scholarly journals Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Jonathan Colasanti ◽  
Jeri Sumitani ◽  
C Christina Mehta ◽  
Yiran Zhang ◽  
Minh Ly Nguyen ◽  
...  
Keyword(s):  
United States ◽  
Viral Suppression ◽  
Hiv Transmission ◽  
Positive Impact ◽  
Population Level ◽  
The United States ◽  
Clinic Visit ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Sex With Men

Abstract Background Rapid entry programs (REPs) improve time to antiretroviral therapy (ART) initiation (TAI) and time to viral suppression (TVS). We assessed the feasibility and effectiveness of a REP in a large HIV clinic in Atlanta, Georgia, serving a predominately un- or underinsured population. Methods The Rapid Entry and ART in Clinic for HIV (REACH) program was implemented on May 16, 2016. We performed a retrospective cohort study with the main independent variable being period of enrollment: January 1, 2016, through May 15, 2016 (pre-REACH); May 16, 2016, through July 31, 2016 (post-REACH). Included individuals were HIV-infected and new to the clinic with detectable HIV-1 RNA. Six-month follow-up data were collected for each participant. Survival analyses were conducted for TVS. Logistic and linear regression analyses were used to evaluate secondary outcomes: attendance at first clinic visit, viral suppression, TAI, and time to first attended provider visit. Results There were 117 pre-REACH and 90 post-REACH individuals. Median age (interquartile range [IQR]) was 35 (25–45) years, 80% were male, 91% black, 60% men who have sex with men, 57% uninsured, and 44% active substance users. TVS decreased from 77 (62–96) to 57 (41–70) days (P < .0022). Time to first attended provider visit decreased from 17 to 5 days, and TAI from 21 to 7 days (P < .0001), each remaining significant in adjusted models. Conclusions This is the largest rapid entry cohort described in the United States and suggests that rapid entry is feasible and could have a positive impact on HIV transmission at the population level.

scholarly journals Epidemiology of Human Immunodeficiency Virus in the United States

2007 ◽  
Vol 20 (3) ◽  
pp. 478-488 ◽  
Author(s):  
Susan Hariri ◽  
Matthew T. McKenna
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
The United States ◽  
Population Based ◽  
True Incidence ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Fundamental Shift

SUMMARY The human immunodeficiency virus (HIV) epidemic emerged in the early 1980s with HIV infection as a highly lethal disease among men who have sex with men and among frequent recipients of blood product transfusions. Advances in the treatment of HIV infection have resulted in a fundamental shift in its epidemiology, to a potentially chronic and manageable condition. However, challenges in the prevention of this infection remain. In particular, increasing evidence suggests that transmission of drug-resistant virus is becoming more common and that the epidemic is having a profound impact on morbidity and mortality in ethnic and racial minority subgroups in the United States. New population-based data collection systems designed to describe trends in behaviors associated with HIV transmission and better methods for measuring the true incidence of transmission will better elucidate the characteristics of HIV infection in the United States and inform future public health policies.

scholarly journals Antiretroviral therapy for prevention of HIV transmission: implications for Europe

2013 ◽  
Vol 18 (48) ◽  
Author(s):  
V Cambiano ◽  
J O’Connor ◽  
A N Phillips ◽  
A Rodger ◽  
R Lodwick ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
People Who Inject Drugs ◽  
Hiv Transmission ◽  
Controlled Trial ◽  
Population Level ◽  
Hiv Infections ◽  
Cd4 Count ◽  
Art Initiation ◽  
Sex With Men ◽  
Randomised Controlled

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

scholarly journals Statewide Evaluation of New HIV Diagnoses in Rhode Island: Implications for Prevention

2018 ◽  
Vol 133 (4) ◽  
pp. 489-496
Author(s):  
Philip A. Chan ◽  
Madeline C. Montgomery ◽  
Jennifer Rose ◽  
Alec Tributino ◽  
Christina Crowley ◽  
...  
Keyword(s):  
United States ◽  
Rhode Island ◽  
Latent Class ◽  
Hiv Transmission ◽  
The United States ◽  
Newly Diagnosed ◽  
Foreign Born ◽  
Class 1 ◽  
Sex With Men ◽  
Exposure Prophylaxis

