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Ge Q, Lu X, Jiang R, Zhang Y, Zhuang X. Data mining and machine learning in HIV infection risk research: An overview and recommendations. Artif Intell Med 2024; 153:102887. [PMID: 38735156 DOI: 10.1016/j.artmed.2024.102887] [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: 08/22/2023] [Revised: 03/07/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
In the contemporary era, the applications of data mining and machine learning have permeated extensively into medical research, significantly contributing to areas such as HIV studies. By reviewing 38 articles published in the past 15 years, the study presents a roadmap based on seven different aspects, utilizing various machine learning techniques for both novice researchers and experienced researchers seeking to comprehend the current state of the art in this area. While traditional regression modeling techniques have been commonly used, researchers are increasingly adopting more advanced fully supervised machine learning and deep learning techniques, which often outperform the traditional methods in predictive performance. Additionally, the study identifies nine new open research issues and outlines possible future research plans to enhance the outcomes of HIV infection risk research. This review is expected to be an insightful guide for researchers, illuminating current practices and suggesting advancements in the field.
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Affiliation(s)
- Qiwei Ge
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Xinyu Lu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Run Jiang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Yuyu Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Xun Zhuang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China.
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Vermandere H, Martínez-Silva G, Aguilera-Mijares S, Martínez-Dávalos A, Bautista-Arredondo S. Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020. Public Health Rep 2024:333549241230479. [PMID: 38491784 DOI: 10.1177/00333549241230479] [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: 03/18/2024] Open
Abstract
OBJECTIVES Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. METHODS We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. RESULTS Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). CONCLUSION The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.
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Affiliation(s)
- Heleen Vermandere
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Gisela Martínez-Silva
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Santiago Aguilera-Mijares
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Araczy Martínez-Dávalos
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Sergio Bautista-Arredondo
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
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3
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Ademe B, Bogale EK, Anagaw TF. Utilization of HIV Pre-exposure Prophylaxis and Associated Factors Among Female Sex Workers in Bahir Dar City, North-West Ethiopia, Cross-sectional Study, 2022. Int J Gen Med 2023; 16:6015-6024. [PMID: 38146329 PMCID: PMC10749782 DOI: 10.2147/ijgm.s443477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023] Open
Abstract
Objective This study aimed to assess the utilization of HIV pre-exposure prophylaxis and associated factors among commercial female sex workers in Bahir Dar City, Northwest Ethiopia, in 2022. Methods An institution-based cross-sectional study was conducted in Bahir Dar City from November 1 to 30, 2022. The random sampling technique was used to select 396 commercial female sex workers. Kobo Collector was used to gather the data, which was then exported to STATA 14 for analysis. In bivariate regression analysis, all variables with a P-value of <0.2 were entered into multivariable logistic regression. Multivariable logistic regression variables with P-values ≤0.05 at a 95% confidence interval were declared to be significantly linked with the utilization of HIV pre-exposure prophylaxis. Results In this study, 183 (46.2%) (95%CI: 41.33-51.16) of respondents utilized HIV pre-exposure prophylaxis. Educational status: secondary and above (AOR: 2.18, 95%CI: 1.05-4.53). Age of sex workers 26-36 (AOR: 0.20, 95%CI: 0.17-0.84); experience of sex work 3-5 years (AOR: 0.25, 95%CI: 0.24-0.83); and having good knowledge (AOR: 4.98, 95%CI: 3.90-10.65) were significantly associated with the utilization of HIV pre-exposure prophylaxis. Conclusion In this study, HIV pre-exposure prophylaxis was not widely used by commercial female sex workers. Therefore, social and behavioral change communication strategies focus on creating awareness and building knowledge on HIV pre-exposure prophylaxis utilization.
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Affiliation(s)
- Bezza Ademe
- Department of Nursing, Tibebe Ghion Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Hazlett C, Ramos AP, Smith S. Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions. Sci Rep 2023; 13:21706. [PMID: 38066048 PMCID: PMC10709389 DOI: 10.1038/s41598-023-48888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.
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Affiliation(s)
- Chad Hazlett
- Professor, Department of Political Science and Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
| | - Antonio P Ramos
- Research Scientist, Califonia Center for Population Research, University of California, Los Angeles, USA.
