Years Since Diagnosis Among People Living With Diagnosed HIV in New York City

Antiretroviral treatment has greatly improved the survival of people living with diagnosed HIV (PLWDH), but little information is available on the time since diagnosis among them. Using New York City HIV surveillance data, we described the trend in the number of years since diagnosis among PLWDH during 2010-2019 and reported the mean, median, and interquartile range (IQR) of years since diagnosis among PLWDH in New York City in 2019, overall and by gender, race and ethnicity, and transmission risk. The median number of years since diagnosis among PLWDH in New York City increased from 10.5 years (IQR, 6.3-15.6) in 2010 to 16.3 years (IQR, 8.9-22.1) in 2019. By gender, transgender people had the shortest time since diagnosis, with a median of 11.4 years (IQR, 5.6-17.9), compared with men (median = 15.2 years; IQR, 8.1-21.6) and women (median, 18.5 years; IQR, 12.0-23.0). By race and ethnicity, non-Hispanic White people had been living with the diagnosis for the longest time (median = 17.4 years; IQR, 9.5-23.5), and Asian/Pacific Islander people had been living with the diagnosis for the shortest time (median = 10.1 years; IQR, 4.7-17.0). With an expected and continuing increase in the number of years since HIV diagnosis among PLWDH, programs that provide treatment and support services will need to be expanded, updated, and improved.

Spatiotemporal distribution of HIV self-test kits purchased online and implications for HIV prevention: analysis of transaction data from a leading e-commerce platform in China (Preprint)

BACKGROUND HIV self-testing (HIVST) holds great promise for expanding HIV testing. Yet, large scale data on HIVST behavior is scant. Millions of HIVST kits were sold through e-commerce platforms each year. OBJECTIVE This study aimed to analyze spatiotemporal distribution of the HIVST kit purchasing population (HIVSTKPP) in China. METHODS Deidentified transaction data were retrieved from a leading e-commerce platform in China. Bayesian spatiotemporal analysis was performed to locate hot spots with HIVSTKPP rates. Spatial autocorrelation analysis and space-time cluster analysis were conducted to identify clusters of HIVSTKPP RESULTS Between 1 January 2016 and 31 December 2019, a total of 2.18 million anonyms in China placed 4.15 million orders and purchased 4.51 million HIVST kits online. In each year, the observed monthly HIVSTKPP peaked in December, the month of the World AIDS Day. HIVSTKPP rates per 100,000 population significantly increased from 20.62 in 2016 to 64.82 in 2019. Hot spots were mainly located in municipalities, provincial capitals, and large cities, while high-high clusters and high-demand clusters were predominantly detected in cities along the southeast coast. We found positive correlations between a region’s number of HIV testing facilities, urbanization ratio, and GDP per capita and the HIVSTKPP. CONCLUSIONS Our study identified key areas in larger demands for HIVST for public health policymakers to re-allocate resources and optimize the HIV care continuum. Further research combining spatiotemporal patterns of HIVST with HIV surveillance data is urgently needed to identify potential gaps in current HIV-monitoring practices.

Suboptimal HIV status ascertainment at antenatal clinics and the impact on HIV prevalence estimates

IntroductionHIV prevalence estimates is a key indicator to inform the coverage and effectiveness of HIV prevention measures. Many countries including Kenya transitioned from sentinel surveillance to the use of routine antenatal care data to estimate the burden of HIV. Countries in Sub Saharan Africa reported several challenges of this transition, including low uptake of HIV testing and sub national / site-level differences in HIV prevalence estimates.MethodsWe examine routine data from Kwale County, Kenya, for the period January 2015 to December 2019 and predict HIV prevalence among women attending antenatal care (ANC) at 100% HIV status ascertainment. We estimate the bias in HIV prevalence estimates as a result of imperfect uptake of HIV testing and make recommendations to improve the utility of ANC routine data for HIV surveillance. We used a generalized estimating equation with binomial distribution to model the observed HIV prevalence as explained by HIV status ascertainment and region (Sub County). We then used marginal standardization to predict the HIV prevalence at 100% HIV status ascertainment.ResultsHIV testing at ANC was at 91.3%, slightly above the global target of 90%. If there was 100% HIV status ascertainment at ANC, the HIV prevalence would be 2.7% (95% CI 2.3-3.2). This was 0.3% lower than the observed prevalence. Similar trends were observed with yearly predictions except for 2018 where the HIV prevalence was underestimated with an absolute bias of -0.2%. This implies missed opportunities for identifying new HIV infections in the year 2018.ConclusionsImperfect HIV status ascertainment at ANC overestimates HIV prevalence among women attending ANC in Kwale County. However, the use of ANC routine data may underestimate the true population prevalence. There is need to address both community level and health facility level barriers to the uptake of ANC services.Key questionsWhat is already known?▪HIV surveillance estimates from antenatal clinics (ANC) can serve as a useful proxy for HIV prevalence trends in the general female population.▪Kenya has conducted multiple studies which have shown that national HIV prevalence estimates from sentinel surveillance and those from routine program data to be similar.▪However, these studies have also revealed ongoing challenges to the suitability of using routine data as compared to sentinel surveillance including sub optimal uptake of HIV testing and sub national/ site-level differences in HIV prevalence estimates.What are the new findings?▪HIV positive pregnant women are more likely to be tested at ANC as compared to HIV negative women, leading to higher HIV prevalence estimates among women attending ANC.▪Health facility level HIV prevalence estimates are lower than that of the general population.What do the new findings imply?▪HIV positive women are underrepresented in antenatal clinics.▪In Kwale County (and similar contexts), use of routine ANC data is still not a reliable method to estimate HIV prevalence, both at facility and community level.

