74.15), diagnosed in Flanders (OR 7.28, 95% CI 4.23–12.53), diagnosed at a recent stage of infection (OR 7.19, 95% CI 2.88-17.95) or declared to be MSM (OR 34.8, 95% CI 16.0–75.6). Together with a Spanish clade, this Belgian clade was embedded in the genetic diversity of Brazilian subtype F1 strains and most probably emerged after one or only a few migration events from Brazil to the European continent before 2002. The origin of the Belgian outbreak was dated back to 2002 (95% higher posterior density 2000–2004) and birth-death models suggested that its extensive growth had been controlled (Re < 1) by 2012, coinciding with a time period where delay in antiretroviral treatment initiation substantially declined. In conclusion, phylogenetic reconstruction of the Belgian HIV-1 sub-subtype F1 epidemic illustrates the introduction and substantial dissemination of viral strains in a geographically restricted risk group that was most likely controlled by effective treatment as prevention.
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Affiliation(s)
- Lore Vinken
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Katrien Fransen
- AIDS Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Lize Cuypers
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ivailo Alexiev
- National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Claudia Balotta
- Infectious Diseases and Immunopathology Section, 'L. Sacco' Department of Biomedical and Clinical Sciences, 'L. Sacco' Hospital, University of Milan, Milan, Italy
| | - Laurent Debaisieux
- AIDS Reference Laboratory, CUB-Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Carole Seguin-Devaux
- Laboratory of Retrovirology, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Sergio García Ribas
- AIDS Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Perpétua Gomes
- Serviço de Patologia Clínica, Laboratorio de Biologia Molecular, LMCBM, Centro Hospitalar Lisboa Ocidental, Hospital Egas Moniz, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
| | | | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Jean Ruelle
- Unit of Medical Microbiology, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Murat Sayan
- PCR Unit, Clinical Laboratory, Kocaeli University, İzmit, Turkey.,Research Center of Experimental Health Sciences, Near East University, Nicosia, Cyprus
| | - Simona Paraschiv
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases 'Matei Bals', Bucharest, Romania
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Martine Peeters
- UMI 233 TransVIHMI/INSERM1175, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ellen Vancutsem
- AIDS Reference Laboratory, Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anne-Mieke Vandamme
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,Unidade de Microbiologia, Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sigi Van den Wijngaert
- AIDS Reference Laboratory, Department of Microbiology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Marc Van Ranst
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Chris Verhofstede
- AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Tanja Stadler
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Philippe Lemey
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Kristel Van Laethem
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
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Gunn LH, Janson B, Lorjuste I, Summers L, Burns P, Bryant T. Healthcare providers' knowledge, readiness, prescribing behaviors, and perceived barriers regarding routine HIV testing and pre-exposure prophylaxis in DeLand, Florida. SAGE Open Med 2019; 7:2050312119836030. [PMID: 30886716 PMCID: PMC6413419 DOI: 10.1177/2050312119836030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives Florida ranks highest in the United States among newly diagnosed HIV infections. This ranking reflects the need for investigation of healthcare providers' knowledge, readiness, prescribing behaviors, and perceived barriers to routine HIV testing and pre-exposure prophylaxis. Methods We adapted national questionnaires with questions co-developed with Florida Department of Health to form a 25-item instrument. Questionnaires were distributed to the population of eligible healthcare providers in DeLand, Florida. Results Results from an approximate 20% response rate that encompasses 12 providers demonstrate baseline findings to inform future studies. For example, 75% of respondents were aware of FL Administrative Code 64D-3.042 that pregnant women should receive HIV testing during first and third trimesters. However, 50% of respondents rarely or never offer tests to pregnant women according to practice guidelines. About 75% of respondents strongly agree or agree with willingness to prescribe pre-exposure prophylaxis to high-risk patients, yet 8.3% always or very often prescribe pre-exposure prophylaxis. Conclusions Results convey the importance of and need for greater collaboration between providers and the Florida Department of Health to enhance providers' knowledge, readiness, and, ultimately, behaviors regarding routine HIV testing and pre-exposure prophylaxis prescription.