- Principal Research Scientist, José Luiz Egydio Setúbal Foundation, São Paulo, Brazil.
| | - Stephen Smith
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
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Chou R, Spencer H, Bougatsos C, Blazina I, Ahmed A, Selph S. Preexposure Prophylaxis for the Prevention of HIV: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2023; 330:746-763. [PMID: 37606667 DOI: 10.1001/jama.2023.9865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Importance A 2019 review for the US Preventive Services Task Force (USPSTF) found oral preexposure prophylaxis (PrEP) associated with decreased HIV infection risk vs placebo or no PrEP in adults at increased HIV acquisition risk. Newer PrEP regimens are available. Objective To update the 2019 review on PrEP, to inform the USPSTF. Data Sources Ovid MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Embase (January 2018 to May 16, 2022); surveillance through March 24, 2023. Study Selection Randomized clinical trials of PrEP vs placebo or no PrEP or newer vs older PrEP regimens and diagnostic accuracy studies of instruments for predicting incident HIV infection. Data Extraction and Synthesis Dual review of titles and abstracts, full-text articles, study quality, and data abstraction. Data were pooled using the DerSimonian and Laird random-effects model. Main Outcomes and Measures HIV acquisition, mortality, and harms; and diagnostic test accuracy. Results Thirty-two studies were included in the review (20 randomized clinical trials [N = 36 543] and 12 studies of diagnostic accuracy [N = 5 544 500]). Eleven trials in the 2019 review found oral PrEP associated with decreased HIV infection risk vs placebo or no PrEP (n = 18 172; relative risk [RR], 0.46 [95% CI, 0.33-0.66]). Higher adherence was associated with greater efficacy. One new trial (n = 5335) found oral tenofovir alafenamide/emtricitabine (TAF/FTC) to be noninferior to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in men who have sex with men (RR, 0.47 [95% CI, 0.19-1.14]). Two new trials found long-acting injectable cabotegravir associated with decreased risk of HIV infection vs oral TDF/FTC (RR, 0.33 [95% CI, 0.18-0.62] in cisgender men who have sex with men and transgender women [n = 4490] and RR, 0.11 [95% CI, 0.04-0.31] in cisgender women [n = 3178]). Discrimination of instruments for predicting incident HIV infection was moderate in men who have sex with men (5 studies; n = 25 488) and moderate to high in general populations of persons without HIV (2 studies; n = 5 477 291). Conclusions and Relevance In adults at increased HIV acquisition risk, oral PrEP was associated with decreased risk of acquiring HIV infection compared with placebo or no PrEP. Oral TAF/FTC was noninferior to oral TDF/FTC, and injectable cabotegravir reduced the risk of HIV infection compared with oral TDF/FTC in the populations studied.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | - Hunter Spencer
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | - Christina Bougatsos
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Azrah Ahmed
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Shelley Selph
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Harkness A, Lozano A, Bainter S, Mayo D, Hernandez Altamirano D, Rogers BG, Prado G, Safren SA. Engaging Latino sexual minority men in PrEP and behavioral health care: multilevel barriers, facilitators, and potential implementation strategies. J Behav Med 2023; 46:655-667. [PMID: 36472703 PMCID: PMC10442148 DOI: 10.1007/s10865-022-00371-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022]
Abstract
Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Sierra Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Luo Q, Luo Y, Cui T, Li T. Performance of HIV Infection Prediction Models in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02574-x. [PMID: 36884160 DOI: 10.1007/s10508-023-02574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/29/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Effective ways to identify and predict men who have sex with men (MSM) at substantial risk for HIV is a global priority. HIV risk assessment tools can improve individual risk awareness and subsequent health-seeking actions. We sought to identify and characterize the performance of HIV infection risk prediction models in MSM through systematic review and meta-analysis. PubMed, Embase, and The Cochrane Library were searched. Eighteen HIV infection risk assessment models with a total of 151,422 participants and 3643 HIV cases were identified, eight of which have been externally validated by at least one study (HIRI-MSM, Menza Score, SDET Score, Li Model, DHRS, Amsterdam Score, SexPro model, and UMRSS). The number of predictor variables in each model ranged from three to 12, age, the number of male sexual partners, unprotected receptive anal intercourse, recreational drug usage (amphetamines, poppers), and sexually transmitted infections were critical scoring variables. All eight externally validated models performed well in terms of discrimination, with the pooled area under the receiver operating characteristic curve (AUC) ranging from 0.62 (95%CI: 0.51 to 0.73, SDET Score) to 0.83 (95%CI: 0.48 to 0.99, Amsterdam Score). Calibration performance was only reported in 10 studies (35.7%, 10/28). The HIV infection risk prediction models showed moderate-to-good discrimination performance. Validation of prediction models across different geographic and ethnic environments is needed to ensure their real-world application.