Objectives: Patterns of HIV transmission vary widely across demographic groups. Identifying and engaging these groups are necessary to prevent new infections and diagnose disease among people who are unaware of their infection. The objective of this study was to determine characteristics of newly diagnosed individuals across an entire state to determine patterns of HIV transmission. Methods: We evaluated data on people with new HIV diagnoses in Rhode Island from 2013 through 2015. We performed a latent class analysis (LCA) to identify underlying demographic and behavioral characteristics of people with newly diagnosed HIV. Results: Of 167 people with new HIV diagnoses interviewed in Rhode Island from 2013 through 2015, 132 (79%) were male, 84 (50%) were nonwhite, 112 (67%) were men who have sex with men (MSM), 112 (67%) were born in the United States, and 61 (37%) were born in Rhode Island. LCA revealed 2 major classes. Of the 98 people in class 1, 96% were male, 85% were MSM, 80% were white, 94% were born in the United States, and 80% believed they acquired HIV in Rhode Island. Class 2 was 63% male and 69% Hispanic/Latino; 29% were born in the United States, and 61% believed they acquired HIV in Rhode Island. Conclusions: Most new HIV diagnoses in Rhode Island were among MSM born in the United States, and a substantial number were likely infected in-state. People with newly diagnosed HIV who were foreign-born, including Hispanic/Latino and heterosexual groups, were less likely to have acquired HIV in Rhode Island than were MSM. HIV prevention approaches, including pre-exposure prophylaxis, should be adapted to the needs of specific groups. Rhode Island offers lessons for other states focused on eliminating HIV transmission.

scholarly journals Association between rectal gonorrhoea and HIV incidence in men who have sex with men: a meta-analysis

2021 ◽  
pp. sextrans-2021-055254
Author(s):  
Deborah Donnell ◽  
Kidist Zewdie ◽  
Natasha Ratna ◽  
Veronica Miller ◽  
John Michael Saunders ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Population Level ◽  
Incidence Rates ◽  
Hiv Incidence ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Hiv Exposure ◽  
Sex With Men ◽  
Sexual Health Clinics ◽  
Hiv Negative

BackgroundIncidence of rectal gonorrhoea (GC) has been hypothesised as a correlate of HIV exposure in prevention trials of men who have sex with men (MSM). High rectal GC incidence in MSM trials of new biomedical prevention drugs may provide supportive evidence for ongoing HIV risk. Empirical evidence of correlation between rectal GC and HIV incidence is needed to assess whether high rectal GC rates reliably correlate with high risk of HIV.MethodsRectal GC and HIV are routinely tested in sexual health clinics (SHCs) throughout England. Through routine surveillance data collected at visits to SHCs, we assessed HIV incidence and new rectal GC diagnoses in repeat visits by HIV-negative MSM between 2011 and 2018, predating widespread roll-out of pre-exposure prophylaxis. Meta-analysis regression assessed population-level association between HIV and rectal GC incidence over time.FindingsBetween 2011 and 2018, HIV and rectal GC incidence was assessed in 541 056 HIV-negative MSM attending SHCs in England. HIV incidence among MSM attending SHCs fell from 1.26/100 person-years (PYs) in 2011 to 0.28/100 PYs in 2018. Rectal GC rates increased from 3.5/100 PYs to 11.1/100 PYs over the same period. The rate of HIV incidence decreased by 22.3% for each percent increase in rectal GC (95% CI –30.8 to –14.7, p<0.001).InterpretationAmong the population of MSM attending SHCs in England, rectal GC rates increased substantially while HIV incidence rates decreased between 2011 and 2018. HIV incidence likely decreased through expanded HIV testing, prompt antiretroviral treatment (ART) initiation and increased viral suppression in persons living with HIV, interventions that did not decrease rectal GC. Rectal GC may not be an ideal proxy for HIV incidence in trials, as HIV exposure risk is complex and context dependent, given effective HIV prevention interventions in MSM.Introduction

scholarly journals Molecular analysis allows inference into HIV transmission among young men who have sex with men in the United States

