451
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Persson A, Smith AKJ, Wallace J, valentine K, Bryant J, Hamilton M, Newman CE. Understanding ‘risk’ in families living with mixed blood-borne viral infection status: The doing and undoing of ‘difference’. Health (London) 2020; 26:284-301. [DOI: 10.1177/1363459320946469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
‘Risk’ has long been at the centre of expert and popular perceptions of transmissible and stigmatised blood-borne viral infections, such as HIV and viral hepatitis. There is a substantial body of research on transmission risk among couples with mixed viral infection status (serodiscordance). But we know very little about how families affected by HIV and viral hepatitis engage with understandings of infectiousness and how these shape family relationships in different ways. Guided by cultural theories of risk that build on Mary Douglas’ work, we draw on qualitative interviews to explore the ‘performativity’ of risk in serodiscordant families in Australia. We show how the ‘doing’ of risk could be constitutive of difference, which unsettled the family connection or deepened existing fault lines. Conversely, the ‘undoing’ of risk enabled the preservation of the family bond by rejecting difference and reframing risk as an external threat to the family in the form of stigma. We conclude that risk in the context of serodiscordant families had relational implications far beyond viral transmission and consider what our findings might mean for service provision and health promotion campaigns related to blood-borne viruses.
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Affiliation(s)
| | | | | | | | - Joanne Bryant
- Centre for Social Research in Health, UNSW, Australia
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452
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Abstract
PURPOSE OF REVIEW More than half of new HIV diagnoses occur in the Southern United States where the epidemic disproportionately affects persons of color. Although other areas of the country are seeing dramatic declines in the number of new cases, the progress in the South lags behind. This review will examine the reasons for that disparity. Many are unique to the South. RECENT FINDINGS Despite advances in antiretroviral therapy for HIV, many in the South are not benefiting from these medications, at either a personal or public health level. The reasons are complex and include lack of access to healthcare, lower levels of funding than other areas of the country, stigma, structural racism, increased barriers due to social determinants of health, coexisting mental health disorders, substance use disorders and sexually transmitted diseases and insufficient workforce capacity to meet the needs of those living with HIV. SUMMARY These findings should underline the need for investment in the South for a holistic healthcare approach to persons living with HIV including supporting basic needs such as access to food, transportation and housing. Prioritization among politicians for policy and systems changes and approaches to decrease stigma and enhance education about HIV will be key.
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453
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Abstract
PURPOSE OF REVIEW Although cities present opportunities for infectious pathogens such as HIV to spread, public health infrastructure within these cities also provides opportunities to design effective approaches to eliminate transmission of these pathogens. The HIV Transmission Elimination AMsterdam (H-TEAM) Initiative, a consortium of relevant stakeholders involved in HIV prevention and care, designed an integrated approach to curb the HIV epidemic in Amsterdam, including providing preexposure prophylaxis (PrEP), increasing awareness of acute HIV infection, offering same-day test and treat, and improving indicator disease-driven HIV testing. RECENT FINDINGS In 2013, approximately 230 people in Amsterdam were newly diagnosed with HIV, largely belonging to one of two key affected populations, namely MSM and people with a migration background. Since the start of H-TEAM in 2014, a decrease in new diagnoses was observed (130 in 2017), with an increasing proportion of MSM who had been diagnosed with a recent infection. SUMMARY The H-TEAM shows that a city-based concerted effort is feasible. However, major challenges remain, such as reducing the number of late HIV diagnoses, and identifying and providing appropriate services to a diminishing group of individuals who are likely the source of transmission.
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454
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Hahn A, Kröger C, Meyer CG, Loderstädt U, Meyer T, Frickmann H, Zautner AE. Comparison of Self-Reported Sexual Activity Among Heterosexuals with Sexual Spread of Poorly Transmittable Agents: A Minimalistic Approach to Estimating Sexual Activity Based on HIV Incidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155504. [PMID: 32751507 PMCID: PMC7432220 DOI: 10.3390/ijerph17155504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022]
Abstract
The aim of this study was to assess whether epidemics of sexually transmitted infections caused by poorly transmittable agents corresponded to self-reported sexual activity in a distinct population. To exemplify this, a model was used to investigate whether HIV infection incidences corresponded to the extent of sexual activity as assessed by a questionnaire-based study. The model suggested between 97 and 486 sexual contacts per German individual during a sexually active lifetime based on the annual HIV incidence of 680 among the heterosexual population reported by the German National Health Authority. This is in line with the estimated 296 sexual contacts during one's lifetime, which was indicated by questionnaire respondents. The model confirms the correspondence of self-reported sexual activity with HIV incidence as reported by the German National Health Authority. Accordingly, HIV incidence- and prevalence-based modeling of sexual activity in a population provides crude estimations in situations where a range of uncertainty is acceptable. The model's veracity is limited by a number of assumptions necessitated by the paucity of data. Nevertheless, the model may be suitable in settings where severe reporting bias has to be expected for legal or socio-cultural reasons.
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Affiliation(s)
- Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (H.F.)
| | - Christoph Kröger
- Department of Clinical Psychology and Psychotherapy, University of Hildesheim, 31141 Hildesheim, Germany;
| | - Christian G. Meyer
- Faculty of Medicine, Duy Tan University, ĐàNẵng 550000, Vietnam;
- Institute of Tropical Medicine, Eberhard Karls University, 72074 Tübingen, Germany
- Vietnamese-German Center of Medical Research, Hanoi 113601, Vietnam
| | - Ulrike Loderstädt
- Diagnostic Department, Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany;
| | - Thomas Meyer
- Clinic of Dermatology, St. Josef-Hospital, Ruhr-University, 44791 Bochum, Germany;
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (A.H.); (H.F.)
- Department of Microbiology and Hygiene, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany
| | - Andreas Erich Zautner
- Institute for Medical Microbiology, University Medical Center Göttingen, 37075 Göttingen, Germany
- Correspondence: ; Tel.: +49-0551-39-5927
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455
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Positive Health Check evaluation: A type 1 hybrid design randomized trial to decrease HIV viral loads in patients seen in HIV primary care. Contemp Clin Trials 2020; 96:106097. [PMID: 32738408 PMCID: PMC8820779 DOI: 10.1016/j.cct.2020.106097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
For people with HIV, important transmission prevention strategies include early initiation and adherence to antiretroviral therapy and retention in clinical care with the goal of reducing viral loads as quickly as possible. Consequently, at this point in the HIV epidemic, innovative and effective strategies are urgently needed to engage and retain people in health care to support medication adherence. To address this gap, the Positive Health Check Evaluation Trial uses a type 1 hybrid randomized trial design to test whether the use of a highly tailored video doctor intervention will reduce HIV viral load and retain people with HIV in health care. Eligible and consenting patients from four HIV primary care clinical sites are randomly assigned to receive either the Positive Health Check intervention in addition to the standard of care or the standard of care only. The primary aim is to determine the effectiveness of the intervention. A second aim is to understand the implementation potential of the intervention in clinic workflows, and a third aim is to assess the costs of intervention implementation. The trial findings will have important real-world applicability for understanding how digital interventions that take the form of video doctors can be used to decrease viral load and to support retention in care among diverse patients attending HIV primary care clinics.
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456
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Matacotta JJ, Rosales-Perez FJ, Carrillo CM. HIV Preexposure Prophylaxis and Treatment as Prevention - Beliefs and Access Barriers in Men Who Have Sex With Men (MSM) and Transgender Women: A Systematic Review. J Patient Cent Res Rev 2020; 7:265-274. [PMID: 32760758 DOI: 10.17294/2330-0698.1737] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose While the annual rate of new HIV infections and diagnoses has remained stable for most groups, troubling increases are seen in transgender women and racial/ethnic-minority men who have sex with men (MSM), groups that are disproportionately affected by HIV. The primary purpose of this systematic review is to examine factors that impact attitudes and beliefs about preexposure prophylaxis (PrEP) and treatment as prevention (TasP) and to explore barriers to PrEP uptake in MSM and transgender women. Methods Using MeSH terms and relevant keywords, we conducted a systematic review of studies published between 2010 and 2019. We searched 4 literature databases and identified studies on MSM and transgender women to elucidate perceptions of PrEP and TasP as well as barriers to access. Results The search yielded several prominent themes associated with beliefs about HIV prevention approaches and barriers to PrEP access in MSM and transgender women. One was a lack of awareness or insufficient knowledge of PrEP and TasP. Structural barriers and geographic isolation also prevent access to HIV prevention. Sexual minority and HIV-related stigma, internalized homonegativity, and misinterpretations of messages within HIV prevention campaigns have negatively impacted PrEP uptake and beliefs about PrEP and TasP. Quality of the relationship MSM or transgender people have with their health care provider can facilitate or hinder HIV prevention. Finally, variability in beliefs about the efficacy of TasP has negatively affected the impact of TasP messaging campaigns. Conclusions Although there is evidence of increasing PrEP use in at-risk individuals, several barriers prevent wider acceptance and uptake. Misunderstanding about the meaning of "undetectable" and skepticism about the evidence behind TasP messaging campaigns are likely to delay the World Health Organization's stated goal of getting to zero transmissions.