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Affiliation(s)
- Qianqian Luo
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China.
| | - Yongchuan Luo
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Tianyu Cui
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Tianying Li
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China
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Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review. Curr HIV/AIDS Rep 2022; 19:154-165. [PMID: 35147855 PMCID: PMC8832417 DOI: 10.1007/s11904-022-00601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/31/2022]
Abstract
Purpose of review Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). Recent findings Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. Summary We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for “screening in” (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00601-5.
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Meireles P, Moreira C, Rocha M, Plankey M, Barros H. Transitions Between Preexposure Prophylaxis Eligibility States and HIV Infection in the Lisbon Cohort of HIV-Negative Men Who Have Sex With Men: A Multistate Model Analysis. Am J Epidemiol 2022; 191:287-297. [PMID: 34718381 DOI: 10.1093/aje/kwab260] [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: 11/05/2020] [Revised: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to describe transitions between preexposure prophylaxis (PrEP) eligibility and human immunodeficiency virus (HIV) infection among HIV-negative men who have sex with men (MSM). We used data from 1,885 MSM, who had not used PrEP, enrolled in the Lisbon Cohort of MSM, with at least 2 consecutive measurements of PrEP eligibility from 2014-2020. A time-homogeneous Markov multistate model was applied to describe the transitions between states of PrEP eligibility-eligible and ineligible-and from these to HIV infection (HIV). The intensities of the transitions were closer for ineligible-to-eligible and eligible-to-ineligible transitions (intensity ratio, 1.107, 95% confidence interval (CI): 1.080, 1.176), while the intensity of the eligible-to-HIV transition was higher than that for ineligible-to-HIV transition (intensity ratio, 9.558, 95% CI: 0.738, 65.048). The probabilities of transitions increased with time; for 90 days, the probabilities were similar for the ineligible-to-eligible and eligible-to-ineligible transitions (0.285 (95% CI: 0.252, 0.319) vs. 0.258 (95% CI: 0.228, 0.287)), while the eligible-to-HIV transition was more likely than ineligible-to-HIV (0.004 (95% CI: 0.003, 0.007) vs. 0.001 (95% CI: 0.001, 0.008)) but tended to become closer with time. Being classified as ineligible was a short-term indicator of a lower probability of acquiring HIV. Once an individual moved to eligible, he was at a higher risk of seroconversion, demanding a timely delivery ofPrEP.
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Chen W, Ding Y, Chen J, Zhao P, Wang Z, Meng X, Jia T, Zheng H, Yang B, Luo Z, Zou H. Awareness of and Preferences for Preexposure Prophylaxis (PrEP) among MSM at High Risk of HIV Infection in Southern China: Findings from the T2T Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6682932. [PMID: 33869634 PMCID: PMC8035020 DOI: 10.1155/2021/6682932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
This study is aimed at investigating the awareness of and preferences for oral and long-acting injectable HIV preexposure prophylaxis (PrEP) and their associated factors among men who have sex with men (MSM) at high risk of HIV infection in southern China. A cross-sectional survey was conducted among 603 MSM who were recruited through a cohort study called the T2T Study at three sexual health clinics in Guangzhou, Shenzhen, and Wuxi, China, from 2017 to 2018. We collected information on HIV-negative participants' awareness of and willingness to use PrEP and its potential correlations. Univariate and multivariate logistic regressions were used for data analyses. A total of 550 HIV-negative MSM were enrolled in the study. Less than half of at-risk MSM (43.1%) had heard of PrEP before, and the rate of overall willingness to use PrEP was 65.8%, while MSM were more willing to use daily oral PrEP than long-acting injectable- (LAI-) PrEP (62.2% vs. 38.5%). MSM who had university degrees or above (aOR = 1.55, 95% CI: 1.01-2.37), used condoms during last anal sex (1.52, 1.01-2.29), and tested 3 times or more for HIV (2.45, 1.10-5.47) were more likely to be aware of PrEP. MSM who had use of gay dating apps (1.51, 1.02-2.23), ever participated in HIV- or sexually transmitted disease (STD-) related studies (1.91, 1.24-2.94), and had heard of PrEP (3.06, 2.06-4.54) were more willing to use any regimen of PrEP. MSM at high risk of HIV infection had low awareness of PrEP and moderate willingness to use PrEP. Further studies of the implementation and promotion of PrEP targeting at-risk MSM should be performed.
