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Sokale I, Wilkerson J, Wermuth P, Atem F, Burnett J, Wejnert C, Khuwaja S, Troisi C. Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs. AIDS Behav 2024; 28:2793-2803. [PMID: 38822083 DOI: 10.1007/s10461-024-04369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/02/2024]
Abstract
Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23-1.31) and SSP participation (aPR 1.19, 95% CI 1.13-1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00-1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment.
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Affiliation(s)
- Itunu Sokale
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Johnny Wilkerson
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paige Wermuth
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA
| | - Folefac Atem
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janet Burnett
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salma Khuwaja
- Disease Prevention and Control Division, Houston Health Department, Houston, TX, USA
| | - Catherine Troisi
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Room RAS E927, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Evans KN, Vettese T, Wortley PM, Gandhi AP, Bradley H. HIV and HCV testing at clinical encounters among people who inject drugs, 2013-2018-Opportunities for increased testing and prevention. J Viral Hepat 2023; 30:848-858. [PMID: 37726974 DOI: 10.1111/jvh.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023]
Abstract
People who inject drugs (PWID) with unsafe injection practices have substantial risk for HIV and hepatitis C virus (HCV) infections. We describe frequency of, and factors associated with, HIV and HCV testing during clinical encounters with PWID. Inpatient and Emergency Department clinical encounters at an Atlanta hospital were abstracted from medical records spanning January 2013-December 2018. We estimated frequency of HIV and HCV testing during injection drug use (IDU)-related encounters among PWID without previous diagnoses. We assessed associations between patient factors and testing using generalized estimating equations models. HIV testing occurred in 39.3% and HCV testing occurred in 17.1% of eligible IDU-related encounters. Testing was more likely in IDU-related encounters during 2017-2018 than in encounters during 2013-2014; (HIV, AOR = 2.14, 95% CI, 1.32-3.49, p < .01). Testing was less likely among Black/African American patients compared to White patients (adjusted odds ratio [AOR]: HIV, AOR = 0.48, 95% confidence interval [CI], 0.33-0.72, p < .01); HCV, AOR = 0.41, 95% CI, 0.24-0.70, p < .01). This difference may be attributable to recent testing among Black patients in non-IDU related encounters. HIV and HCV testing improved over time; however, missed opportunities for testing still existed. Strategies should aim to improve equitable HIV and HCV testing among PWID.
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Affiliation(s)
- Kimberly N Evans
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Theresa Vettese
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Ami P Gandhi
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
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Roshanfekr P, Karimi SE, Narouee S, Moftakhar L, Vameghi M, Ali D, Higgs P, Soleimanvandiazar N. Life-time HIV testing among people who inject drugs in Iran: results from the National Rapid Assessment and Response survey. Front Public Health 2023; 11:1253407. [PMID: 37915820 PMCID: PMC10616789 DOI: 10.3389/fpubh.2023.1253407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023] Open
Abstract
Background HIV testing is recommended for people who inject drugs (PWID). The aim of this study was to determine the prevalence of lifetime HIV testing among PWID and to better understand the predictors for HIV testing in a convenience sample across Iran. Materials and methods This study is a secondary analysis of Iran's National Rapid Assessment and Response survey conducted between October 2016 and March 2017. Analysis includes the 999 people who reported injecting drugs across the capital cities of 21 provinces. Data were collected by using the venue-based application of the Time Location Sampling (TLS) frame. Chi-square tests were used to examine the difference between HIV testing across different quantitative variables. Logistic regression was used to determine the predictors of life-time HIV testing. Analysis was performed using STATA V.12 software with a significance level of 95%. Results Most participants were male (n = 902, 93.50%), and over half (n = 555, 59.17%) were older than 35 years old. About one-third, (n = 326, 38%) of people interviewed were single and another one-third (n = 251, 29%) reported being divorced. Over two-thirds of participants (n = 678, 69.78%) in this study reported lifetime HIV testing. The results from a multiple variable logistic regression showed people with a university education were more likely to have been previously tested for HIV than illiterate people (OR = 18.87, 95%CI 2.85-124.6, value of p = 0.002). Those individuals who reported ever receiving methadone treatment were 2.8 times more likely to have been tested for HIV than individuals without methadone treatment experience (OR = 2.89, 95%CI 1.53-5.42, value of p < 0.001). Needle syringe sharing in last month, was negatively associated with life-time HIV testing (OR = 0.29, 95%CI 0.17-0.48, value of p < 0.001). Conclusion Despite Iran's wide availability and access to counseling services for HIV testing in key populations, the proportion of PWID being tested for HIV could be improved. Developing effective strategies to increase people's understanding and awareness of the importance of and need for HIV prevention and familiarity with HIV testing sites is an essential step in increasing HIV testing for this population. Studies on more recent HIV testing are required to better assess and understand the frequency of HIV testing among PWID in Iran.