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Affiliation(s)
- Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.,School of Public Health, Imperial College London, London, UK
| | | | | | - Lindsay Summers
- Infectious Disease Management, Intervention, and Community Practice, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paula Burns
- Disease Control and Health Protection, Florida Department of Health in Volusia County, Daytona Beach, FL, USA
| | - Thomas Bryant
- Office of Planning and Performance Management, Florida Department of Health in Volusia County, Daytona Beach, FL, USA
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Variation in antiretroviral treatment coverage and virological suppression among three HIV key populations. AIDS 2018; 32:2807-2819. [PMID: 30289816 DOI: 10.1097/qad.0000000000002035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We assessed differences in antiretroviral treatment (ART) coverage and virological suppression across three HIV key populations, as defined by self-reported HIV transmission category: sex between men, injection drug use (IDU) and heterosexual transmission. DESIGN A multinational cohort study. METHODS Within the EuroSIDA study, we assessed region-specific percentages of ART-coverage among those in care and virological suppression (<500 copies/ml) among those on ART, and analysed differences between transmission categories using logistic regression. RESULTS Among 12 872 participants followed from 1 July 2014 to 30 June 2016, the percentages of ART-coverage and virological suppression varied between transmission categories, depending on geographical region (global P for interaction: P = 0.0148 for ART-coverage, P = 0.0006 for virological suppression). In Western [adjusted odds ratio (aOR) 1.41 (95% confidence interval 1.14-1.75)] and Northern Europe [aOR 1.68 (95% confidence interval 1.25-2.26)], heterosexuals were more likely to receive ART than MSM, while in Eastern Europe, there was some evidence that infection through IDU [aOR 0.60 (95% confidence interval 0.31-1.14)] or heterosexual contact [aOR 0.58 (95% confidence interval 0.30-1.10)] was associated with lower odds of receiving ART. In terms of virological suppression, people infected through IDU or heterosexual contact in East Central and Eastern Europe were around half as likely as MSM to have a suppressed viral load on ART, while we observed no differences in virological suppression across transmission categories in Western and Northern Europe. CONCLUSION In our cohort, patterns of ART-coverage and virological suppression among key populations varied by geographical region, emphasizing the importance of tailoring HIV programmes to the local epidemic.
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Burton NT, Misra K, Bocour A, Shah S, Gutierrez R, Udeagu CC. Inconsistent condom use with known HIV-positive partners among newly diagnosed HIV-positive men who have sex with men interviewed for partner services in New York City, 2014. Sex Transm Infect 2018; 95:108-114. [PMID: 30409918 DOI: 10.1136/sextrans-2017-053479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 09/06/2018] [Accepted: 10/10/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Condomless anal intercourse contributes significantly to the spread of HIV among men who have sex with men (MSM). Factors related to condomless anal intercourse with known HIV-positive partners among MSM are not well understood. The authors describe factors associated with inconsistent condom use with known HIV-positive partners prior to participants' diagnosis with HIV. METHODS New York City health department disease intervention specialists interviewed newly HIV-diagnosed MSM ages ≥13 years reporting knowingly having anal sex with HIV-positive partners between June 2013 and October 2014. Univariate and bivariate statistics were calculated, in addition to logistic regression analysis. RESULTS Among 95 MSM interviewed, 56% were >30 years and 74% had higher than a high school education. Respondents reported a median of 2 known HIV-positive sex partners. Drug or alcohol use during last sex with their last known HIV-positive partner was reported by 53% of participants. Sixty-five per cent of participants reported inconsistent condom use with last known HIV-positive partner. Inconsistent condom use with all HIV-positive partners was higher among individuals reporting two or more known HIV-positive partners since sexual debut than among those with one (90% vs 59%, p<0.01) and among those reporting feelings of love/emotional attachment as a reason for having sex (85% vs 63%, p=0.02). In the bivariate logistic regression models for inconsistent condom use, feelings of love or emotional attachment were the only significant predictor of inconsistent condom use (OR 3.43, 95% CI 1.23 to 9.58). After adjusting for confounding, the relationship feelings of love or emotional attachment continued to be the only significant predictor of inconsistent condom use (OR 3.69, 95% CI 1.06 to 12.82). CONCLUSIONS Surveyed MSM engaged in high-risk behaviours, including condomless anal sex and drug or alcohol use during sex with persons known to be HIV-positive. These findings can inform interventions with MSM in serodiscordant partnerships.
