scholarly journals 1527. Incident Sexually Transmitted Infections among Southern Men Who Have Sex with Men Living with HIV in the Era of Biomedical Prevention

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S764-S765
Author(s):  
Ronnie M Gravett ◽  
John D Cleveland ◽  
Edgar T Overton ◽  
Jeanne Marrazzo ◽  
Jeanne Marrazzo
Keyword(s):  
Viral Load ◽  
Sexually Transmitted Infections ◽  
Incidence Rate ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Living With Hiv ◽  
Incident Rates ◽  
The U.S

Abstract Background Sexually transmitted infections (STI) and HIV disproportionately affect men who have sex with men (MSM) in the U.S. Deep South. The South also continues to bear the majority of incident HIV in the U.S.; concomitantly, STIs have increased among MSM in this region. HIV virologic suppression effectively prevents sexual transmission of HIV (treatment as prevention, TasP), but STIs occur commonly in MSM living with HIV despite this. Here, we describe the incidence of gonorrhea and chlamydia in MSM living with HIV in the context of their viral load (VL) management from 2016 to 2019. Methods We analyzed data from adult MSM living with HIV from 2016-2019 in HIV care in Birmingham, AL. Eligible MSM were prospectively enrolled in the CFAR Network of Integrated Clinical Sites (CNICS) and had documentation of at least one HIV viral load and one STI test (gonorrhea or chlamydia at any anatomic site) in the same calendar year. Demographic data is presented by year. STI incident rates were calculated by year by viral load (VL) category, suppressed (VL < 200 copies/ml) and unsuppressed (VL ≥ 200 copies/ml), with incident rate ratios (IRR) and 95% confidence intervals for comparing suppressed VL to unsuppressed VL. Results The study cohort included 943, 1084, 1080, and 1106 MSM in each year from 2016-2019, respectively. Of these men, 551 (58%), 623 (58%), 639 (63%), and 676 (61%) were Black or African American with a median age (years) of 46, 45, 44, and 43 from 2016-2019. Most had VL < 200 (79%, 81%, 82%, and 80% from 2016-2019). There were 100, 131, 139, and 168 men with positive GC or CT results per year from 2016-2019. The annual incident rates per 100 person years (PY) for MSM by suppressed and unsuppressed VL as well as IRR are presented in Table 1; the IRR ranged from 3.00-4.34 through the study period. Figure 1 shows incidence rate by VL category. Figure 1. Incidence Rate by Viral Load Category. PY, person years. Conclusion In this cohort, incident bacterial STIs were common and increased each year in this analysis for both groups, reflecting national STI trends. MSM with suppressed VL had higher bacterial STI incidence rates and higher risk for incident STI compared to MSM with unsuppressed VL. Novel approaches to STI prevention, such as pre- and post-exposure prophylaxis or vaccines, are necessary to alter the STI epidemic in this population and limit its impact on HIV transmission. Disclosures All Authors: No reported disclosures

scholarly journals Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic

2020 ◽  
Vol 31 (2) ◽  
pp. 127-135 ◽  
Author(s):  
Ronnie M Gravett ◽  
Andrew O Westfall ◽  
Edgar T Overton ◽  
Kachina Kudroff ◽  
Christina A Muzny ◽  
...  
Keyword(s):  
High Risk ◽  
Sexually Transmitted Infections ◽  
Incidence Rate ◽  
Sexual Behaviors ◽  
The United States ◽  
Sexual Partners ◽  
Deep South ◽  
Multiple Sexual Partners ◽  
Sexually Transmitted ◽  
Sex With Men

HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%. Twenty-six of 81 eligible MSM on PrEP had incident STIs with an incidence rate of 33.1 cases per 100 person-years. Significantly higher proportions of high PrEP adherence, multiple sexual partners, and inconsistent condom use were seen in those with incident STI, and we identified MSM with both high PrEP adherence and multiple sexual partners as being at especially high risk for bacterial STIs (hazard ratio: 7.57, 95% confidence interval: 1.75–32.74). Bacterial STIs are common after initiating PrEP in this clinic, and MSM reporting high PrEP adherence and multiple sexual partners have a significant risk for incident STI. High-risk sexual behaviors persisted after starting PrEP, highlighting the importance of ongoing, intensive sexual health screening and interventions.

