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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Scaramutti C, Hervera B, Rivera Y, Chueng TA, Forrest DW, Suarez E, Serota DP, Alkamli H, Ciraldo K, Bartholomew TS, Tookes HE. Improving access to HIV care among people who inject drugs through tele-harm reduction: a qualitative analysis of perceived discrimination and stigma. Harm Reduct J 2024; 21:50. [PMID: 38396017 PMCID: PMC10893685 DOI: 10.1186/s12954-024-00961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Tele-harm reduction (THR) is a telehealth-enhanced, peer-led, harm reduction intervention delivered within a trusted syringe services program (SSP) venue. The primary goal of THR is to facilitate linkage to care and rapid, enduring virologic suppression among people who inject drugs (PWID) with HIV. An SSP in Miami, Florida, developed THR to circumvent pervasive stigma within the traditional healthcare system. METHODS During intervention development, we conducted in-depth interviews with PWID with HIV (n = 25) to identify barriers and facilitators to care via THR. We employed a general inductive approach to transcripts guided by iterative readings of the raw data to derive the concepts, themes, and interpretations of the THR intervention. RESULTS Of the 25 PWID interviewed, 15 were in HIV care and adherent to medication; 4 were in HIV care but non-adherent; and 6 were not in care. Themes that emerged from the qualitative analysis included the trust and confidence PWID have with SSP clinicians as opposed to professionals within the traditional healthcare system. Several barriers to treatment were reported among PWID, including perceived and actual discrimination by friends and family, negative internalized behaviors, denial of HIV status, and fear of engaging in care. Facilitators to HIV care included empathy and respect by SSP staff, flexibility of telehealth location, and an overall destigmatizing approach. CONCLUSION PWID identified barriers and facilitators to receipt of HIV care through the THR intervention. Interviews helped inform THR intervention development, centered on PWID in the destigmatizing environment of an SSP.
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Affiliation(s)
- Carolina Scaramutti
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Belén Hervera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yanexy Rivera
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teresa A Chueng
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hatoun Alkamli
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Department of Family and Community Medicine & Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- 2Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Acceptability, feasibility, and pilot results of the tele-harm reduction intervention for rapid initiation of antiretrovirals among people who inject drugs. Drug Alcohol Depend 2021; 229:109124. [PMID: 34781096 PMCID: PMC9102418 DOI: 10.1016/j.drugalcdep.2021.109124] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/25/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have been a marginalized and a stigmatized population since the beginning of the AIDS epidemic and have not experienced the same life-changing benefits of antiretroviral therapy as others. Tele-Harm Reduction (THR) is a telehealth-enhanced, harm reduction intervention, delivered within a trusted SSP venue. It aims to facilitate initiation of care and achieve rapid HIV viral suppression among PWID living with HIV. METHODS In this mixed-methods study, we employed the Practical, Robust, Implementation and Sustainability Model (PRISM) implementation science framework to identify multilevel barriers and facilitators to implementing the THR intervention. Focus groups (n = 2, 16 participants), stakeholder interviews (n = 7) and in-depth interviews were conducted with PWID living with HIV (n = 25). In addition, to assess feasibility and acceptability, we pilot tested the THR intervention and reported viral suppression at 6 months. RESULTS Focus groups and stakeholder interviews revealed system and organizational level barriers to implementation including requirements for identification and in person visits, waiting times, stigma, case management inexperience, multiple electronic health records, and billing. A potential facilitator was using telehealth for case management and initial provider visit. In the in depth interviews conducted with PWID living with HIV, participants expressed that the SSP creates a convenient, comfortable, confidential environment for delivering multiple, non-stigmatizing PWID-specific services. 35 PWID living with HIV were enrolled in the pilot study, 35 initiated antiretroviral therapy, and 25 (78.1%) were virally suppressed at six months. CONCLUSION Rooted in harm reduction, the THR intervention shows promise in being an acceptable and feasible intervention that may facilitate engagement in HIV care and viral suppression among PWID.
