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Rael CT, Das D, Porter J, Lopez-Ríos J, Abascal E, Dolezal C, Vaughn MP, Giffenig P, Lopez JM, Stonbraker S, Sun C, Velasco RA, Bitterfeld L, Bockting WO, Bauermeister J. Provider Factors Likely to Impact Access and Uptake of Long-Acting Injectable Cabotegravir for Transgender Women in the United States: Results of a Qualitative Study. J Assoc Nurses AIDS Care 2024; 35:437-449. [PMID: 39137316 PMCID: PMC11361836 DOI: 10.1097/jnc.0000000000000488] [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] [Indexed: 08/15/2024]
Abstract
ABSTRACT Long-acting injectable cabotegravir (CAB-LA) was US Food and Drug Administration-approved in 2021. However, little is known about providers' CAB-LA knowledge, attitudes, challenges, and prescribing preferences for transgender women patients. Understanding this is critical to developing new pre-exposure prophylaxis (PrEP) interventions tailored to transgender women. We conducted 45-min, in-depth Zoom interviews (IDIs) with United States-based health care providers who prescribe PrEP to transgender women. IDIs focused on providers' CAB-LA knowledge/acceptability, willingness to prescribe CAB-LA to transgender women, potential challenges, and solutions to mitigate challenges. Providers ( N = 17) had a mean age of 43 years, and 35.4% ( n = 6) identified as people of color. Most ( n = 12) had basic knowledge of CAB-LA but wanted additional training. All participants found CAB-LA acceptable and were willing to prescribe. Most ( n = 11) anticipated minimal challenges to implementation. Others ( n = 4) reported potential issues, including logistical/scheduling concerns that impede CAB-LA integration and staffing concerns. Many providers expressed support for self-injection ( n = 13) and injections at "drop-in" clinics ( n = 8) to overcome challenges.
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Affiliation(s)
| | - Doyel Das
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jonathan Porter
- Columbia University Mailman School of Public Health, New York, New York, USA; University of Colorado College of Nursing, Aurora, Colorado, USA.; Optem Serve Consulting/The Lewin Group, New York, NY, USA
| | - Javier Lopez-Ríos
- Dornsife School of Public Health at Drexel University, Philadelphia, Philadelphia, USA
| | - Elena Abascal
- Columbia University School of Nursing, New York, New York, USA; New York State Psychiatric Institute (NYSPI), New York, New York, USA.; Columbia University Irving Medical Center/New York Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute/Columbia University Psychiatry, New York, NY, USA
| | - Michael P. Vaughn
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute/Columbia University Psychiatry, New York, New York, USA.; Capital One Bank, New York, NY, USA
| | - Pilar Giffenig
- Columbia University School of Nursing, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA.; Medical Associates of Wall Street, New York, NY, USA
| | - Jasmine M. Lopez
- HIV Center for Clinical and Behavioral Studies at NYSPI/Columbia University Psychiatry, New York, New York, USA
| | | | - Christina Sun
- University of Colorado Collee of Nursing, Aurora, Colorado, USA
| | | | | | - Walter O. Bockting
- New York State Psychiatric InstituteI/Columbia University, New York, New York, USA; Columbia University School of Nursing, New York, New York, USA
| | - Jose Bauermeister
- School of Nursing and School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wirtz AL, Poteat T, Borquez A, Linton S, Stevenson M, Case J, Brown C, Lint A, Miller M, Radix A, Althoff KN, Schneider JS, Haw JS, Wawrzyniak AJ, Rodriguez A, Cooney E, Humes E, Pontes C, Seopaul S, White C, Beyrer C, Reisner SL. Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States. JMIR Res Protoc 2024; 13:e59846. [PMID: 39190916 DOI: 10.2196/59846] [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: 04/23/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes. OBJECTIVE Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities. METHODS To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030. RESULTS Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort. CONCLUSIONS Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59846.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Department of Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, NC, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States
| | - Sabriya Linton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James Case
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Carter Brown
- National Black Transgender Advocacy Coalition, Carrolton, TX, United States
| | - Arianna Lint
- Arianna's Center, Fort Lauderdale, FL, United States
