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Cassell MM, Wilcher R, Ramautarsing RA, Phanuphak N, Mastro TD. Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:614-625. [PMID: 33361230 PMCID: PMC7784070 DOI: 10.9745/ghsp-d-19-00418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
Essentially all HIV transmission is from people living with HIV who are not virally suppressed. An HIV micro-epidemic control approach that differentiates treatment support and prevention services for people living with HIV and their network members according to viral burden could optimize the impact of epidemic control efforts.
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Affiliation(s)
| | | | | | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand.,Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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Plymoth M, Sanders EJ, Van Der Elst EM, Medstrand P, Tesfaye F, Winqvist N, Balcha T, Björkman P. Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0244066. [PMID: 33320900 PMCID: PMC7737988 DOI: 10.1371/journal.pone.0244066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
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Affiliation(s)
- Martin Plymoth
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail: ,
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, United Kingdom
| | - Elise M. Van Der Elst
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Patrik Medstrand
- Clinical Virology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Kim H, Harling G, Vandormael A, Tomita A, Cuadros DF, Bärnighausen T, Tanser F. HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis. J Int AIDS Soc 2020; 23:e25432. [PMID: 31916420 PMCID: PMC6949466 DOI: 10.1002/jia2.25432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub-Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. METHODS We followed adults (≥15 years old) using a population-based, longitudinal and open surveillance system in KwaZulu-Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual-based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV-positive or HIV-negative partners by participants' own time-varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. RESULTS A total of 18,341 HIV-negative and 11,361 HIV-positive individuals contributed 154,469 person-years (PY) of follow-up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV-positive seroconcordant (i.e. both individuals in the partnership were HIV-positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV-positive, 1.12/1000PY with HIV-negative and 2.65/1000PY with unknown serostatus partners. HIV-positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV-positive partner than did HIV-negative individuals after adjusting for age, opposite-sex HIV prevalence (by 5-years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV-negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV-negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). CONCLUSIONS A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.
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Affiliation(s)
- Hae‐Young Kim
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNYUSA
| | - Guy Harling
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Alain Vandormael
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
| | - Andrew Tomita
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Centre for Rural HealthSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Diego F Cuadros
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiCincinnatiOHUSA
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Frank Tanser
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Lincoln Institute for HealthUniversity of LincolnLincolnUK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
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Hart-Malloy R, Rosenthal M, Patterson W, Currenti S, O’Donnell T, Gunn JKL. Syphilis among adult males with a history of male-to-male sexual contact living with diagnosed HIV in New York State (excluding New York City): The challenge of intersecting epidemics. PLoS One 2019; 14:e0226614. [PMID: 31851719 PMCID: PMC6919591 DOI: 10.1371/journal.pone.0226614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022] Open
Abstract
Since 2009, syphilis has been increasing in New York State (NYS) excluding New York City (NYC) among men with a history of male-to-male sexual contact (MSM). Because MSM make up a disproportionate number of new HIV infections, this study aims to: 1) establish yearly rates of early syphilis diagnosis, 2) assess factors associated with early syphilis diagnosis, and 3) describe missed opportunities for earlier diagnosis of syphilis among MSM living with diagnosed HIV(MSMLWDH) in NYS, excluding NYC. A cohort of adult MSMLWDH alive in 2013 were followed through 2016 to identify individuals with at least one early syphilis diagnosis between July 2014 and December 2016. Early syphilis diagnosis rates were calculated for 2015 and 2016. Crude relative risks and 95% confidence intervals were calculated to determine associations between available covariates and both syphilis diagnosis and missed opportunities. Missed opportunities were defined as reports of an HIV-related laboratory test within a given window corresponding to syphilis staging where syphilis testing was not performed at the same time. Of 7,512 MSMLWDH, 50.0% were non-Hispanic white, 85.4% aged ≥35, and 320(4.3%) had an early syphilis diagnosis. Yearly rates were: 1,838/100,000, and 1,681/100,000 in 2015 and 2016, respectively. Persons who were non-Hispanic black, living with diagnosed HIV for less than three years, aged <45, and were always virally suppressed or always in HIV care were significantly more likely to have a syphilis diagnosis. Over half of individuals had evidence of a missed opportunity for earlier syphilis diagnosis. Syphilis stage at diagnosis, older age, and syphilis diagnosis not concurrent with an HIV-related laboratory test were associated with a higher likelihood of having a missed opportunity. This study supports high interrelatedness of the syphilis and HIV epidemics among MSM. Since syphilis can impact HIV viral load suppression status, efforts to end the HIV epidemic need to be coupled with syphilis elimination efforts.