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Affiliation(s)
- Payam Roshanfekr
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Narouee
- Department of Statistics and Epidemiology, Faculty of Health, Kerman University Medical of Sciences, Kerman, Iran
| | - Leila Moftakhar
- Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Delaram Ali
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, VIC, Australia
| | - Neda Soleimanvandiazar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Evans KN, Vettese T, Wortley PM, Gandhi AP, Bradley H. Missed opportunities for prevention: prevalence and incidence of human immunodeficiency virus and hepatitis C virus diagnoses among a cohort of individuals discharged from an urban hospital with injection drug-related diagnoses, 2012-2019. Ann Epidemiol 2023; 80:69-75.e2. [PMID: 36791871 DOI: 10.1016/j.annepidem.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections has increased due to the ongoing opioid epidemic and unsafe injection practices. We estimated the prevalence and incidence of HIV and HCV diagnoses among people who inject drugs from hospital-based clinical encounters. METHODS We linked clinical encounters at an Atlanta hospital during 2012-2018 with state HIV and HCV surveillance records to examine the prevalence of infections at discharge and incidence of infections post clinical encounter. RESULTS At discharge, 32.9% and 28.6% of patients with injection drug use-related clinical encounters had an HIV or HCV diagnosis, respectively. HIV and HCV diagnoses at the time of discharge were mostly among 40-64 years old patients, males, and Black/African Americans. Post clinical encounter, 3.8% of patients were later diagnosed with HIV, and 16.5% were later diagnosed with HCV, translating to incidence rates of 9.3 per 1000 person-years and 41.5 per 1000 person-years, respectively. The majority of HIV and HCV diagnoses post clinical encounter occurred among Black/African Americans and males. Of patients with HIV and HCV diagnoses post clinical encounter, 27.3% and 11.9% had been tested during their clinical encounter, respectively. CONCLUSIONS Targeted interventions for HIV/HCV prevention, screening, diagnosis, and linkage to treatment are needed to reduce the incidence of new infections among people who inject drugs.
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Affiliation(s)
- Kimberly N Evans
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta.
| | - Theresa Vettese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pascale M Wortley
- Department of Population Health Sciences, Georgia Department of Public Health, Atlanta, GA, USA
| | - Ami P Gandhi
- Department of Population Health Sciences, Georgia Department of Public Health, Atlanta, GA, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta
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Olakunde BO, Pharr JR, Adeyinka DA, Conserve DF. Nonuptake of HIV Testing Among Transgender Populations in the United States: Results from the 2015 U.S. Transgender Survey. Transgend Health 2022; 7:430-439. [PMID: 36644483 PMCID: PMC9829162 DOI: 10.1089/trgh.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose In this study, we examined the nonuptake of HIV testing and the main reasons for never testing among transgender populations. Methods Data on 26,927 respondents from the 2015 U.S. Transgender Survey were analyzed in this study. The main reasons for never testing were categorized as low risk perception; access related; fear or HIV-related stigma; and others. We performed weighted descriptive statistics and multivariable logistic regression analyses, controlling for sociodemographic characteristics and sexual orientation. Results Forty-five percent of the respondents had never tested for HIV. Trans women (adjusted odds ratio [aOR]=1.1, 95% confidence interval [CI]=1.07-1.25) and assigned female at birth genderqueer/nonbinary individuals (AFAB GQ/NB) (aOR=1.3, 95% CI=1.16-1.35) had significantly higher odds of reporting never testing for HIV compared with trans men. The most reported reason for never testing was low risk perception (87%). AFAB GQ/NB (aOR=1.4, 95% CI=1.22-1.66) had significantly higher odds of reporting low risk perception as the main reason for never testing for HIV relative to trans men. AFAB GQ/NB were less likely to report access related as the main reason for never testing (aOR=0.8, 95% CI=0.56-0.95). The odds of trans women and assigned male at birth GQ/NB individuals reporting fear or HIV-related stigma as the main reason for never testing were 1.7 (95% CI=1.13-2.55) and 2.8 (95% CI=1.69-4.70) times that of trans men. Both trans women (aOR=0.8, 95% CI=0.65-0.97) and AFAB GQ/NB (aOR=0.7, 95% CI=0.60-0.88) had lower odds of reporting others. The main reasons for never testing also varied by sociodemographic factors, including age, educational attainment, race/ethnicity, employment status, poverty, and sexual orientation. Conclusions HIV testing is suboptimal among transgender populations. Our findings also suggest that barriers to HIV testing vary by transgender populations, thus interventions for improved uptake should be population specific.
