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Webster JL, Thorpe LE, Duncan DT, Goldstein ND. Accessibility of HIV Services in Philadelphia: Location-Allocation Analysis. Am J Prev Med 2022; 63:1053-1061. [PMID: 36057459 PMCID: PMC10152388 DOI: 10.1016/j.amepre.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION As the first step in the HIV care continuum, timely diagnosis is central to reducing transmission of the virus and ending the HIV epidemic. Studies have shown that distance from a testing site is essential for ease of access to services and educational material. This study shows how location-allocation analysis can be used to improve allocation of HIV testing services utilizing existing publicly available data from 2015 to 2019 on HIV prevalence, testing site location, and factors related to HIV in Philadelphia, Pennsylvania. METHODS The ArcGIS Location-Allocation analytic tool was used to calculate locations for HIV testing sites using a method that minimizes the distance between demand-point locations and service facilities. ZIP code level demand was initially specified on the basis of the percentage of late HIV diagnoses and in a sensitivity analysis on the basis of a composite of multiple factors. Travel time and distance from demand to facilities determined the facility location allocation. This analysis was conducted from 2021 to 2022. RESULTS Compared with the 37 facilities located in 20 (43%) Philadelphia ZIP codes, the model proposed reallocating testing facilities to 37 (79%) ZIP codes using percent late diagnoses to define demand. On average, this would reduce distance to the facilities by 65% and travel time to the facilities by 56%. Results using the sensitivity analysis were similar. CONCLUSIONS A wider distribution of HIV testing services across the city of Philadelphia may reduce distance and travel time to facilities, improve accessibility of testing, and in turn increase the percentage of people with knowledge of their status.
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Affiliation(s)
- Jessica L Webster
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Lorna E Thorpe
- Department of Population Health, New York University Langone Health, New York, New York
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.
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2
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Nguyen VT, Jatta A, Mayer R, Meier JL. Evaluation of Undiagnosed HIV Estimates Computed from the CD4 Depletion Model in a Rural, Medium-low HIV Prevalence State. AIDS Behav 2022; 26:613-622. [PMID: 34355286 DOI: 10.1007/s10461-021-03419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/25/2022]
Abstract
The CD4 depletion model estimates diagnosis delays by approximating infection date from CD4 T-cell count at diagnosis, and back-calculation can compute the proportion of undiagnosed PLWHA. The model assumes the immigration of PLWHA to the U.S. is negligible and counts as a transmission event, which may be impractical outside high prevalence states. Duration of U.S. residency among foreign-born PLWHA and diagnosis delays were compared. The impact on estimates of undiagnosed PLWHA was tested through simulation with different proportions of foreign-born people assumed to have acquired HIV abroad. In 67% of foreign-born people, the mean (SD) years of delay (9.9 (6.3)) exceeded the duration of U.S. residency (2.0 (1.9)). Additionally, inaccuracies in the estimates for proportions of undiagnosed PLWHA were pronounced when foreign-born people who acquired HIV abroad comprised 30% of diagnoses. The CD4 model inadvertently misclassified some diagnoses as in-state transmission events. Consequently, simulated results demonstrated inaccuracies and unstable calculations.
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Affiliation(s)
- V T Nguyen
- College of Public Health, University of Iowa, Iowa City, IA, USA.
- VA Connecticut Health Care System, West Haven, CT, USA.
- Yale University, Epidemiology & Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| | - A Jatta
- Iowa Department of Public Health, Bureau of HIV, STD, and Hepatitis, Des Moines, IA, USA
| | - R Mayer
- Iowa Department of Public Health, Bureau of HIV, STD, and Hepatitis, Des Moines, IA, USA
| | - J L Meier
- College of Public Health, University of Iowa, Iowa City, IA, USA
- College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
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3
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Carter G, Brown L, Mahnke B, Ohmit A, Woodward B. Sexual Communication Self-Efficacy and PrEP Literacy Helps to Meet HIV Prevention Outcomes Among Black and Latinx Individuals. J Prim Care Community Health 2022; 13:21501319221099789. [PMID: 35578769 PMCID: PMC9118410 DOI: 10.1177/21501319221099789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Ending the HIV Epidemic is a campaign dedicated to reducing new HIV infections in the United States by 90% by 2030. Preexposure prophylaxis (PrEP) holds significant promise as a prevention tool. However, uptake has not improved much since then. As a result, this research looked at how PrEP literacy relates to sexual communication self-efficacy Methods: Between August 4 and 21, 2020, we performed a community-informed cross-sectional study of Black and Latino residents in Indiana. We collected demographic information as well as PrEP literacy, sexual communication self-efficacy, and awareness of HIV status. Results: Being unaware of one’s own HIV status and being unsure of one’s sexual identity were both linked to reduced self-efficacy in the domain of sex communication. Those who had a greater level of PrEP literacy felt more confident in their ability to communicate with others about sexually related topics. People living in rural areas showed a significantly lower degree of sexual communication self-efficacy than participants in urban settings. Conclusion: Providing information about PrEP to those at risk of acquiring the virus may help them connect with treatment or prevention services. Healthcare professionals should take the time to understand their patients’ levels of PrEP literacy and communication self-efficacy regarding sexual health.
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Affiliation(s)
- Gregory Carter
- Indiana University School of Nursing, Bloomington, IN, USA.,The Kinsey Institute, Bloomington, IN, USA
| | - Lucy Brown
- The Kinsey Institute, Bloomington, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brianna Mahnke
- The Kinsey Institute, Bloomington, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anita Ohmit
- Indiana Minority Health Coalition, Indianapolis, IN, USA
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4
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Williams LD, Tempalski B, Hall HI, Johnson AS, Wang G, Friedman SR. Trajectories of and disparities in HIV prevalence among Black, White, and Hispanic/Latino High Risk Heterosexuals in 89 U.S. Metropolitan statistical areas, 1992-2013. Ann Epidemiol 2021; 64:140-148. [PMID: 34433105 PMCID: PMC8747890 DOI: 10.1016/j.annepidem.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Estimates of HIV prevalence, and how it changes over time, are needed to inform action (e.g., resource allocation) to improve HIV-related public health. However, creating adequate estimates of (diagnosed and undiagnosed) HIV prevalence is challenging due to biases in samples receiving HIV testing and due to difficulties enumerating key risk populations. To our knowledge, estimates of HIV prevalence among high risk heterosexuals in the United States produced for geographic areas smaller than the entire nation have to date been only for single years and/or for single cities (or other single geographic locations). METHODS The present study addresses these gaps by using multilevel modeling on multiple data series, in combination with previous estimates of HIV prevalence among heterosexuals from the extant literature, to produce annual estimates of HIV prevalence among high risk heterosexuals for each of 89 metropolitan statistical areas, from 1992 to 2013. It also produces estimates for these MSAs and years by racial/ethnic subgroup to allow for an examination of change over time in racial/ethnic disparities in HIV prevalence among high risk heterosexuals. RESULTS The resulting estimates suggest that HIV prevalence among high risk heterosexuals has decreased steadily, on average, from 1992 to 2013. Examination of these estimates by racial/ ethnic subgroup suggests that this trend is primarily due to decreases among Black and Hispanic/Latino high risk heterosexuals. HIV prevalence among white high risk heterosexuals remained steady over time at around 1% during the study period. Although HIV prevalence among Black and Hispanic/Latino high risk heterosexuals was much higher (approximately 3.5% and 3.3%, respectively) than that among whites in 1992, over time these differences decreased as HIV prevalence decreased over time among these subgroups. By 2013, HIV prevalence among Hispanic/Latino high risk heterosexuals was estimated to be very similar to that among white high risk heterosexuals (approximately 1%), with prevalence among Black high risk heterosexuals still estimated to be almost twice as high. CONCLUSIONS It is likely that as HIV incidence has decreased among heterosexuals from 1992 to 2013, mortality due to all causes has remained disparately high among racial/ethnic minorities, thereby outpacing new HIV cases. Future research should aim to empirically examine this by comparing changes over time in estimated HIV incidence among heterosexuals to changes over time in mortality and causes of death among HIV-positive heterosexuals, by racial/ethnic subgroup.
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Affiliation(s)
- Leslie D Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States.
| | - Barbara Tempalski
- North Jersey Community Research Initiative (NJCRI), North Jersey AIDS Alliance, Newark, NJ, United States; Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States
| | - H Irene Hall
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Guoshen Wang
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY, United States; Department of Population Health, New York University School of Medicine, New York, NY, United States
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5
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Nemoto T, Iwamoto M, Suico S, Stanislaus V, Piroth K. Sociocultural Contexts of Access to HIV Primary Care and Participant Experience with an Intervention Project: African American Transgender Women Living with HIV in Alameda County, California. AIDS Behav 2021; 25:84-95. [PMID: 31925609 DOI: 10.1007/s10461-019-02752-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The baseline data of the intervention project for African American transgender women living with HIV showed that more than one-third of the participants having ever enrolled in HIV care had not received ART and that among those in ART, more than half reported their adherence to ART was poor. Those who had engaged in sex work, sold drugs, or experienced higher levels of transphobia were less likely to have enrolled in care. The qualitative interviews with participants who had completed the intervention or dropped out revealed barriers to enroll in care, such as community stigma and transphobia.