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Affiliation(s)
- Nicole Theresa Burton
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Kavita Misra
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Angelica Bocour
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Sharmila Shah
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Rodolfo Gutierrez
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Chi-Chi Udeagu
- Field Services Unit, New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
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25
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Palk L, Gerstoft J, Obel N, Blower S. A modeling study of the Danish HIV epidemic in men who have sex with men: travel, pre-exposure prophylaxis and elimination. Sci Rep 2018; 8:16003. [PMID: 30375426 PMCID: PMC6207710 DOI: 10.1038/s41598-018-33570-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
UNAIDS has identified the Danish HIV epidemic in men who have sex with men (MSM) as a priority for elimination. Incidence is close to the elimination threshold of one new infection per year per 1,000 individuals. However, surveillance data show that HIV strains are being imported into Denmark, mainly due to travel. We use a transmission model to predict (from 2018 to 2030) the impact of pre-exposure prophylaxis (PrEP) on incidence. Our model reflects the current epidemic and diagnosis rates in the Danish MSM community. We conduct a sensitivity analysis based on 20,000 simulations, and assume that PrEP coverage could range from zero to 50% and diagnosis rates increase up to three-fold. We predict that incidence will fall below the elimination threshold, even without the introduction of PrEP, reaching 0.87 (median, 95% Confidence Interval: 0.65-1.23) new infections per 1,000 MSM by 2030. PrEP could reduce incidence to well below the threshold, if it results in a significant increase in diagnosis rates and reduces the number of infections occurring abroad. The Danish Medicine Agency and Danish Health Authority have recommended introducing PrEP. Our study provides strong support for this recommendation, and shows the importance of Danish MSM using PrEP when abroad.
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Affiliation(s)
- Laurence Palk
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, 90024, USA
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Sally Blower
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, 90024, USA.
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26
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Leoni MC, Ustianowski A, Farooq H, Arends JE. HIV, HCV and HBV: A Review of Parallels and Differences. Infect Dis Ther 2018; 7:407-419. [PMID: 30182282 PMCID: PMC6249183 DOI: 10.1007/s40121-018-0210-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 02/06/2023] Open
Abstract
Elimination of the three blood-borne viruses—human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV)—as public health issues may be plausible in the near future. Spectacular advances have been made with the introduction of highly effective antiviral agents into clinical practice, and prevention strategies are available for all three infections. Effective disease control, laid out by WHO global strategies, is currently feasible for all three viruses. However, for worldwide elimination of these viruses, effective vaccines are required that are currently only available for HBV. In this review differences and parallels among HIV, HCV and HBV will be discussed with a focus on virologic and therapeutic issues, and prospects for the future of HBV will be presented.