| | - Marissa Miller
- Trans Solutions Research and Resource Center, Indianapolis, IN, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason S Schneider
- Division of General Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allan Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Erin Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Ceza Pontes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shannon Seopaul
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Camille White
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Sari L Reisner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MD, United States
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Jongen VW, Daans C, van Sighem A, Schim van der Loeff M, Hage K, Welling C, von Vaupel‐Klein A, den Heijer M, Peters EJG, van der Valk M, Reiss P, Prins M, Hoornenborg E. Assessing the HIV care continuum among transgender women during 11 years of follow-up: results from the Netherlands' ATHENA observational cohort. J Int AIDS Soc 2024; 27:e26317. [PMID: 39118295 PMCID: PMC11310271 DOI: 10.1002/jia2.26317] [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: 12/07/2023] [Accepted: 06/04/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Transgender women are at increased risk of acquiring HIV. Earlier studies reported lower retention in HIV care, antiretroviral therapy uptake, adherence and viral suppression. We assessed the stages of the HIV care continuum of transgender women in the Netherlands over an 11-year period. In addition, we assessed new HIV diagnoses and late presentation, as well as disengagement from care, between 2011 and 2021. METHODS Using data from the Dutch national ATHENA cohort, we separately assessed viral suppression, as well as time to achieving viral suppression, among transgender women for each year between 2011 and 2021. We also assessed trends in new HIV diagnoses and late presentation (CD4 count of <350 cells/µl and/or AIDS at diagnosis), and disengagement from care. RESULTS Between 2011 and 2021, a total of 260 transgender women attended at least one HIV clinical visit. Across all years, <90% of transgender women were virally suppressed (207/239 [87%] in 2021). The number of new HIV diagnoses fluctuated for transgender women (ptrend = 0.053) and late presentation was common (ranging between 10% and 67% of new HIV diagnoses). Of the 260 transgender women, 26 (10%) disengaged from care between 2011 and 2021 (incidence rate = 1.10 per 100 person-years, 95% confidence interval = 0.75-1.61). CONCLUSIONS Between 2011 and 2021, less than 90% of transgender women linked to HIV care were virally suppressed. Late presentation at the time of diagnosis and disengagement from care were common. Efforts are needed to identify barriers to early HIV diagnosis and to optimize the different steps across the care continuum for transgender women.
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Affiliation(s)
- Vita W. Jongen
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Stichting hiv monitoringAmsterdamThe Netherlands
| | - Ceranza Daans
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | | | - Maarten Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Kris Hage
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
| | - Camiel Welling
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Alex von Vaupel‐Klein
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Trans United EuropeAmsterdamThe Netherlands
| | - Martin den Heijer
- Amsterdam UMCVrije Universiteit Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMCVU University Medical CenterAmsterdamThe Netherlands
| | - Edgar J. G. Peters
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam UMCVrije Universiteit Amsterdam, Internal MedicineAmsterdamThe Netherlands
| | - Marc van der Valk
- Stichting hiv monitoringAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
| | - Peter Reiss
- Stichting hiv monitoringAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Global HealthAmsterdamThe Netherlands
- Amsterdam Institute for Global Health and DevelopmentAmsterdamThe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversity of Amsterdam, Internal MedicineAmsterdamThe Netherlands
- Amsterdam Institute for Infection and Immunity (AII)AmsterdamThe Netherlands
- Amsterdam Public Health Research Institute (APH)AmsterdamThe Netherlands
