Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

ABSTRACTObjectiveWe sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030.DesignA stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction.MethodsModel scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive.ResultsA 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta.ConclusionsInterventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.

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High levels of mild to moderate depression among men who have sex with men and transgender women in Lima, Peru: implications for integrated depression and HIV care

10.1101/2020.01.07.20016808 ◽

2020 ◽

Author(s):

Jerome T. Galea ◽

Stephanie Marhefka ◽

Segundo R. León ◽

Guitele Rahill ◽

Elena Cyrus ◽

...

Keyword(s):

Hiv Prevention ◽

Transgender Women ◽

Hiv Care ◽

Depression Care ◽

Care Services ◽

Treatment Services ◽

Moderate Depression ◽

Prevention And Treatment ◽

Patient Health ◽

Sex With Men

ABSTRACTDepression disproportionally affects people at risk of acquiring or living with HIV and is associated with worse health outcomes; however, depression care is not routinely integrated with HIV prevention and treatment services. Selection of the best depression intervention(s) for integration depends both on the prevalence and severity of depression among potential users. To inform depression care integration in a community-based setting in Lima, Peru, we retrospectively analyzed routinely collected depression screening data from men who have sex with men and transgender women seeking HIV prevention and care services (N=185). Depression was screened for using the Patient Health Questionnaire-9. Prevalence of any depression (PHQ-9 ≥5) was 42% and was significantly associated with the last sexual partner being “casual” (p=0.01). Most (81%) depressive symptoms were mild to moderate (≥5 PHQ-9 ≤14). Integrating depression care with HIV prevention and treatment services in Peru should begin by implementing interventions targeting mild to moderate depression.

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The reporting of the mode of transmission among HIV-positive men who have sex with men in Lviv oblast, Ukraine, 2014-2018

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11967 ◽

2020 ◽

Vol 14 (11.1) ◽

pp. 122S-127S

Author(s):

Maryana Sluzhynska ◽

Olga Denisiuk ◽

Ruzanna Grigoryan ◽

Yulia Sereda ◽

Gennadiy Slabkiy ◽

...

Keyword(s):

Urban Areas ◽

Hiv Transmission ◽

Cross Sectional Study ◽

Medical Doctor ◽

Hiv Care ◽

Hiv Positive ◽

Cross Sectional ◽

Aids Epidemic ◽

Mode Of Transmission ◽

Sex With Men

Introduction: Men who have sex with men (MSM) are one of the key populations driving HIV/AIDS epidemic globally. To date, MSM is the only population in Ukraine where the prevalence and incidence of HIV is increasing. As HIV-positive MSM might feel uncomfortable to report homosexual intercourses as a possible mode of transmission (MoT) of HIV, they prefer being registered as patients with heterosexual or non-defined MoT. This study aimed to calculate the proportion of misclassified MoT among HIV-positive MSM registered in Lviv oblast, Ukraine, during 2014-2018. Methodology: Cross-sectional study with 127 HIV-positive MSM patients from Lviv region for the period of 2014-2018. Results: Out of 127 HIV-positive MSM included in the study, 110 (86.6%) were from urban areas. In addition, 52 patients (40.9%) were diagnosed with stage 1 HIV, 16 (12.6%) – stage 2, 19 (15%) – stage 3, and 36 (28.3%) – stage 4. CD4 count < 200 cells/μL was found in 35 (27.6%) patients. Mean time from registration to antiretroviral therapy initiation was 80 days. During the first visit to medical doctor out of those 48 patients who had previously reported “other modes” of HIV transmission, 33 patients (68.7%) disclosed homosexual MoT of HIV. The remaining 15 (31.3%) patients disclosed their homosexual MoT of HIV later – during their regular follow-up visits to the doctor. Conclusion: Special measures are needed to improve the reporting of homosexual MoT which can potentially strengthen the HIV care among MSM.