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Affiliation(s)
- Tooru Nemoto
- Public Health Institute, 1333 Broadway, Suite P110, Oakland, CA, 94612, USA.
| | - Mariko Iwamoto
- Public Health Institute, 1333 Broadway, Suite P110, Oakland, CA, 94612, USA
| | - Sabrina Suico
- Public Health Institute, 1333 Broadway, Suite P110, Oakland, CA, 94612, USA
| | | | - Kirsten Piroth
- Public Health Institute, 1333 Broadway, Suite P110, Oakland, CA, 94612, USA
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6
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Shoemaker ES, Volpini K, Smith S, Loutfy M, Kendall C. Equitable Timing of HIV Diagnosis Prior to Pregnancy: A Canadian Perspective. Cureus 2021; 13:e16691. [PMID: 34466322 PMCID: PMC8396133 DOI: 10.7759/cureus.16691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/28/2022] Open
Abstract
Initiating antiretrovirals prior to conception leads to a negligible risk of perinatal transmission. This study aimed to determine the timing of HIV diagnosis among pregnant women with HIV in Ontario. A retrospective population-level cohort study using linked health administrative databases was conducted to establish maternal HIV status and timing of HIV diagnosis of all women living with HIV who gave birth in 2006-2018. The majority of the 1012 women living with HIV who gave birth in Ontario were diagnosed prior to pregnancy (87.9%); however, many were not (12.1%). Among those diagnosed during pregnancy, only 23% were diagnosed in the first trimester. While HIV screening tests are being well directed towards young women, several women still enter pregnancy undiagnosed and are not diagnosed early. This calls for a continuous effort to promote universal pre-conception screening and to use HIV point-of-care testing for at-risk pregnant women and those presenting late to prenatal care.
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Affiliation(s)
- Esther S Shoemaker
- Internal Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN
- Internal Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN
- Internal Medicine, Ottawa Hospital Research Institute, Ottawa, CAN
| | - Kate Volpini
- Internal Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN
- Internal Medicine, University of Ottawa, Ottawa, CAN
| | - Stephanie Smith
- Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN
| | - Mona Loutfy
- Infectious Disease, Women's College Research Institute, Women's College Hospital, Toronto, CAN
- Internal Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN
- Internal Medicine, University of Toronto, Toronto, CAN
| | - Claire Kendall
- Family Medicine, C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, CAN
- Family Medicine, Institute for Clinical Evaluative Sciences (ICES), Toronto, CAN
- Family Medicine, Ottawa Hospital Research Institute, Ottawa, CAN
- Family Medicine, University of Ottawa, Ottawa, CAN
- Family Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, CAN
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7
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Kaufman CE, Keane EM, Shangreau C, Arthur-Asmah R, Morse B, Whitesell NR. Dissemination and uptake of HIV/STD preventive interventions in American Indian and Alaska Native communities: a case study. ETHNICITY & HEALTH 2021; 26:352-363. [PMID: 30146899 DOI: 10.1080/13557858.2018.1514456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Objectives: HIV and sexually transmitted diseases (STDs) are serious health conditions among American Indian and Alaska Native (AIAN) populations, especially youth. However, few sexual risk reduction evidence-based interventions (EBIs) have been implemented by AIAN-serving organizations. This project sought to identify and assess the parameters facilitating the uptake and use of EBIs in order to strengthen opportunities for sustainability and improved sexual health among AIANs.Design: Guided by Rogers' theory of diffusion of innovation, we conducted a survey with a national sample of stakeholders involved with sexual health and well-being of AIAN youth (N = 142). We collected surveys for nine months beginning September 2010 and analyzed data in 2014 and 2015. We assessed respondents' perceptions of factors that might facilitate or hinder the use of a sexual risk reduction EBI, called RESPECT, in their communities. We regressed the scale of likely program uptake (alpha = 0.88) on each of five measures of perception of diffusion and uptake: trialability (extent new program can be altered), relative advantage (more advantageous than current program), observability (impact of program), complexity (difficulty of implementation), and compatibility (consistent with community values and practices).Results: Trialability (p = .009), observability (p = .003), and compatibility (p = .005) were found to be significantly related to program uptake in the adjusted model. Standardized betas showed that compatibility ranked highest of the three, followed by trialability and observability.Conclusions: For AIAN-serving organizations and AIAN communities, demonstrating trialability, compatibility, and observability of a sexual risk reduction EBI in specific cultural settings may increase likelihood of implementation and sustainability.
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Affiliation(s)
- Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Ellen M Keane
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Carly Shangreau
- Great Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's Health Board, Rapid City, SD, USA
| | - Ruth Arthur-Asmah
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley Morse
- The Butler Institute, University of Denver, Denver, CO, USA
| | - Nancy R Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
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8
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Windsor LC, Pinto RM, Lee CA. Interprofessional collaboration associated with frequency of life-saving links to HIV continuum of care services in the urban environment of Newark, New Jersey. BMC Health Serv Res 2020; 20:1014. [PMID: 33160344 PMCID: PMC7648428 DOI: 10.1186/s12913-020-05866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV continuum of care has been used as a strategy to reduce HIV transmission rates, with timely engagement in HIV testing being the first and most critical step. This study examines interprofessional-collaboration (IPC) after controlling for agency/ provider demographics, provider training and self-efficacy as a significant predictor of how frequently HIV service providers link their clients to HIV testing. METHODS Multilevel binary logistic regression analysis was conducted to examine the effects of IPC on links to HIV testing while controlling for demographic and agency information, provider training, and standardized measures of providers' feelings, attitudes, and opinions about IPC. Cross-sectional data from 142 providers in 13 agencies offering treatment and prevention services for HIV and substance-use disorders were collected via a survey. RESULTS Those who scored higher on the IPC scale reported significantly higher rates of linkages to HIV testing. Compared to the null model (i.e., no predictor model), the final multilevel binary logistic regression model showed a significantly improved likelihood of linkage to HIV testing by 11.4%, p. < .05. The final model correctly classified 90.2% of links to HIV testing. Providers in agencies with smaller budgets and in agencies offering substance use disorder services were more likely to link clients to HIV testing. Younger providers who received HIV training were also more likely to link clients to HIV testing. CONCLUSIONS Findings suggest IPC training as a potential strategy to improve linkages to HIV testing for clients at risk for HIV infection. Future research is recommended to identify specific areas of IPC that might have differential effects on links to HIV testing.
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Affiliation(s)
| | | | - Carol Ann Lee
- University of Illinois at Urbana-Champaign, 1010 W. Nevada Street, Urbana, IL, 61801, USA
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9
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Furness BW, Goldhammer H, Montalvo W, Gagnon K, Bifulco L, Lentine D, Anderson D. Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative. Ann Fam Med 2020; 18:292-302. [PMID: 32661029 PMCID: PMC7358016 DOI: 10.1370/afm.2542] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people experience multiple disparities in access to care and health outcomes. We developed a quality improvement initiative, Transforming Primary Care for LGBT People, to enhance the capacity of federally qualified health centers (FQHCs) to provide culturally affirming care for this population. METHODS The 1-year intervention blended the models of Practice Improvement Collaboratives and Project ECHO (Extension for Community Health Outcomes) to facilitate learning and translate knowledge into action. FQHC teams received coaching in creating LGBT-inclusive environments, collecting sexual orientation and gender identity (SOGI) data, taking risk-based sexual histories, and screening LGBT people for syphilis, chlamydia and gonorrhea, and HIV. We used a preintervention-postintervention evaluation design. RESULTS We selected 10 FQHCs serving 441,387 patients in 123 clinical sites in 9 states. The intervention spread from 10 clinicians in 10 clinical sites to 431 clinicians in 79 clinical sites. FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9% increase) and identifying LGBT patient liaisons (300.0% increase). Postintervention, among 9 FQHCs reporting SOGI data from electronic health records, SOGI documentation increased from 13.5% to 50.8% of patients (276.3% increase). Among 8 FQHCs reporting number of LGBT patients, screening of LGBT patients increased from 22.3% (95% CI, 4.9%-40.0%) to 34.6% (95% CI, 19.4%-48.6%) for syphilis (86.5% increase); from 25.3% (95% CI, 7.6%-43.1%) to 44.1% (95% CI, 30.2%-58.1%) for chlamydia and gonorrhea (109.0% increase); and from 14.8% (95% CI, 3.2%-26.5%) to 30.5% (95% CI, 26.7%-34.3%) for HIV (132.4% increase). CONCLUSIONS FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients.
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Affiliation(s)
- Bruce W Furness
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wanda Montalvo
- Jonas Nursing & Veterans Healthcare, Columbia University, New York, New York.,Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
| | - Kelly Gagnon
- Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut.,University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Lauren Bifulco
- Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
| | - Daniel Lentine
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daren Anderson
- Weitzman Institute, Community Health Center, Inc, Middletown, Connecticut
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10
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Tran L, Tran P, Tran L. Influence of Rurality on HIV Testing Practices Across the United States, 2012-2017. AIDS Behav 2020; 24:404-417. [PMID: 30762188 DOI: 10.1007/s10461-019-02436-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In the US, HIV testing has been key in the identification of new HIV cases, allowing for the initiation of antiretroviral treatment and a reduction in disease transmission. We consider the influence of living in a rural area (rurality) on HIV testing between different US regions and states as existing work in this area is limited. Using the 2012-2017 Behavioral Risk Factor Surveillance Systems surveys, we explored the independent role of rurality on having ever been tested for HIV and having a recent HIV test at the national, regional, and state levels by calculating average adjusted predictions (AAPs) and average marginal effects (AMEs). Suburban and urban areas had higher odds and AAPs of having ever been tested for HIV and having a recent HIV test compared to rural areas across the US. The Midwest had the lowest AAPs for both having ever been tested for HIV (17.57-20.32%) and having a recent HIV test (37.65-41.14%) compared to other regions. For both questions on HIV testing, regions with the highest AAPs had the greatest rural-urban differences in probabilities and regions with the lowest AAPs had the smallest rural-urban difference in probabilities. The highest rural-urban testing disparities were observed in states with high AAPs for HIV testing. HIV testing estimates were higher in urban compared to rural areas at the national, regional, and state level. This study examines the isolated influence of rurality on HIV testing and identifies specific US areas where future efforts to increase HIV testing should be directed to.