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Affiliation(s)
- Babayemi O. Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Daniel A. Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Donaldson F. Conserve
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, District of Columbia, USA
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Jawa R, Stein MD, Anderson B, Liebschutz JM, Stewart C, Phillips KT, Barocas JA. Behavioral Risk Factors for HIV Infection in Hospitalized Persons Who Co-use Stimulants and Opioids. AIDS Behav 2022; 26:1047-1055. [PMID: 34510289 PMCID: PMC8435119 DOI: 10.1007/s10461-021-03460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/03/2023]
Abstract
We investigated the association of 90-day opioid and stimulant co-use and HIV risk behaviors in a cross-sectional analysis of hospitalized HIV-negative people who inject drugs (PWID). We compared those injecting opioids alone to two sub-groups who co-used opioids with (1) cocaine, (2) amphetamine-type stimulants (ATS), on sex and injection drug risk behaviors assessed via the Risk Assessment Battery (RAB), where a higher score indicates a higher risk. Of 197 participants who injected opioids, 53% co-used cocaine only, 5% co-used ATS only, 18% co-used both cocaine and ATS, 24% co-used neither stimulant. PWID who injected opioids alone had a mean RAB drug risk score of 5.98 points and sex risk score of 2.16 points. Compared to PWID who injected opioids alone, PWID who co-used stimulants had higher mean drug risk RAB scores: cocaine, b = 2.84 points [95% confidence interval (CI) 1.01; 4.67]; ATS, b = 3.43 points (95% CI 1.29; 5.57). Compared to PWID who injected opioids alone, cocaine co-use was associated with higher sex RAB scores b = 1.06 points (95% CI 0.32; 1.79). Overall, we found a significant association between stimulant co-use and higher HIV sex and drug risk scores.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Michael D Stein
- Boston University School of Public Health, Boston, MA, USA
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Bradley Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Jane M Liebschutz
- Division of General Internal Medicine, Center for Research On Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Honolulu, Honolulu, HI, USA
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, USA
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Cyrus E, Johnson SA, Perez-Gilbe HR, Wuyke G, Fajardo FJ, Garba NA, Deviéux J, Jimenez D, Garcia S, Holder CL. Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida. Transgend Health 2022; 7:52-60. [PMID: 35224190 PMCID: PMC8867217 DOI: 10.1089/trgh.2020.0066] [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: 11/12/2022] Open
Abstract
Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.
