scholarly journals Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

2018 ◽  
Author(s):  
Samuel M. Jenness ◽  
Kevin M. Maloney ◽  
Dawn K. Smith ◽  
Karen W. Hoover ◽  
Steven M. Goodreau ◽  
...  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
Hiv Transmission ◽  
White Men ◽  
The United States ◽  
Hiv Incidence ◽  
Black And White ◽  
Empirical Estimates ◽  
Preexposure Prophylaxis ◽  
Sex With Men

ABSTRACTThe potential for HIV preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States may be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (B/WMSM) in the Atlanta area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could impact HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (HR = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (HR = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.

Changes in Disparities in Estimated HIV Incidence Rates Among Black, Hispanic/Latino, and White Men Who Have Sex With Men (MSM) in the United States, 2010–2015

2019 ◽  
Vol 81 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Donna Hubbard McCree ◽  
Austin M. Williams ◽  
Harrell W. Chesson ◽  
Linda Beer ◽  
William L. Jeffries ◽  
...  
Keyword(s):  
United States ◽  
White Men ◽  
The United States ◽  
Incidence Rates ◽  
Hiv Incidence ◽  
Sex With Men

scholarly journals Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

2018 ◽  
Vol 188 (4) ◽  
pp. 743-752 ◽  
Author(s):  
Samuel M Jenness ◽  
Kevin M Maloney ◽  
Dawn K Smith ◽  
Karen W Hoover ◽  
Steven M Goodreau ◽  
...  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
The United States ◽  
Hiv Incidence ◽  
Preexposure Prophylaxis

scholarly journals The Role of Networks in Racial Disparities in HIV Incidence Among Men Who Have Sex with Men in the United States

2020 ◽  
Vol 24 (10) ◽  
pp. 2781-2796
Author(s):  
Stephen Bonett ◽  
Steven Meanley ◽  
Robin Stevens ◽  
Bridgette Brawner ◽  
José Bauermeister
Keyword(s):  
United States ◽  
Racial Disparities ◽  
The United States ◽  
Hiv Incidence ◽  
Sex With Men

scholarly journals Disparities in HIV transmission risk among HIV-infected black and white men who have sex with men, United States, 2009

AIDS ◽  
2014 ◽  
Vol 28 (1) ◽  
pp. 105-114 ◽  
Author(s):  
Linda Beer ◽  
Alexandra M. Oster ◽  
Christine L. Mattson ◽  
Jacek Skarbinski
Keyword(s):  
United States ◽  
Hiv Transmission ◽  
White Men ◽  
Transmission Risk ◽  
Black And White ◽  
Sex With Men ◽  
Hiv Transmission Risk

scholarly journals Predicted Effectiveness of Daily and Nondaily Preexposure Prophylaxis for Men Who Have Sex With Men Based on Sex and Pill-taking Patterns From the Human Immuno Virus Prevention Trials Network 067/ADAPT Study

2019 ◽  
Vol 71 (2) ◽  
pp. 249-255 ◽  
Author(s):  
Dobromir Dimitrov ◽  
James R Moore ◽  
Daniel Wood ◽  
Kate M Mitchell ◽  
Maoji Li ◽  
...  
Keyword(s):  
United States ◽  
Mathematical Model ◽  
New York ◽  
The United States ◽  
Hiv Incidence ◽  
Percentage Points ◽  
Preexposure Prophylaxis ◽  
Dosing Regimens ◽  
Prevention Trials ◽  
Sex With Men

Abstract Background The HIV Prevention Trials Network (HPTN) 067/Alternative Dosing to Augment PrEP Pill Taking (ADAPT) Study evaluated the feasibility of daily and nondaily human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) regimens among high-risk populations, including men who have sex with men (MSM) and transgender women, in Bangkok, Thailand and Harlem, New York. We used a mathematical model to predict the efficacy and effectiveness of different dosing regimens. Methods An individual-based mathematical model was used to simulate annual HIV incidence among MSM cohorts. PrEP efficacy for covered sex acts, as defined in the HPTN 067/ADAPT protocol, was estimated using subgroup efficacy estimates from the preexposure prophylaxis initiative (iPrEx) trial. Effectiveness was estimated by comparison of the HIV incidence with and without PrEP use. Results We estimated that PrEP was highly protective (85%–96% efficacy across regimens and sites) for fully covered acts. PrEP was more protective for partially covered acts in Bangkok (71%–88% efficacy) than in Harlem (62%–81% efficacy). Our model projects 80%, 62%, and 68% effectiveness of daily, time-driven, and event-driven PrEP for MSM in Harlem compared with 90%, 85%, and 79% for MSM in Bangkok. Halving the efficacy for partially covered acts decreases effectiveness by 8–9 percentage points in Harlem and by 5–9 percentage points in Bangkok across regimens. Conclusions Our analysis suggests that PrEP was more effective among MSM in Thailand than in the United States as a result of more fully covered sex acts and more pills taken around partially covered acts. Overall, nondaily PrEP was less effective than daily PrEP, especially in the United States where the sex act coverage associated with daily use was substantially higher.

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 Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States

2016 ◽  
Vol 214 (12) ◽  
pp. 1800-1807 ◽  
Author(s):  
Samuel M. Jenness ◽  
Steven M. Goodreau ◽  
Eli Rosenberg ◽  
Emily N. Beylerian ◽  
Karen W. Hoover ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Preexposure Prophylaxis ◽  
Sex With Men

Abstract 15: Trends in Atrial Fibrillation-related Cardiovascular Mortality Rates in The United States: 1999-2017

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yoshihiro Tanaka ◽  
Nilay Shah ◽  
Rod Passman ◽  
Philip Greenland ◽  
Sadiya Khan
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Black Men ◽  
Cause Of Death ◽  
Age Groups ◽  
White Men ◽  
The United States ◽  
Mortality Rates ◽  
Men And Women ◽  
Black And White

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and the prevalence is increasing due to the aging of the population and the growing burden of vascular risk factors. Although deaths due to cardiovascular disease (CVD) death have dramatically decreased in recent years, trends in AF-related CVD death has not been previously investigated. Purpose: We sought to quantify trends in AF-related CVD death rates in the United States. Methods: AF-related CVD death was ascertained using the CDC WONDER online database. AF-related CVD deaths were identified by listing CVD (I00-I78) as underlying cause of death and AF (I48) as contributing cause of death among persons aged 35 to 84 years. We calculated age-adjusted mortality rates (AAMR) per 100,000 population, and examined trends over time estimating average annual percent change (AAPC) using Joinpoint Regression Program (National Cancer Institute). Subgroup analyses were performed to compare AAMRs by sex-race (black and white men and women) and across two age groups (younger: 35-64 years, older 65-84 years). Results: A total of 522,104 AF-related CVD deaths were identified between 1999 and 2017. AAMR increased from 16.0 to 22.2 per 100,000 from 1999 to 2017 with an acceleration following an inflection point in 2009. AAPC before 2009 was significantly lower than that after 2009 [0.4% (95% CI, 0.0 - 0.7) vs 3.5% (95% CI, 3.1 - 3.9), p < 0.001). The increase of AAMR was observed across black and white men and women overall and in both age groups (FIGURE), with a more pronounced increase in black men and white men. Black men had the highest AAMR among the younger decedents, whereas white men had the highest AAMR among the older decedents. Conclusion: This study revealed that death rate for AF-related CVD has increased over the last two decades and that there are greater black-white disparities in younger decedents (<65 years). Targeting equitable risk factor reduction that predisposes to AF and CVD mortality is needed to reduce observed health inequities.

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