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11
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Implementation of Targeted Point of Care HIV Testing in a Pediatric Emergency Department. Pediatr Qual Saf 2020; 5:e248. [PMID: 32190794 PMCID: PMC7056291 DOI: 10.1097/pq9.0000000000000248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022] Open
Abstract
HIV infection rates are increasing among adolescents. Despite guidelines recommending annual HIV screening among sexually active adolescents, 3.6% of adolescents tested for other sexually transmitted infections (STI) in a pediatric emergency department (PED) were screened for HIV. The aim was to increase HIV screening to 90%.
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12
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Singh K, Chander G, Lau B, Edwards JK, Moore RD, Lesko CR. Association of History of Injection Drug Use with External Cause-Related Mortality Among Persons Linked to HIV Care in an Urban Clinic, 2001-2015. AIDS Behav 2019; 23:3286-3293. [PMID: 30955176 DOI: 10.1007/s10461-019-02497-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High mortality rates among persons with HIV with a history of injection drug use (PWID) are thought to be driven in part by higher rates of external cause-related mortality. We followed 4796 persons aged 18-70 engaged in continuity HIV care from 2001 to 2015 until death or administrative censoring. We compared cause-specific (csHR) and subdistribution hazards (sdHR) of death due to external causes among PWID and persons who acquired their HIV infection through other routes (non-IDU). We standardized estimates on age, sex, race, and HIV-related health status. The standardized csHR for external cause-related death was 3.57 (95% CI 2.39, 5.33), and the sdHR was 3.14 (95% CI 2.16, 4.55). The majority of external cause-related deaths were overdose-related and standardized sdHR was 4.02 (95% CI 2.40, 6.72). Absolute rate of suicide was low but the csHR for PWID compared to non-IDU was most elevated for suicide (6.50, 95% CI 1.51, 28.03). HIV-infected PWID are at a disproportionately increased risk of death due to external causes, particularly overdose and suicide.
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Affiliation(s)
- Kanal Singh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
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Dunn Navarra AM, Viorst Gwadz M, Bakken S, Whittemore R, Cleland CM, D'Eramo Melkus G. Adherence Connection for Counseling, Education, and Support: Research Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2019; 8:e12543. [PMID: 30920377 PMCID: PMC6458537 DOI: 10.2196/12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background The highest rates of new HIV infections are observed in African Americans and Hispanics/Latinos (ethnic minority) adolescents and young adults (youth). HIV-infected ethnic minority youth are less likely to initiate and maintain adherence to antiretroviral treatment (ART) and medical care, as compared with their adult counterparts. Objective The objective of this research protocol was to describe our proposed methods for testing a peer-led mobile health cognitive behavioral intervention, delivered via remote videoconferencing and smartphones with HIV-infected ethnic minority youth, Adherence Connection for Counseling, Education, and Support (ACCESS). Our secondary aim was to obtain initial estimates of the biobehavioral impact of ACCESS on HIV virologic outcomes and self-reported ART adherence, beliefs and knowledge about ART treatment, adherence self-efficacy, and health care utilization (retention in care). Methods An exploratory, sequential mixed-methods study design will be used with conceptual determinants of adherence behavior informed by the information-motivation-behavioral skills model. HIV-infected ethnic minority youth aged 16 to 29 years with a detectable HIV serum viral load of more than 200 copies/ml (N=25) will be recruited. Qualitative pretesting will be conducted, including semistructured, in-depth, individual interviews with a convenience sample meeting the study inclusion criteria. Preliminary analysis of qualitative data will be used to inform and tailor the ACCESS intervention. Testing and implementation will include a one-group pre-posttest pilot, delivered by a trained successful peer health coach who lives with HIV and is well-engaged in HIV care and taking ART. A total of 5 peer-led remote videoconferencing sessions will be delivered using study-funded smartphones and targeting adherence information (HIV knowledge), motivation (beliefs and perceptions), and behavioral skills (self-efficacy). Participant satisfaction will be assessed with poststudy focus groups and quantitative survey methodology. Bivariate analyses will be computed to compare pre- and postintervention changes in HIV biomarkers, self-reported ART adherence, beliefs and knowledge about ART, adherence self-efficacy, and retention in care. Results As of December 2018, we are in the data analysis phase of this pilot and anticipate completion with dissemination of final study findings by spring/summer 2019. The major outcomes will include intervention feasibility, acceptability, and preliminary evidence of impact on serum HIV RNA quantitative viral load (primary adherence outcome variable). Self-reported ART adherence and retention in care will be assessed as secondary outcomes. Findings from the qualitative pretesting will contribute to an improved understanding of adherence behavior. Conclusions Should the ACCESS intervention prove feasible and acceptable, this research protocol will contribute to a shift in existent HIV research paradigms by offering a blueprint for technology-enabled peer-led interventions and models. International Registered Report Identifier (IRRID) DERR1-10.2196/12543
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Affiliation(s)
| | - Marya Viorst Gwadz
- Silver School of Social Work, New York University, New York, NY, United States
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, NY, United States
| | - Robin Whittemore
- School of Nursing, Yale University, New Haven, CT, United States
| | - Charles M Cleland
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Muñoz-Laboy M, Martinez O, Draine J, Guilamo-Ramos V, Severson N, Levine E, Benjamin G. The Assets and Challenges of Formerly Incarcerated Latino Men's Social Support Networks in Promoting Healthy Behaviors. J Urban Health 2018; 95:534-546. [PMID: 28779273 PMCID: PMC6095759 DOI: 10.1007/s11524-017-0183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
After being exposed to high-risk environments in correctional facilities, formerly incarcerated Latino men (FILM) encounter new risks upon reentering their community of residence including drug use and sexual risk behaviors. Families and close social support networks are critical in potentially mitigating the stressors and risks associated with reentry and reducing the likelihood of recidivism. We conducted a study to examine the material and cognitive assets that familial networks can use to provide support to FILM to engage in health-promoting practices. This analysis is based on linear and logistic regression modeling of cross-sectional data collected through a computer-administered survey with dyads of FILM (ages 18-49, who had been in jail or prison within the past 5 years) and their nominated social network (n = 130 dyads). We found that both male and female social supports (MSS and FSS) have significantly higher levels of structural resources (education and employment) than FILM. Though FSS reported higher self-efficacy on health-promoting practices than FILM, contrary to what we predicted, FILM and FSS/MSS reported similar levels of mental health and behavioral risks. Our results suggest a number of limitations in designing family-based intervention strategies, but they also provided insight into the specificities needed to enhance the social support networks of FILM.
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Gargallo-Bernad C, Sangrós-González FJ, Arazo-Garcés P, Martínez-Álvarez R, Malo-Aznar C, Gargallo-Bernad A, Ballester-Luna A, Cabrero-Pascual LE, Gil-Orna P, Abadía-Gallego VJ, Torres-Peña I, Ordiz-Suárez H. Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance. Enferm Infecc Microbiol Clin 2018; 37:100-108. [PMID: 29724618 DOI: 10.1016/j.eimc.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/11/2018] [Accepted: 03/24/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Late Diagnosis (LD) of Human Immunodeficiency Virus (HIV) infection (CD4 lymphocytes <350/μl at diagnosis of the disease), deteriorates the condition of those affected and increases the probability of transmission. The objective of the present study was to analyse the prevalence of LD, to identify missed diagnostic opportunities (MDO) and to find out which level of the health care delivery system they took place. METHODS Retrospective, observational and descriptive study of the population diagnosed with infection of HIV/AIDS in the period 2011-2015 in Aragon. MDO were identified during the 3 years prior to diagnosis of the disease in all levels of the health care delivery system as well as frequentation of consultations. The indicator conditions (IC) that generated more MDO were analysed according to the latest recommendations for early diagnosis of HIV in the health care setting. RESULTS 435 newly diagnosed HIV/AIDS cases were analysed. 45.1% were diagnosed in Primary Healthcare (PH). 49.4% presented criteria of LD and 61.1% were infected through heterosexual contact. The majority of MDO (68.5%) were given in PH. The IC that generated the most MDO were seborrheic dermatitis/exanthema (19.4%) and fever of unknown origin (10.3%). However, the IC that were associated with higher LD were pneumonia acquired in the community and unjustified weight loss. CONCLUSION In Aragon, prevalence of LD is high, the main route of infection is heterosexual and most of MDO go unnoticed in PH. The dissemination of current guidelines for requesting IC guided HIV testing and HIV screening across the preoperative period will result in an effective measure to decrease the LD.