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Affiliation(s)
- Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA.,*Address correspondence to: Elena Cyrus, PhD, MPH, Department of Population Health Sciences, College of Medicine, University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA,
| | - Shaina A. Johnson
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Hector R. Perez-Gilbe
- Health Sciences UCI Libraries, University of California-Irvine, Irvine, California, USA
| | - Gabriella Wuyke
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Francisco J. Fajardo
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Nana Aisha Garba
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jessy Deviéux
- Robert Stempel College of Public Health and Social Work, Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, USA
| | - Daniel Jimenez
- Robert Stempel College of Public Health and Social Work, School of Social Work, Florida International University, Miami, Florida, USA
| | - Stephanie Garcia
- Integrated Biostatistics and Data Management Center, Florida International University, Miami, Florida, USA
| | - Cheryl L. Holder
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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Peruski AH, Wu B, Linley L, Delaney KP, DiNenno EA, Johnson AS. Time From HIV Infection to Diagnosis in the U.S., 2014-2018. Am J Prev Med 2021; 61:636-643. [PMID: 34217552 PMCID: PMC11010647 DOI: 10.1016/j.amepre.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/15/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Understanding the role of sociologic, structural, and biomedical factors that influence the length of time from HIV infection to diagnosis and reducing the time from infection to diagnosis are critical for achieving the goals of the Ending the HIV Epidemic initiative. In a retrospective analysis, the length of time from HIV infection to diagnosis and its association with individual- and facility-level attributes are determined. METHODS Data reported by December 2019 to the U.S. National HIV Surveillance System for people with HIV diagnosed during 2014-2018 were analyzed during December 2020. A CD4 depletion model was used to estimate the time from HIV infection to diagnosis. RESULTS During 2018, the median time from HIV infection to diagnosis was shorter for those infections diagnosed using the rapid testing algorithm (30.3 months, 95% CI=25.5, 34.5) than those diagnosed using the recommended (41.0 months, 95% CI=39.5, 42.0), traditional (37.0 months, 95% CI=29.5, 43.5), or other (35.5 months, 95% CI=32.5, 38.0) diagnostic testing algorithms. From 2014 to 2018, the time from HIV infection to diagnosis remained stable overall for all testing methods except for the traditional diagnostic testing algorithm. In multivariate analyses, those more likely to have HIV diagnosed closer to the time of infection were younger, were White, had transmission risk factors of injection drug use or heterosexual contact (for female individuals) or male-to-male sexual contact and injection drug use, or had HIV diagnosed at a correctional or screening facility (p<0.01). CONCLUSIONS Providing access to expanded testing, including rapid testing in nonclinical settings, is likely to result in a decrease in the length of time a person is unaware of their HIV infection and thus reduce onward transmission of HIV infection.
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Affiliation(s)
- Anne H Peruski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Baohua Wu
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurie Linley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin P Delaney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth A DiNenno
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Trayner KMA, Palmateer NE, McAuley A, Metcalfe R, Goldberg DJ, Peters E, Craik J, Gunson RN, Thain D, Carter D, Hutchinson SJ. Evaluation of the scale-up of HIV testing among people who inject drugs in Scotland in the context of an ongoing HIV outbreak. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103304. [PMID: 34325970 DOI: 10.1016/j.drugpo.2021.103304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND A large outbreak of HIV among people who inject drugs (PWID) has been ongoing in Glasgow city centre (GCC), Scotland since early 2015. The outbreak is associated with high levels of homelessness, cocaine injecting and injecting in public places. A key component of the public health response was the scale-up of HIV testing in a range of services engaged with PWID. Our aims were to: 1) evaluate the extent of and change in HIV testing over the course of the outbreak and 2) examine factors associated with reporting an HIV test. METHODS Self-report of an HIV test in the last 12 months was collected for 15,081 PWID interviewed in six national cross-sectional bio-behavioural surveys during 2008-2018. Multi-variate logistic regression was undertaken to determine trends in HIV testing by region of recruitment (GCC; rest of Glasgow; other Scottish city centres (SCC); and rest of Scotland) and outbreak period (pre: 2008-14; early: 2015-16; ongoing: 2017-18). RESULTS HIV testing increased across all regions and was most pronounced in GCC comparing the ongoing (67%) to the pre-outbreak period (33%) (aOR=4.68, 95% CI 3.23 to 6.77, p<0.001). However, compared to other SCCs pre-outbreak (with 46% reporting testing), those recruited in GCC had a lower odds of HIV testing early outbreak (aOR=0.37, 95% CI 0.27 to 0.54, p<0.001) and more modest increased odds in the ongoing outbreak period (aOR=1.41, 95% CI 0.97 to 2.05, p=0.069). Among PWID recruited in the whole of Glasgow in the ongoing phase, reporting an HIV test was associated with injecting cocaine or in public places (aOR=2.20, 95% CI 1.53 to 3.17, p<0.001), receipt of methadone (aOR=1.48, 95% CI 1.01 to 2.17, p=0.042) and incarceration in the last year (aOR=1.72, 95% CI 1.18 to 2.51, p=0.004). CONCLUSIONS Relatively low levels of HIV testing pre- and early-outbreak likely hindered efforts to control the spread of infection among PWID in Glasgow. Uptake has since increased with expansion of testing across multiple settings, particularly among those at high risk of infection. Further effort is needed to ensure the vast majority of PWID are regularly tested, not just in the epicentre of the outbreak but in other areas with low population prevalence of infection.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Rebecca Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Erica Peters
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Julie Craik
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Donna Thain
- Sexual Health and Blood-Borne Viruses, Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Daniel Carter
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
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Furukawa NW, Blau EF, Reau Z, Carlson D, Raney ZD, Johnson TK, Deputy NP, Sami S, McClung RP, Neblett-Fanfair R, de Fijter S, Ingram T, Thoroughman D, Vogel S, Lyss SB. Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use-Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak-Cincinnati/Northern Kentucky, 2017-2018. Clin Infect Dis 2021; 72:1961-1967. [PMID: 32748940 DOI: 10.1093/cid/ciaa507] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. METHODS PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017-September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. RESULTS Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70-4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10-2.82). CONCLUSIONS PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.