scholarly journals Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W Dunbar ◽  
N Sohler ◽  
Y Coppieters
Keyword(s):  
Viral Suppression ◽  
Continuum Of Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Care Clinic ◽  
Effective Interventions ◽  
Sex With Men ◽  
Living With Hiv

Abstract Background The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step. Methods We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis. Results Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001). Conclusions HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV. Key messages Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.

scholarly journals Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Jose Lucar ◽  
Rachel Hart ◽  
Nabil Rayeed ◽  
Arpi Terzian ◽  
Amy Weintrob ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Poisson Regression ◽  
Hiv Transmission ◽  
The United States ◽  
Transmission Risk ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Hiv Transmission Risk ◽  
Hiv Acquisition

Abstract Background Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. Methods We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk. Results Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1–8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL. Conclusions STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

scholarly journals 374. Lymphogranuloma Venereum (LGV) Outbreak Among People Living with HIV (PLWH): Michigan, 2015–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S195-S196
Author(s):  
Christine Convery ◽  
James B Kent
Keyword(s):  
Disease Surveillance ◽  
Communicable Disease ◽  
Lymphogranuloma Venereum ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Disease Surveillance System ◽  
Sex With Men ◽  
Living With Hiv

Abstract Background Sexually transmitted infections (STIs) have increased in recent years both nationally and in Michigan. At the same time, HIV prevention is shifting toward intense efforts to “ending the epidemic.” Detecting and mitigating outbreaks, as well as monitoring co-infections in people living with HIV (PLWH), will be critical in these efforts. Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by a serovar of Chlamydia trachomatis and may present with proctitis, lymphadenopathy, or genital ulcers. Methods While not nationally reportable, LGV remains on the list of reportable conditions in Michigan. No cases were reported between 2009 and 2014, but from August 12, 2015 to December 4, 2018, 68 cases of LGV were identified in 66 patients and reported by providers and laboratories through the Michigan Disease Surveillance System (MDSS). These reported cases were analyzed by specimen collection date and matched to other communicable disease databases for HIV co-infection status and STI history using SAS 9.4. Results The outbreak was local to Southeast Michigan where all but three patients resided; 72% cases lived in Detroit (Figure 1). 94% of cases were co-infected with HIV, including 4 who were co-diagnosed within 30 days of LGV diagnosis. Among the 60 cases of PLWH (excluding co-diagnoses), 62% were virally suppressed (VS) and 32% were in care but not suppressed at the time of LGV diagnosis. The majority (88%) of outbreak patients had between 1 and 7 additional bacterial STIs in the two years prior to LGV. All reported cases were men who have sex with men (MSM) with two patients also reporting injection drug use (MSM/IDU). Conclusion Testing for LGV is not routine and in some settings not available so there are likely unreported cases missing from this outbreak analysis. HIV care outcomes differed from statewide estimates with outbreak patients more likely to be receiving care but not sufficiently engaged compared with all PLWH (Figure 2). A high proportion of cases with additional STI history combined with lower than average VS rate means transmission of HIV is likely. This highlights a need to integrate HIV care support with STI services. Additional analyses of HIV co-infection with syphilis or other STIs are needed to further inform these strategies. Disclosures All authors: No reported disclosures.

Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression among Young People Living with HIV (Preprint)

2021 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin M Turner ◽  
Dillon Trujillo ◽  
Jarett Maycott ◽  
Erin C Wilson
Keyword(s):  
Mental Health ◽  
Viral Load ◽  
Young People ◽  
Text Messaging ◽  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Social Inequities ◽  
Sex With Men ◽  
Living With Hiv

BACKGROUND The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, anti-trans discrimination, and racism, shaping not only those at-risk for HIV infection, but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. OBJECTIVE This study assessed 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV (YPLWH) in San Francisco We examined dose-response relationships between intervention exposure (e.g. text messaging) and viral suppression and mental health. Health electronic navigation (eNavigation or eNav) is a 6-month, text message-based, digital HIV care navigation intervention, in which YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included: identifying as a man who has sex with men or a trans woman; being between the ages of 18 and 34 years; and being newly diagnosed with HIV or not being engaged/retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographic, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations (GEE) to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. RESULTS Over the entire 12-month study period showed that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio, aOR = 1.01, 95% CI = 1.00 – 1.02, p = 0.03). We found that mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term: 0.97, 95%CI = 0.96-0.99, p < 0.01). CONCLUSIONS Digital care navigation interventions like Health eNavigation may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics due to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped to improve viral suppression and mental health – intersecting, co-morbid conditions – 6-months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Thiago Silva Torres ◽  
Emilia Moreira Jalil ◽  
Lara Esteves Coelho ◽  
Daniel Rodrigues Barros Bezerra ◽  
Cristina Moreira Jalil ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Sexually Transmitted Infections ◽  
Text Messages ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Hiv Prevention Strategies ◽  
Adherence Intervention ◽  
Sex With Men ◽  
Prevention Counseling ◽  
Biomedical Interventions