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Affiliation(s)
- Rachel Hart-Malloy
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States of America
- * E-mail:
| | - Mark Rosenthal
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
| | - Wendy Patterson
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
| | - Salvatore Currenti
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
| | - Travis O’Donnell
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
| | - Jayleen KL Gunn
- Division of HIV/STD Epidemiology, Evaluation, and Partner Services, AIDS Institute, New York State Department of Health, Albany, New York, United States of America
- United States Public Health Service, Atlanta, Georgia, United States of America
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Villa-Rueda AA, Onofre-Rodríguez DJ, Churchill S, Ramírez-Barajas F, Benavides-Torres RA. Multilevel elements associated with HIV serosorting for sexual encounters: a scoping literature review. CIENCIA & SAUDE COLETIVA 2019; 26:2183-2194. [PMID: 34231730 DOI: 10.1590/1413-81232021266.13142019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022] Open
Abstract
A scoping literature review to identify the multilevel HIV serosorting related elements was developed. Articles from EBSCO, PubMed, PsyNET and Science Direct with serosort* or serosorting at the tittle or abstract, written in English or Spanish were included. No restriction in type of population or design were applied. 239 records were retrieved after duplicates removed, but 181 references were extracted for full-text review. Individual level: HIV knowledge, serostatus, risk perceptions, abilities to disclose and for condom use negotiation, motivations, use of drugs, stigma, attitudes toward condom use, and perceptions/beliefs about the HIV and related treatments, HIV infection rates/testing and behavioral factors. Interpersonal level: social networks, abilities (sexual behavior negotiation, and communication). Community level: stigma, social norms, access to HIV related services. Structural level: political context, HIV related funding and public policies. HIV Serosorting is not solely an interpersonal behavior it involves multilevel elements that must be acknowledged by professionals and stakeholders.
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Affiliation(s)
- Alma Angélica Villa-Rueda
- School of Nursing, Universidad Autónoma de Baja California. Calle G S/N Z.C. 21100. Mexicali Baja California México
| | - Dora Julia Onofre-Rodríguez
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
| | - Siobhan Churchill
- Department of Epidemiology and Biostatistics, University of Western Ontario. London ON Canada
| | - Fernanda Ramírez-Barajas
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
| | - Raquel Alicia Benavides-Torres
- School of Nursing, Universidad Autónoma de Nuevo León. Dr. José Eleuterio González #1500, Mitras Centro, Z.C. 64460 Monterrey Nuevo León México
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Cassell JA. Highlights from this issue. Br J Vener Dis 2018. [DOI: 10.1136/sextrans-2018-053638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Udeagu CCN, Shah S, Misra K, Sepkowitz KA, Braunstein SL. Where Are They Now? Assessing if Persons Returned to HIV Care Following Loss to Follow-Up by Public Health Case Workers Were Engaged in Care in Follow-Up Years. AIDS Patient Care STDS 2018; 32:181-190. [PMID: 29750551 DOI: 10.1089/apc.2018.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We examined care engagement and viral suppression (VS) over a 1- to 5-year period among persons re-engaged in HIV care using retrospective cohort study and longitudinal follow-up. The population comprised five cohorts of persons re-engaged in care from 2009 to 2013. We used surveillance data [CD4 T cell count or HIV viral load (VL) RNA] to measure four outcomes 1-5 years post-care engagement. Engagement-in-care indicated persons with laboratory reports in each follow-up year. Continuous engagement or sustained engagement, respectively, included persons with ≥1 or ≥2 (separated by 90 days) CD4 or VL reports in each follow-up year. VS indicated persons living with HIV (PLWH) re-engaged in care with VL ≤200 copies/mL in any follow-up year, and we measured re-engaged PLWH who subsequently became out of care (OOC) in each follow-up year. Overall, 84-86% PLWH were engaged in care in any follow-up year. The proportions of PLWH cohorts continuously engaged in care [86% (1 year), 77% (2 years), 72% (3 years), 67% (4 years), and 63% (5 years)] declined over time. Thirty-four percent of the PLWH who were re-engaged in care were subsequently OOC in the follow-up years. Most re-engaged PLWH became OOC in their first (40%) and second (30%) follow-up years. In follow-up years (1-5 years), fewer PLWH continuously engaged in care with ≥1 CD4 or VL reports in the registry had VS ≤200 copies/mL: 65%, 58%, 49%, 44%, and 42%, respectively. Encouragingly, higher proportions had VL ≤1500 copies/mL in follow-up years (1-5): (75%, 72%, 73%, 75%, and 70%), likely reflecting levels of HIV treatment. Our results support the use of surveillance data to identify and re-engage OOC PLWH in care. However, structures and programs are needed to support retention in care and reduce repeat OOC.
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Affiliation(s)
- Chi-Chi N. Udeagu
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Sharmila Shah
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Kavita Misra
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Kent A. Sepkowitz
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
- Memorial Sloan Kettering Center, New York, New York
| | - Sarah L. Braunstein
- Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, Long Island City, New York
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