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Affiliation(s)
- Maria C Leoni
- Department of Internal Medicine, Section Infectious Diseases, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Andrew Ustianowski
- Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
- School of Medical Sciences, University of Manchester, Manchester, UK
| | - Hamzah Farooq
- Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
| | - Joop E Arends
- Department of Internal Medicine, Section Infectious Diseases, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
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Okano JT, Gerstoft J, Obel N, Blower S. HIV elimination and population viral load. Lancet HIV 2018; 3:e507-e509. [PMID: 27788865 DOI: 10.1016/s2352-3018(16)30174-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/06/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Justin T Okano
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sally Blower
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
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28
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Borgdorff MW, Kwaro D, Obor D, Otieno G, Kamire V, Odongo F, Owuor P, Muthusi J, Mills LA, Joseph R, Schmitz ME, Young PW, Zielinski-Gutierrez E, De Cock KM. HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis. Lancet HIV 2018; 5:e241-e249. [PMID: 29650451 DOI: 10.1016/s2352-3018(18)30025-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND In Kenya, coverage of antiretroviral therapy (ART) among people with HIV infection has increased from 7% in 2006, to 57% in 2016; and, in western Kenya, coverage of voluntary medical male circumcision (VMMC) increased from 45% in 2008, to 72% in 2014. We investigated trends in HIV prevalence and incidence in a high burden area in western Kenya in 2011-16. METHODS In 2011, 2012, and 2016, population-based surveys were done via a health and demographic surveillance system and home-based counselling and testing in Gem, Siaya County, Kenya, including 28 688, 17 021, and 16 772 individuals aged 15-64 years. Data on demographic variables, self-reported HIV status, and risk factors were collected. Rapid HIV testing was offered to survey participants. Participants were tracked between surveys by use of health and demographic surveillance system identification numbers. HIV prevalence was calculated as a proportion, and HIV incidence was expressed as number of new infections per 1000 person-years of follow-up. FINDINGS HIV prevalence was stable in participants aged 15-64 years: 15% (4300/28 532) in 2011, 12% (2051/16 875) in 2012, and 15% (2312/15 626) in 2016. Crude prevalences in participants aged 15-34 years were 11% (1893/17 197) in 2011, 10% (1015/10 118) in 2012, and 9% (848/9125) in 2016; adjusted for age and sex these prevalences were 11%, 9%, and 8%. 12 606 (41%) of the 30 520 non-HIV-infected individuals enrolled were seen again in at least one more survey round, and were included in the analysis of HIV incidence. HIV incidence was 11·1 (95% CI 9·1-13·1) per 1000 person-years from 2011 to 2012, and 5·7 (4·6-6·9) per 1000 person-years from 2012 to 2016. INTERPRETATION With increasing coverage of ART and VMMC, HIV incidence declined substantially in Siaya County between 2011 and 2016. VMMC, but not ART, was suggested to have a direct protective effect, presumably because ART tended to be given to individuals with advanced HIV infection. HIV incidence is still high and not close to the elimination target of one per 1000 person-years. The effect of further scale-up of ART and VMMC needs to be monitored. FUNDING Data were collected under Cooperative Agreements with the US Centers for Disease Control and Prevention, with funding from the President's Emergency Fund for AIDS Relief.
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Affiliation(s)
- Martien W Borgdorff
- US Centers for Disease Control and Prevention, Nairobi, Kenya; Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel Kwaro
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - David Obor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - George Otieno
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Viviane Kamire
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Frederick Odongo
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Patrick Owuor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Jacques Muthusi
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lisa A Mills
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Rachael Joseph
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mary E Schmitz
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peter W Young
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - Kevin M De Cock
- US Centers for Disease Control and Prevention, Nairobi, Kenya.
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Reyes-Urueña JM, Campbell CNJ, Vives N, Esteve A, Ambrosioni J, Tural C, Ferrer E, Navarro G, Force L, García I, Masabeu À, Vilaró JM, García de Olalla P, Caylà JA, Miró JM, Casabona J. Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population. BMJ Open 2018; 8:e018533. [PMID: 29490955 PMCID: PMC5855442 DOI: 10.1136/bmjopen-2017-018533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations. METHODS To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort. RESULTS The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%). CONCLUSIONS By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.
