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Iqbal HS, Gunaratne MP, Loeb TA, Pradeep A, McFall AM, Srikrishnan AK, Anderson M, Rodgers MA, Celentano DD, Mehta SH, Clohertly GA, Solomon SS. High prevalence of hepatitis B virus among MSM living with HIV in India. J Viral Hepat 2024; 31:271-274. [PMID: 38385866 DOI: 10.1111/jvh.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
People living with HIV (PWH) have been shown to bear a higher burden of hepatitis B virus (HBV) due to shared routes and risk factors for transmission. Populations such as men who have sex with men (MSM) are at an increased risk of both being infected with HBV and HIV, that places them at higher risk of hepatocellular carcinoma. Using weighted and adjusted multilevel logistic regression, we characterized the prevalence and correlates of hepatitis B surface antigen (HBsAg) among MSM living with HIV across 12 Indian cities from 2012 to 2013. Overall, the prevalence of HBsAg was 8% (range across cities: 0.5%-19%). Being between the ages of 25-34, and 35-44 increased the odds of having chronic HBV infection compared to MSM 24 years or younger. Daily or seasonal employment and being unemployed increased the odds of HBsAg prevalence compared to those with monthly or weekly wages. Sexual risk behaviours such as having had sex with both men and women in the prior 6 months and history of sex work increased the odds of having HBV. Ever having insertive sex with a man or hijra (assigned male at birth, currently identifies as female/nonbinary) was negatively associated with HBV. Despite the existence of efficacious vaccines, HBV continues to have high prevalence among PWHs. Programmes to increase early screening, vaccinations and HBV literacy are urgently needed. Integrating HBV and HIV programmes for MSM populations could be critical in addressing this dual burden and improving outcomes for both infections.
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Affiliation(s)
| | - Mihili P Gunaratne
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Talia A Loeb
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amrose Pradeep
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Mark Anderson
- Abbott Pandemic Defense Coalition, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Mary A Rodgers
- Abbott Pandemic Defense Coalition, Abbott Laboratories, Abbott Park, Illinois, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gavin A Clohertly
- Abbott Pandemic Defense Coalition, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, Maryland, USA
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Loeb TA, Murray SM, Cooney EE, Poteat T, Althoff KN, Cannon CM, Schneider JS, Mayer KH, Haw JS, Wawrzyniak AJ, Radix AE, Malone J, Adams D, Stevenson M, Reisner SL, Wirtz AL. Access to healthcare among transgender women living with and without HIV in the United States: associations with gender minority stress and resilience factors. BMC Public Health 2024; 24:243. [PMID: 38245684 PMCID: PMC10800069 DOI: 10.1186/s12889-024-17764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States. METHODS This study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status. RESULTS Higher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. CONCLUSIONS Gender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities.
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Affiliation(s)
- Talia A Loeb
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | | | - Jason S Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY, USA
| | | | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard School of Public Health, Boston, MA, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
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Loeb TA, McFall AM, Srikrishnan AK, Anand S, Vasudevan CK, Mehta SH, Solomon SS. Integration of a geospatially targeted community-based testing approach with respondent-driven sampling to identify people who inject drugs living with HIV and HCV in Patti and Gorakhpur, India. Drug Alcohol Depend 2023; 247:109874. [PMID: 37087926 PMCID: PMC10612114 DOI: 10.1016/j.drugalcdep.2023.109874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Respondent-driven sampling (RDS), a network recruitment approach, is effective at reaching people who inject drugs (PWID), but other strategies may be needed to reach PWID at risk or living with HIV and/or Hepatitis C (HCV). We examined the impact of integrating geospatially targeted community-based HIV/HCV testing with an RDS survey. METHODS PWID were recruited between 2019 and 2021 in Patti and Gorakhpur, India, in a two-phased approach for identifying PWID living with HIV/HCV. Phase 1 was an RDS survey, in which participants reported injection venues. Venues with the highest prevalence of HIV/HCV viremia were selected for Phase 2: community-based testing. All participants underwent rapid HIV and HCV testing and viral load quantification. Using Pearson's chi-squared test, two-sided exact significance tests, and t-tests, we compared prevalence and identification rates for each of the primary outcomes: the number of PWID 1) living with HIV/HCV, 2) undiagnosed, and 3) viremic. RESULTS Both approaches identified large numbers of PWID (n∼500 each; N=2011) who were living with HIV/HCV and had transmission potential (i.e., detectable viremia). The community-based approach identified a higher proportion of individuals living with HCV (76.4% vs. 69.6% in Gorakhpur and 36.3% vs. 29.0% in Patti). Community-based testing was also faster at identifying PWID with detectable HIV viremia. Both approaches identified PWID with varying demographic characteristics. CONCLUSIONS Community-based testing was more efficient than RDS overall, but both may be required to reach PWID of varying characteristics. Surveillance should collect data on injection venues to facilitate community-based testing and maximize case identification.
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Affiliation(s)
- Talia A Loeb
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Allison M McFall
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - Shruti H Mehta
- The Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Sunil S Solomon
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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