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Affiliation(s)
- Joshua J Matacotta
- College of Health Sciences, Western University of Health Sciences, Pomona, CA
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457
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Ensuring the sexual and reproductive health and rights in healthcare of women living with HIV. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100541. [PMID: 32707519 DOI: 10.1016/j.srhc.2020.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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458
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Cooper TJ, Woodward BL, Alom S, Harky A. Coronavirus disease 2019 (COVID-19) outcomes in HIV/AIDS patients: a systematic review. HIV Med 2020; 21:567-577. [PMID: 32671970 PMCID: PMC7405326 DOI: 10.1111/hiv.12911] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of the study was to systematically review current studies reporting on clinical outcomes in people living with HIV (PLHIV) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted in Global Health, SCOPUS, Medline and EMBASE using pertinent key words and Medical Subject Headings (MeSH) terms relating to coronavirus disease 2019 (COVID-19) and HIV. A narrative synthesis was undertaken. Articles are summarized in relevant sections. RESULTS Two hundred and eighty-five articles were identified after duplicates had been removed. After screening, eight studies were analysed, totalling 70 HIV-infected patients (57 without AIDS and 13 with AIDS). Three themes were identified: (1) controlled HIV infection does not appear to result in poorer COVID-19 outcomes, (2) more data are needed to determine COVID-19 outcomes in patients with AIDS and (3) HIV-infected patients presenting with COVID-19 symptoms should be investigated for superinfections. CONCLUSIONS Our findings suggest that PLHIV with well-controlled disease are not at risk of poorer COVID-19 disease outcomes than the general population. It is not clear whether those with poorly controlled HIV disease and AIDS have poorer outcomes. Superimposed bacterial pneumonia may be a risk factor for more severe COVID-19 but further research is urgently needed to elucidate whether PLHIV are more at risk than the general population.
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Affiliation(s)
- T J Cooper
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - B L Woodward
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Alom
- School of Public Health, Imperial College London, London, UK
| | - A Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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459
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Kutscha F, Gaskins M, Sammons M, Nast A, Werner RN. HIV Pre-Exposure Prophylaxis (PrEP) Counseling in Germany: Knowledge, Attitudes and Practice in Non-governmental and in Public HIV and STI Testing and Counseling Centers. Front Public Health 2020; 8:298. [PMID: 32760688 PMCID: PMC7372106 DOI: 10.3389/fpubh.2020.00298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Providers of sexual health services play an important role in counseling persons at risk of acquiring HIV. The aim of the present study was to investigate the knowledge of and attitudes toward HIV pre-exposure prophylaxis (PrEP) among counselors in non-governmental counseling centers ("NG counseling centers") and in counseling centers of the local health authorities ("local health offices") in Germany and to determine the extent to which PrEP plays a role in their current counseling practice. Methods: An anonymous cross-sectional study using an online questionnaire was conducted among counselors from sexual health centers across Germany. All NG counseling centers in Germany offering HIV testing were asked to participate. For each NG counseling center, a local health office in the same city was also invited. A "knowledge score" and an "attitudes score" were calculated from single items on various relevant aspects. The association of these scores with the proportion of PrEP advice provided proactively in sessions with men who have sex with men (MSM) and trans persons who met the German and Austrian guideline criteria for being offered PrEP ('at-risk clients') was quantified. Results: From Oct. to Dec. 2018, 145 counselors completed the survey. Both self-assessed knowledge of PrEP and attitudes toward PrEP were greater or more positive among counselors from NG counseling centers compared with counselors from local health offices [Median knowledge score (range 0-20): 18.0 (IQR = 5.0) vs. 14.0 (IQR = 4.0), p < 0.001; median attitudes score (range 0-20): 18.0 (IQR = 4.0) vs. 14.0 (IQR = 6.8), p < 0.001]. The proportion of PrEP advice provided proactively in sessions with at-risk clients was larger in counseling centers than in local health offices [50.0% (IQR = 60.0) vs. 30.0% (IQR = 70.0); p = 0.003]. The results of the multiple linear regression model indicate that knowledge and attitudes of the individual counselors, but not the type of center in which they worked, were independent predictors of the proportion of proactive advice on PrEP. Conclusions: There is room for improvement in the current PrEP counseling practice of sexual health services in Germany. The findings of the present study suggest opportunities to improve the implementation of PrEP as part of a comprehensive HIV prevention strategy.
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Affiliation(s)
- Frank Kutscha
- Schwulenberatung Berlin, Berlin, Germany.,Alice Salomon Hochschule Berlin-University of Applied Sciences, Berlin, Germany
| | - Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mary Sammons
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ricardo Niklas Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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460
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McIntosh EDG. Development of vaccines against the sexually transmitted infections gonorrhoea, syphilis, Chlamydia, herpes simplex virus, human immunodeficiency virus and Zika virus. Ther Adv Vaccines Immunother 2020; 8:2515135520923887. [PMID: 32647779 PMCID: PMC7325543 DOI: 10.1177/2515135520923887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/07/2020] [Indexed: 01/13/2023] Open
Abstract
The success in preventing hepatitis B virus and human papillomavirus infections by means of vaccination paves the way for the development of other vaccines to prevent sexually transmitted infections (STIs) such as gonorrhoea, syphilis, chlamydia, herpes simplex virus, human immunodeficiency virus and Zika virus. The current status of vaccine development for these infections will be explored in this review. The general principles for success include the need for prevention of latency, persistence and repeat infections. A reduction in transmission of STIs would reduce the global burden of disease. Therapeutic activity of vaccines against STIs would be advantageous over preventative activity alone, and prevention of congenital and neonatal infections would be an added benefit. There would be an added value in the prevention of long-term consequences of STIs. It may be possible to re-purpose ‘old’ vaccines for new indications. One of the major challenges is the determination of the target populations for STI vaccination.
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Affiliation(s)
- Edwin David G McIntosh
- FEO - Faculty Education Office (Medicine), Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, SW7 2AZ, UK
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461
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Meulbroek M, Dalmau-Bueno A, Saz J, Marazzi G, Pérez F, Coll J, Taboada H, Pujol F. Falling HIV incidence in a community clinic cohort of men who have sex with men and transgender women in Barcelona, Spain. Int J STD AIDS 2020; 31:841-848. [PMID: 32623981 DOI: 10.1177/0956462420932424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Barcelona, Spain prior to 2006, HIV testing was mostly limited to formal healthcare facilities with no incidence data reported. A community-based organization (BCN Checkpoint) was established to increase HIV testing in a peer-led community location to generate incidence data in men who have sex with men and transgender women. Three community engagement interventions were conducted between 2009 and 2017 as follows: 2009-2011 (peer-led point-of-care testing for HIV), 2012-2014 (12-monthly HIV testing with an emphasis on testing in partnerships), 2015-2017 (three-monthly HIV testing with rapid referral for antiretroviral initiation). Between 2009 and 2017 a predominantly cisgender male (99.4%) and Spanish national (62.4%) population with mean age of 34.8 years had 49,630 visits. Mean visit number increased from 1.69 in the first to 2.07 in the last three-year period. HIV incidence fell from 4.17 (95% confidence interval [CI]: 3.53-4.93) per 100 person-years in 2009-2011 to 1.57 (95% CI: 1.30-1.89) per 100 person-years in 2015-2017. This represents a 62% reduction (incidence rate ratio: 0.38, 95% CI: 0.29-0.48) between the first and third study period (p < 0.001). These early interventions may have contributed to the reduction seen in HIV incidence in this cohort.
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Affiliation(s)
| | | | - Jorge Saz
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | | | - Josep Coll
- BCN Checkpoint, Barcelona, Spain.,IrsiCaixa, Badalona, Spain
| | | | - Ferran Pujol
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
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462
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Leech AA, Biancarelli D, Aaron E, Miller ES, Coleman JS, Anderson PL, Nkwihoreze H, Condron B, Sullivan M. HIV Pre-Exposure Prophylaxis for Conception Among HIV Serodiscordant Couples in the United States: A Cohort Study. AIDS Patient Care STDS 2020; 34:295-302. [PMID: 32639209 DOI: 10.1089/apc.2020.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Practice guidelines on pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples recommend PrEP when the viral load of the partner living with HIV is either detectable or unknown. However, adherence to combination antiretroviral therapy is inconsistent, and research has found that individuals vulnerable to HIV place value on additional protective barriers. We conducted a prospective cohort study to assess the feasibility, perceptions, and adherence associated with periconceptional PrEP use among females without HIV and their male partners living with HIV across four academic medical centers in the United States. We performed descriptive statistics, McNemar's test of marginal homogeneity to assess discordance in female/male survey responses, and Spearman's correlation to determine associations between dried blood spot levels and female self-reported adherence to PrEP. We enrolled 25 women without HIV and 24 men living with HIV (one male partner did not consent to the study). Women took PrEP for a median of 10.9 months (interquartile range 3.8-12.0) and were generally adherent. In total, 87% of women (20/23) had a dried blood spot with >700 fmol/punch or ≥4 doses/week, 4% (1/23) at 350-699 fmol/punch or 2-3 doses/week, and 9% (2/23) at <350 fmol/punch or <2 doses/week (correlation between drug levels and adherence is based on prior data). Dried blood spot levels closely aligned with self-reported adherence (Spearman's rho = 0.64, p = 0.001). There were 10 pregnancies among 8 participants, 4 of which resulted in spontaneous abortions. There was one preterm delivery (36 5/7 weeks), no congenital abnormalities, and no HIV transmissions. Ten couples (40%) were either lost to follow-up or ended the study early. Overall, women attempting conception with male partners living with HIV in the United States are interested and able to adhere to PrEP as an additional tool for safer conception.