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Affiliation(s)
| | | | - Piedad Arazo-Garcés
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Rosa Martínez-Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Alba Ballester-Luna
- Servicio de Medicina Interna, Hospital Ernest Lluch Martín, Calatayud, Zaragoza, España
| | | | - Pablo Gil-Orna
- Servicio de Urgencias, Hospital Universitario Miguel Servet, Zaragoza, España
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Leblanc NM, Mitchell J. Providers' Perceptions of Couples' HIV Testing and Counseling (CHTC): Perspectives From a U.S. HIV Epicenter. ACTA ACUST UNITED AC 2018; 7:22-33. [PMID: 30319926 DOI: 10.1037/cfp0000097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current epidemiology demonstrate the significance of couple-based HIV transmission among vulnerable U.S. populations and its contribution to health disparity in HIV prevalence. Couples HIV testing and counseling (CHTC) can be used to address couple-based HIV risk in the U.S. Though a globally recognized service, the literature lacks U.S.-based healthcare providers' (HCP) perspectives of CHTC. To address this research gap, a qualitative descriptive design was used to ascertain HCPs' perceptions about CHTC. Semi-structured in-depth interviews were conducted with 22 HCPs who were experienced with engaging patients or clients across the HIV care continuum. Overall, HCPs supported CHTC among different U.S. POPULATIONS Content and thematic analysis revealed HCPs perceived CHTC to be an evolution from current HIV testing approaches and a mechanism to screen people who may not otherwise. CHTC was perceived to have biomedical and bio-behavioral merit that warranted consideration for implementation within health service settings and among populations with heightened HIV risk. This strategy was perceived to be a mechanism for introducing PrEP and conception health into one's practice. CHTC also signaled patients reorienting perceptions of personal health as being linked to the health of another individual. Providers recognized that couples have evolved to be increasingly non-heteronormative and thought that CHTC should be offered to all couples. However, participants also noted that HCPs in the U.S. need to be comfortable with promoting sexual health among various populations for implementation of CHTC to be successful.
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Affiliation(s)
- Natalie M Leblanc
- Post-doctorate Associate at the University of Rochester School of Nursing, Rochester, NY
| | - Jason Mitchell
- Assistant Professor in Office of Public Health Studies at the University of Hawai'i at Mānoa, Honolulu, HI
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Bouris A, Jaffe K, Eavou R, Liao C, Kuhns L, Voisin D, Schneider JA. Project nGage: Results of a Randomized Controlled Trial of a Dyadic Network Support Intervention to Retain Young Black Men Who Have Sex With Men in HIV Care. AIDS Behav 2017; 21:3618-3629. [PMID: 29079949 PMCID: PMC5705428 DOI: 10.1007/s10461-017-1954-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
HIV-positive young black MSM (YBMSM) experience poor outcomes along the HIV care continuum, yet few interventions have been developed expressly for YBMSM retention in care. Project nGage was a randomized controlled trial conducted across five Chicago clinics with 98 HIV-positive YBMSM aged 16-29 between 2012 and 2015. The intervention used a social network elicitation approach with index YBMSM (n = 45) to identify and recruit a support confidant (SC) to the study. Each index-SC dyad met with a social worker to improve HIV-care knowledge, activate dyadic social support, and develop a retention in care plan. Each index and SC also received four mini-booster sessions. Control participants (n = 53) received treatment as usual. Surveys and medical records at baseline, 3-, and 12-months post-intervention assessed visit history (3 or more visits over 12 months; primary outcome), and sociodemographic, network, social-psychological, and behavioral factors. At baseline, there were no differences in age (M = 23.8 years), time since diagnosis (M ≤ 2 years), clinic visits in the previous 12 months (M = 4.1), and medication adherence (68.6 ≥ 90% adherence). In multivariate logistic regression analysis, intervention participants were 3.01 times more likely to have had at least 3 provider visits (95% CI 1.0-7.3) than were control participants over 12 months. Project nGage demonstrates preliminary efficacy in improving retention in care among YBMSM. Results suggest that engaging supportive network members may improve key HIV care continuum outcomes.
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Affiliation(s)
- Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, USA.
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA.
| | - Kaitlyn Jaffe
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca Eavou
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Lisa Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Third Coast Center for AIDS Research, University of Chicago and Northwestern University, 969 E. 60th St, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Modeling the Declining Positivity Rates for Human Immunodeficiency Virus Testing in New York State. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21:556-63. [PMID: 25599377 DOI: 10.1097/phh.0000000000000203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE New York health care providers have experienced declining percentages of positive human immunodeficiency virus (HIV) tests among patients. Furthermore, observed positivity rates are lower than expected on the basis of the national estimate that one-fifth of HIV-infected residents are unaware of their infection. We used mathematical modeling to evaluate whether this decline could be a result of declining numbers of HIV-infected persons who are unaware of their infection, a measure that is impossible to measure directly. DESIGN AND SETTING A stock-and-flow mathematical model of HIV incidence, testing, and diagnosis was developed. The model includes stocks for uninfected, infected and unaware (in 4 disease stages), and diagnosed individuals. Inputs came from published literature and time series (2006-2009) for estimated new infections, newly diagnosed HIV cases, living diagnosed cases, mortality, and diagnosis rates in New York. MAIN OUTCOME MEASURES Primary model outcomes were the percentage of HIV-infected persons unaware of their infection and the percentage of HIV tests with a positive result (HIV positivity rate). RESULTS In the base case, the estimated percentage of unaware HIV-infected persons declined from 14.2% in 2006 (range, 11.9%-16.5%) to 11.8% in 2010 (range, 9.9%-13.1%). The HIV positivity rate, assuming testing occurred independent of risk, was 0.12% in 2006 (range, 0.11%-0.15%) and 0.11% in 2010 (range, 0.10%-0.13%). The observed HIV positivity rate was more than 4 times the expected positivity rate based on the model. CONCLUSIONS HIV test positivity is a readily available indicator, but it cannot distinguish causes of underlying changes. Findings suggest that the percentage of unaware HIV-infected New Yorkers is lower than the national estimate and that the observed HIV test positivity rate is greater than expected if infected and uninfected individuals tested at the same rate, indicating that testing efforts are appropriately targeting undiagnosed cases.
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Washington TA, Applewhite S, Glenn W. Using Facebook as a Platform to Direct Young Black Men Who Have Sex With Men to a Video-Based HIV Testing Intervention: A Feasibility Study. URBAN SOCIAL WORK 2017; 1:36-52. [PMID: 29276800 PMCID: PMC5737932 DOI: 10.1891/2474-8684.1.1.36] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE A randomized control pilot study was conducted with Black men who have sex with men (BMSM; N = 42) aged 18-30 years to examine the feasibility of implementing a video intervention delivered using Facebook to motivate HIV testing. METHODS At baseline, participants were unaware of their HIV status and had not tested for HIV in the past 6 months, residing in Los Angeles County. The intervention content included topics such as social influence, HIV knowledge, stigma, HIV positive knowledge, and benefits of knowing one's HIV status. FINDINGS Logistic regression revealed that those receiving the video intervention were 7 times more likely to have tested for HIV than those in the control group at 6-week follow-up (odds ratio [OR] = 7.00, 95% confidence interval [1.72, 28.33], p = .006). CONCLUSION Data suggest that the intervention was feasible for motivating HIV testing.
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Affiliation(s)
- Thomas Alex Washington
- College of Health and Human Services, School of Social Work, California State University, Long Beach, CA, USA
| | - Sheldon Applewhite
- Department of Sociology, Borough of Manhattan Community College, City University of New York, New York, NY, USA
| | - Wendell Glenn
- ADAM Project, Behavioral Health Services, Long Beach, CA, USA
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20
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Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Polilli E, Sozio F, Di Stefano P, Sciacca A, Ursini T, Paoloni M, Vecchiet J, Di Giammartino D, Sciotti MP, Grimaldi A, Cortesi V, Fazii P, Ricci E, D'Amario C, Ippolito G, Pippa L, Parruti G. Web-Based HIV Testing in Abruzzo, Italy: Analysis of 15-Month Activity Results. AIDS Patient Care STDS 2016; 30:471-475. [PMID: 27749107 DOI: 10.1089/apc.2016.0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Undiagnosed cases of HIV infection in developed countries are estimated at 20-30% of individuals living with HIV. Web-based strategies may represent a new approach to easier, wider, and unrestricted access to early testing. The Abruzzo Region, Italy, developed a Web-based tool to recruit persons at high risk of HIV and other sexually transmitted infections (STIs). At the Website www.failtestanchetu.it , browsers found information on STIs (HIV, hepatitis B and C, and syphilis), a structured questionnaire called "risk calculator" to assess one's own risk behaviors and direct booking of their test at one of six sites throughout the region. The Website was advertised on local media and in pharmacies, high schools, sports facilities, and factories. Between February 1, 2014, and May 31, 2015, about 6000 users visited the Website; 3046 people attended a visit for counseling on risk behaviors, signs, or symptoms of STIs and accepted blood drawing for HIV, hepatitis B Virus (HBV), hepatitis C Virus (HCV), and syphilis tests. Fifty-eight (1.90%) subjects were positive for HCV, 56 (1.84%) for HBsAg, 90 (2.95%) for Treponema pallidum antibodies, and 28 (0.92%) for HIV. Ninety-two percent of HIV-positive patients were successfully linked to care. Late presenters were less frequent in this sample than in the population diagnosed with HIV in Italy in 2014. An overall 7% proportion of HIV, HBV, HCV, and syphilis-unaware cases were all transferred to care, with the exception of three people. HIV seropositivity among testers was higher than 2/1000, the cost-effectiveness threshold suggested for effective testing. Therefore, our Web-based unrestricted and free access methodology appears worth further and wider evaluation.