BACKGROUND In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. OBJECTIVE We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. METHODS A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. RESULTS The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. CONCLUSIONS The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/34885

scholarly journals A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study

10.2196/34885 ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. e34885
Author(s):  
Thiago Silva Torres ◽  
Emilia Moreira Jalil ◽  
Lara Esteves Coelho ◽  
Daniel Rodrigues Barros Bezerra ◽  
Cristina Moreira Jalil ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Sexually Transmitted Infections ◽  
Text Messages ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Hiv Prevention Strategies ◽  
Adherence Intervention ◽  
Sex With Men ◽  
Prevention Counseling ◽  
Biomedical Interventions

Background In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. Objective We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. Methods A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. Results The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. Conclusions The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. International Registered Report Identifier (IRRID) DERR1-10.2196/34885

scholarly journals Couples-focused intervention to improve engagement in HIV care: protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037468
Author(s):  
Alyssa Paige Tabrisky ◽  
Lara S Coffin ◽  
David P Olem ◽  
Torsten B Neilands ◽  
Mallory O'Neill Johnson
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Virological Suppression ◽  
Hiv Care ◽  
Randomised Control Trial ◽  
Engagement In Care ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Counselling Intervention

Introduction Advances in HIV treatment have proven to be effective in increasing virological suppression, thereby decreasing morbidity, and increasing survival. Medication adherence is an important factor in reducing viral load among people living with HIV (PLWH) and in the elimination of transmission of HIV to uninfected partners. Achieving optimal medication adherence involves individuals taking their medications every day or as prescribed by their provider. However, not all PLWH in the USA are engaged in care, and only a minority have achieved suppressed viral load (viral load that is lower than the detectable limit of the assay). Sexual and gender minorities (SGM; those who do not identify as heterosexual or those who do not identify as the sex they were assigned at birth) represent a high-risk population for poor clinical outcomes and increased risk of HIV transmission, as they face barriers that can prevent optimal engagement in HIV care. Research in dyadic support, specifically within primary romantic partnerships, offers a promising avenue to improving engagement in care and treatment outcomes among SGM couples. Dyadic interventions, especially focused on primary romantic partnerships, have the potential to have a sustained impact after the structured intervention ends. Methods and analysis This paper describes the protocol for a randomised control trial of a theory-grounded, piloted intervention (DuoPACT) that cultivates and leverages the inherent sources of support within primary romantic relationships to improve engagement in HIV care and thus clinical outcomes among persons who are living with HIV and who identify as SGM (or their partners). Eligible participants must report being in a primary romantic relationship for at least 3 months, speak English, at least one partner must identify as a sexual or gender minority and at least one partner must be HIV+ with suboptimal engagement in HIV care, defined as less than excellent medication adherence, having not seen a provider in at least the past 8 months, having a detectable or unknown viral load or not currently on antiretroviral therapy. Eligible consenting couples are allocated equally to the two study arms: a structured six-session couples counselling intervention (DuoPACT) or a three-session individually-delivered HIV adherence counselling intervention (LifeSteps). The primary aim is to evaluate the efficacy of DuoPACT on virological suppression among HIV+ members of SGM couples with suboptimal engagement in care. The DuoPACT study began its target enrolment of 150 couples (300 individuals) in August 2017, and will continue to enrol until June 2021. Ethics and dissemination All procedures are approved by the Institutional Review Board at the University of California, San Francisco. Written informed consent is obtained from all participants at enrolment, and study progress is reviewed twice yearly by an external Safety Monitoring Committee. Dissemination activities will include formal publications and report back sessions with the community. Trial registration number NCT02925949; Pre-results.

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