A multi-state Markov model using notification data to estimate HIV incidence, number of undiagnosed individuals living with HIV, and delay between infection and diagnosis: Illustration in France, 2008–2018

Thirty-five years since the discovery of the human immunodeficiency virus (HIV), the epidemic is still ongoing in France. To guide HIV prevention strategies and monitor their impact, it is essential to understand the dynamics of the HIV epidemic. The indicator for reporting the progress of new infections is the HIV incidence. Given that HIV is mainly transmitted by undiagnosed individuals and that earlier treatment leads to less HIV transmission, it is essential to know the number of infected people unaware of their HIV-positive status as well as the time between infection and diagnosis. Our approach is based on a non-homogeneous multi-state Markov model describing the progression of the HIV disease. We propose a penalized likelihood approach to estimate the HIV incidence curve as well as the diagnosis rates. The HIV incidence curve was approximated using cubic M-splines, while an approximation of the cross-validation criterion was used to estimate the smoothing parameter. In a simulation study, we evaluate the performance of the model for reconstructing the HIV incidence curve and diagnosis rates. The method is illustrated in the population of men who have sex with men using HIV surveillance data collected by the French Institute for Public Health Surveillance since 2004.

HIV/AIDS surveillance in the Eastern Mediterranean Region

Reporting of AIDS cases began right from the inception of national AIDS programmes in the Eastern Mediterranean Region. HIV surveillance was initiated with ad hoc serological surveys of selected groups of population. However, these surveys suffered from statistical bias. To minimize this bias, sentinel surveillance was introduced in two groups:patients with sexually transmitted diseases and antenatal clinic attendants. Apart from surveillance, many other population groups are being tested for HIV, mainly for case-finding. As HIV surveillance has an important role in AIDS prevention and control, adequate attention should be paid to its improvement, including the use of unlinked anonymous testing and the participation of the private sector

Forty Years of HIV: The Intersection of Laws, Stigma, and Sexual Behavior and Identity

Forty years after the Centers for Disease Control and Prevention’s (CDC’s) June 1981 Morbidity and Mortality Weekly Report about five gay men with a syndrome that came to be called AIDS, both the impact of HIV and the legal landscape in the United States for the most affected population have changed dramatically. Laws, policies, and how they are enforced reflect the values and prejudices of society, and laws can help or hinder public health efforts, regardless of intent. From the outset, HIV aroused widespread fear and new stigmatizing laws and policies, and the crisis revealed injustices in existing laws that compounded stigma and health disparities among the most affected groups. In the 1980s, HIV engulfed already stigmatized communities of gay and bisexual men and other men who have sex with men (MSM) and people who inject drugs. The CDC’s HIV surveillance reports show that, throughout the epidemic, MSM have constituted the majority of annual and prevalent cases, and the burden on racial or ethnic minority MSM has increased disproportionately since the early 1990s.1 It is timely to reflect on the intertwining of HIV, laws, stigma, and inequity in the United States and their intersection with the lives of gay and bisexual men (both cisgender and transgender). (Am J Public Health. Published online ahead of print June 10, 2021: e1–e3. https://doi.org/10.2105/AJPH.2021.306335 )

HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

Objective Multiple HIV outbreaks among persons who inject drugs (PWID) have occurred in the US since 2015. Emergency departments (EDs), recognized as essential venues for HIV screening, may play a unique role in identifying undiagnosed HIV among PWID, who frequently present for complications of injection drug use (IDU). Our objective was to describe changes in HIV diagnoses among PWID detected by an ED HIV screening program and estimate the program’s contribution to HIV diagnoses among PWID county-wide during the emergence of a regional HIV outbreak. Methods This was a retrospective study of electronically queried clinical records from an urban, safety-net ED’s HIV screening program and publicly available HIV surveillance data for its surrounding county, Hamilton County, Ohio. Outcomes included the change in number of HIV diagnoses and the ED’s contribution to case identification county-wide, overall and for PWID during 2014–2018. Results During 2014–2018, the annual number of HIV diagnoses made by the ED program increased from 20 to 42 overall, and from 1 to 18 for PWID. We estimated that the ED contributed 18% of HIV diagnoses in the county and 22% of diagnoses among PWID. Conclusions The ED program contributed 1 in 5 new HIV diagnoses among PWID county-wide, further illustrating the importance of ED HIV screening programs in identifying undiagnosed HIV infections. In areas experiencing increasing IDU, HIV screening in EDs can provide an early indication of increasing HIV diagnoses among PWID and can substantially contribute to case-finding during an HIV outbreak.