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Affiliation(s)
- Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Federica Sozio
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Paola Di Stefano
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Antonina Sciacca
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Tamara Ursini
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Maurizio Paoloni
- Infectious Diseases Unit, Avezzano General Hospital, Avezzano, Italy
| | - Jacopo Vecchiet
- Infectious Diseases Clinic, University of Chieti, Chieti, Italy
| | | | | | | | | | - Paolo Fazii
- Microbiology and Virology Unit, Pescara General Hospital, Italy
| | - Elena Ricci
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Lucio Pippa
- Fondazione Onlus Camillo de Lellis per l'Innovazione e la Ricerca in Medicina, Pescara, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Gopalappa C, Farnham PG, Chen YH, Sansom SL. Progression and Transmission of HIV/AIDS (PATH 2.0). Med Decis Making 2016; 37:224-233. [PMID: 27646567 DOI: 10.1177/0272989x16668509] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum-individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention. METHODS The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U.S.A. Persons uninfected were modeled as populations, stratified by risk and gender. The model included detailed individual-level data from several large national surveillance databases. The outcomes focused on average annual transmission rates from 2008 through 2011 by disease stage, HIV care continuum, and sexual risk group. RESULTS The relative risk of transmission of those in the acute phase was nine-times [5th and 95th percentile simulation interval (SI): 7, 12] that of those in the non-acute phase, although, on average, those with acute infections comprised 1% of all PLWH. The relative risk of transmission was 24- to 50-times as high for those in the non-acute phase who had not achieved viral load suppression as compared with those who had. The relative risk of transmission among MSM was 3.2-times [SI: 2.7, 4.0] that of heterosexuals. Men who have sex with men and women generated 46% of sexually acquired transmissions among heterosexuals. CONCLUSIONS The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.
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Affiliation(s)
| | - Paul G Farnham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Yao-Hsuan Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
| | - Stephanie L Sansom
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS)
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Abstract
BACKGROUND Estimates of the size of the undiagnosed HIV-infected population are important to understand the HIV epidemic and to plan interventions, including "test-and-treat" strategies. METHODS We developed a multi-state back-calculation model to estimate HIV incidence, time between infection and diagnosis, and the undiagnosed population by CD4 count strata, using surveillance data on new HIV and AIDS diagnoses. The HIV incidence curve was modelled using cubic splines. The model was tested on simulated data and applied to surveillance data on men who have sex with men in The Netherlands. RESULTS The number of HIV infections could be estimated accurately using simulated data, with most values within the 95% confidence intervals of model predictions. When applying the model to Dutch surveillance data, 15,400 (95% confidence interval [CI] = 15,000, 16,000) men who have sex with men were estimated to have been infected between 1980 and 2011. HIV incidence showed a bimodal distribution, with peaks around 1985 and 2005 and a decline in recent years. Mean time to diagnosis was 6.1 (95% CI = 5.8, 6.4) years between 1984 and 1995 and decreased to 2.6 (2.3, 3.0) years in 2011. By the end of 2011, 11,500 (11,000, 12,000) men who have sex with men in The Netherlands were estimated to be living with HIV, of whom 1,750 (1,450, 2,200) were still undiagnosed. Of the undiagnosed men who have sex with men, 29% (22, 37) were infected for less than 1 year, and 16% (13, 20) for more than 5 years. CONCLUSIONS This multi-state back-calculation model will be useful to estimate HIV incidence, time to diagnosis, and the undiagnosed HIV epidemic based on routine surveillance data.
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Abstract
Objective: To estimate the size and characteristics of the undiagnosed HIV population in Italy in 2012 applying a method that does not require surveillance data from the beginning of the HIV epidemic. Methods: We adapted the method known as ‘London method 2’; the undiagnosed population is estimated as the ratio between the estimated annual number of simultaneous HIV/clinical AIDS diagnoses and the expected annual progression rate to clinical AIDS in the undiagnosed HIV population; the latter is estimated using the CD4+ cell count distribution of asymptomatic patients reported to surveillance. Under-reporting/ascertainment of new diagnoses was also considered. Also, the total number of people living with HIV was estimated. Results: The undiagnosed HIV population in 2012 was 13 729 (95% confidence interval: 12 152–15 592), 15 102 (13 366–17 151) and 16 475 (14 581–18 710), assuming no under-reporting/ascertainment, 10 and 20% of under-reporting/ascertainment, respectively. The percentage of undiagnosed cases was higher among HIV people aged below 25 years (25–28%), MSM (16–19%) and people born abroad (16–19%), whereas it was small among injection drug users (3%). Conclusion: The estimate of people in Italy with undiagnosed HIV in 2012 was in a plausible range of 12 000–18 000 cases, corresponding to 11–13% of the overall prevalence. The method is straightforward to implement only requiring annual information from the HIV surveillance system about CD4+ cell count and clinical stage at HIV diagnosis. Thus, it could be used to monitor if a certain prevention initiative lead to the reduction of the undiagnosed HIV population over time. It can also be easily implemented in other countries collecting the same basic information from the HIV surveillance system.
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Frimpong JA, D'Aunno T, Perlman DC, Strauss SM, Mallow A, Hernandez D, Schackman BR, Feaster DJ, Metsch LR. On-site bundled rapid HIV/HCV testing in substance use disorder treatment programs: study protocol for a hybrid design randomized controlled trial. Trials 2016; 17:117. [PMID: 26936623 PMCID: PMC4776446 DOI: 10.1186/s13063-016-1225-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND More than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25 % of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD). METHODS/DESIGN In this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs. DISCUSSION Novel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades. TRIAL REGISTRATION ClinicalTrials.gov: NCT02355080 . (30 January 2015).
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, USA.
| | - Thomas D'Aunno
- Robert F. Wagner Graduate School of Public Service, New York University, New York, USA.
| | - David C Perlman
- Mount Sinai Beth Israel; Ichan School of Medicine at Mount Sinai, New York, USA.
| | | | - Alissa Mallow
- Montefiore Health System, New York, USA, New York, USA.
| | - Diana Hernandez
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, USA.
| | - Daniel J Feaster
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
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Hernández D, Feaster DJ, Gooden L, Douaihy A, Mandler R, Erickson SJ, Kyle T, Haynes L, Schwartz R, Das M, Metsch L. Self-Reported HIV and HCV Screening Rates and Serostatus Among Substance Abuse Treatment Patients. AIDS Behav 2016; 20:204-14. [PMID: 25952768 PMCID: PMC4637257 DOI: 10.1007/s10461-015-1074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Substance users are at increased risk for HIV and HCV infection. Still, many substance use treatment programs (SUTP) fail to offer HIV/HCV testing. The present secondary analysis of screening data from a multi-site randomized trial of rapid HIV testing examines self-reported HIV/HCV testing patterns and serostatus of 2473 SUTP patients in 12 community-based sites that had not previously offered on-site testing. Results indicate that most respondents screened for the randomized trial tested more than a year prior to intake for HIV (52 %) and HCV (38 %). Prevalence rates were 3.6 and 30 % for HIV and HCV, respectively. The majority of participants that were HIV (52.2 %) and HCV-positive (40.5 %) reported having been diagnosed within the last 1-5 years. Multivariable logistic regression showed that members of high-risk groups were more likely to have tested. Bundled HIV/HCV testing and linkage to care issues are recommended for expanding testing in community-based SUTP settings.
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Affiliation(s)
- Diana Hernández
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA.
| | | | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
| | - Antoine Douaihy
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raul Mandler
- National Institute on Drug Abuse, Bethesda, MD, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Tiffany Kyle
- The Center for Drug Free Living, Orlando, FL, USA
| | - Louise Haynes
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Moupali Das
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St, Rm 934, New York, NY, 10032, USA
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Jiang H, Yin J, Fan Y, Liu J, Zhang Z, Liu L, Nie S. Gender difference in advanced HIV disease and late presentation according to European consensus definitions. Sci Rep 2015; 5:14543. [PMID: 26412578 PMCID: PMC4585954 DOI: 10.1038/srep14543] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/27/2015] [Indexed: 11/09/2022] Open
Abstract
Effectiveness of highly active antiretroviral therapy is limited for a large proportion of individuals living with HIV presenting for medical care at an advanced stage. Controversial results of gender differences in risk of late HIV diagnosis were reported among existing literatures. Therefore, we conducted this meta-analysis to synthesize a summary of gender differences in risk of advanced HIV disease (AHD) and late presentation (LP) according to European consensus definitions. Totally, 32 studies were included based on predetermined selection criteria. The pooled adjusted odds ratios of males presenting with AHD and LP compared with females were 1.73 (95% confidence interval [CI], 1.59-1.89) and 1.38 (95% CI, 1.18-1.62) with significant heterogeneity observed (I(2) = 78.50%, and I(2) = 85.60%, respectively). Subgroup analysis revealed that time lag, study location, number of patients, proportion of females, study design, number of adjusted variables might be potential source of heterogeneity. Sensitivity analysis showed robustness of the results. No publication bias was observed in studies on AHD or LP. The current meta-analysis indicated that males are at higher risk of AHD or LP compared with females. More attention should be paid to males to make sure early testing, diagnosis, and treatment, and ultimately improve individual and population health.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Jieyun Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Yunzhou Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Jianhua Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Zhixia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
| | - Shaofa Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, P.R. China
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Abstract
BACKGROUND UNAIDS aims for 90% of HIV-positive individuals to be diagnosed by 2020, but few attempts have been made in developing countries to estimate the fraction of the HIV-positive population that has been diagnosed. METHODS To estimate the rate of HIV diagnosis in South Africa, reported numbers of HIV tests performed in the South African public and private health sectors were aggregated, and estimates of HIV prevalence in individuals tested for HIV were combined. The data were integrated into a mathematical model of the South African HIV epidemic, which was additionally calibrated to estimates of the fraction of the population ever tested for HIV, as reported in three national household surveys. RESULTS The fraction of HIV-positive adults who were undiagnosed declined from more than 80% in the early 2000s to 23.7% [95% confidence interval (95% CI) 23.1-24.3] in 2012. The undiagnosed proportion in 2012 was substantially higher in men (31.9%, 95% CI 29.7-34.3) than in women (19.0%, 95% CI 17.9-19.9). Projected probabilities of experiencing disease progression (CD4 cell count <350 cells/μl) without diagnosis are more than 50% for most HIV-positive adults over the age of 40. The fraction of HIV-positive adults who are undiagnosed is projected to decline to 8.9% by 2020 if current targets (10 million tests per annum) are met. CONCLUSION South Africa has made significant progress in expanding access to HIV testing, and at current testing rates, the target of 90% of HIV-positive adults diagnosed by 2020 is likely to be reached. However, uptake is relatively low in men and older adults.
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Nodin N, Carballo-Diéguez A, Leal IP. Comportamentos sexuais de risco e preventivos masculinos: resultados de uma amostra recolhida através da internet em Portugal. SAUDE E SOCIEDADE 2015. [DOI: 10.1590/s0104-12902015000200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pretendeu-se com a pesquisa realizada estudar e comparar padrões de testagem em relação ao VIH; resultados do teste para o VIH; e comportamentos sexuais preventivos de homens homo, hetero e bissexuais. Os dados foram recolhidos através de um questionário on-line. A amostra foi constituída por 732 participantes com idade média de 32,2 anos, dos quais 53,7% identificaram-se como homossexual/gay; 27,4%, como heterossexual; e 18,3%, como bissexual, refletindo a divulgação privilegiada do estudo junto a organizações de lésbicas, gays, bissexuais e transgênero (LGBT). Nunca tinham realizado o teste para o VIH 26,6% dos participantes; 7,2% indicaram ser portadores do HIV. Homens gays apresentaram níveis significativamente mais elevados de testagem para o VIH e de soropositividade, quando comparados com os restantes. No geral, verificou-se ainda que homens gays indicaram ter mais comportamentos preventivos. Todos os grupos estudados apresentaram padrões comportamentais específicos e diferenciados em relação ao VIH. Conclui-se que são de grande importância intervenções comportamentais desenhadas à medida das necessidades dos diferentes grupos estudados, em particular junto aos homens heterossexuais e gays.
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Affiliation(s)
- Nuno Nodin
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Portugal
| | | | - Isabel Pereira Leal
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Portugal
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Pilowsky DJ, Wu LT. Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review. Subst Abuse Rehabil 2015; 6:51-60. [PMID: 25960684 PMCID: PMC4410899 DOI: 10.2147/sar.s78808] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50–59 years (24.3%; 95% confidence interval, 15.6–35.8) and declined with age, with a 17.1% prevalence among those aged 60–69 years (17.1%; 95% confidence interval, 7.3–34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.
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Affiliation(s)
- Daniel J Pilowsky
- Columbia University Medical Center, Department of Epidemiology, Mailman School of Public Health New York City, NY, USA ; Division of Epidemiology, New York State Psychiatric Institute, New York City, NY, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA ; Center for Child and Family Policy, Duke University, Durham, NC, USA
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Camoni L, Raimondo M, Dorrucci M, Regine V, Salfa MC, Suligoi B. Estimating minimum adult HIV prevalence: a cross-sectional study to assess the characteristics of people living with HIV in Italy. AIDS Res Hum Retroviruses 2015; 31:282-7. [PMID: 25432098 DOI: 10.1089/aid.2014.0154] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/μl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/μl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load.
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Affiliation(s)
- Laura Camoni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Mariangela Raimondo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Dorrucci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Vincenza Regine
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Barbara Suligoi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Cragin L, Pan F, Peng S, Zenilman JM, Green J, Doucet C, Chalfin DB, de Lissovoy G. Cost-effectiveness of a Fourth-Generation Combination Immunoassay for Human Immunodeficiency Virus (HIV) Antibody and p24 Antigen for the Detection of HIV Infections in the United States. HIV CLINICAL TRIALS 2015. [DOI: 10.1310/hct1301-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Goodman MD. Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_44-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Arya M, Patel S, Kumar D, Zheng MY, Kallen MA, Street RL, Viswanath K, Giordano TP. Why Physicians Don't Ask: Interpersonal and Intrapersonal Barriers to HIV Testing-Making a Case for a Patient-Initiated Campaign. J Int Assoc Provid AIDS Care 2014; 15:306-12. [PMID: 25421929 DOI: 10.1177/2325957414557268] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons.
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Affiliation(s)
- Monisha Arya
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sajani Patel
- Rice University, Houston, TX, USA Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Disha Kumar
- Rice University, Houston, TX, USA School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Micha Yin Zheng
- Rice University, Houston, TX, USA School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard L Street
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas P Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Arya M, Kumar D, Patel S, Street RL, Giordano TP, Viswanath K. Mitigating HIV health disparities: the promise of mobile health for a patient-initiated solution. Am J Public Health 2014; 104:2251-5. [PMID: 25322292 DOI: 10.2105/ajph.2014.302120] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient-physician communication, improve HIV testing, and increase use of mHealth.
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Affiliation(s)
- Monisha Arya
- Monisha Arya, Richard L. Street Jr, and Thomas P. Giordano are with the IQuESt, Michael E. Debakey VA Medical Center, Houston, TX, and with the Department of Medicine, Baylor College of Medicine, Houston. Disha Kumar and Sajani Patel are with the Weiss School of Natural Sciences, Rice University, Houston. Kasisomayajula Viswanath is with the Department of Social and Behavioral Science, Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, MA
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McMahon JM, Myers JE, Kurth AE, Cohen SE, Mannheimer SB, Simmons J, Pouget ER, Trabold N, Haberer JE. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care STDS 2014; 28:462-74. [PMID: 25045996 PMCID: PMC4135325 DOI: 10.1089/apc.2013.0302] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Ann E. Kurth
- College of Nursing, New York University, New York, New York
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, STD Prevention and Control, San Francisco, California
| | - Sharon B. Mannheimer
- Department of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Janie Simmons
- National Development and Research Institutes, New York, New York
| | | | - Nicole Trabold
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, Massachusetts
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Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:117-26. [PMID: 25114592 PMCID: PMC4126574 DOI: 10.2147/hiv.s49083] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 60% of human immunodeficiency virus (HIV)-infected individuals are unaware of their infection, and stigma and discrimination continue to threaten acceptance of HIV testing services worldwide. Self-testing for HIV has garnered controversy for years and the debate reignited with the approval of a point-of-care test for over-the-counter sale in the US in 2012. Here, we present arguments for and against HIV self-testing. The case in support of HIV self-testing contends that: the modality is highly acceptable, especially among the most at-risk individuals; self-testing empowers users, thus helping to normalize testing; and mutual partner testing has the potential to increase awareness of risk and avert condomless sex between discordant partners. Arguments against HIV self-testing include: cost limits access to those who need testing most; false-negative results, especially during the window period, may lead to false reassurance and could promote sex between discordant partners at the time of highest infectivity; opportunities for counseling, linkage to care, and diagnosis of other sexually transmitted infections may be missed; and self-testing leads to potential for coercion between partners. Research is needed to better define the risks of self-testing, especially as performance of the assays improves, and to delineate the benefits of programs designed to improve access to self-test kits, because this testing modality has numerous potential advantages and drawbacks.