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Affiliation(s)
- Ashley A. Leech
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dea Biancarelli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Erika Aaron
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily S. Miller
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Jenell S. Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter L. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Brianne Condron
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Meg Sullivan
- Department of Medicine, Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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463
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Kazemian P, Costantini S, Neilan AM, Resch SC, Walensky RP, Weinstein MC, Freedberg KA. A novel method to estimate the indirect community benefit of HIV interventions using a microsimulation model of HIV disease. J Biomed Inform 2020; 107:103475. [PMID: 32526280 PMCID: PMC7374016 DOI: 10.1016/j.jbi.2020.103475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/22/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Microsimulation models of human immunodeficiency virus (HIV) disease that simulate individual patients one at a time and assess clinical and economic outcomes of HIV interventions often provide key details regarding direct individual clinical benefits ("individual benefit"), but they may lack detail on transmissions, and thus may underestimate an intervention's indirect benefits ("community benefit"). Dynamic transmission models can be used to simulate HIV transmissions, but they may do so at the expense of the clinical detail of microsimulations. We sought to develop, validate, and demonstrate a practical, novel method that can be integrated into existing HIV microsimulation models to capture this community benefit, integrating the effects of reduced transmission while keeping the clinical detail of microsimulations. METHODS We developed a new method to capture the community benefit of HIV interventions by estimating HIV transmissions from the primary cohort of interest. The method captures the benefit of averting infections within the cohort of interest by estimating a corresponding gradual decline in incidence within the cohort. For infections averted outside the cohort of interest, our method estimates transmissions averted based on reductions in HIV viral load within the cohort, and the benefit (life-years gained and cost savings) of averting those infections based on the time they were averted. To assess the validity of our method, we paired it with the Cost-effectiveness of Preventing AIDS Complications (CEPAC) Model - a validated and widely-published microsimulation model of HIV disease. We then compared the consistency of model-estimated outcomes against outcomes of a widely-validated dynamic compartmental transmission model of HIV disease, the HIV Optimization and Prevention Economics (HOPE) model, using the intraclass correlation coefficient (ICC) with a two-way mixed effects model. Replicating an analysis done with HOPE, validation endpoints were number of HIV transmissions averted by offering pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and people who inject drugs (PWID) in the US at various uptake and efficacy levels. Finally, we demonstrated an application of our method in a different setting by evaluating the clinical and economic outcomes of a PrEP program for MSM in India, a country currently considering PrEP rollout for this high-risk group. RESULTS The new method paired with CEPAC demonstrated excellent consistency with the HOPE model (ICC = 0.98 for MSM and 0.99 for PWID). With only the individual benefit of the intervention incorporated, a PrEP program for MSM in India averted 43,000 transmissions over a 5-year period and resulted in a lifetime incremental cost-effectiveness ratio (ICER) of US$2,300/year-of-life saved (YLS) compared to the status quo. After applying both the direct (individual) and indirect (community) benefits, PrEP averted 86,000 transmissions over the same period and resulted in an ICER of US$600/YLS. CONCLUSIONS Our method enables HIV microsimulation models that evaluate clinical and economic outcomes of HIV interventions to estimate the community benefit of these interventions (in terms of survival gains and cost savings) efficiently and without sacrificing clinical detail. This method addresses an important methodological gap in health economics microsimulation modeling and allows decision scientists to make more accurate policy recommendations.
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Affiliation(s)
- Pooyan Kazemian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Sydney Costantini
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, USA
| | - Stephen C Resch
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
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464
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Pharaon J, Bauch CT. The Impact of Pre-exposure Prophylaxis for Human Immunodeficiency Virus on Gonorrhea Prevalence. Bull Math Biol 2020; 82:85. [PMID: 32613297 DOI: 10.1007/s11538-020-00762-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in reducing the risk of HIV infection in gay and bisexual men who have sex with men (GbMSM). However, PrEP does not protect against other sexually transmitted infections (STIs). In some populations, PrEP has also led to riskier behavior such as reduced condom usage, with the result that the prevalence of bacterial STIs like gonorrhea has increased. Here, we develop a compartmental model of the transmission of HIV and gonorrhea and the impacts of PrEP, condom usage, STI testing frequency and potential changes in sexual risk behavior stemming from the introduction of PrEP in a population of GbMSM. We find that introducing PrEP causes an increase in gonorrhea prevalence for a wide range of parameter values, including at the currently recommended frequency of STI testing once every three months for individuals on PrEP. Moreover, the model predicts that a higher STI testing frequency alone is not enough to prevent a rise in gonorrhea prevalence, unless the testing frequency is increased to impractical levels. However, testing every 2 months in combination with a 10-25 % reduction in risky behavior by individuals on PrEP would maintain gonorrhea prevalence at pre-PrEP levels. The results emphasize that programs making PrEP more available should be accompanied by efforts to support condom usage and frequent STI testing, in order to avoid an increase in the prevalence of gonorrhea and other bacterial STIs.
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Affiliation(s)
- Joe Pharaon
- Department of Applied Mathematics, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
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465
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Calabrese SK, Mayer KH. Stigma impedes HIV prevention by stifling patient-provider communication about U = U. J Int AIDS Soc 2020; 23:e25559. [PMID: 32686324 PMCID: PMC7369401 DOI: 10.1002/jia2.25559] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain SciencesGeorge Washington UniversityWashingtonDCUSA
- Department of Prevention and Community HealthGeorge Washington UniversityWashingtonDCUSA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
- The Fenway InstituteFenway HealthBostonMAUSA
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466
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Duracinsky M, Thonon F, Bun S, Ben Nasr I, Dara AF, Lakhdari S, Coblentz-Baumann L, Lert F, Dimi S, Chassany O. Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study. PLoS One 2020; 15:e0235260. [PMID: 32589652 PMCID: PMC7319329 DOI: 10.1371/journal.pone.0235260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The prevalence of HIV, hepatitis B, and hepatitis C amongst migrants in France is high. Thus, effective screening and follow-up is needed. The mandatory medical check-up for residency application is an opportunity to offer rapid HIV and hepatitis testing. The main objective of the STRADA study is to create a feasible and acceptable screening strategy for migrants. Within the STRADA study, this qualitative research examined the acceptability of conducting screening tests in the context of residency application. Methods We conducted a qualitative study amongst legal migrants over 18 years of age with sufficient knowledge of the French, English, or Arabic language. Interviews were performed following a semi-structured interview guide of open-ended questions. Interviews were transcribed verbatim and subsequently analyzed through thematic analysis. Results We interviewed 34 migrants. Mean age was 32.6 (min-max: 19, 59) years. The participants’ region of origin was mostly Sub-Saharan Africa and the main reason for migrating to France was family reunification. Migrants' acceptability of HIV and hepatitis testing was high. Participants who accepted testing indicated a benefit for individual health and to avoid transmission. Most preferred rapid tests; reluctance was related to anxiety about the immediate results and the perceived reliability of rapid tests. Migrants' knowledge about HIV was satisfactory, but inadequate for hepatitis. Screening in the context of a compulsory medical visit did not present an obstacle for acceptability. Some expressed concern in the case of HIV but when explained, the independence between obtaining the residence permit along with screening and access to medical care was well understood. Discussion Medical check-ups at immigration centers is an opportunity to screen for HIV and hepatitis which is considered acceptable by migrants. Informing migrants that test results do not affect residency applications, and incorporating their preferences, are all important to optimize the acceptability of screening.
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Affiliation(s)
- Martin Duracinsky
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- Hôpital Bicêtre, Service d’infectiologie, Le Kremlin Bicêtre, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
- * E-mail:
| | - Frédérique Thonon
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sonia Bun
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Imène Ben Nasr
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Aïchata Fofana Dara
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sabrina Lakhdari
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | | | - France Lert
- Agence nationale de recherche sur le sida et les hépatites virales (ANRS), Paris, France
| | - Svetlane Dimi
- Hôpital Foch, Service d’Hépatologie, Suresnes, France
| | - Olivier Chassany
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
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467
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Whittaker R, Case KK, Nilsen Ø, Blystad H, Cowan S, Kløvstad H, van Sighem A. Monitoring progress towards the first UNAIDS 90-90-90 target in key populations living with HIV in Norway. BMC Infect Dis 2020; 20:451. [PMID: 32590964 PMCID: PMC7318482 DOI: 10.1186/s12879-020-05178-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, Norway aims for at least 90% of people living with HIV (PLHIV) to know their HIV-status. We produced current estimates of the number of PLHIV and undiagnosed population in Norway, overall and for six key subpopulations: Norwegian-born men who have sex with men (MSM), migrant MSM, Norwegian-born heterosexuals, migrant Sub-Saharan Africa (SSA)-born heterosexuals, migrant non-SSA-born heterosexuals and people who inject drugs. METHODS We used the European Centre for Disease Prevention and Control (ECDC) HIV Modelling Tool on Norwegian HIV surveillance data through 2018 to estimate incidence, time from infection to diagnosis, PLHIV, and the number and proportion undiagnosed. As surveillance data on CD4 count at diagnosis were not collected in Norway, we ran two models; using default model CD4 assumptions, or a proxy for CD4 distribution based on Danish national surveillance data. We also generated alternative overall PLHIV estimates using the Spectrum AIDS Impact Model, to compare with those obtained from the ECDC tool. RESULTS Estimates of the overall number of PLHIV in 2018 using different modelling approaches aligned at approximately 5000. In both ECDC models, the overall number undiagnosed decreased continuously from 2008. The proportion undiagnosed in 2018 was lower using default model CD4 assumptions (7.1% [95%CI: 5.3-8.9%]), than the Danish CD4 proxy (10.2% [8.3-12.1%]). This difference was driven by results for heterosexual migrants. Estimates for Norwegian-born MSM, migrant MSM and Norwegian-born heterosexuals were similar in both models. In these three subpopulations, incidence in 2018 was < 30 new infections, and the number undiagnosed had decreased in recent years. Norwegian-born MSM had the lowest estimated number of undiagnosed infections (45 [30-75], using default CD4 assumptions) and undiagnosed fraction (3.6% [2.4-5.7%], using default CD4 assumptions) in 2018. CONCLUSIONS Results allow cautious confidence in concluding that Norway has achieved the first UNAIDS 90-90-90 target, and clearly highlight the success of prevention strategies among MSM. Estimates for subpopulations strongly influenced by migration remain less clear, and future modelling should appropriately account for all-cause mortality and out-migration, and adjust for time of in-migration.