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Affiliation(s)
- Weiying Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Yi Ding
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Jianghao Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Peipei Zhao
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago IL 60601, USA
| | - Zhenyu Wang
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
| | - Xiaojun Meng
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Tianjian Jia
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Zhenzhou Luo
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Huachun Zou
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
- Kirby Institute, University of New South Wales, Sydney 1466, Australia
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Tordoff DM, Barbee LA, Khosropour CM, Hughes JP, Golden MR. Derivation and Validation of an HIV Risk Prediction Score Among Gay, Bisexual, and Other Men Who Have Sex With Men to Inform PrEP Initiation in an STD Clinic Setting. J Acquir Immune Defic Syndr 2021; 85:263-271. [PMID: 32658131 DOI: 10.1097/qai.0000000000002438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinicians and health departments would ideally undertake targeted efforts to promote HIV pre-exposure prophylaxis (PrEP) and frequent HIV testing using data-based criteria to identify populations at elevated risk for HIV. We developed an HIV risk prediction score for men who have sex with men (MSM) to identify individuals at substantial risk for HIV acquisition. METHODS We created a retrospective cohort of MSM who tested HIV-negative at the sexually transmitted disease clinic in Seattle, WA, from 2001 to 2015, and identified seroconversions using HIV surveillance data. We split the cohort randomly 2:1 into derivation and validation data sets, and used Cox proportional hazards to estimate the hazard of acquiring HIV associated with behavioral and clinical predictors, and the Akaike information criterion to determine which variables to retain in our model. RESULTS Among 16,448 MSM, 640 seroconverted over a 14.3-year follow-up period. The best prediction model included 13 variables and had an area under the receiver operating characteristic curve of 0.73 (95% confidence interval: 0.71 to 0.76), 76% sensitivity, and 63% specificity at a score cutoff ≥11. A simplified model restricted to 2011-2015 included 4 predictors [methamphetamine use, condomless receptive anal intercourse (CRAI), ≥10 partners, and current diagnosis or self-reported gonorrhea/syphilis in the past year]. This model, the Seattle PrEP Score, had an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.64 to 0.73), 62% sensitivity, and 70% specificity. One-year incidence was 0.5% for a score of 0, 0.7% for a score of 1, and 2.1% for scores ≥2. CONCLUSIONS The Seattle PrEP Score was predictive of HIV acquisition and could help clinicians and public health agencies identify MSM who could benefit from PrEP and frequent HIV testing.
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Affiliation(s)
| | - Lindley A Barbee
- Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - Christine M Khosropour
- Departments of Epidemiology.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- Departments of Epidemiology.,Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
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Wu MY, Gong HZ, Hu KR, Zheng HY, Wan X, Li J. Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis. Sex Transm Infect 2020; 97:525-533. [PMID: 33219164 PMCID: PMC8543214 DOI: 10.1136/sextrans-2020-054706] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Co-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations. Methods Five electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics. Results A total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)). Conclusions Syphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.