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Affiliation(s)
- Juliana Maria Reyes-Urueña
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Colin N J Campbell
- Tuberculosis Section, Centre for Infectious Disease Surveillance and Control, National Infection Service, Public Health England, London, UK
| | - Núria Vives
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Esteve
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Ambrosioni
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Cristina Tural
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Elena Ferrer
- Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Navarro
- Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
| | | | | | | | | | - Patricia García de Olalla
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Joan Artur Caylà
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - Josep M Miró
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
- Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Kumi Smith M, Jewell BL, Hallett TB, Cohen MS. Treatment of HIV for the Prevention of Transmission in Discordant Couples and at the Population Level. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1075:125-162. [PMID: 30030792 DOI: 10.1007/978-981-13-0484-2_6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The scientific breakthrough proving that antiretroviral therapy (ART) can halt heterosexual HIV transmission came in the form of a landmark clinical trial conducted among serodiscordant couples. Study findings immediately informed global recommendations for the use of treatment as prevention in serodiscordant couples. The extent to which these findings are generalizable to other key populations or to groups exposed to HIV through nonsexual transmission routes (i.e., anal intercourse or unsafe injection of drugs) has since driven a large body of research. This review explores the history of HIV research in serodiscordant couples, the implications for management of couples, subsequent research on treatment as prevention in other key populations, and challenges in community implementation of these strategies.
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Affiliation(s)
- M Kumi Smith
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Myron S Cohen
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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Grabowski MK, Serwadda DM, Gray RH, Nakigozi G, Kigozi G, Kagaayi J, Ssekubugu R, Nalugoda F, Lessler J, Lutalo T, Galiwango RM, Makumbi F, Kong X, Kabatesi D, Alamo ST, Wiersma S, Sewankambo NK, Tobian AAR, Laeyendecker O, Quinn TC, Reynolds SJ, Wawer MJ, Chang LW. HIV Prevention Efforts and Incidence of HIV in Uganda. N Engl J Med 2017; 377:2154-2166. [PMID: 29171817 PMCID: PMC5627523 DOI: 10.1056/nejmoa1702150] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participant-reported male circumcision, viral-load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) - from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). CONCLUSIONS In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a population-level effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- M Kate Grabowski
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - David M Serwadda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald H Gray
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Gertrude Nakigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Godfrey Kigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Joseph Kagaayi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Robert Ssekubugu
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Nalugoda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Justin Lessler
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas Lutalo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald M Galiwango
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Makumbi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Xiangrong Kong
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Donna Kabatesi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Stella T Alamo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven Wiersma
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Nelson K Sewankambo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Aaron A R Tobian
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Oliver Laeyendecker
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas C Quinn
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven J Reynolds
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Maria J Wawer
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Larry W Chang
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
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Casabona J. Profilaxis pre-exposición del VIH: que el árbol no impida ver el bosque. Aten Primaria 2017; 49:317-318. [PMID: 28521860 PMCID: PMC6876267 DOI: 10.1016/j.aprim.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT), Departament de Salut, Barcelona, España; Grupo de Diagnóstico Precoz del VIH en Atención Primaria en España, Barcelona, España; Centro de Investigación Biomédica en RED de Epidemiología y Salud Pública (CIBERESP).
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Coburn BJ, Okano JT, Blower S. Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa. Sci Transl Med 2017; 9:eaag0019. [PMID: 28356504 PMCID: PMC5734867 DOI: 10.1126/scitranslmed.aag0019] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/20/2016] [Accepted: 01/13/2017] [Indexed: 12/25/2022]
Abstract
Treatment as prevention (TasP) has been proposed by the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) as a global strategy for eliminating HIV. The rationale is that treating individuals reduces their infectivity. We present a geostatistical framework for designing TasP-based HIV elimination strategies in sub-Saharan Africa. We focused on Lesotho, where ~25% of the population is infected. We constructed a density of infection map by gridding high-resolution demographic data and spatially smoothing georeferenced HIV testing data. The map revealed the countrywide geographic dispersion pattern of HIV-infected individuals. We found that ~20% of the HIV-infected population lives in urban areas and that almost all rural communities have at least one HIV-infected individual. We used the map to design an optimal elimination strategy and identified which communities should use TasP. This strategy minimized the area that needed to be covered to find and treat HIV-infected individuals. We show that UNAIDS's elimination strategy would not be feasible in Lesotho because it would require deploying treatment in areas where there are ~4 infected individuals/km2 Our results show that the spatial dispersion of Lesotho's population hinders, and may even prevent, the elimination of HIV.