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Affiliation(s)
- Robert Whittaker
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
- European Program for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Kelsey K. Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Øivind Nilsen
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | - Hans Blystad
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | | | - Hilde Kløvstad
- Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
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468
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Krueger A, Johnson C, Heitgerd J, Patel D, Harris N. State Trends in HIV Testing Among US Adults Aged 18-64 Years, 2011-2017. Public Health Rep 2020; 135:501-510. [PMID: 32579861 DOI: 10.1177/0033354920931833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. METHODS Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. RESULTS The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. CONCLUSION Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.
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Affiliation(s)
- Amy Krueger
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,School of Health Sciences, University of Tampere, Finland
| | - Christopher Johnson
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Heitgerd
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deesha Patel
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Norma Harris
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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469
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Tucker JD, Shields K, Villa G. STI perspectives. Sex Transm Infect 2020; 96:313-314. [PMID: 32423998 DOI: 10.1136/sextrans-2019-054272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joseph D Tucker
- IGHID, University of North Carolina, Chapel Hill, North Carolina, USA .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristine Shields
- Shields' Medical Writing and Consulting, Philadelphia, Pennsylvania, USA
| | - Giovanni Villa
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
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470
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Kostaki EG, Hodges-Mameletzis I, Magiorkinis G, Adamis G, Xylomenos G, Nikolopoulos G, Lazanas M, Chini M, Mangafas N, Skoutelis A, Papastamopoulos V, Antoniadou A, Papadopoulos A, Protopapas K, Psichogiou M, Basoulis D, Chrysos G, Paraskeva D, Paparizos V, Kourkounti S, Sambatakou H, Sipsas NV, Lada M, Panagopoulos P, Maltezos E, Hatzakis A, Paraskevis D. Earlier treatment initiation is associated with a decreased number of HIV-1 subtype A1 transmissions in Greece. Sex Transm Infect 2020; 97:232-237. [PMID: 32561553 DOI: 10.1136/sextrans-2020-054509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Subtypes A1 and B are the most prevalent HIV-1 clades in Greece. Subtype A1 epidemic is highly monophyletic and corresponds to transmissions that occurred locally. Our aim in this molecular epidemiology analysis was to investigate the role of early treatment in preventing new HIV-1 transmissions. METHODS Our analysis focused on 791 subtype A1 sequences from treatment-naïve individuals in Greece. Estimation of infection dates was performed by molecular clock calculations using Bayesian methods. We estimated the time interval between (1) the infection and sampling dates (linkage to care window), (2) the sampling dates and antiretroviral therapy (ART) initiation (treatment window), and (3) the infection dates and ART initiation (transmissibility window) for the study population. We also inferred the putative source of HIV infections between individuals of different groups divided according to the length of treatment, linkage to care or transmissibility window. RESULTS A significant decline was detected for the treatment window during 2014-2015 versus the 2 previous years (p=0.0273), while the linkage to care interval remained unchanged during the study period. Inference of the putative source of HIV infections suggested that individuals with a recent diagnosis or narrow transmissibility window (time period between HIV infection and ART initiation) were not sources of HIV infections to other groups. Contrarily, a significant number of HIV infections originated from individuals with longer transmissibility window interval. CONCLUSIONS Our findings showed that the treatment window is decreasing over time, presumably due to the updated treatment guidelines. Our study also demonstrates that people treated earlier after infection do not transmit at high rates, thus documenting the benefits of early ART initiation in preventing ongoing HIV-1 transmission.
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Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G Gennimatas GH, Athens, Greece
| | | | | | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases, Evaggelismos GH, Athens, Greece
| | | | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vasileios Paparizos
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Sofia Kourkounti
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion GH, Athens, Greece
| | - Periklis Panagopoulos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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471
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Fearon E, Tenza S, Mokoena C, Moodley K, Smith AD, Bourne A, Weatherburn P, Palanee-Phillips T. HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa. PLoS One 2020; 15:e0234384. [PMID: 32555703 PMCID: PMC7299351 DOI: 10.1371/journal.pone.0234384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/26/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. METHODS We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. RESULTS There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). CONCLUSIONS HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.
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Affiliation(s)
- Elizabeth Fearon
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Cecilia Mokoena
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Kerushini Moodley
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Adrian D. Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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472
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Chayama KL, McNeil R, Shoveller J, Small W, Knight R. Implementation opportunities and challenges identified by key stakeholders in scaling up HIV Treatment as Prevention in British Columbia, Canada: a qualitative study. Implement Sci Commun 2020; 1:54. [PMID: 32885210 PMCID: PMC7427937 DOI: 10.1186/s43058-020-00044-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The province of British Columbia (BC), Canada, was among the first jurisdictions to scale up HIV Treatment as Prevention (TasP) to the population level, including funding and policy commitments that enhanced HIV testing efforts (e.g., expansion of routine, opt-out testing), while also making antiretroviral therapy universally available to all people living with HIV. As such, BC represents a critical context within which to identify factors that influenced the scalability of TasP (e.g., acceptability, adoption, fidelity, equitable reach, sustainability), including key opportunities and challenges. Methods We draw on in-depth, semi-structured interviews with 10 key stakeholders, comprised policymakers at the local and provincial levels and representatives from community-based organizations. Using the Consolidated Framework for Implementation Research (CFIR) to guide data collection, coding, and analysis, we identified key factors that influenced practice transformation and scale up. Results Key factors that contributed to the successful scale up of TasP included: (i) opportunities that enhanced stakeholder buy-in based on features of the intervention characteristics, including with regard to assessments about the quality and strength of evidence supporting TasP; (ii) an inner setting implementation climate that was, in part, shaped by the large and highly symbolic government investments into TasP; (iii) features of the outer setting such as external policies (e.g., harm reduction) that cultivated opportunities to implement new "systems-level" approaches to HIV intervention; (iv) the personal attributes of some "middle-level" influencers, including a team that was comprised of some highly motivated and social justice-oriented individuals (e.g., folks who were deeply committed to serving marginalized populations); and (v) the capacity to develop various implementation processes that could maintain "nimble and evidence-informed" adaptations across a highly decentralized service delivery system, while also creating opportunities to adapt features of TasP programming based on "real time" program data. Conclusion Constructs across all five domains of CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process) were identified to influence the success of TasP in BC. Our findings provide important insights into how BC can successfully implement and scale up other systems-level interventions that have demonstrated efficacy, while also offering insights for other jurisdictions that are currently or planning to scale up TasP.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1 M9 Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,General Internal Medicine, School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06520 USA.,Yale Program in Addiction Medicine, School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06520 USA
| | - Jean Shoveller
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2 Canada.,Izaak Walton Killam Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8 Canada
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada.,Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 W. Hastings Street, Vancouver, BC V6B 5 K3 Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
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473
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Neue Strategien der HIV-Prävention für „Men who have sex with men“ (MSM): Die Präexpositionsprophylaxe (PrEP) und eine ethische Evaluierung ihrer Potentiale und Probleme. Ethik Med 2020. [DOI: 10.1007/s00481-020-00589-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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474
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Repositioning Implementation Science in the HIV Response: Looking Ahead From AIDS 2018. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S299-S304. [PMID: 31764267 DOI: 10.1097/qai.0000000000002209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implementation science (IS) occupies a critical place in HIV/AIDS research, reflected by a scientific track ("Track E") at the biannual International AIDS Conference. IS seeks to identify health delivery strategies that cost-effectively translate the efficacy of evidence-based interventions for HIV prevention, testing, and treatment into impact on HIV incidence, quality of life, and mortality. METHOD We reviewed the content of Track E, and other presentations relevant to IS, at the 22nd International AIDS Conference held in Amsterdam in 2018. We identified key findings and themes and made recommendations for areas where the field can be strengthened by the 2020 meeting. RESULTS Trials of "treat all" strategies in Africa showed mixed evidence of effect. Innovations in HIV testing included expanding self-testing and index testing, which are reaching groups, such as men, where previously testing rates have been low. Adherence clubs and other innovations are being trialed to improve retention in care, with mixed findings. The implementation of pre-exposure prophylaxis for HIV prevention continues but with many challenges remaining in identifying implementation strategies that strengthen demand and support continuation. DISCUSSION IS for HIV/AIDS treatment and prevention continues to expand. IS for primary HIV prevention must be prioritized with a dearth of rigorous, intersectoral studies in this area. The weakness of routine data must be addressed. Costing and financing studies should form a stronger component of the conference agenda. Implementation scientists must continue to grapple with the methodological challenges posed by the real-world context for their research.
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475
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Guvenc F, Kaul R, Gray-Owen SD. Intimate Relations: Molecular and Immunologic Interactions Between Neisseria gonorrhoeae and HIV-1. Front Microbiol 2020; 11:1299. [PMID: 32582133 PMCID: PMC7284112 DOI: 10.3389/fmicb.2020.01299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
While the global incidence of human immunodeficiency virus (HIV-1) remains well above UNAIDS targets, sexual transmission HIV is surprisingly inefficient. A variety of host, viral and environmental factors can either increase HIV-1 shedding in the infected partner and/or increase mucosal susceptibility of the HIV-1 uninfected partner. Clinical and epidemiological studies have clearly established that Neisseria gonorrhoeae substantially enhances HIV-1 transmission, despite it not being an ulcerative infection. This review will consider findings from molecular, immunologic and clinical studies that have focused on each of these two human-restricted pathogens, in order to develop an integrative model that describes how gonococci can both increase mucosal shedding of HIV-1 from a co-infected person and facilitate virus establishment in a susceptible host.