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Affiliation(s)
- Meng Yin Wu
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zi Gong
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kui Ru Hu
- Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China
| | - He-Yi Zheng
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Wan
- Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Palmer S, Dijkstra M, Ket JCF, Wahome EW, Walimbwa J, Gichuru E, van der Elst EM, Schim van der Loeff MF, de Bree GJ, Sanders EJ. Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis. J Int AIDS Soc 2020; 23 Suppl 6:e25590. [PMID: 33000916 PMCID: PMC7527764 DOI: 10.1002/jia2.25590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. METHODS We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). RESULTS Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. CONCLUSIONS Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
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Affiliation(s)
- Shaun Palmer
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- International AIDS Vaccine InitiativeAmsterdamthe Netherlands
| | - Maartje Dijkstra
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Johannes CF Ket
- Medical LibraryVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elizabeth W Wahome
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | | | - Evanson Gichuru
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Elise M van der Elst
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Godelieve J de Bree
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- Department of Global Health, and Amsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
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14
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Low HIV incidence among women following sexually transmitted infection does not support national pre-exposure prophylaxis recommendations. AIDS 2020; 34:1429-1431. [PMID: 32590439 DOI: 10.1097/qad.0000000000002561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Current United States guidelines recommend that clinicians offer HIV pre-exposure prophylaxis (PrEP) to women with gonorrhea or syphilis. We estimated HIV incidence among women following a syphilis, gonorrhea, or chlamydia diagnosis among women in King County, WA using surveillance data from 2008 to 2018. Among women with diagnosed with gonorrhea and among women diagnosed with chlamydia the estimated HIV incidence rates were 0.06 and 0.02 per 100 person years, respectively. No women reported with syphilis were diagnosed with HIV.
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15
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Meireles P, Plankey M, Rocha M, Brito J, Mendão L, Barros H. Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014-2018. Euro Surveill 2020; 25:1900636. [PMID: 32700673 PMCID: PMC7376846 DOI: 10.2807/1560-7917.es.2020.25.28.1900636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/15/2020] [Indexed: 11/20/2022] Open
Abstract
IntroductionGuidelines for pre-exposure prophylaxis (PrEP) provide criteria to identify individuals at higher risk of HIV infection. We compared the ability to predict HIV seroconversion of four guidelines: the World Health Organization (WHO), the United States Public Health Service and Centers for Disease Control and Prevention (US CDC), the European AIDS Clinical Society (EACS) and the Portuguese National Health Service (PNHS).AimWe aimed to measure the association between guideline-specific eligibility and HIV seroconversion.MethodsWe studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion.ResultsWe found 28 incident cases (IR: 1.62/100 PY; 95% confidence interval (CI) 1.12-2.35). Guidelines' sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46/100 PY; IRR = 4.61; 95% CI: 1.60-13.27) and lowest for the WHO guideline (1.89/100 PY; IRR = 1.52; 95% CI: 0.69-3.35).ConclusionsBeing identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.
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Affiliation(s)
- Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Michael Plankey
- Georgetown University Medical Center, Georgetown University, Washington DC, United States
| | - Miguel Rocha
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - João Brito
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - Luís Mendão
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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16
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Aisner AJ, Zappas M, Marks A. Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Brief Report: Impact of PrEP Training for Family Planning Providers on HIV Prevention Counseling and Patient Interest in PrEP in Atlanta, Georgia. J Acquir Immune Defic Syndr 2020; 81:414-418. [PMID: 30985558 DOI: 10.1097/qai.0000000000002057] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Safety net family planning (FP) clinics provide vital care for women in high HIV-burden areas and may be ideal pre-exposure prophylaxis (PrEP) delivery sites. Yet, many FP providers lack knowledge about PrEP. SETTING Four safety net FP clinics in Atlanta, Georgia. METHODS We provided a 1.5-hour PrEP informational training for 28 providers working in these sites. To assess the training's impact on PrEP counseling, we enrolled 500 female patients after training (47% ≤ 28 years; 69% black; 12% Hispanic) and determined their PrEP indication based on CDC guidelines. We conducted a postvisit survey to assess provider counseling and patients' interest in PrEP and acceptance of off-site PrEP referral. RESULTS From pre-training to post-training, provider PrEP knowledge and confidence to identify women who may benefit from PrEP significantly increased. Only 19% of women knew about PrEP before the visit. Among 376 sexually active women, 29% had risk consistent with PrEP indication. Among PrEP-indicated women, 66% reported the provider discussed PrEP, 29% were interested in taking PrEP, but only 18% accepted off-site PrEP referral. Most (76%) were more willing to take PrEP if provided by the FP clinic. CONCLUSIONS After a brief PrEP training, most women with HIV-risk indicators received PrEP counseling during their visits. Once counseled, women expressed interest if it were offered at the FP clinic rather than through off-site referral. Findings highlight the potential impact that PrEP capacity building within safety net FP clinics in high HIV-burden areas may have on PrEP scale-up for women.