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Mirzazadeh A, Chen YH, Lin J, Burk K, Wilson EC, Miller D, Veloso D, McFarland W, Morris MD. Progress toward closing gaps in the hepatitis C virus cascade of care for people who inject drugs in San Francisco. PLoS One 2021; 16:e0249585. [PMID: 33798243 PMCID: PMC8018615 DOI: 10.1371/journal.pone.0249585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV). Data tracking the engagement of PWID in the continuum of HCV care are needed to assess the reach, target the response, and gauge impact of HCV elimination efforts. Methods We analyzed data from the National HIV Behavioral Surveillance (NHBS) surveys of PWID recruited via respondent driven sampling (RDS) in San Francisco in 2018. We calculated the number and proportion who self-reported ever: (1) tested for HCV, (2) tested positive for HCV antibody, (3) diagnosed with HCV, (4) received HCV treatment, (5) and attained sustained viral response (SVR). To assess temporal changes, we compared 2018 estimates to those from the 2015 NHBS sample. Results Of 456 PWID interviewed in 2018, 88% had previously been tested for HCV, 63% tested antibody positive, and 50% were diagnosed with HCV infection. Of those diagnosed, 42% received treatment. Eighty-one percent of those who received treatment attained SVR. In 2015 a similar proportion of PWID were tested and received an HCV diagnosis, compared to 2018. However, HCV treatment was more prevalent in the 2018 sample (19% vs. 42%, P-value 0.01). Adjusted analysis of 2018 survey data showed having no health insurance (APR 1.6, P-value 0.01) and having no usual source of health care (APR 1.5, P-value 0.01) were significantly associated with untreated HCV prevalence. Conclusion While findings indicate an improvement in HCV treatment uptake among PWID in San Francisco, more than half of PWID diagnosed with HCV infection had not received HCV treatment in 2018. Policies and interventions to increase coverage are necessary, particularly among PWID who are uninsured and outside of regular care.
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Affiliation(s)
- Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Yea-Hung Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jess Lin
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Katie Burk
- Community Health Equity and Promotion Branch, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Erin C. Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Desmond Miller
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Danielle Veloso
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
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Rao S, Song W, Mulatu MS, Seena E, Essuon A, Heitgerd J. Human Immunodeficiency Virus Testing, Diagnosis, Linkage to Care, and Prevention Services Among Persons Who Inject Drugs, United States, 2012-2017. J Infect Dis 2021; 222:S268-S277. [PMID: 32877556 DOI: 10.1093/infdis/jiaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) testing and early diagnosis is associated with effective disease management and reduction in HIV transmission among persons who inject drugs (PWID). We examined trends in HIV testing outcomes among PWID during 2012-2017. METHODS Centers for Disease Control and Prevention (CDC)-funded HIV testing data submitted by 61 health departments and 150 directly-funded community-based organizations during 2012-2017 were analyzed. We calculated estimated annual percentage changes (EAPC) to assess trends for HIV testing and testing outcomes. RESULTS A total of 19 739 857 CDC-funded HIV tests were conducted during 2012-2017. Of these, 529 349 (2.7%) were among PWID. The percentage of newly diagnosed HIV increased from .7% in 2012 to .8% in 2017 (EAPC, 4.15%). The percentage interviewed for partner services increased from 46.7% in 2012 to 66.3% in 2017 (EAPC, 1.81%). No significant change was identified in trends for linkage to HIV medical care ≤90 days after diagnosis (EAPC, 0.52%) or referral to HIV prevention services (EAPC, 0.98%). CONCLUSIONS Human immunodeficiency virus testing data revealed an increasing trend in newly diagnosed HIV among PWID but not linkage to HIV medical care or referral to prevention services. Expanding efforts to increase HIV testing and enhance linkage to services can lead to reductions in HIV transmission and improved health outcomes.