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Affiliation(s)
- Furkan Guvenc
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Scott D Gray-Owen
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
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476
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Maloney KM, Beer L, Tie Y, Dasgupta S. Prevalence of Non-medical Amphetamine Use Among Men with Diagnosed HIV Infection Who Have Sex with Men in the United States, 2015-2016. AIDS Behav 2020; 24:1865-1875. [PMID: 31834542 DOI: 10.1007/s10461-019-02761-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Amphetamine use is higher among men who have sex with men (MSM) compared with other men, and is associated with sexual behavior linked to HIV transmission. No national estimates of amphetamine use among MSM with HIV have been published. We used data from the Medical Monitoring Project, a nationally representative sample of persons with diagnosed HIV, to describe patterns in amphetamine use in the past 12 months among MSM during 2015-2016 (N = 3796). Prevalence of amphetamine use in this population was 9.6% (95% CI 7.6, 11.6%) in the past 12 months. MSM who used amphetamines were more likely to have condomless sex with partners without HIV or of unknown serostatus (PR 1.87; 95% CI 1.62, 2.16) and less likely to be durably virally suppressed (PR 0.81; 95% CI 0.71, 0.91). Interventions to address amphetamine use and associated transmission risk behaviors among MSM living with HIV may decrease transmission.
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Affiliation(s)
- Kevin M Maloney
- Department of Epidemiology, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA.
| | - Linda Beer
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharoda Dasgupta
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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477
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Miltz AR, Rodger AJ, Lepri AC, Sewell J, Nwokolo NC, Allan S, Scott C, Ivens D, Lascar M, Speakman A, Phillips AN, Sherr L, Collins S, Elford J, Lampe FC. Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation. AIDS Behav 2020; 24:1793-1806. [PMID: 31782068 PMCID: PMC7220884 DOI: 10.1007/s10461-019-02724-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013–2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.
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Affiliation(s)
- A R Miltz
- Institute for Global Health, University College London, London, UK.
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - A Cozzi Lepri
- Institute for Global Health, University College London, London, UK
| | - J Sewell
- Institute for Global Health, University College London, London, UK
| | | | - S Allan
- City of Coventry Healthcare Centre, Coventry, UK
| | - C Scott
- West London Centre for Sexual Health, London, UK
| | - D Ivens
- Royal Free Hospital, London, UK
| | - M Lascar
- Whipps Cross Hospital, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - L Sherr
- Institute for Global Health, University College London, London, UK
| | | | - J Elford
- City, University of London, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
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478
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Shah HS, Dolwick Grieb SM, Flores-Miller A, Greenbaum A, Castellanos-Aguirre J, Page KR. Sólo Se Vive Una Vez: The Implementation and Reach of an HIV Screening Campaign for Latinx Immigrants. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:229-242. [PMID: 32749875 DOI: 10.1521/aeap.2020.32.3.229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Latinxs in the United States are disproportionately affected by HIV and present with more advanced disease than their non-Latinx peers, due to numerous barriers to care including HIV stigma. We describe the adaptation, implementation, and reach of Sólo Se Vive Una Vez (You Only Live Once), Baltimore's first social marketing campaign promoting HIV screening among Spanish-speaking Latinxs. The 6-month campaign promoted free HIV testing by addressing HIV stigma. The campaign included a website, a social marketing campaign, community outreach events, and advertisements via radio, billboards, local partners, and buses. During the campaign, there were 9,784 unique website users, and ads were served to over 84,592 people on social media platforms. Among Latinx HIV testers at the Baltimore City Health Department, 31.6% reported having seen or heard of Sólo Se Vive Una Vez and 25.3% of Latinx HIV testers reported that the campaign influenced them to get tested.
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Affiliation(s)
- Harita S Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alejandra Flores-Miller
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
| | | | | | - Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Baltimore City Health Department, Baltimore, Maryland
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479
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Cernasev A, Larson WL, Peden-McAlpine C, Rockwood T, Ranelli PL, Okoro O, Schommer JC. "Stigma and HIV Are Like Brother and Sister!": The Experience of African-Born Persons Living with HIV in the US. PHARMACY 2020; 8:pharmacy8020092. [PMID: 32486263 PMCID: PMC7357078 DOI: 10.3390/pharmacy8020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/02/2022] Open
Abstract
Minnesota has seen an increase in the number of immigrants from Africa, notably in the mid-1990s, making up around 2% of Minnesota’s total population. This population also faces many impediments that cause important difficulties not only for HIV prevention but also for treatment and care options. The objectives of this study were to capture the experiences of Persons Living with HIV (PLWH) in Minnesota (US) and to elicit their stories about their diagnosis news and what management strategies they use for coping with the stigma associated with the disease. Participants were recruited via fliers in pharmacies, clinics, and HIV service centers located in Minnesota. Recruitment continued until thematic saturation was obtained. Fourteen subjects participated in audio-recorded, semi-structured interviews that were transcribed verbatim into written text. The transcriptions were analyzed using Thematic Analysis. Three themes emerged from the data. Theme 1: Cruel News: “HIV-Oooooo! I wish I was dead”, Theme 2: This is My Secret! and Theme 3: “Stigma and HIV are brother and sister”. The results demonstrate that stigma is an ever-present problem in African-born PLWH living in the US. Participants perceived the stigma associated with HIV status to affect their lives and culture at individual, familial, and societal levels.
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Affiliation(s)
- Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, 301 S Perimeter Park Drive, Suite 220, Nashville, TN 37211, USA
- Correspondence:
| | - William L. Larson
- Allina Health Uptown Clinic, 1221 West Lake St., Suite 201, Minneapolis, MN 55455, USA;
| | - Cynthia Peden-McAlpine
- School of Nursing, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
| | - Todd Rockwood
- School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA;
| | - Paul L. Ranelli
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Olihe Okoro
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Jon C. Schommer
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
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480
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Ndlovu Z, Burton R, Stewart R, Bygrave H, Roberts T, Fajardo E, Mataka A, Szumilin E, Kerschberger B, Van Cutsem G, Ellman T. Framework for the implementation of advanced HIV disease diagnostics in sub-Saharan Africa: programmatic perspectives. Lancet HIV 2020; 7:e514-e520. [PMID: 32473102 DOI: 10.1016/s2352-3018(20)30101-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023]
Abstract
Patients with advanced HIV disease have a high risk of mortality, mainly from tuberculosis and cryptococcal meningitis. The advanced HIV disease management package recommended by WHO, which includes diagnostics, therapeutics, and patient psychosocial support, is barely implemented in many different countries. Here, we present a framework for the implementation of advanced HIV disease diagnostics. Laboratory and point-of-care-based reflex testing, coupled with provider-initiated requested testing, for cryptococcal antigen and urinary Mycobacterium tuberculosis lipoarabinomannan antigen, should be done for all patients with CD4+ cell counts of 200 cells per μL or less. Implementation of the advanced HIV disease package should be encouraged within primary health-care facilities and task shifting of testing to lay cadres could facilitate access to rapid results. Implementation of differentiated antiretroviral therapy delivery models can allow clinicians enough time to focus on the management of patients with advanced HIV disease. Efficient up-referral and post-discharge systems, including the development of patient-centric advanced HIV disease literacy, are also crucial. Implementation of the advanced HIV disease package is feasible at all health-care levels, and it should be part of the core of the global response towards ending AIDS as a public health threat.
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Affiliation(s)
- Zibusiso Ndlovu
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa.
| | - Rosie Burton
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
| | | | - Helen Bygrave
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | - Teri Roberts
- Médecins Sans Frontières, Access Campaign, Geneva, Switzerland
| | | | - Anafi Mataka
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
| | | | | | - Gilles Van Cutsem
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Tom Ellman
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
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481
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Fleischer L, Avery A. Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV. SAGE Open Med 2020; 8:2050312120915405. [PMID: 32435479 PMCID: PMC7222653 DOI: 10.1177/2050312120915405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 02/13/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives: Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy. Methods: We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States. Results: We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team. Conclusion: Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.
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Affiliation(s)
- Lisa Fleischer
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann Avery
- Division of Infectious Disease, MetroHealth Medical Center, Cleveland, OH, USA
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482
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Tattsbridge J, Wiskin C, de Wildt G, Clavé Llavall A, Ramal-Asayag C. HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study. BMC Public Health 2020; 20:728. [PMID: 32429863 PMCID: PMC7238527 DOI: 10.1186/s12889-020-08745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto. METHODS Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used. RESULTS A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes. CONCLUSION More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
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Affiliation(s)
- Jasmine Tattsbridge
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Connie Wiskin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna Clavé Llavall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - César Ramal-Asayag
- Department of Infectious Diseases, Regional Hospital of Loreto, Iquitos, Peru.,Department of Clinical Sciences, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
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483
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Uptake and acceptability of assisted and unassisted HIV self-testing among men who purchase sex in brothels in Indonesia: a pilot intervention study. BMC Public Health 2020; 20:730. [PMID: 32429950 PMCID: PMC7238614 DOI: 10.1186/s12889-020-08812-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background Along with sexual partners of other high-risk groups, men who purchase sex (MWPS) represented 18% of new HIV diagnoses worldwide in 2018. They are therefore an important population for HIV prevention globally. Despite very low HIV testing coverage among MWPS in many countries, the role of HIV self-testing to increase testing coverage has not been explored. We, therefore, conducted a pilot intervention study to evaluate the uptake and acceptability of assisted and unassisted HIV self-testing among MWPS in Indonesia. Methods MWPS attending seven brothels in Bali between December 2017 and January 2018 were recruited by lay health providers to participate in a brief health survey, and then invited to have a HIV self-test (assisted or unassisted) with an OraQuick® ADVANCE Rapid HIV-1/2 Antibody Test and complete a post-test acceptability survey. Results A total of 292 men completed the health survey (response rate: 70%) and 188 (64.6%) accepted HIV self-testing. Of these men, 13.3% had ever tested for HIV and 58.9% reported condom use at their last sexual encounter with a brothel-based female sex worker. Nearly all men (98.9%) who accepted a HIV self-test preferred assisted HIV self-testing – of whom 83.9% preferred to be fully assisted and 16.1% opted to be partially assisted and read their results privately. Of the men who accepted the test and showed the result to the lay health providers, 4 (2.1%) received reactive results. Linkage following HIV self-test is a concern, as none of the four men with a reactive result attended HIV testing at the recommended referral HIV testing clinic over a two-month follow-up period. Conclusions This study is the first to investigate the acceptance of HIV self-testing when offered to MWPS in brothels by lay health providers. The high uptake of HIV self-testing suggests that this testing model is acceptable and could increase the very low HIV testing coverage among MWPS. The strong preference for fully assisted HIV self-testing highlights the importance of involving lay health providers in future testing programs. When scaling up HIV self-testing programmatically, strategies to improve linkage-to-care should be considered and evaluated.