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Affiliation(s)
- Brian R Wood
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Carl Ballenger
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Joanne D Stekler
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA ; Public Health, Seattle and King County HIV/STD Program, Seattle, WA, USA
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Goyal MK, Witt R, Hayes KL, Zaoutis TE, Gerber JS. Clinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus. J Pediatr 2014; 165:343-7. [PMID: 24840761 PMCID: PMC4111974 DOI: 10.1016/j.jpeds.2014.04.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/19/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate clinician adherence to guidelines for documentation of sexual history and screening for sexually transmitted infection (STI)/HIV infection during routine adolescent well visits. Secondary objectives were to determine patient and clinician factors associated with sexual history documentation and STI/HIV testing. STUDY DESIGN Retrospective, cross-sectional study of 1000 randomly selected 13- to 19-year-old routine well visits at all 29 pediatric primary care practices affiliated with a children's hospital. We evaluated frequency of documentation of sexual history and testing for gonorrhea (GC)/chlamydia (CT) and HIV testing. Multivariable logistic regression was performed to identify factors associated with documentation and testing. RESULTS Of the 1000 patient visits reviewed, 212 (21.2%; 95% CI, 18.7-23.7) had a documented sexual history, of which 45 adolescents' (21.2%; 95% CI, 15.7-26.8) encounters were documented as being sexually active. Overall, 26 (2.6%; 95% CI, 1.6-3.6) patients were tested for GC/CT and 16 (1.6%; 95% CI, 0.8-2.4) were tested for HIV infection. In multivariable analyses, factors associated with sexual history documentation included older patient age, non-Hispanic black race/ethnicity, nonprivate insurance status, and care by female clinician. Factors associated with GC/CT testing included male gender, non-Hispanic black race/ethnicity, and nonprivate insurance. HIV testing was more likely to be performed on older adolescents, those of non-Hispanic black race/ethnicity, and those with nonprivate insurance. CONCLUSIONS Pediatric primary care clinicians infrequently document sexual histories and perform STI and HIV testing on adolescent patients. Future studies should investigate provider beliefs, clinical decision-making principles, and perceived barriers to improve the sexual health care of adolescents and evaluate interventions to increase rates of adolescent sexual health screening.
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Affiliation(s)
- Monika K Goyal
- Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC.
| | - Rachel Witt
- Perelman School of Medicine, University of Pennsylvania
| | | | - Theoklis E Zaoutis
- Children’s Hospital of Philadelphia,Perelman School of Medicine, University of Pennsylvania
| | - Jeffrey S Gerber
- Children’s Hospital of Philadelphia,Perelman School of Medicine, University of Pennsylvania
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Abstract
BACKGROUND Describing the undiagnosed HIV-infected population is essential for guiding HIV screening policy, implementing interventions, and resource planning. METHODS We used French national HIV surveillance data and a back-calculation approach to estimate the number of undiagnosed HIV-infected individuals in France and the distribution of time since HIV infection among undiagnosed individuals. We also used data on CD4⁺ cell count decline to assess the CD4⁺ cell count distribution among undiagnosed individuals. RESULTS We estimated that 29,000 [95% confidence interval (CI): 24,200-33,900] individuals were living with undiagnosed HIV infection at the end of 2010. Of these, 28.7% (95% CI: 27.1-30.4) were infected less than a year ago, 16.4% (95% CI: 15.0-17.8) more than 5 years ago, and 59.6% (95% CI: 59.2-59.8) were eligible for antiretroviral treatment (CD4⁺ cell count less than 500 cells/μl) according to the 2010 French guidelines. Men represented 70.0% of the undiagnosed HIV-infected individuals and had lower CD4⁺ cell counts than women. The numbers of undiagnosed infections in MSM, non-French national heterosexuals, and French national heterosexuals were similar (9200, 9300, 10,000, respectively). However, because of differences in group size, undiagnosed HIV prevalence varied significantly between these groups (2.95, 0.36, 0.03%, respectively; P less than 0.001). CONCLUSION Our findings suggest that many undiagnosed HIV-infected individuals were eligible for treatment and, thus, lack of HIV diagnosis is a lost chance for them; many more heterosexuals than MSM will need to be tested to find those undiagnosed; and universal screening of men may be cost-effective, especially in the areas most affected by the epidemic, such as the Paris region.
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Kaufman CE, Whitesell NR, Keane EM, Desserich JA, Giago C, Sam A, Mitchell CM. Effectiveness of Circle of Life, an HIV-preventive intervention for American Indian middle school youths: a group randomized trial in a Northern Plains tribe. Am J Public Health 2014; 104:e106-12. [PMID: 24754555 PMCID: PMC4062020 DOI: 10.2105/ajph.2013.301822] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effectiveness of Circle of Life (COL), an HIV-preventive intervention developed specifically for American Indian and Alaska Native (AI/AN) middle school youths. METHODS By partnering with a tribal community, we conducted a longitudinal wait-listed group randomized trial with 635 seventh and eighth graders in 13 schools of a Northern Plains tribe. We surveyed participants at baseline, 3 months, and 12 months from 2006 to 2007. RESULTS COL was found to increase HIV knowledge in the short term, but had no effect on sexual activity compared with those who did not receive it. However, COL was found to be effective for delaying the onset of sexual activity, with the greatest reduction in risk occurring for those receiving COL at early ages. CONCLUSIONS Community partnership was key to successful project design, implementation, and analysis. The project confirmed the importance of the timing of interventions in early adolescence. COL may be a key resource for reducing sexual risk among AI/AN youths.
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Affiliation(s)
- Carol E Kaufman
- Carol E. Kaufman, Nancy Rumbaugh Whitesell, Ellen M. Keane, and Christina M. Mitchell are with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. At the time of the study, Jennifer A. Desserich was with the Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus. Cindy Giago and Angela Sam were with the Northern Plains Field Office, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
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Momplaisir F, Yehia BR, Harhay MO, Fetzer B, Brady KA, Long JA. HIV testing trends: Southeastern Pennsylvania, 2002-2010. AIDS Patient Care STDS 2014; 28:303-10. [PMID: 24742326 PMCID: PMC4076999 DOI: 10.1089/apc.2014.0044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are limited data on HIV testing trends after 2006 when the Centers for Disease Control and Prevention (CDC) introduced opt-out HIV testing with the aims of identifying HIV-infected persons early and linking them to care. We used data from the Southeastern Pennsylvania Household Health Survey between 2002 and 2010 to evaluate HIV testing over time. 50,698 adult (≥18 years) survey respondents were included. HIV testing increased after the CDC recommendations: 42.1% of survey respondents received testing at least once in 2002 versus 51.4% in 2010, p<0.001. Testing trends increased among all demographic groups, but existing differences in testing before 2006 persisted after that year as follows: younger patients, racial/ethnic minorities, patients on Medicaid were all more likely to get tested than their counterparts. Blacks and patients seeking care in community health centers had the fastest rise in HIV testing. The probability of HIV testing in Blacks was 0.56 (95% CI 0.54-0.60) in 2002 and increased to 0.73 (0.70-0.76) by 2010. Patients seeking care in community health centers had a probability of HIV testing of 0.57 (0.47-0.66) in 2002, which increased to 0.69 (0.60-0.77) by 2010. In comparison, patients in private clinics had an HIV testing probability of 0.40 (0.36-0.43) in 2002 compared to 0.47 (0.40-0.54) in 2010. HIV testing is increasing, particularly among ethnic minorities and in community health centers. However, testing remains to be improved in that setting and across all clinic types.
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Affiliation(s)
- Florence Momplaisir
- Section of Infectious Diseases, Temple University Hospital, Philadelphia, Pennsylvania
| | - Baligh R. Yehia
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael O. Harhay
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Bradley Fetzer
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kathleen A. Brady
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Judith A. Long
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Philadelphia VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
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Wang Y, Guo J, Lu W. Effects of rapid versus standard HIV voluntary counselling and testing on receipt rate of HIV test results: a meta-analysis. Int J STD AIDS 2014; 26:196-205. [PMID: 24810217 DOI: 10.1177/0956462414533671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapid HIV voluntary counselling and testing (RVCT) is an alternative method of standard HIV voluntary counselling and testing (SVCT). Less is known about whether RVCT improves the receipt rate of HIV test results among clients who seek HIV counselling and testing. We aimed to evaluate effectiveness of RVCT on result receipt rate. We conducted a comprehensive search of databases containing Medline, EBSCO, Web of science, and Cochrane library to identify studies published up to August 2012. Reviewers extracted information independently. Risk of bias was evaluated with Cochrane Collaboration's tool for assessing study quality. Five randomised controlled trials were included and analysed for the result receipt rate using a random-effects model. The pooled receipt rate of HIV test results in the RVCT was significantly higher than in the SVCT (RR = 1.74, 95% CI = 1.47-2.07). Our results suggest RVCT as a favourable method to increase the receipt of HIV test results. Only two included studies assessed the modification of risk behaviour after HIV-CT in a different manner; also, the sample size was small in the current meta-analysis. In future research, it is necessary to confirm the effect of RVCT on disinhibition of post-test risk behaviour.
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Affiliation(s)
- Yuan Wang
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jian Guo
- Department of AIDS control and prevention, Tianjin Binhai New Area Tanggu Center for Disease Control and Prevention, Tianjin, China
| | - Wenli Lu
- Department of Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
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43
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Kuo I, Magnus M, Phillips G, Castel A, Opoku J, Peterson J, Jia Y, West T, Greenberg A. HIV testing among heterosexuals at elevated risk for HIV in the District of Columbia: has anything changed over time? AIDS Behav 2014; 18 Suppl 3:333-9. [PMID: 24057933 DOI: 10.1007/s10461-013-0616-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The District of Columbia launched a routine HIV testing initiative in 2006. We examined HIV testing behaviors among heterosexuals at risk for HIV over time using CDC National HIV Behavioral Surveillance data from Washington, DC for the heterosexual cycles from 2006 to 2007 (Cycle 1) and 2010 (Cycle 2). Past year and past 2-year HIV testing across study cycles were compared using Chi square tests. Weighted multivariable logistic regression identified correlates of past year testing. The majority of participants across both cycles were black and female. Cycle 1 participants were significantly more likely to have ≥4 partners in the past year, casual sex partners, and have anal sex at last sexual encounter (p < 0.05). Lifetime testing was high, and individuals from Cycle 2 versus Cycle 1 were more likely to have been tested in the past 2 years. There were no significant differences in past year testing or being offered the HIV test at last health care visit by cycle. Independent correlates of past year testing were seeing a health care provider in the past year and using condoms at last vaginal sex. In conclusion, although past year testing did not differ between the two data collection years, the proportion of heterosexuals testing in the past 2 years was higher in Cycle 2 versus Cycle 1, suggesting successful expansion of HIV testing between the two time periods.