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Affiliation(s)
- Shubha Rao
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Song
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mesfin S Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emilie Seena
- Northrop Grumman Corporation, Atlanta, Georgia, USA
| | - Aba Essuon
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Heitgerd
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Krebs E, Zang X, Enns B, Min JE, Behrends CN, Del Rio C, Dombrowski JC, Feaster DJ, Gebo KA, Marshall BDL, Mehta SH, Metsch LR, Pandya A, Schackman BR, Strathdee SA, Nosyk B. Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities. J Infect Dis 2021; 222:S301-S311. [PMID: 32877548 DOI: 10.1093/infdis/jiaa130] [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: 11/13/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities. METHODS Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US). RESULTS Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%-13.2%) in Seattle and 54.4% (CI, 37.6%-73.9%) in Miami. Incidence reduction reached 16.1%-75.5% at ideal scale. CONCLUSIONS Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.
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Affiliation(s)
- Emanuel Krebs
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Xiao Zang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Benjamin Enns
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jeong E Min
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
| | - Carlos Del Rio
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kelly A Gebo
- School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
| | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
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Tookes H, Bartholomew TS, Geary S, Matthias J, Poschman K, Blackmore C, Philip C, Suarez E, Forrest DW, Rodriguez AE, Kolber MA, Knaul F, Colucci L, Spencer E. Rapid Identification and Investigation of an HIV Risk Network Among People Who Inject Drugs -Miami, FL, 2018. AIDS Behav 2020; 24:246-256. [PMID: 31555932 PMCID: PMC6954140 DOI: 10.1007/s10461-019-02680-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States. The first legal syringe services program (SSP) in Florida implemented routine screening in 2018 leading to the identification of ten anonymous HIV seroconversions. The SSP collaborated with the Department of Health to conduct an epidemiologic investigation. All seven acute HIV seroconversions were linked to care (86% within 30 days) and achieved viral suppression (mean 70 days). Six of the seven individuals are epidemiologically and/or socially linked to at least two other seroconversions. Analysis of the HIV genotypes revealed that two individuals are connected molecularly at 0.5% genetic distance. We identified a risk network with complex transmission dynamics that could not be explained by epidemiological methods or molecular analyses alone. Providing wrap-around services through the SSP, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.
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Affiliation(s)
- Hansel Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | | | - Shana Geary
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - James Matthias
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of STD Prevention, Atlanta, GA, USA
| | - Karalee Poschman
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Carina Blackmore
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Celeste Philip
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
| | - Edward Suarez
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
| | - David W Forrest
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
| | | | - Michael A Kolber
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
| | - Felicia Knaul
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
| | - Leah Colucci
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
| | - Emma Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL, USA
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How are transgender women acquiring HIV? Insights from phylogenetic transmission clusters in San Francisco. AIDS 2019; 33:2073-2079. [PMID: 31335804 DOI: 10.1097/qad.0000000000002318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We explored potential HIV transmission typologies that involve transgender women to obtain insights on sexual and needle-sharing networks as sources of HIV infection. DESIGN San Francisco residents diagnosed with HIV in care at public facilities who had available viral pol sequences from June 2001 to January 2016 were included in the analysis. METHODS Viral sequence data were matched to the San Francisco HIV/AIDS Case Registry to obtain demographic and risk classification information. Transmission clusters with at least two cases were identified by bootstrap values at least 90% and mean pairwise genetic distances 0.025 or less substitutions per site. RESULTS Transgender women represented 275 of 5200 patients; 86 were present in 70 clusters. Four typologies were hypothesized: first, transgender women in clusters with MSM; second, transgender women who inject drugs in clusters with cisgender women and men who inject drugs; third, multiple transgender women in clusters with one man; and fourth, multiple transgender women who do not inject drugs in clusters with men and cisgender women who inject drugs. CONCLUSION Transmission patterns of transgender women may stand apart from MSM epidemics. Transgender women clustered with people who inject drugs, and with men who have sex with transgender women and cisgender women. Aggregation of transgender women into the category of MSM may obscure understanding of how they acquire HIV and to whom they may transmit infection. Phylogenetic insights strengthen the case that HIV prevention programs for MSM may not be applicable to transgender women or their partners.
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