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Aldhouse NVJ, Chan EKH, Al-Zubeidi T, McKee S, Oriol Mathieu V, El Khoury AC, Kitchen H. Perceptions and Acceptance of a Prophylactic Vaccine for Human Immunodeficiency Virus (HIV): A Qualitative Study. THE PATIENT 2024; 17:457-469. [PMID: 38581599 PMCID: PMC11189960 DOI: 10.1007/s40271-024-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Despite advances in human immunodeficiency virus (HIV) prevention methods, such as the advent of pre-exposure prophylaxis (PrEP), the number of people with newly acquired HIV remains high, particularly in at-risk groups. A prophylactic HIV vaccine could contribute to reduced disease prevalence and future transmission and address limitations of existing options, such as suboptimal long-term adherence to PrEPs. METHODS This qualitative study aimed to capture perceptions towards and acceptance of prophylactic HIV vaccination in three adult populations in the United States: the general population, 'at-risk' individuals (e.g. men who have sex with men, transgender individuals, gender-nonconforming individuals, and individuals in a sexual relationship with a person living with HIV), and parents/caregivers of children aged 9-17 years. Interviews were conducted with 55 participants to explore key drivers and barriers to HIV vaccine uptake, and a conceptual model was developed. RESULTS The sample was diverse; participants were 51% female, aged 20-57 years (mean 37 years), 33% with high school diploma as highest education level, and identified as White (42%), Black or African American (35%), of Hispanic, Latino, or Spanish origin (22%), or other races/ethnicities (8%) [groupings are not mutually exclusive]. Perceptions were influenced by individual, interpersonal, community, institutional, and structural factors. Overall, 98% of participants thought vaccination would be beneficial in preventing HIV. Key considerations/barriers included perceived susceptibility, i.e. whether participants felt there was a risk of contracting HIV (discussed by 90%); the clinical profile of the vaccine (e.g. the adverse effect profile [98%], and vaccine efficacy [85%], cost [73%] and administration schedule [88%]); and concerns around potential vaccine-induced seropositivity (VISP; 62%). Stigma was not found to be an important barrier, with a general view that vaccination status was personal. Participants in the 'at-risk' group were the most likely to accept an HIV vaccine (70%). Unique concerns in the subgroups included how a potential vaccine's clinical profile compared with PrEP, voiced by those receiving/considering PrEP, and considerations of children's views on the topic, voiced by parents/caregivers. CONCLUSIONS Understanding these factors could help develop HIV vaccine research strategies and contribute toward public health messaging to support future HIV vaccination programs.
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Borre ED, Ahonkhai AA, Chi KYK, Osman A, Thayer K, Person AK, Weddle A, Flanagan CF, Pettit AC, Closs D, Cotton M, Agwu AL, Cespedes MS, Ciaranello AL, Gonsalves G, Hyle EP, Paltiel AD, Freedberg KA, Neilan AM. Projecting the Potential Clinical and Economic Impact of Human Immunodeficiency Virus Prevention Resource Reallocation in Tennessee. Clin Infect Dis 2024:ciae243. [PMID: 38913762 DOI: 10.1093/cid/ciae243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In 2023, Tennessee replaced $6.2 M in US Centers for Disease Control and Prevention (CDC) human immunodeficiency virus (HIV) prevention funding with state funds to redirect support away from men who have sex with men (MSM), transgender women (TGW), and heterosexual Black women (HSBW) and to prioritize instead first responders (FR), pregnant people (PP), and survivors of sex trafficking (SST). METHODS We used a simulation model of HIV disease to compare the clinical impact of Current, the present allocation of condoms, preexposure prophylaxis (PrEP), and HIV testing to CDC priority risk groups (MSM/TGW/HSBW); with Reallocation, funding instead increased HIV testing and linkage of Tennessee-determined priority populations (FR/PP/SST). Key model inputs included baseline condom use (45%-49%), PrEP provision (0.1%-8%), HIV testing frequency (every 2.5-4.8 years), and 30-day HIV care linkage (57%-65%). We assumed Reallocation would reduce condom use (-4%), PrEP provision (-26%), and HIV testing (-47%) in MSM/TGW/HSBW, whereas it would increase HIV testing among FR (+47%) and HIV care linkage (to 100%/90%) among PP/SST. RESULTS Reallocation would lead to 166 additional HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. HIV testing reductions were most influential in sensitivity analysis; even a 24% reduction would result in 287 more deaths compared to Current. With pessimistic assumptions, we projected 1359 additional HIV transmissions, 712 additional deaths, and 2778 life-years lost over 10 years. CONCLUSIONS Redirecting HIV prevention funding in Tennessee would greatly harm CDC priority populations while conferring minimal benefits to new priority populations.