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Affiliation(s)
- Brian J Coburn
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Justin T Okano
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sally Blower
- Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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34
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Iwamoto A, Taira R, Yokomaku Y, Koibuchi T, Rahman M, Izumi Y, Tadokoro K. The HIV care cascade: Japanese perspectives. PLoS One 2017; 12:e0174360. [PMID: 28319197 PMCID: PMC5358866 DOI: 10.1371/journal.pone.0174360] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/07/2017] [Indexed: 11/30/2022] Open
Abstract
Japan has been known as a low HIV-prevalence country with a concentrated epidemic among high-risk groups. However, it has not been determined whether Japan meets the 90-90-90 goals set by the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO). Moreover, to date, the HIV care cascade has not been examined. We estimated the total number of diagnosed people living with HIV/AIDS (PLWHA) (n = 22,840) based on legal reports to the Ministry of Health, Labour and Welfare by subtracting the number of foreigners who left Japan (n = 2,273) and deaths (n = 2,321) from the cumulative diagnosis report (n = 27,434). The number of total undiagnosed PLWHA was estimated by age and sex specific HIV-positive rates observed among first-time blood donors between 2011–2015 in Japan. Our estimates show that 14.4% (n = 3,830) of all PLWHA (n = 26,670) were undiagnosed in Japan at the end of 2015. The number of patients retained in care (n = 20,615: 77.3% of PLWHA), the percentage of those on antiretroviral therapy (n = 18,921: 70.9% of PLWHA) and those with suppressed viral loads (<200 copies/mL; n = 18,756: 70.3% of PLWHA) were obtained through a questionnaire survey conducted in the AIDS Core Hospitals throughout the country. According to these estimates, Japan failed to achieve the first two of the three UNAIDS/WHO targets (22,840/26,670 = 85.6% of HIV-positive cases were diagnosed; 18,921/22,840 = 82.8% of those diagnosed were treated; 18,756/18,921 = 99.1% of those treated experienced viral suppression). Although the antiretroviral treatment uptake and success after retention in medical care appears to be excellent in Japan, there are unmet needs, mainly at the surveillance level before patients are retained in care. The promotion of HIV testing and treatment programs among the key affected populations (especially men who have sex with men) may contribute to further decreasing the HIV epidemic and achieving the UNAIDS/WHO targets in Japan.
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Affiliation(s)
- Aikichi Iwamoto
- Japan Agency for Medical Research and Development, Tokyo, Japan
- * E-mail:
| | - Rikizo Taira
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yoshiyuki Yokomaku
- Clinical Research Center, Nagoya Medical Center, National Hospital Organization. Nagoya, Japan
| | - Tomohiko Koibuchi
- The Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | | | - Yoko Izumi
- Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Kenji Tadokoro
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Abstract
We reviewed published national HIV care continua for men who have sex with men (MSM), people who inject drugs (PWID), and female sex workers (FSWs) to track progress toward the 90-90-90 target. We searched the Internet, PubMed, surveillance reports, United Nations Programme on HIV/AIDS country reports, US President's Emergency Plan for AIDS Relief country/regional operational plans, and conference abstracts for the continua and graded them on quality. We found 12 continua for MSM, 7 for PWID, and 5 for FSW from 12 countries. HIV diagnosis, antiretroviral therapy coverage, and viral suppression varied between (1) 5% and 85%, 2% and 73%, and 1% and 72%, respectively for MSM; (2) 54% and 96%, 14% and 80%, and 8% and 68%, respectively for PWID; and (3) 27% and 63%, 8% and 16%, and 2% and 14%, respectively for FSW. Two countries, using data from national cohorts, were high quality. There are limited key population continua in the public domain. Of the few available, none have achieved 90-90-90. Improved monitoring and evaluation of key population continua is necessary to achieve the 90-90-90 target.