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Affiliation(s)
- Irene Kuo
- The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue NW, 8th Floor, Washington, DC, 20037, USA,
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Reilly KH, Neaigus A, Jenness SM, Wendel T, Marshall DM, Hagan H. Factors associated with recent HIV testing among men who have sex with men in New York City. AIDS Behav 2014; 18 Suppl 3:297-304. [PMID: 23605156 DOI: 10.1007/s10461-013-0483-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Understanding factors associated with recent HIV testing among men who have sex with men (MSM) is important for designing interventions to increase testing rates and link cases to care. A cross-sectional study of MSM was conducted in NYC in 2011 using venue-based sampling. Associations between HIV testing in the past 12 months and relevant variables were examined through the estimation of prevalence ratios (PR) and 95 % confidence intervals (CI). Of 448 participants, 107 (23.9 %) had not been tested in the past 12 months. Factors independently associated with not testing in the previous 12 months were: lack of a visit to a healthcare provider in the past 12 months (aPR: 2.5; 95 % CI: 1.9, 3.2); age ≥30 (adjusted PR: 1.9; 95 % CI: 1.4, 2.7); not having completed a bachelor's degree (aPR: 1.6; 95 % CI: 1.0, 2.4); and non-gay sexual identity (aPR: 1.4; 95 % CI: 1.0, 1.8); such MSM may be less aware of the need for frequent HIV testing.
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Affiliation(s)
- K H Reilly
- HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, New York City, NY, USA,
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45
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Salivary biomarkers: toward future clinical and diagnostic utilities. Clin Microbiol Rev 2014; 26:781-91. [PMID: 24092855 DOI: 10.1128/cmr.00021-13] [Citation(s) in RCA: 386] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The pursuit of timely, cost-effective, accurate, and noninvasive diagnostic methodologies is an endeavor of urgency among clinicians and scientists alike. Detecting pathologies at their earliest stages can significantly affect patient discomfort, prognosis, therapeutic intervention, survival rates, and recurrence. Diagnosis and monitoring often require painful invasive procedures such as biopsies and repeated blood draws, adding undue stress to an already unpleasant experience. The discovery of saliva-based microbial, immunologic, and molecular biomarkers offers unique opportunities to bypass these measures by utilizing oral fluids to evaluate the condition of both healthy and diseased individuals. Here we discuss saliva and its significance as a source of indicators for local, systemic, and infectious disorders. We highlight contemporary innovations and explore recent discoveries that deem saliva a mediator of the body's physiological condition. Additionally, we examine the current state of salivary diagnostics and its associated technologies, future aspirations, and potential as the preferred route of disease detection, monitoring, and prognosis.
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Romley JA, Juday T, Solomon MD, Seekins D, Brookmeyer R, Goldman DP. Early HIV Treatment Led To Life Expectancy Gains Valued At $80 Billion For People Infected In 1996–2009. Health Aff (Millwood) 2014; 33:370-7. [DOI: 10.1377/hlthaff.2013.0623] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- John A. Romley
- John A. Romley is a research assistant professor of public policy at the University of Southern California, in Los Angeles
| | - Timothy Juday
- Timothy Juday was director of health economics and outcomes research in virology and immunoscience for Bristol-Myers Squibb at the time of this research. He is now senior director of health economics and outcomes research in virology for AbbVie, in Chicago, Illinois
| | - Matthew D. Solomon
- Matthew D. Solomon is a consulting assistant professor of medicine at Stanford University, in California
| | - Daniel Seekins
- Daniel Seekins is group medical director, virology external collaborations, for Bristol-Myers Squibb, in Plainsboro, New Jersey
| | - Ronald Brookmeyer
- Ronald Brookmeyer is a professor of biostatistics at the University of California, Los Angeles
| | - Dana P. Goldman
- Dana P. Goldman is the Leonard D. Schaeffer Chair and director of the Schaeffer Center for Health Policy and Economics, University of Southern California
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Rakhmanina N, Messenger N, Phillips G, Teach S, Morrison S, Hern J, Payne J, Ganesan K, Castel AD. Factors affecting acceptance of routine human immunodeficiency virus screening by adolescents in pediatric emergency departments. J Adolesc Health 2014; 54:176-82. [PMID: 24060572 DOI: 10.1016/j.jadohealth.2013.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV) screening in health care settings including emergency departments (EDs) is recommended for adolescents in the United States. This study aimed to evaluate the acceptance of and the factors affecting the HIV screening in pediatric EDs. METHODS A prospective, cross-sectional study of rapid opt-out oral HIV screening among adolescents ≥13 years of age was conducted in two pediatric EDs during 2009-2011. Descriptive statistics and logistic regression models were used to identify factors associated with the acceptance of HIV screening. RESULTS During 24 months, 8,519 adolescents were approached for HIV screening; 6,184 (72.6%) did not opt out, and of those 5,764 (93.2%) were tested for HIV. Most adolescents who accepted testing were black (80.5%), female (57.6%), aged 15-17 years (50.1%), and District of Columbia residents (67.7%), and were accompanied by a guardian (69.1%). Acceptance of HIV screening varied by age, race/ethnicity, and state of residence, with younger (<15 years) (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.33-2.09), non-black adolescents (aOR, .88; 95% CI, .77-.99) and non-District of Columbia residents (aOR, .86; 95% CI, .77-.96) being more likely to opt out of testing. Lower odds of opt-out of HIV testing were seen among adolescents with a guardian present (aOR, .42; 95% CI, .34-.53). The reasons for opt-out varied significantly by age and the presence of a guardian. CONCLUSIONS The patient's age and the presence of a guardian were significantly associated with adolescents' decision and reasons to opt out of HIV screening in pediatric EDs. Further studies are necessary to evaluate the interventions needed to increase routine ED HIV screening in adolescents.
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Affiliation(s)
- Natella Rakhmanina
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.
| | - Nicole Messenger
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Gregory Phillips
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC
| | - Stephen Teach
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Division of Allergy and Immunology, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Sephora Morrison
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jaclyn Hern
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Jun Payne
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Kavitha Ganesan
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Amanda D Castel
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC
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48
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Przybyla SM. Rapid HIV Testing on the College Campus: Comparing Traditional and Outreach Models. JOURNAL OF AIDS AND HIV RESEARCH (ONLINE) 2014; 5. [PMID: 24416620 DOI: 10.5897/jahr12.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The purpose of this study was to compare rapid HIV testing services on a college campus between a clinic-based testing group and an outreach-based testing group. Study participants were 1,233 individuals who underwent HIV counseling and testing. Questionnaires assessed demographics and HIV transmission risk behaviors. Results indicate that outreach-based testers were more likely to be younger, female, and African American relative to clinic-based testers. Overall, 100% of clinic-based testers and 99.5% of outreach-based testers receiving their test results. All individuals with positive rapid test results received confirmatory blood testing and entered medical care within one week of preliminary diagnosis. College campuses may provide a unique setting to deliver HIV testing and may help increase the percentage of young people who are aware of their serostatus, particularly younger, female, and African American students who may be less likely to undergo testing in traditional clinic settings.
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Affiliation(s)
- Sarahmona M Przybyla
- Research Institute on Addictions, University at Buffalo, State University of New York
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49
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McNairy ML, El-Sadr WM. Antiretroviral therapy for the prevention of HIV transmission: what will it take? Clin Infect Dis 2014; 58:1003-11. [PMID: 24429438 DOI: 10.1093/cid/ciu018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The evidence in support of use of antiretroviral therapy (ART) for prevention of human immunodeficiency virus (HIV) transmission is encouraging and has stimulated optimism for achieving a dramatic change in the trajectory of the HIV epidemic. Yet, there are substantial challenges that, if not addressed, could be the Achilles' heel for this concept. These challenges require strengthening every step of the HIV care continuum, including expansion of HIV testing to reach all those with HIV infection, effective linkage to and retention in care, timely initiation of ART, and high levels of treatment adherence with viral load suppression. Also important is the identification of individuals with acute HIV infection whose contribution to HIV transmission may be substantial. Implementation research is needed to identify strategies that address these challenges and to determine the efficacy of ART for prevention in key populations as well as to evaluate the effectiveness of combination strategies for HIV prevention at the population level.
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Abstract
In the past several years, the debate of "treatment vs prevention" has shifted with the introduction of the concept of "treatment as prevention," (TasP), stemming from a series of compelling observational, ecological, and modeling studies as well as HPTN 052, a randomized clinical trial, demonstrating that use of ART is associated with a decrease in HIV transmission. In addition to TasP being viewed as 1 intervention in a combination strategy for HIV Prevention, TasP is, in and of itself, a combination of multiple interventions that need to be implemented with high coverage in order to achieve its potential impact.
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