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Affiliation(s)
- Ethan D Borre
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Aima A Ahonkhai
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyu-Young Kevin Chi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amna Osman
- Nashville CARES, Nashville, Tennessee, USA
| | | | - Anna K Person
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea Weddle
- HIV Medicine Association of the Infectious Diseases Society of America, Arlington, Virginia, USA
| | - Clare F Flanagan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - April C Pettit
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mia Cotton
- Friends For All, Memphis, Tennessee, USA
| | - Allison L Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle S Cespedes
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea L Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA
| | - Gregg Gonsalves
- Public Health Modeling Unit and Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA
| | - A David Paltiel
- Public Health Modeling Unit and Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA
| | - Anne M Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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Brown EE, Patel EU, Poteat TC, Mayer K, Wawrzyniak AJ, Radix AE, Cooney EE, Laeyendecker O, Reisner SL, Wirtz AL. Prevalence of Sexually Transmitted Infections Among Transgender Women With and Without HIV in the Eastern and Southern United States. J Infect Dis 2024; 229:1614-1627. [PMID: 38232978 PMCID: PMC11175699 DOI: 10.1093/infdis/jiad605] [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: 05/05/2023] [Revised: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Data on the epidemiology of sexually transmitted infections (STIs) among transgender women (TGW) with and without human immunodeficiency virus (HIV) are limited. METHODS We analyzed baseline data collected from a cohort of adult TGW across 6 eastern and southern US cities between March 2018 and August 2020 (n = 1018). Participants completed oral HIV screening, provided self-collected rectal and urogenital specimens for chlamydia and gonorrhea testing, and provided sera specimens for syphilis testing. We assessed associations with ≥1 prevalent bacterial STI using modified Poisson regression. RESULTS Bacterial STI prevalence was high and differed by HIV status: 32% among TGW with HIV and 11% among those without HIV (demographic-adjusted prevalence ratio = 1.91; 95% confidence interval = 1.39-2.62). Among TGW without HIV, bacterial STI prevalence differed by geographic region, race and ethnicity, and gender identity, and was positively associated with reporting >1 sexual partner, hazardous alcohol use, homelessness, having safety concerns regarding transit to health care, and no prior receipt of gender-affirming health services. Among TGW with HIV, older age was inversely associated with bacterial STI. CONCLUSIONS TGW had a high prevalence of bacterial STIs. The prevalence and correlates of bacterial STI differed by HIV status, highlighting the unique needs and risks of TGW with and without HIV. Tailored interventions may reduce sexual health-related inequities.
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Affiliation(s)
- Erin E Brown
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland, USA
| | - Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tonia C Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, New York, USA
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Baltimore, Maryland, USA
| | - Sari L Reisner
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bonett S, Li Q, Sweeney A, Gaither-Hardy D, Safa H. Telehealth Models for PrEP Delivery: A Systematic Review of Acceptability, Implementation, and Impact on the PrEP Care Continuum in the United States. AIDS Behav 2024:10.1007/s10461-024-04366-3. [PMID: 38856846 DOI: 10.1007/s10461-024-04366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is pivotal in curbing HIV transmission and is integral to the national plan to end the HIV epidemic in the United States (US). Nonetheless, widespread PrEP adoption faces barriers. Telehealth delivery models for PrEP, or telePrEP, can enhance PrEP access and adherence by providing flexible care remotely. This study presents a systematic review of telePrEP programs in the US, aiming to describe model characteristics and summarize clinical, implementation, and equity outcomes. We reviewed studies published from 2012 to 2023. We included articles that described telePrEP systems in the US and measured PrEP care continuum outcomes (awareness, initiation, uptake, adherence) or acceptability of the intervention by program users. Eight articles describing six distinct telePrEP initiatives met our inclusion criteria. Studies described models implemented in community-based, academic, and commercial settings, with most programs using a direct-to-client telePrEP model. Across studies, clients reported high acceptability of the telePrEP programs, finding them easy to use, convenient, and helpful as a tool for accessing HIV prevention services. No programs were offering injectable PrEP at the time these studies were conducted. Data was limited in measuring PrEP retention rates and the reach of services to underserved populations, including Black and Latinx communities, transgender individuals, and cis-gender women. Findings underscore the potential of telePrEP to bolster the reach of PrEP care and address structural barriers to access. As telehealth models for PrEP care gain prominence, future research should concentrate on refining implementation strategies, enhancing equity outcomes, and expanding services to include injectable PrEP.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Qian Li