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Engaging Young Men in the HIV Prevention and Care Continua: Experiences From Young Men of Color Who Have Sex With Men

AIDS Education and Prevention ◽

10.1521/aeap.2019.31.4.325 ◽

2019 ◽

Vol 31 (4) ◽

pp. 325-343

Author(s):

Katrina Kubicek ◽

William J. Beyer ◽

Carolyn F. Wong ◽

Michele D. Kipke

Keyword(s):

Health Care ◽

Hiv Prevention ◽

Sexual Minority ◽

Young Men ◽

Health Care Research ◽

Hiv Care ◽

Health Concerns ◽

Men Of Color ◽

Sex With Men ◽

The Continuum

Sexual minority individuals experience barriers to receiving equitable health care. Research also indicates that young men who have sex with men (YMSM), particularly young men of color, have limited engagement in the HIV care continuum and there are significant disparities across the continuum. This study aims to uncover how providers can engage YMSM of color in all forms of care, including primary care and HIV prevention through an HIV prevention continuum. This qualitative study reports data from the Healthy Young Men's Cohort Study; a total of 49 YMSM participated in the eight focus groups. This study provides a description of YMSM's overall health concerns, experiences with health care, and under what circumstances YMSM seek care. We then present a model describing the salient characteristics of a HIV prevention continuum for YMSM of color and provide clear areas for education, intervention, and policy change to support better overall health for YMSM of color.

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Mental health in 2020 for men who have sex with men in the United States

Sexual Health ◽

10.1071/sh16083 ◽

2017 ◽

Vol 14 (1) ◽

pp. 59 ◽

Cited By ~ 19

Author(s):

Abigail W. Batchelder ◽

Steven Safren ◽

Avery D. Mitchell ◽

Ivan Ivardic ◽

Conall O'Cleirigh

Keyword(s):

Mental Health ◽

Hiv Prevention ◽

The United States ◽

Hiv Care ◽

Hiv Care Cascade ◽

Age Related ◽

The Us ◽

Prevention And Treatment ◽

Sex With Men ◽

Hiv Aids

Despite continued advances in HIV prevention and treatment, gay and bisexual men and other men who have sex with men (MSM) remain the population most impacted by HIV/AIDS in the US and many other Western countries. Additionally, MSM are disproportionately affected by various psychological problems, including depression, distress, trauma and substance use. These challenges frequently co-occur, and are associated with higher rates of behaviours related to HIV acquisition and transmission, HIV infection, and, for those living with HIV/AIDS, lower levels of treatment engagement. Moreover, racial disparities exist among MSM in the US; for example, young African American MSM bear a disproportionate burden of the continuing HIV epidemic, likely related to disparate HIV prevalence in partner pools as well as long-standing structural inequities. In this review, the mental health challenges facing MSM primarily in the US, related to HIV and STI prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence, are illustrated. Disparities among MSM including racial and ethnic, age-related and structural barriers associated with HIV prevention and treatment, as well as current interventions, are also described. Moving forward towards 2020, resources will be needed to assess and implement scalable intervention strategies to address psychological and social barriers to HIV and STI risk reduction and treatment for MSM, with a particular focus on the most vulnerable subpopulations. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

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Associations of social capital resources and experiences of homophobia with HIV transmission risk behavior and HIV care continuum among men who have sex with men in Los Angeles

AIDS Care ◽

10.1080/09540121.2020.1828798 ◽

2020 ◽

pp. 1-12

Author(s):

Sae Takada ◽

Pamina Gorbach ◽

Ron Brookmeyer ◽

Steve Shoptaw

Keyword(s):

Social Capital ◽

Los Angeles ◽

Risk Behavior ◽

Hiv Transmission ◽

Transmission Risk ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Sex With Men ◽

Hiv Transmission Risk

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Client perspectives on an outreach approach for HIV prevention targeting Indonesian MSM and transwomen

Health Promotion International ◽

10.1093/heapro/daz075 ◽

2019 ◽

Vol 35 (5) ◽

pp. 916-924 ◽

Cited By ~ 1

Author(s):

Adi Nugroho ◽

Vicki Erasmus ◽

Sarah E Krier ◽

Kusnindyah P Reviagana ◽

Pipiet A Laksmono ◽

...

Keyword(s):