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18
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Maitino EM, Shafir SC, Beymer MR, Shover CL, Cunningham NJ, Flynn RP, Bolan RK. Age at first HIV test for MSM at a community health clinic in Los Angeles. AIDS Care 2019; 32:186-192. [PMID: 31663365 DOI: 10.1080/09540121.2019.1683806] [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: 10/25/2022]
Abstract
Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.
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Affiliation(s)
- Emily M Maitino
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Matt R Beymer
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Los Angles LBGT Center, Los Angeles, CA, USA
| | - Chelsea L Shover
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nicole J Cunningham
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Risa P Flynn
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert K Bolan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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19
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Allan-Blitz LT, Konda KA, Vargas SK, Wang X, Segura ER, Fazio BM, Calvo GM, Caceres CF, Klausner JD. The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru. Sex Health 2019; 15:261-268. [PMID: 30021680 DOI: 10.1071/sh17118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. METHODS Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. RESULTS Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. CONCLUSIONS Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Silver K Vargas
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90095, USA
| | - Eddy R Segura
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Boris M Fazio
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Gino M Calvo
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
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20
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Sales JM, Sheth AN. Associations Among Perceived HIV Risk, Behavioral Risk and Interest in PrEP Among Black Women in the Southern US. AIDS Behav 2019; 23:1871-1876. [PMID: 30387025 DOI: 10.1007/s10461-018-2333-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Utilizing data from Southern women, we created an HIV risk index with expanded partner-level factors to better capture women who may benefit from HIV pre-exposure prophylaxis (PrEP). We examined the relationships between potential HIV risk as estimated by laboratory-confirmed bacterial STIs, HIV risk index, perceived HIV risk, and interest in PrEP. Women had multiple PrEP indications; partner characteristics better differentiated STI status than other indicators. Perceived HIV risk differentiated STI status, significantly correlated with the HIV risk index, as well as predicted greater interest in PrEP. Findings can inform how best to evaluate HIV risk and PrEP acceptability among women.
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Affiliation(s)
- Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road, Room 570, Atlanta, GA, 30322, USA.
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, USA
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21
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Luo Q, Huang X, Li L, Ding Y, Mi G, Scott SR, Zhao Y, Rou K, He N, Wu H, Wu Z. External validation of a prediction tool to estimate the risk of human immunodeficiency virus infection amongst men who have sex with men. Medicine (Baltimore) 2019; 98:e16375. [PMID: 31335685 PMCID: PMC6708837 DOI: 10.1097/md.0000000000016375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A human immunodeficiency virus (HIV) risk assessment tool was previously developed for predicting HIV infection among men who have sex with men (MSM), but was not externally validated. We evaluated the tool's validity for predicting HIV infection in an independent cohort.The tool was assessed using data from a retrospective cohort study of HIV-negative adult MSM who were recruited in Beijing, China between January 2009 and December 2016.High-risk behaviors occurring within 6 months before the survey were evaluated. Area under curve (AUC) of the receiver operating character curve (ROC) was used to quantify discrimination performance; calibration curve and Hosmer-Lemeshow statistic were used for calibration performance valuation; and decision curve analysis (DCA) was used to evaluate clinical usage.One thousand four hundred forty two participants from the cohort were included in the analysis; 246 (17.1%) sero-converted during follow-up. External validation of the tool showed good calibration, the Hosmer-Lemeshow test showed no statistical difference between observed probability and tool-based predictive probability of HIV infection (X = 4.55, P = .80). The tool had modest discrimination ability (AUC = 0.63, 95% confidence interval [CI]: 0.61-0.66). The decision curve analysis indicated that implementing treatment measures based on the tool's predicative risk thresholds ranging from 10% to 30% might increase the net benefit of treatment when compared with treating all or no MSM.The HIV risk assessment tool can predict the actual risk of HIV infection well amongst MSM in China, but it has a moderate ability to discriminate those at high risk of HIV infection.