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Anna Sweeney
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | | | - Hussein Safa
- Albert Einstein Healthcare Network, Philadelphia, PA, USA
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Moen M, Sublette N, Alves J, Walker CM. Policy Challenges and Resiliency Related to Ending the HIV Epidemic in the Southern and Rural United States: A Call to Action. J Assoc Nurses AIDS Care 2024; 35:161-172. [PMID: 38306307 DOI: 10.1097/jnc.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT In this commentary, we describe current policy trends and their implications for the health of populations in the Southern and rural United States. We outline policy changes that threaten the prevention, care, and treatment of people at risk for HIV or with HIV and sociopolitical factors contributing to these policy trends. We also issue a call-to-action for individuals with Southern and rural US policy expertise and lived or living experience to collaboratively engage on a systematic policy analysis to thoroughly document relevant policies and deepen our understanding of the influences behind these policies. Finally, we provide examples of individual, community, and national level resiliency and courage-strategies that inspire advocacy and hope in the face of policy setbacks.
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Affiliation(s)
- Marik Moen
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Nina Sublette
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Justin Alves
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Crystal Martin Walker
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [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] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Cooney EE, Saleem HT, Stevenson M, Aguayo‐Romero RA, Althoff KN, Poteat TC, Beckham SW, Adams D, Radix AE, Wawrzyniak AJ, Cannon CM, Schneider JS, Haw JS, Rodriguez AE, Mayer KH, Beyrer C, Reisner SL, Wirtz AL. PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study. J Int AIDS Soc 2023; 26:e26199. [PMID: 38123897 PMCID: PMC10733152 DOI: 10.1002/jia2.26199] [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: 02/16/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Transgender women in the United States experience high HIV incidence and suboptimal Pre-exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women. METHODS Using a sequential, explanatory, mixed-methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow-up 24 months; interquartile range 15-36). Cox regression models assessed predictors of initiation and discontinuation. In-depth interviews were conducted among 18 participants, including life history calendars to explore key events and experiences surrounding discontinuations. Qualitative and quantitative data were integrated to generate typologies of discontinuation, inform meta-inferences and facilitate the interpretation of findings. RESULTS 21.8% (n = 286) of participants reported taking PrEP at one or more study visits while under observation. We observed 139 PrEP initiations over 2127 person-years (6.5 initiations/100 person-years, 95% CI: 5.5-7.7). Predictors of initiation included identifying as Black and PrEP indication. The rate of initiation among those who were PrEP-indicated was 9.6 initiations/100 person-years (132/1372 person-years; 95% CI: 8.1-11.4). We observed 138 PrEP discontinuations over 368 person-years (37.5 discontinuations/100 person-years, 95% CI: 31.7-44.3). Predictors of discontinuation included high school education or less and initiating PrEP for the first time while under observation. Four discontinuation typologies emerged: (1) seroconversion following discontinuation; (2) ongoing HIV acquisition risk following discontinuation; (3) reassessment of HIV/STI prevention strategy following discontinuation; and (4) dynamic PrEP use coinciding with changes in HIV acquisition risk. CONCLUSIONS PrEP initiation rates were low and discontinuation rates were high. Complex motivations to stop using PrEP did not consistently correspond with HIV acquisition risk reduction. Evidence-based interventions to increase PrEP persistence among transgender women with ongoing acquisition risk and provide HIV prevention support for those who discontinue PrEP are necessary to reduce HIV incidence in this population.