AIDS ◽  
2015 ◽  
Vol 29 (18) ◽  
pp. 2517-2522 ◽  
Author(s):  
Y. Omar Whiteside ◽  
Ruiguang Song ◽  
Joel O. Wertheim ◽  
Alexandra M. Oster
Keyword(s):  
United States ◽  
Molecular Analysis ◽  
Hiv Transmission ◽  
Young Men ◽  
The United States ◽  
Sex With Men

scholarly journals Parenting Desires Among Individuals Living With Human Immunodeficiency Virus in the United States

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Susan E Cohn ◽  
Lisa B Haddad ◽  
Anandi N Sheth ◽  
Christina Hayford ◽  
Joan S Chmiel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Transmission ◽  
The United States ◽  
Art Initiation ◽  
Immunodeficiency Virus ◽  
The Future ◽  
Reproductive Services ◽  
Sex With Men ◽  
Aids Clinical Trials ◽  
Living With Hiv

Abstract Background In 1988, 1 of 3 women (W) and heterosexual men living with human immunodeficiency virus (HIV) reported wanting children, but little is known about parenting desires of men who have sex with men (MSM) living with HIV. We examined parenting desires among persons initiating antiretroviral therapy (ART). Methods Of 1809 participants in the AIDS Clinical Trials Group (ACTG) Study 5257, 1425 W aged ≤45 years or men completed questionnaires about parenting desires at baseline and 96 weeks after initiating ART. Self-reported desires for children in the future (yes/unsure vs no) and associations between baseline sociodemographics and parenting desires at 96 weeks were examined using multivariable logistic regression, overall and within subgroups. Results The 1425 participants were as follows: 36% white, 39% black, 22% Hispanic; median age 36 (interquartile range, 28–44); 70% MSM, 13% men reported sex only with W (MSW), 17% W. At baseline, 42% may want children in the future (42% MSM, 37% MSW, 43% W); at 96 weeks, 41% may want children (41% MSM, 37% MSW, 43% W). At follow-up, approximately 10% of responses changed in each direction. In multivariable analyses, education greater than high school, &lt;30 years, and having no children were significantly associated with future parenting desires among all subgroups. Among MSM, being black was associated with desiring children. Conclusions Approximately 40% of MSM, W, and MSW with HIV may want children, both at baseline and 96 weeks after ART initiation. These results highlight the need to regularly assess parenting goals, provide access to comprehensive reproductive services, and address prevention of vertical and heterosexual HIV transmission.

scholarly journals A spatial approach for Ending the HIV Epidemic for the United States – A DC Model

2020 ◽  
Author(s):  
Suparna Das ◽  
Adam Allston ◽  
Jenevieve Opoku ◽  
Michael Kharfen
Keyword(s):  
United States ◽  
At Risk ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Positive ◽  
Population At Risk ◽  
Hiv Epidemic ◽  
Spatial Approach ◽  
Mode Of Transmission ◽  
Sex With Men

Abstract Background Mode of transmission based hotspots is a smart approach to HIV mitigation yet remains poorly evaluated and implemented in the United States. The primary aim of the analysis is identifying mode of transmission based hotspots and population at risk of lower viral suppression to assist in targeted planning and implementation of programs. Methods We implemented spatial statistics to identify global-local hotspots and regression to find population at risk of lower viral suppression within the hotspots. Data was obtained from DC’s active surveillance system which were geocoded based on address of current residence. Results The analysis identified 6001 HIV positive men-who-have-sex with men (MSMs) and 6077 HIV positives non-MSMs (n=12078) living in DC, end of 2018. The hotspots for MSMs were central DC and non-MSM in south DC. Trends of viral suppression within MSM hotspots shows plateauing and among non-MSMs showed decline. The regression analysis showed MSM aged 21 – 25 (RR: 3.199, 95% CI: 1.832, 5.586) and not linked to care (8.592; 2.907, 25.398) were at higher risk of being virally unsuppressed within the hotspots. For non-MSMs we found that aged 12 – 18 (9.025; 3.314, 2.581) and unknown linkages (6.087; 3.346, 13.848) were at higher risk of being virally unsuppressed within the hotspots. Conclusion Our analysis provides a model that may be used by other jurisdictions to identify areas of priorities and plan treatment adherence programs using surveillance data. Attaining viral suppression is crucial in reducing new diagnoses and spatial approach can be an important tool Ending the HIV Epidemic.