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484
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Atias D, Levine H, Elinav H, Haouzi-Bashan M, Lior Y, Mor Z. Community Vs. hospital HIV testing sites in Jerusalem, Israel - who's tested and who's at risk? Isr J Health Policy Res 2020; 9:10. [PMID: 32418539 PMCID: PMC7232836 DOI: 10.1186/s13584-020-00368-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background After decades of constant increase in HIV diagnoses among men who have sex with men (MSM), a gradual decrease has been reported in recent years. Timely detection of HIV leads to early treatment and behavioral changes which decrease further transmissions. This cross-sectional study aimed to assess demographic and behavioral characteristics of individuals who were tested for HIV in Jerusalem, Israel. Methods This study compared individuals who were tested at Hadassah AIDS Center (HAC) with those tested at the Jerusalem Open House (JOH) - an LGBTQ community center. Participants completed anonymous questionnaires regarding their demographic, HIV-testing history, and sexual behaviors. High-risk sexual behavior (HRSB) was defined as a diagnosis of sexually transmitted disease or condomless anal/vaginal sex during the last year. Results Among 863 participants, 104 (12.1%) were tested in HAC and 759 (87.9%) in JOH. Of those, 19 (18.3%) and 227 (29.9%) were HRSB, respectively. Two MSM were tested positive in JOH. JOH received more MSM, HRSB and individuals who were previously tested for HIV, while HAC received more migrants and health-care workers. HRSB-participants were more commonly younger, males, non-Jewish, with lower income, previously tested for HIV, reported more sexual partners, payed for sex or used drugs. Conclusions MSM and HRSB-individuals were more likely to be tested in JOH, while migrants and health-care workers in HAC, possibly due to the geographic location, reputation and specific atmosphere. In order to encourage HIV-tests among HRSB and non-Jews, additional interventions should be employed, including outreach activities, extending opening hours and reducing testing costs should be employed.
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Affiliation(s)
- Dor Atias
- The Hebrew University Hadassah Medical School, Jerusalem, Israel. .,The Jerusalem Open House for Pride and Tolerance, Jerusalem, Israel.
| | - Hagai Levine
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Hila Elinav
- Hadassah AIDS center, department of clinical microbiology and infectious diseases, Hadassah Hebrew University medical center, Jerusalem, Israel
| | - Michele Haouzi-Bashan
- Hadassah AIDS center, department of clinical microbiology and infectious diseases, Hadassah Hebrew University medical center, Jerusalem, Israel
| | - Yotam Lior
- The Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Zohar Mor
- Tel Aviv Department of Health, Tel Aviv, Israel.,School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
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485
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Managing and preventing blood-borne viral infection transmission in assisted reproduction: a Canadian Fertility and Andrology Society clinical practice guideline. Reprod Biomed Online 2020; 41:203-216. [PMID: 32546334 DOI: 10.1016/j.rbmo.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Fertility care providers have an obligation to provide safe and effective care to patients. When a user of assisted reproductive technology (ART) is living with a blood-borne viral infection (BBVI: HIV, hepatitis C or hepatitis B), physicians and ART laboratory personnel need to know the requirements for providing quality care. Recent developments in the treatment of BBVI and understanding of transmission have changed these requirements. This guideline from the Canadian Fertility and Andrology Society (CFAS) provides comprehensive, evidence-based guidelines for reducing horizontal transmission and cross-contamination in the ART setting.
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486
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Boone CA, Bowleg L. Structuring Sexual Pleasure: Equitable Access to Biomedical HIV Prevention for Black Men Who Have Sex with Men. Am J Public Health 2020; 110:157-159. [PMID: 31913679 DOI: 10.2105/ajph.2019.305503] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Cheriko A Boone
- Cheriko A. Boone is with the Department of Psychological and Brain Sciences, the Intersectionality Training Institute, and the DC Center for AIDS Research, George Washington University, Washington, DC. Lisa Bowleg is with the Department of Psychological and Brain Sciences, founding director of the Intersectionality Training Institute, and director of the Social and Behavioral Sciences Core of the DC Center for AIDS Research, George Washington University
| | - Lisa Bowleg
- Cheriko A. Boone is with the Department of Psychological and Brain Sciences, the Intersectionality Training Institute, and the DC Center for AIDS Research, George Washington University, Washington, DC. Lisa Bowleg is with the Department of Psychological and Brain Sciences, founding director of the Intersectionality Training Institute, and director of the Social and Behavioral Sciences Core of the DC Center for AIDS Research, George Washington University
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487
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Wang L, Hong W, Zhu W, Lu L, Yang Z, Zhao F, Xu X, Xiong W, Wang L, Zeng J. Efficacy of early antiretroviral therapy 36 hours after HIV infection in one blood donor. Transfusion 2020; 60:1633-1638. [PMID: 32358857 DOI: 10.1111/trf.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Discrepancies can occur with the use of clinical human immunodeficiency virus (HIV) diagnostic reagents for the HIV window period (WP; time from RNA to antibody detection by diagnostic or blood screening assays). Antiretroviral therapy (ART) during acute HIV infection can impact HIV-specific antibodies, antigens, and DNA/RNA detection. In this study, an HIV WP blood donor who initiated ART was monitored, evaluating the immunological and nucleic acid testing (NAT) results for early ART and discussing the potential effects on blood safety. STUDY DESIGN AND METHODS This was a follow-up study of a HIV WP donor detected 36 hours after high-risk sexual behavior, who was subsequently treated with ART. Immunological and NAT methods were comparatively analyzed. RESULTS The 4th generation HIV serologic assays were positive at Day 11, and the 3rd generation domestic anti-HIV assay was positive at Day 33. Individual donation (ID) NAT and minipool (MP) NAT of six samples were reactive, but 12-sample MP-NAT was nonreactive. ART resulted in a slow decline of HIV RNA, but HIV DNA was still detected on Day 757. CONCLUSION After ART, ID-NAT was more sensitive than MP-NAT or serologic detection; however, HIV DNA detection was more sensitive, with DNA but not RNA persistently detectable.
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Affiliation(s)
- Lilin Wang
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Wenxu Hong
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Weigang Zhu
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Liang Lu
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Zhengrong Yang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Fang Zhao
- Shenzhen Third People's Hospital, Shenzhen, China
| | - Xiaoxuan Xu
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Wen Xiong
- Shenzhen Blood Center, Shenzhen, Guangdong, China
| | - Lunan Wang
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, China
| | - Jinfeng Zeng
- Shenzhen Blood Center, Shenzhen, Guangdong, China
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488
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Abstract
Development of improved approaches for HIV-1 prevention will likely be required for a durable end to the global AIDS pandemic. Recent advances in preclinical studies and early phase clinical trials offer renewed promise for immunologic strategies for blocking acquisition of HIV-1 infection. Clinical trials are currently underway to evaluate the efficacy of two vaccine candidates and a broadly neutralizing antibody (bNAb) to prevent HIV-1 infection in humans. However, the vast diversity of HIV-1 is a major challenge for both active and passive immunization. Here we review current immunologic strategies for HIV-1 prevention, with a focus on current and next-generation vaccines and bNAbs.
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Affiliation(s)
- Kathryn E Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA;
- Ragon Institute of Massachusetts General Hospital, MIT, and Harvard, Boston, Massachusetts 02114, USA
| | - Kshitij Wagh
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico Consortium, Los Alamos, New Mexico 87545, USA
| | - Bette Korber
- Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- New Mexico Consortium, Los Alamos, New Mexico 87545, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA;
- Ragon Institute of Massachusetts General Hospital, MIT, and Harvard, Boston, Massachusetts 02114, USA
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489
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Gannon B, Davis R, Kuhns LM, Rodriguez RG, Garofalo R, Schnall R. A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation. JMIR Form Res 2020; 4:e17901. [PMID: 32254043 PMCID: PMC7175191 DOI: 10.2196/17901] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. OBJECTIVE The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. METHODS Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. RESULTS A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. CONCLUSIONS Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group.
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Affiliation(s)
- Brittany Gannon
- School of Nursing, Columbia University, New York, NY, United States
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York City, NY, United States
| | - Rindcy Davis
- Gertrude H Sergievsky Center, Columbia University, New York, NY, United States
| | - Lisa M Kuhns
- Lurie Children's Hospital, Chicago, IL, United States
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IN, United States
| | | | - Robert Garofalo
- Lurie Children's Hospital, Chicago, IL, United States
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IN, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, United States
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490
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Giacomelli A, Micheli V, Cattaneo D, Mancon A, Gervasoni C. Multidrug-resistant HIV viral rebound during early syphilis: a case report. BMC Infect Dis 2020; 20:273. [PMID: 32264923 PMCID: PMC7140389 DOI: 10.1186/s12879-020-04999-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 11/27/2022] Open
Abstract
Background Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the first to highlight the risk of a multidrug-resistant HIV viral rebound during the course of early syphilis even if antiretroviral drug concentrations are within the therapeutic range. Case presentation This 50-year-old HIV-1-positive male patient with concomitant early syphilis presented with an HIV RNA rebound (8908 copies/mL) during a scheduled visit to our clinic. He was receiving a stable ART regimen consisting of darunavir/cobicistat plus dolutegravir, and had a 15-year history of viral suppression. Good short-term drug adherence could be inferred as liquid chromatography tandem mass spectrometry showed that his trough antiretroviral drug concentrations were within the therapeutic range: darunavir 2353 ng/mL (minimum effective concentration > 500 ng/mL) and dolutegravir 986 ng/mL (minimum effective concentration > 100 ng/mL). A plasma RNA genotype resistance test revealed wild-type virus in the integrase region and protease region (PR), but extensive resistance in the reverse transcriptase (RT) region (M41L, E44D, D67N, K70R, M184V, L210W and T215Y). Phylogenetic analysis of next-generation sequences (used to investigate the presence of minor viral variants), the PR and RT sequences from plasma HIV RNA and pro-viral DNA extracted from peripheral blood mononuclear cells during the viral rebound, and a Sanger sequence obtained during a previous virological failure suggested clonal viral expression because the previous PR resistance mutations had been lost or had not been archived in pro-viral DNA. Conclusions This case shows that early syphilis may cause an HIV RNA rebound in patients under stable virological control with the potential of transmitting an extensively drug-resistant virus.