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Affiliation(s)
- Erin E. Cooney
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Haneefa T. Saleem
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Meg Stevenson
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rodrigo A. Aguayo‐Romero
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
| | - Keri N. Althoff
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tonia C. Poteat
- Department of Social MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - S. Wilson Beckham
- Department of HealthBehavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Dee Adams
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Asa E. Radix
- Callen‐Lorde Community Health CenterNew YorkNew YorkUSA
| | - Andrew J. Wawrzyniak
- Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Jason S. Schneider
- Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - J. Sonya Haw
- Division of Endocrinology, Metabolism and LipidsEmory University School of MedicineAtlantaGeorgiaUSA
| | - Allan E. Rodriguez
- Division of Infectious DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Kenneth H. Mayer
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
| | - Chris Beyrer
- Duke UniversityGlobal Health InstituteDurhamNorth CarolinaUSA
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes, and HypertensionBrigham and Women's HospitalBostonMassachusettsUSA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Fenway HealthThe Fenway InstituteBostonMassachusettsUSA
- Department of EpidemiologyHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Andrea L. Wirtz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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11
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Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-x] [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: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
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Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
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12
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Faraci G, Park SY, Love TMT, Dubé MP, Lee HY. Precision detection of recent HIV infections using high-throughput genomic incidence assay. Microbiol Spectr 2023; 11:e0228523. [PMID: 37712639 PMCID: PMC10580985 DOI: 10.1128/spectrum.02285-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/21/2023] [Indexed: 09/16/2023] Open
Abstract
HIV incidence is a key measure for tracking disease spread and identifying populations and geographic regions where new infections are most concentrated. The HIV sequence population provides a robust signal for the stage of infection. Large-scale and high-precision HIV sequencing is crucial for effective genomic incidence surveillance. We produced 1,034 full-length envelope gene sequences from a seroconversion cohort by conducting HIV microdrop sequencing and measuring the genomic incidence assay's genome similarity index (GSI) dynamics. The measured dynamics of 9 of 12 individuals aligned with the GSI distribution estimated independently using 417 publicly available incident samples. We enhanced the capacity to identify individuals with recent infections, achieving predicted detection accuracies of 92% (89%-94%) for cases within 6 months and 81% (74%-87%) for cases within 9 months. These accuracy levels agreed with the observed detection accuracy intervals of an independent validation data set. Additionally, we produced 131 full-length envelope gene sequences from eight individuals with chronic HIV infection. This analysis confirmed a false recency rate (FRR) of 0%, which was consistent with 162 publicly available chronic samples. The mean duration of recent infection (MDRI) was 238 (209-267) days, indicating an 83% improvement in performance compared to current recent infection testing algorithms. The shifted Poisson mixture model was then used to estimate the time since infection, and the model estimates showed an 88% consistency with the days post infection derived from HIV RNA test dates and/or seroconversion dates. HIV microdrop sequencing provides unique prospects for large-scale incidence surveillance using high-throughput sequencing. IMPORTANCE Accurate identification of recently infected individuals is vital for prioritizing specific populations for interventions, reducing onward transmission risks, and optimizing public health services. However, current HIV-specific antibody-based methods have not been satisfactory in accurately identifying incident cases, hindering the use of HIV recency testing for prevention efforts and partner protection. Genomic incidence assays offer a promising alternative for identifying recent infections. In our study, we used microdroplet technologies to produce a large number of complete HIV envelope gene sequences, enabling the accurate detection of early infection signs. We assessed the dynamics of the incidence assay's metrics and compared them with statistical models. Our approach demonstrated high accuracy in identifying individuals with recent infections, achieving predicted detection rates exceeding 90% within 6 months and over 80% within 9 months of infection. This high-resolution method holds significant potential for enhancing the effectiveness of HIV incidence screening for case-based surveillance in public health initiatives.