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Affiliation(s)
- Nathan W Furukawa
- 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.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin F Blau
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA.,Kentucky Department for Public Health, Frankfort, Kentucky, USA
| | - Zach Reau
- Ohio Department of Health, Columbus, Ohio, USA
| | - David Carlson
- Hamilton County Public Health, Cincinnati, Ohio, USA
| | - Zachary D Raney
- Northern Kentucky Health Department, Florence, Kentucky, USA
| | - Tisha K Johnson
- Kentucky Department for Public Health, Frankfort, Kentucky, USA
| | - Nicholas P Deputy
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA.,Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samira Sami
- 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.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert P McClung
- 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.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Robyn Neblett-Fanfair
- 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.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | | | - Tim Ingram
- Hamilton County Public Health, Cincinnati, Ohio, USA
| | - Doug Thoroughman
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA.,Kentucky Department for Public Health, Frankfort, Kentucky, USA.,Career Epidemiology Field Officer Program, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Vogel
- Northern Kentucky Health Department, Florence, Kentucky, USA
| | - Sheryl B Lyss
- 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.,US Public Health Service Commissioned Corps, Rockville, Maryland, USA
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11
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Bartholomew TS, Tookes HE, Serota DP, Behrends CN, Forrest DW, Feaster DJ. Impact of routine opt-out HIV/HCV screening on testing uptake at a syringe services program: An interrupted time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102875. [PMID: 32731112 PMCID: PMC8814936 DOI: 10.1016/j.drugpo.2020.102875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023]
Abstract
Background: Hepatitis C (HCV) is the most common infectious disease among people who inject drugs (PWID). Engaging PWID in harm reduction services, such as syringe service programs (SSPs), is critical to reduce HCV and HIV transmission. Additionally, testing for HIV and HCV among PWID is important to improve diagnosis and linkage to care. On March 1, 2018, Florida’s only legal SSP implemented bundled opt-out HIV/HCV testing at enrollment. We aimed to examine the differences in HIV/HCV testing uptake before and after the implementation of the opt-out testing policy. Methods: Multivariable logistic regression was used to assess predictors of accepting HIV/HCV tests, controlling for opt-in and opt-out policy. Monthly estimates of the percent of participants accepting an HIV test, HCV test, or both were generated. Interrupted Time Series (ITS) analysis evaluated the immediate policy impact on level of uptake and trend in uptake over time for bundled HIV/HCV testing before and after the opt-out testing policy. Results: The total study period was 37 months between December 2016–January 2020 with 512 SSP participants 15 months prior and 547 SSP participants 22 months after implementation of bundled HIV/HCV opt-out testing. Significant predictors of accepting both HIV/HCV tests were cocaine injection (aOR = 2.36), self-reported HIV positive status (aOR = 0.39) and self-reported HCV positive status (aOR = 0.27). Based on the ITS results, there was a significant increase in uptake of HIV/HCV testing by 42.4% (95% CI: 26.2%–58.5%, p < 0.001) immediately after the policy change to opt-out testing. Conclusion: Bundled opt-out HIV/HCV testing substantially increased the percentage of SSP clients who received HIV and HCV rapid tests at enrollment into the program, and the effect remained stable across the 22 months post opt-out testing policy. Future investigation must assess PWID-level perspective of testing preferences and examine whether this testing approach improves HIV/HCV detection among PWID previously unaware of their status.