Hiv Prevention ◽

Hiv Testing ◽

Qualitative Interviews ◽

Hiv Care ◽

Face To Face ◽

Outreach Workers ◽

The Face ◽

Positive Experiences ◽

Sex With Men ◽

Prevention Approach

Abstract This study explored clients’ perspective on an outreach approach to promote HIV testing in Indonesia targeting men who have sex with men (MSM) and transgender women (transwomen or waria). Semi-structured qualitative interviews were conducted with 32 individuals (21 MSM and 11 waria) who had received services from outreach workers (OWs) in five cities in Indonesia. Participants in this study reported positive experiences with the outreach approach and perceived OWs as their motivators in accessing HIV testing as well as HIV care and treatment. OWs provided easy-to-understand HIV information. Clients expected OWs to be well-trained and more creative in performing outreach. They perceived that the Internet and social media have helped them considerably to stay in touch with OWs. Yet, they expressed that such virtual contacts could not simply replace the face-to-face contact, especially for waria. Furthermore, clients suggested outreach to be delivered in a more appealing manner, for example through activities that may facilitate clients learning professional or life skills. They also asserted that as an HIV prevention approach, outreach needs to use more positive framing and go beyond HIV and health contents, chiefly for the youth. Future outreach programmes should facilitate OWs in providing tailored services based on the level and type of support that the clients need, and in applying varied proportion and levels of sophistication in the use of online and virtual platforms for outreach.

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Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

BMJ Open ◽

10.1136/bmjopen-2017-018533 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018533 ◽

Cited By ~ 8

Author(s):

Juliana Maria Reyes-Urueña ◽

Colin N J Campbell ◽

Núria Vives ◽

Anna Esteve ◽

Juan Ambrosioni ◽

...

Keyword(s):

Hiv Transmission ◽

Retention In Care ◽

Hiv And Aids ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Cascade ◽

Care Cascade ◽

Undiagnosed Hiv ◽

Sex With Men ◽

Living With Hiv

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations.MethodsTo estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort.ResultsThe total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%).ConclusionsBy the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

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Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand

International Journal of STD & AIDS ◽

10.1177/0956462420920394 ◽

2020 ◽

Vol 31 (7) ◽

pp. 637-641

Author(s):

Sarika Pattanasin ◽

Betsy L Cadwell ◽

Dawn K Smith ◽

Wichuda Sukwicha ◽

Philip A Mock ◽

...

Keyword(s):

Condom Use ◽

Hiv Infections ◽

Substantial Impact ◽

Combination Prevention ◽

Hiv Epidemic ◽

Immunodeficiency Virus ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Impact ◽

Combined Interventions

In Thailand, pre-exposure prophylaxis (PrEP) is recommended for human immunodeficiency virus (HIV) prevention among at-risk men who have sex with men (MSM). We modeled the impact of PrEP and condom use as independent and combined interventions on the estimated number of HIV infections among a hypothetical population of 10,000 MSM in Bangkok, Thailand. Our model demonstrated a 92% (95% confidence interval 89.7, 94.2) reduction in HIV infections among Thai MSM who took daily PrEP and self-reported using condoms correctly and consistently (100% condom use). Increased use of PrEP and condoms likely would have a substantial impact on the HIV epidemic in Thailand.

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Preliminary evidence of HIV seroconversion among HIV-negative men who have sex with men taking non-prescribed antiretroviral medication for HIV prevention in Miami, Florida, USA

Sexual Health ◽

10.1071/sh16108 ◽

2017 ◽

Vol 14 (2) ◽

pp. 193 ◽

Cited By ~ 7

Author(s):

Mance E. Buttram ◽

Steven P. Kurtz

Keyword(s):

Hiv Prevention ◽

Hiv Transmission ◽

Qualitative Interviews ◽

Transmission Risk ◽

Accurate Information ◽

Limited Information ◽

Antiretroviral Medication ◽

Hiv Seroconversion ◽

Sex With Men ◽

Hiv Negative

Background Limited information suggests that men who have sex with men (MSM) are informally obtaining antiretroviral medication (ARVs) and using them for HIV pre-exposure prophylaxis (PrEP). Methods: Data are drawn from an on-going study examining the use of non-prescribed ARVs for PrEP. To date, 24 qualitative interviews have been conducted with HIV-negative, substance-using MSM living in Miami, Florida, USA. Data are presented from two participants who reported HIV seroconversion while using non-prescribed ARVs for PrEP. Results: Preliminary data indicate that some young MSM: (i) lack awareness of and accurate information about the efficacious use of PrEP; (ii) obtain non-prescribed ARVs from HIV-positive sex partners and use these medications for PrEP in a way that does not provide adequate protection against HIV infection or cohere with established guidelines; and (iii) engage in multiple HIV transmission risk behaviours, including condomless anal sex and injection drug use. Conclusions: The informal, non-prescribed and non-medically supervised use of ARVs for HIV prevention has the potential to undermine the protective benefits of PrEP and leave men unprotected against HIV transmission and at risk for ARV resistance.

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