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Affiliation(s)
- Gina Faraci
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sung Yong Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Tanzy M. T. Love
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Michael P. Dubé
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ha Youn Lee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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13
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Tran NK, Lunn MR, Schulkey CE, Tesfaye S, Nambiar S, Chatterjee S, Kozlowski D, Lozano P, Randal FT, Mo Y, Qi S, Hundertmark E, Eastburn C, Pho AT, Dastur Z, Lubensky ME, Flentje A, Obedin-Maliver J. Prevalence of 12 Common Health Conditions in Sexual and Gender Minority Participants in the All of Us Research Program. JAMA Netw Open 2023; 6:e2324969. [PMID: 37523187 PMCID: PMC10391317 DOI: 10.1001/jamanetworkopen.2023.24969] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Limited data describe the health status of sexual or gender minority (SGM) people due to inaccurate and inconsistent ascertainment of gender identity, sex assigned at birth, and sexual orientation. Objective To evaluate whether the prevalence of 12 health conditions is higher among SGM adults in the All of Us Research Program data compared with cisgender heterosexual (non-SGM) people. Design, Setting, and Participants This cross-sectional study used data from a multidisciplinary research consortium, the All of Us Research Program, that links participant-reported survey information to electronic health records (EHR) and physical measurements. In total, 372 082 US adults recruited and enrolled at an All of Us health care provider organization or by directly visiting the enrollment website from May 31, 2017, to January 1, 2022, and were assessed for study eligibility. Exposures Self-identified gender identity and sexual orientation group. Main Outcomes and Measures Twelve health conditions were evaluated: 11 using EHR data and 1, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), using participants' physical measurements. Logistic regression (adjusting for age, income, and employment, enrollment year, and US Census division) was used to obtain adjusted odds ratios (AORs) for the associations between each SGM group and health condition compared with a non-SGM reference group. Results The analytic sample included 346 868 participants (median [IQR] age, 55 [39-68] years; 30 763 [8.9%] self-identified as SGM). Among participants with available BMI (80.2%) and EHR data (69.4%), SGM groups had higher odds of anxiety, depression, HIV diagnosis, and tobacco use disorder but lower odds of cardiovascular disease, kidney disease, diabetes, and hypertension. Estimated associations for asthma (AOR, 0.39 [95% CI, 0.24-0.63] for gender diverse people assigned male at birth; AOR, 0.51 [95% CI, 0.38-0.69] for transgender women), a BMI of 25 or higher (AOR, 1.65 [95% CI, 1.38-1.96] for transgender men), cancer (AOR, 1.15 [95% CI, 1.07-1.23] for cisgender sexual minority men; AOR, 0.88 [95% CI, 0.81-0.95] for cisgender sexual minority women), and substance use disorder (AOR, 0.35 [95% CI, 0.24-0.52] for gender diverse people assigned female at birth; AOR, 0.65 [95% CI, 0.49-0.87] for transgender men) varied substantially across SGM groups compared with non-SGM groups. Conclusions and Relevance In this cross-sectional analysis of data from the All of Us Research Program, SGM participants experienced health inequities that varied by group and condition. The All of Us Research Program can be a valuable resource for conducting health research focused on SGM people.
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Affiliation(s)
- Nguyen K Tran
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
| | - Claire E Schulkey
- All of Us Research Program, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Paula Lozano
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Fornessa T Randal
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Yicklun Mo
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Siya Qi
- Center for Asian Health Equity, The University of Chicago Medicine, Chicago, Illinois
- Asian Health Coalition, Chicago, Illinois
| | - Ell Hundertmark
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Chloe Eastburn
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Los Angeles LGBT Center, Los Angeles, California
| | - Anthony T Pho
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Community Health Systems, University of California, San Francisco
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Community Health Systems, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Departments of Medicine and of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
- Division of Gynecology and Gynecologic Specialties, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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14
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Wirtz AL, Restar A. Gender-affirming HIV care as a tool to end the HIV epidemic. Lancet HIV 2023:S2352-3018(23)00087-5. [PMID: 37119826 DOI: 10.1016/s2352-3018(23)00087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Arjee Restar
- Departments of Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, WA, USA; Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
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15
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Cáceres CF, Salazar X. Social determinants of transgender women's health. Lancet HIV 2023; 10:e276-e278. [PMID: 36868259 DOI: 10.1016/s2352-3018(23)00048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS, and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Ximena Salazar
- Center for Interdisciplinary Studies in Sexuality, AIDS, and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
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