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Affiliation(s)
- Andrea Giacomelli
- Department of Biomedical and Clinical Sciences, DIBIC Luigi Sacco, Milan University, Via G.B. Grassi 74, 20157, Milan, Italy. .,III Infectious Disease Unit, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.
| | - Valeria Micheli
- Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Dario Cattaneo
- Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.,Unit of Clinical Pharmacology, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Alessandro Mancon
- Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | - Cristina Gervasoni
- III Infectious Disease Unit, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy.,Gestione Ambulatoriale Politerapie (GAP) Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
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491
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López Zúñiga MÁ, Chueca N, de Salazar A, Fernández Caballero JA, Gutierrez Valencia A, Vinuesa García D, Omar Mohamed Balgahata M, Hidalgo Tenorio C, Lopez-Ruz MA, Garcia F. Genetic diversity of HIV in seminal plasma remains higher than in blood after short-term antiretroviral therapy. Sex Transm Infect 2020; 96:337-341. [PMID: 32245779 PMCID: PMC7402555 DOI: 10.1136/sextrans-2020-054439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To provide insight on viral kinetics and genetic diversity of HIV in seminal plasma at baseline and 1 month after initiating antiretroviral therapy (ART). Patients and methods Blood and seminal samples from patients with newly diagnosed HIV were obtained before ART initiation (T0) and 1 month after ART initiation (T1). HIV env genetic diversity was studied using deep sequencing Nextera and V3 chemistry in a MiSeq Illumina platform. The number of viral quasispecies (5% cut-off) and Shannon Index were used to analyse diversity. Results Forty-seven ART-naive patients were recruited between September 2016 and November 2018. At enrolment, the number of quasispecies in blood (median 4 (IQR 2–5)) was lower than in the seminal compartment (median 6, (IQR 4–8)) (p<0.01); the Shannon Index was also higher (p<0.001) in the seminal compartment than in blood (1.77 vs 0.64). At T1, for the 13 patients with detectable HIV in both blood/seminal plasma, viral diversity remained higher (p=0.139) in seminal plasma (median 2 (IQR 1–4.5)) than in blood (median 1 (IQR 1–1.5)) Integrase inhibitors (INI)-based regimens achieved higher levels of undetectability and led more frequently to lower variability (p<0.001) than protease inhibitors (PI) or non-nucleoside reverse transcriptase inhibitors (NNRTI). Conclusion We provide here further evidence of a larger genetic diversity in seminal plasma, both at diagnosis and short term after ART initiation. Our results strengthen previous findings on HIV diversity in seminal plasma. In addition, INIs decrease variability more rapidly than PI and NNRTI in both blood and seminal plasma.
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Affiliation(s)
| | - Natalia Chueca
- Microbiology Department, San Cecilio University Hospital, Granada, Spain.,Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
| | - Adolfo de Salazar
- Microbiology Department, San Cecilio University Hospital, Granada, Spain
| | | | | | | | | | | | - Miguel Angel Lopez-Ruz
- Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain.,Infectious Disease Service, University Hospital Virgen de las Nieves, Granada, Spain
| | - Federico Garcia
- Microbiology Department, San Cecilio University Hospital, Granada, Spain .,Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
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492
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Rasokat H. Dermato‐Venerologie in Zeiten eines post‐AIDS Sexualverhaltens. J Dtsch Dermatol Ges 2020; 18:307-309. [DOI: 10.1111/ddg.14078_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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493
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Agustí C, Muñoz R, González V, Villegas L, Fibla J, Meroño M, Capitán A, Fernàndez-López L, Platteau T, Casabona J. Outreach HIV testing using oral fluid and online consultation of the results: Pilot intervention in Catalonia. Enferm Infecc Microbiol Clin 2020; 39:3-8. [PMID: 32151468 DOI: 10.1016/j.eimc.2020.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of the intervention was to describe the feasibility and cost-effectiveness of offering HIV testing in outreach interventions and subsequent consultation of the results through a secure web page. METHODS The HIV test was offered "in situ" to men who have sex with men (MSM), migrant sex workers and trans women recruited in places of leisure and sex. Four collaborating NGOs recruited the participants and assisted them to register on the study website (www.swab2know.eu) through a tablet or the smartphone of the same participant. The samples were sent to the reference laboratory and the results were published on the website. RESULTS 834 participants (612 MSMs, 203 women sex workers and 19 trans women) were recruited. In total 22 reagent results (2.6%) were detected: 21 among MSMs (3.4%) and 1 in a trans women (5.3%). While 82.6% of MSMs consulted their outcome, only 39.9% and 26.3% of women sex workers and trans women respectively consulted their outcome CONCLUSIONS: Providing self-sampling in outreach activities, dispatch and analysis in a reference laboratory as well as online communication of test results is feasible. A high proportion of participants with a HIV reactive result were detected among MSMs and trans women.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - Rafael Muñoz
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España
| | - Victoria González
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | | | - Joan Fibla
- Associació Antisida Lleida, Lleida, España
| | | | | | - Laura Fernàndez-López
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Tom Platteau
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Bélgica
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España; Departament de Pediatria, Obstetricia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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494
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Sun L, Liu A, Li J, Shao Y, Li Q, Ye J, Zhang H, Li Z, Wang H. Is PrEP necessary during natural conception in HIV-1-serodiscordant couples on ART with suppressed viral load? A retrospective cohort analysis. BMC Infect Dis 2020; 20:195. [PMID: 32138673 PMCID: PMC7059657 DOI: 10.1186/s12879-020-4912-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antiretroviral therapy (ART) demonstrates high efficacy in reducing the risk of HIV transmission to sexual partners. However, it is not clear if the use of pre-exposure prophylaxis (PrEP) in HIV-1-serodiscordant couples is necessary during natural conception when the HIV-positive partner exhibits a suppressed viral load. The purpose of this study was to assess the role of PrEP during natural conception in this population. Methods A retrospective, multicenter study was conducted in a cohort of HIV-1-serodiscordant couples (positive man, negative woman) with childbearing desires. HIV-positive male partners were treated with ART and achieved viral suppression for more than half a year. The HIV-negative female partners were either treated with PrEP or not treated with PrEP, and outcomes were compared between the two treatment groups. Results Of 246 HIV-1-serodiscordant couples in whom the HIV-positive partner achieved viral suppression, 104 seronegative women were treated with PrEP during natural conception and 142 seronegative women were not treated with PrEP. There were 410 condom-less sexual acts in couples treated with PrEP and 615 condom-less sexual acts in couples not treated with PrEP. We observed no instances of HIV transmission in HIV-1-serodiscordant couples with or without the use of PrEP during the process of natural conception. Conclusions Our results show that PrEP had minimal influence in reducing the risk of HIV transmission during natural conception in HIV-1-serodiscordant couples with a stably suppressed viral load. Thus, it may be an acceptable option for HIV-negative partners to not use PrEP during the process of natural conception if the HIV-positive partner has achieved viral suppression for more than half a year.
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Affiliation(s)
- Lijun Sun
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - An Liu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Jianwei Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Ying Shao
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Qiuyun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Jiangzhu Ye
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Hongwei Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Zaicun Li
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
| | - Hui Wang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, China.
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495
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Kariuki SM, Selhorst P, Norman J, Cohen K, Rebe K, Williamson C, Dorfman JR. Detectable HIV-1 in semen in individuals with very low blood viral loads. Virol J 2020; 17:29. [PMID: 32138741 PMCID: PMC7059658 DOI: 10.1186/s12985-020-01300-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Several reports indicate that a portion (5–10%) of men living with HIV-1 intermittently shed HIV-1 RNA into seminal plasma while on long term effective antiretroviral therapy (ART). This is highly suggestive of an HIV-1 reservoir in the male genital tract. However, the status of this reservoir in men living with HIV-1 who are not under treatment is underexplored and has implications for understanding the origins and evolution of the reservoir. Finding Forty-three HIV-1 positive, antiretroviral therapy naïve study participants attending a men’s health clinic were studied. Semen viral loads and blood viral loads were generally correlated, with semen viral loads generally detected in individuals with blood viral loads > 10,000 cp/ml. However, we found 1 individual with undetectable viral loads (<20cp/ml) and 2 individuals with very low blood viral load (97 and 333cp/ml), but with detectable HIV-1 in semen (485–1157 copies/semen sample). Blood viral loads in the first individual were undetectable when tested three times over the prior 5 years. Conclusions Semen HIV-1 viral loads are usually related to blood viral loads, as we confirm. Nonetheless, this was not true in a substantial minority of individuals suggesting unexpectedly high levels of replication in the male genital tract in a few individuals, despite otherwise effective immune control. This may reflect establishment of a local reservoir of HIV-1 populations.
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Affiliation(s)
- Samuel Mundia Kariuki
- Division of Immunology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa.,International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Department of Biological Sciences, School of Science, University of Eldoret, Eldoret, Kenya
| | - Philippe Selhorst
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer Norman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin Rebe
- Anova Health Institute, Cape Town, South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Carolyn Williamson
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Johannesburg, South Africa
| | - Jeffrey R Dorfman
- Division of Immunology, Department of Pathology, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa. .,Division of Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, South Africa.