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Affiliation(s)
- Tyler S Bartholomew
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Czarina N Behrends
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - David W Forrest
- Department of Anthropology, College of Arts and Sciences, University of Miami, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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12
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Bayani A, Ghiasvand H, Rezaei O, Fattah Moghaddam L, Noroozi A, Ahounbar E, Higgs P, Armoon B. Factors associated with HIV testing among people who inject drugs: a meta-analysis. J Addict Dis 2020; 38:361-374. [DOI: 10.1080/10550887.2020.1771235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke's Campus, University of Exeter, Exeter, UK
| | - Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of nursing, faculty of nursing and midwifery, Tehran medical sciences, Islamic Azad University, Tehran, Iran
| | - Alireza Noroozi
- Psychiatrist, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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13
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Zlotorzynska M, Weidle PJ, Paz-Bailey G, Broz D. Factors associated with obtaining sterile syringes from pharmacies among persons who inject drugs in 20 US cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:51-58. [PMID: 30359873 DOI: 10.1016/j.drugpo.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Increased access to sterile syringes has been shown to reduce HIV risk among people who inject drugs (PWID). Where syringe services programs (SSPs) are limited, pharmacies are an important sterile syringe source. We assessed factors associated with using pharmacies as the primary source of syringes among PWID from 20 US cities. METHODS PWID ages ≥18 years were recruited for the 2015 National HIV Behavioral Surveillance using respondent-driven sampling. Using generalized estimating equation (GEE) models, we assessed demographic characteristics independently associated with participant-reported primary syringe source: pharmacies vs. SSPs. We calculated associations between primary syringe source and various behavioural outcomes, adjusted for participant characteristics. RESULTS PWID who were <30 years old, female, white, and less frequent injectors were more likely have used pharmacies as their primary syringe source. Accessing syringes primarily from pharmacies, as compared to SSPs, was associated with receptive syringe sharing and unsafe syringe disposal; using sterile syringes, recent HIV testing and participation in an HIV behavioural intervention were negatively associated with primary pharmacy use. CONCLUSIONS Pharmacies can play an important role in comprehensive HIV prevention among PWID. Linkage to HIV interventions and syringe disposal services at pharmacies could strengthen prevention efforts for PWID who cannot access or choose not to utilize SSPs.
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Affiliation(s)
- Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Paul J Weidle
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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14
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Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep 2018; 15:245-254. [PMID: 29796965 PMCID: PMC6085134 DOI: 10.1007/s11904-018-0393-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic. RECENT FINDINGS Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
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Affiliation(s)
- Asher J Schranz
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA.
| | - Jessica Barrett
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, Ohio State University College of Public Health, 302 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
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15
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Vermund SH. The Continuum of HIV Care in the Urban United States: Black Men Who Have Sex With Men (MSM) Are Less Likely Than White MSM to Receive Antiretroviral Therapy. J Infect Dis 2017; 216:790-794. [PMID: 28368523 PMCID: PMC5853891 DOI: 10.1093/infdis/jix009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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16
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Exchange Sex and HIV Infection Among Women Who Inject Drugs-20 US Cities, 2009. J Acquir Immune Defic Syndr 2017; 75 Suppl 3:S333-S340. [PMID: 28604435 DOI: 10.1097/qai.0000000000001408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women who inject drugs and who also exchange sex are at increased risk for HIV infection, but data on this population in the United States remain sparse. METHODS This study assessed the prevalence of exchanging sex for money or drugs among women who inject drugs using data from the 2009 US National HIV Behavioral Surveillance (NHBS) system. Prevalence of being HIV-positive (testing positive in NHBS), HIV-positive-unaware (reporting being HIV-negative or unknown status but testing positive in NHBS), and risk behaviors and use of services were compared between women who did and did not exchange sex. The association between exchange sex and being HIV-positive-unaware of the infection was examined using multivariate Poisson models with robust standard errors. RESULTS Among 2305 women who inject drugs, 39% reported receiving things like money or drugs from ≥1 male partners in exchange for oral, vaginal, or anal sex in the previous 12 months. Women who exchanged sex were more likely to be unemployed, homeless, lack health insurance, have multiple condomless vaginal or anal sex partners, and receptively share syringes. In multivariate analysis, exchange sex was associated with being HIV-positive-unaware (adjusted prevalence ratio 1.97, 95% confidence intervals: 1.31 to 2.97). CONCLUSIONS Prevalence of exchange sex was high in this population. Women who exchange sex were more likely to be socially disadvantaged, report sexual and injection risk, and be HIV-positive-unaware. They represent an important group to reach with HIV prevention, testing, and care services.