scholarly journals Longitudinal HIV Transmission Risk Profiles Among Men Who Have Sex With Men Living With HIV in the SUN Study

2018 ◽  
Vol 13 (1) ◽  
pp. 155798831881828
Author(s):  
Jacob J. van den Berg ◽  
Nickolas D. Zaller ◽  
Fizza S. Gillani ◽  
Shira I. Dunsiger ◽  
Brandon D. L. Marshall ◽  
...  
Keyword(s):  
United States ◽  
Hiv Prevention ◽  
Sexual Risk ◽  
Hiv Transmission ◽  
The United States ◽  
Transmission Risk ◽  
Risk Class ◽  
Sex With Men ◽  
Hiv Transmission Risk ◽  
Living With Hiv

Examining how multiple concomitant factors interact to augment HIV transmission risk is needed to inform more effective primary and secondary HIV prevention programs for men who have sex with men (MSM) in the United States. The development of a “taxonomy” of long-term sexual and drug-related risk behavior profiles may have important implications for resource allocation and targeted HIV prevention programming. A secondary data analysis was conducted to explore longitudinal HIV transmission risk profiles among 423 MSM living with HIV enrolled in the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study). Between March 2004 and February 2012, participants completed semiannual, audio computer-assisted self-interviews that included demographics, employment status, medical information, alcohol use, stimulant use, sexual risk, and depression. Latent class analysis was used to identify patterns of risky behavior over time with respect to sexual risk, heavy drinking, and stimulant (i.e., methamphetamine and cocaine) use taken collectively. Three classes were identified: (a) High Sustained Heavy Drinker Class (33%), (b) High Mostly Stable Sexual Risk Class (17%), and (c) Overall Low Risk Class. (50%). Post hoc comparisons between classes revealed that men in Classes 1 ( p = .03) and 2 ( p = .02) were significantly younger than those in Class 3. In comparison to those in Classes 1 and 3, those in Class 2 were less likely to report being a racial/ethnic minority ( p = .04) and had the highest self-reported sexually transmitted infections ( p < .001). Findings indicate the need to better integrate sexual and substance use risk reduction strategies, including brief interventions and engagement in addiction treatment, for MSM living with HIV in the United States.

scholarly journals Recent US Centers for Disease Control and Prevention Activities to Reduce HIV Stigma

2019 ◽  
Vol 18 ◽  
pp. 232595821882354 ◽  
Author(s):  
Linda Beer ◽  
Donna Hubbard McCree ◽  
William L. Jeffries ◽  
Ansley Lemons ◽  
Catlainn Sionean
Keyword(s):  
Disease Control ◽  
Hiv Transmission ◽  
Population Level ◽  
The United States ◽  
Hiv Stigma ◽  
Persons Living With Hiv ◽  
Control And Prevention ◽  
Centers For Disease Control ◽  
Social Marketing Campaigns ◽  
Living With Hiv

HIV stigma affects many persons living with HIV in the United States, and reducing stigma is central to the US Centers for Disease Control and Prevention’s (CDC) mission to promote health and prevent HIV transmission. To this end, CDC funds and implements programmatic activities, research, communication campaigns, and monitoring through data collection and public health surveillance. Centers for Disease Control and Prevention-funded programs have developed promising interventions and educational materials for reducing HIV stigma. Research conducted by CDC staff and their collaborators have made important contributions to the scientific literature on stigma, which have informed current CDC programmatic efforts, including public education activities and social marketing campaigns. By monitoring HIV stigma in multiple populations, CDC can evaluate the population-level effectiveness of stigma-reduction efforts and identify key populations in need of support and intervention. This article describes these and other recent CDC efforts to address HIV stigma, and discusses new strategies with the potential to further reduce stigma.

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