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496
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Ramírez-Ortiz D, Sheehan DM, Ibañez GE, Ibrahimou B, De La Rosa M, Cano MÁ. Self-efficacy and HIV testing among Latino emerging adults: examining the moderating effects of distress tolerance and sexual risk behaviors. AIDS Care 2020; 32:1556-1564. [PMID: 32131621 DOI: 10.1080/09540121.2020.1736259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Latino emerging adults in the United States are at a high risk of HIV and have a low prevalence of HIV testing. This study examined the association between self-efficacy for HIV testing, distress tolerance and lifetime history of HIV testing, and tested the moderating effect of distress tolerance and sexual risk behaviors on the association between self-efficacy and lifetime history of HIV testing. Data were collected from a cross-sectional sample of 157 Latino emerging adults aged 18-25 using an online survey and were analyzed using hierarchical logistic regression and moderation analyses. We found that 62.8% of those engaging in sexual risk behaviors had ever been tested for HIV. Participants that reported higher levels of self-efficacy (aOR=3.49, 95%CI: 1.78-6.83) were more likely to have ever been tested for HIV in their lifetime. There was a statistically significant three-way interaction among self-efficacy for HIV testing, distress tolerance and sexual risk behaviors (b=2.76, 95%CI: .52, 5.00, p=.016). This interaction suggests that among those that reported any sexual risk behaviors, higher levels of self-efficacy were associated with lifetime history of HIV testing only at higher levels of distress tolerance. Further research is warranted to determine how self-efficacy and distress tolerance work together among high-risk groups to promote HIV testing.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA.,Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Boubakari Ibrahimou
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA.,Department of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA
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497
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Daskalopoulou M, Rodger AJ, Phillips AN, Gilson R, Sherr L, Wayal S, Anderson J, Aderogba K, McDonnell J, Wilkins E, Youssef E, Speakman A, Burman WJ, Lampe FC. Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK. AIDS Care 2020; 32:1323-1332. [PMID: 32114800 DOI: 10.1080/09540121.2020.1728218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.
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Affiliation(s)
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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498
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Kutner BA, Simoni JM, King KM, Goodreau SM, Norcini Pala A, Creegan E, Aunon FM, Baral SD, Rosser BRS. Does Stigma Toward Anal Sexuality Impede HIV Prevention Among Men Who Have Sex With Men in the United States? A Structural Equation Modeling Assessment. J Sex Med 2020; 17:477-490. [PMID: 31932256 PMCID: PMC7227779 DOI: 10.1016/j.jsxm.2019.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Men who have sex with men (MSM) are suboptimally engaged in efficacious HIV interventions, due in part to stigma. AIM We sought to validate the Anal Health Stigma Model, developed based on theory and prior qualitative data, by testing the magnitude of associations between measures of anal sex stigma and engagement in HIV prevention practices, while adjusting for covariates. METHODS We conducted a cross-sectional online survey of 1,263 cisgender MSM living in the United States and analyzed data with structural equation modeling. We tested a direct path from Anal Sex Stigma to Engagement in HIV Prevention alongside 2 indirect paths, 1 through Anal Sex Concerns and another through Comfort Discussing Anal Sexuality with Health Workers. The model adjusted for Social Support, Everyday Discrimination, and Sociodemographics. MAIN OUTCOME MEASURE Engagement in HIV Prevention comprised an ad hoc measure of (i) lifetime exposure to a behavioral intervention, (ii) current adherence to biomedical intervention, and (iii) consistent use of a prevention strategy during recent penile-anal intercourse. RESULTS In the final model, anal sex stigma was associated with less engagement (β = -0.22, P < .001), mediated by participants' comfort talking about anal sex practices with health workers (β = -0.52; β = 0.44; both P < .001), adjusting for covariates (R2 = 67%; χ2/df = 2.98, root mean square error of approximation = 0.040, comparative fit index = 0.99 and Tucker-Lewis index = 0.99). Sex-related concerns partially mediated the association between stigma and comfort (β = 0.55; β = 0.14, both P < .001). Modification indices also supported total effects of social support on increased comfort discussing anal sex (β = 0.35, P < .001) and, to a lesser degree, on decreased sex-related concerns (β = -0.10; P < .001). CLINICAL IMPLICATIONS Higher stigma toward anal sexuality is associated with less engagement in HIV prevention, largely due to discomfort discussing anal sex practices with health workers. STRENGTH & LIMITATIONS Adjustment for mediation in a cross-sectional design cannot establish temporal causality. Self-report is vulnerable to social desirability and recall bias. Online samples may not represent cisgender MSM in general. However, findings place HIV- and health-related behaviors within a social and relational context and may suggest points for intervention in health-care settings. CONCLUSION Providers' willingness to engage in discussion about anal sexuality, for example, by responding to questions related to sexual well-being, may function as social support and thereby bolster comfort and improve engagement in HIV prevention. Kutner BA, Simoni JM, King KM, et al. Does Stigma Toward Anal Sexuality Impede HIV Prevention Among Men Who Have Sex With Men in the United States? A Structural Equation Modeling Assessment. J Sex Med 2020;17:477-490.
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Affiliation(s)
- Bryan A Kutner
- The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA.
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin M King
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | | | - Emma Creegan
- Brown University School of Public Health, Providence, RI, USA
| | - Frances M Aunon
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Stefan D Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health University of Minnesota School of Public Health, Minneapolis, MN, USA
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499
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Peluso MJ, Dee L, Campbell D, Taylor J, Hoh R, Rutishauser RL, Sauceda J, Deeks SG, Dubé K. A collaborative, multidisciplinary approach to HIV transmission risk mitigation during analytic treatment interruption. J Virus Erad 2020; 6:34-37. [PMID: 32175090 PMCID: PMC7043899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Analytic treatment interruptions (ATIs) are currently the standard for assessing the impact of experimental interventions aimed at inducing sustained antiretroviral therapy (ART)-free remission in trials related to HIV cure. ATIs are associated with substantial risk to both study participants and their sexual partner(s). Two documented HIV transmissions occurring in the context of ATIs have been recently reported, but recommendations for mitigating the risk of such events during ATIs are limited. We outline a practical approach to risk mitigation during ATI studies and describe strategies we are utilising in an upcoming clinical trial that may be applicable to other centres.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA,Corresponding author: Michael J Peluso,
995 Potrero Ave, Building 80,
San Francisco,
CA94110,
USA
| | - Lynda Dee
- AIDS Action Baltimore,
Baltimore,
MD,
USA,amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Delaney AIDS Research Enterprise Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA
| | - Danielle Campbell
- amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Delaney AIDS Research Enterprise Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA,Charles R Drew University of Medicine and Science, Los Angeles,
CA,
USA
| | - Jeff Taylor
- amfAR Institute for HIV Cure Research Community Advisory Board,
USA,Martin Delaney Collaboratory Community Advisory Board,
USA,University of California, San Diego Antiviral Research Center Community Advisory Board,
San Diego,
CA,
USA,HIV+Aging Research Project, Palm Springs,
CA,
USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA
| | | | - John Sauceda
- Center for AIDS Prevention Studies,
UCSF,
San Francisco,
CA,
USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine,
University of California, San Francisco,
San Francisco,
CA,
USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
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500
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Caetano DG, de Paula HHS, Bello G, Hoagland B, Villela LM, Grinsztejn B, Veloso VG, Morgado MG, Guimarães ML, Côrtes FH. HIV-1 elite controllers present a high frequency of activated regulatory T and Th17 cells. PLoS One 2020; 15:e0228745. [PMID: 32023301 PMCID: PMC7001932 DOI: 10.1371/journal.pone.0228745] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022] Open
Abstract
HIV-1 infection is characterized by generalized deregulation of the immune system, resulting in increased chronic immune activation. However, some individuals called HIV controllers (HICs) present spontaneous control of viral replication and have a more preserved immune system. Among HICs, discordant results have been observed regarding immune activation and the frequency of different T cell subsets, including Treg and Th17 cells. We evaluated T cell immune activation, differentiation and regulatory profiles in two groups of HICs—elite controllers (ECs) and viremic controllers (VCs)—and compared them to those of cART-treated individuals (cART) and HIV-1-negative (HIV-neg) individuals. ECs demonstrated similar levels of activated CD4+ and CD8+ T cells in comparison to HIV-neg, while cART and VCs showed elevated T cell activation. CD4+ T cell subset analyses showed differences only for transitional memory T cell frequency between the EC and HIV-neg groups. However, VC individuals showed higher frequencies of terminally differentiated, naïve, and stem cell memory T cells and lower frequencies of transitional memory and central memory T cells compared to the HIV-neg group. Among CD8+ T cell subsets, ECs presented higher frequencies of stem cell memory T cells, while VCs presented higher frequencies of terminally differentiated T cells compared to the HIV-neg group. HICs showed lower frequencies of total Treg cells compared to the HIV-neg and cART groups. ECs also presented higher frequencies of activated and a lower frequency of resting Treg cells than the HIV-neg and cART groups. Furthermore, we observed a high frequency of Th17 cells in ECs and high Th17/Treg ratios in both HIC groups. Our data showed that ECs had low levels of activated T cells and a high frequency of activated Treg and Th17 cells, which could restrict chronic immune activation and be indicative of a preserved mucosal response in these individuals.
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Affiliation(s)
- Diogo G. Caetano
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Hury H. S. de Paula
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Gonzalo Bello
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Larissa M. Villela
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas—INI, FIOCRUZ, Rio de Janeiro, Brazil
| | - Mariza G. Morgado
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Monick L. Guimarães
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
| | - Fernanda H. Côrtes
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz–IOC, FIOCRUZ, Rio de Janeiro, Brazil
- * E-mail: ,
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