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17
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Ho CLL, Pan W, Taylor LD. Stigma of HIV Testing on Online HIV Forums: Self-Stigma and the Unspoken. J Psychosoc Nurs Ment Health Serv 2017; 55:34-43. [PMID: 28892555 DOI: 10.3928/02793695-20170905-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 11/20/2022]
Abstract
Most studies examining HIV-related content in web forums have revolved around the most frequently used terms in HIV-related messages and topics, as well as the supportive nature of those messages. The current study explored barriers that prevent individuals from seeking HIV testing (specifically stigma). The current study analyzed a total of 210 threads and 319 posts, yielding 13 threads that revealed how individuals self-stigmatize and expressed how the fear of being diagnosed prevented them from seeking HIV testing. Results suggest that forums or online communities may perpetuate subculture values that deviate from mainstream values. Another important finding is that there is a lack of HIV testing information in forums for adolescents, which may contribute to the trend of young individuals engaging in risky sexual behaviors not getting tested in a timely fashion. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 34-43.].
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18
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Luo W, Davis G, Li L, Shriver MK, Mei J, Styer LM, Parker MM, Smith A, Paz-Bailey G, Ethridge S, Wesolowski L, Owen SM, Masciotra S. Evaluation of dried blood spot protocols with the Bio-Rad GS HIV Combo Ag/Ab EIA and Geenius™ HIV 1/2 Supplemental Assay. J Clin Virol 2017; 91:84-89. [PMID: 28366544 PMCID: PMC11111259 DOI: 10.1016/j.jcv.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE FDA-approved antigen/antibody combo and HIV-1/2 differentiation supplemental tests do not have claims for dried blood spot (DBS) use. We compared two DBS-modified protocols, the Bio-Rad GS HIV Combo Ag/Ab (BRC) EIA and Geenius™ HIV-1/2 (Geenius) Supplemental Assay, to plasma protocols and evaluated them in the CDC/APHL HIV diagnostic algorithm. METHODS BRC-DBS p24 analytical sensitivity was calculated from serial dilutions of p24. DBS specimens included 11 HIV-1 seroconverters, 151 HIV-1-positive individuals, including 20 on antiretroviral therapy, 31 HIV-2-positive and one HIV-1/HIV-2-positive individuals. BRC-reactive specimens were tested with Geenius using the same DBS eluate. Matched plasma specimens were tested with BRC, an IgG/IgM immunoassay and Geenius. DBS and plasma results were compared using the McNemar's test. A DBS-algorithm applied to 348 DBS from high-risk individuals who participated in surveillance was compared to HIV status based on local testing algorithms. RESULTS BRC-DBS detects p24 at a concentration 18 times higher than in plasma. In seroconverters, BRC-DBS detected more infections than the IgG/IgM immunoassay in plasma (p=0.0133), but fewer infections than BRC-plasma (p=0.0133). In addition, the BRC/Geenius-plasma algorithm identified more HIV-1 infections than the BRC/Geenius-DBS algorithm (p=0.0455). The DBS protocols correctly identified HIV status for established HIV-1 infections, including those on therapy, HIV-2 infections, and surveillance specimens. CONCLUSIONS The DBS protocols exhibited promising performance and allowed rapid supplemental testing. Although the DBS algorithm missed some early infections, it showed similar results when applied to specimens from a high-risk population. Implementation of a DBS algorithm would benefit testing programs without capacity for venipuncture.
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Affiliation(s)
- Wei Luo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - LiXia Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joanne Mei
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve Ethridge
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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