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Affiliation(s)
- Somya Gupta
- 1 International Association of Providers of AIDS Care, New Delhi, India
| | - Reuben Granich
- 2 International Association of Providers of AIDS Care, Washington DC, USA
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Callander D, Stoové M, Carr A, Hoy JF, Petoumenos K, Hellard M, Elliot J, Templeton DJ, Liaw S, Wilson DP, Grulich A, Cooper DA, Pedrana A, Donovan B, McMahon J, Prestage G, Holt M, Fairley CK, McKellar-Stewart N, Ruth S, Asselin J, Keen P, Cooper C, Allan B, Kaldor JM, Guy R. A longitudinal cohort study of HIV 'treatment as prevention' in gay, bisexual and other men who have sex with men: the Treatment with Antiretrovirals and their Impact on Positive And Negative men (TAIPAN) study protocol. BMC Infect Dis 2016; 16:752. [PMID: 27955627 PMCID: PMC5154018 DOI: 10.1186/s12879-016-2073-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Australia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014. While ART reduces AIDS-related deaths, accumulating evidence suggests that it could also bolster prevention efforts by reducing the risk of HIV transmission ('treatment as prevention'). While promising, evidence of community-level impact of treatment as prevention on reducing HIV incidence among gay and bisexual men is limited. We describe a study protocol that aims to determine if scale up of testing and treatment for HIV leads to a reduction in community viraemia and, in turn, if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men in Australia's two most populous states. METHODS Over the period 2009 to 2017, we will establish two cohorts making use of clinical and laboratory data electronically extracted retrospectively and prospectively from 73 health services and laboratories in the states of New South Wales and Victoria. The 'positive cohort' will consist of approximately 13,000 gay and bisexual men (>90% of all people living with HIV). The 'negative cohort' will consist of at least 40,000 HIV-negative gay and bisexual men (approximately half of the total population). Within the negative cohort we will use standard repeat-testing methods to calculate annual HIV incidence. Community prevalence of viraemia will be defined as the proportion of men with a viral load ≥200RNA copies/mm3, which will combine viral load data from the positive cohort and viraemia estimates among those with an undiagnosed HIV infection. Using regression analyses and adjusting for behavioural and demographic factors associated with infection, we will assess the temporal association between the community prevalence of viraemia and the incidence of HIV infection. Further analyses will make use of these cohorts to assess incidence and predictors of treatment initiation, repeat HIV testing, and viral suppression. DISCUSSION This study will provide important information on whether 'treatment as prevention' is associated with a reduction in HIV incidence at a community level among gay and bisexual men.
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Affiliation(s)
- D Callander
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - M Stoové
- Burnet Institute, Melbourne, VIC, Australia
| | - A Carr
- St Vincent's Hospital, Sydney, NSW, Australia
| | - J F Hoy
- Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - K Petoumenos
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - M Hellard
- Burnet Institute, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - J Elliot
- Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - D J Templeton
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,RPA Sexual Health, Community Health, Sydney Local Health District, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - S Liaw
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - D P Wilson
- Burnet Institute, Melbourne, VIC, Australia
| | - A Grulich
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - D A Cooper
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - A Pedrana
- Monash University, Melbourne, VIC, Australia
| | - B Donovan
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - J McMahon
- Monash University, Melbourne, VIC, Australia.,Alfred Hospital, Melbourne, VIC, Australia
| | - G Prestage
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - M Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
| | - C K Fairley
- Monash University, Melbourne, VIC, Australia.,Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | | | - S Ruth
- Victorian AIDS Council, Melbourne, VIC, Australia
| | - J Asselin
- Burnet Institute, Melbourne, VIC, Australia
| | - P Keen
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - C Cooper
- PositiveLife New South Wales, Sydney, NSW, Australia
| | - B Allan
- Living Positive Victoria, Melbourne, VIC, Australia
| | - J M Kaldor
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - R Guy
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
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37
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Newell ML, Iwuji C. HIV treatment as prevention: applicable in sub-Saharan Africa? THE LANCET. INFECTIOUS DISEASES 2016; 16:754-755. [PMID: 27174505 DOI: 10.1016/s1473-3099(16)30057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marie-Louise Newell
- Academic Unit of Health and Development and Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Collins Iwuji
- Africa Centre for Population Health, University of KwaZulu-Natal, South Africa; Research Department of Infection and Population Health, University College London, UK
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