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Affiliation(s)
- Qianqian Luo
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
- School of Nursing, Binzhou Medical University, Yantai, Shandong
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing You’an Hospital, Capital Medical University
| | - Lingling Li
- Fudan University School of Public Health, Shanghai
| | | | - Guodong Mi
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
- Blue City Holdings, Ltd. Beijing, China
| | - Sarah Robbins Scott
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Yan Zhao
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Keming Rou
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
| | - Na He
- Fudan University School of Public Health, Shanghai
| | - Hao Wu
- Fudan University School of Public Health, Shanghai
| | - Zunyou Wu
- The National Center for Acquired Immunodeficiency Syndromes and Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing
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22
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Curry SJ, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 321:2203-2213. [PMID: 31184747 DOI: 10.1001/jama.2019.6390] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE An estimated 1.1 million individuals in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. In 2017, there were 38 281 new diagnoses of HIV infection reported in the United States; 81% of these new diagnoses were among males and 19% were among females. Although treatable, HIV infection has no cure and has significant health consequences. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on preexposure prophylaxis (PrEP) for the prevention of HIV infection. EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits of PrEP for the prevention of HIV infection with oral tenofovir disoproxil fumarate monotherapy or combined tenofovir disoproxil fumarate and emtricitabine and whether the benefits vary by risk group, population subgroup, or regimen or dosing strategy; the diagnostic accuracy of risk assessment tools to identify persons at high risk of HIV acquisition; the rates of adherence to PrEP in primary care settings; the association between adherence and effectiveness of PrEP; and the harms of PrEP when used for HIV prevention. FINDINGS The USPSTF found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV acquisition. The USPSTF also found convincing evidence that adherence to PrEP is highly associated with its efficacy in preventing the acquisition of HIV infection; thus, adherence to PrEP is central to realizing its benefit. The USPSTF found adequate evidence that PrEP is associated with small harms, including kidney and gastrointestinal adverse effects. The USPSTF concludes with high certainty that the magnitude of benefit of PrEP with oral tenofovir disoproxil fumarate-based therapy to reduce the risk of acquisition of HIV infection in persons at high risk is substantial. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends offering PrEP with effective antiretroviral therapy to persons at high risk of HIV acquisition. (A recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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23
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Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, Grusing S, Korthuis PT. Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321:2214-2230. [PMID: 31184746 DOI: 10.1001/jama.2019.2591] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Effective prevention strategies for HIV infection are an important public health priority. Preexposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) daily or before and after sex to decrease risk of acquiring HIV infection. OBJECTIVE To synthesize the evidence on the benefits and harms of PrEP, instruments for predicting incident HIV infection, and PrEP adherence to inform the US Preventive Services Task Force. DATA SOURCES Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and EMBASE through June 2018, with surveillance through January 2019. STUDY SELECTION English-language placebo-controlled randomized clinical trials of oral PrEP with tenofovir disoproxil fumarate/emtricitabine or tenofovir disoproxil fumarate monotherapy; studies on the diagnostic accuracy of instruments for predicting incident HIV infection; and studies on PrEP adherence. DATA EXTRACTION AND SYNTHESIS Dual review of titles and abstracts, full-text articles, study quality, and data abstraction. Data were pooled using the Dersimonian and Laird random-effects model for effects of PrEP on HIV infection, mortality, and harms. MAIN OUTCOMES AND MEASURES HIV acquisition, mortality, and harms; adherence to PrEP; and diagnostic test accuracy and discrimination. RESULTS Fourteen RCTs (N = 18 837), 8 observational studies (N = 3884), and 7 studies of diagnostic accuracy (N = 32 279) were included. PrEP was associated with decreased risk of HIV infection vs placebo or no PrEP after 4 months to 4 years (11 trials; relative risk [RR], 0.46 [95% CI, 0.33-0.66]; I2 = 67%; absolute risk reduction [ARD], -2.0% [95% CI, -2.8% to -1.2%]). Greater adherence was associated with greater efficacy (RR with adherence ≥70%, 0.27 [95% CI, 0.19-0.39]; I2 = 0%) in 6 trials. PrEP was associated with an increased risk of renal adverse events (12 trials; RR, 1.43 [95% CI, 1.18-1.75]; I2 = 0%; ARD, 0.56% [95% CI, 0.09%-1.04%]) and gastrointestinal adverse events (12 trials; RR, 1.63 [95% CI, 1.26-2.11]; I2 = 43%; ARD, 1.95% [95% CI, 0.48%-3.43%]); most adverse events were mild and reversible. Instruments for predicting incident HIV infection had moderate discrimination (area under the receiver operating characteristic curve, 0.49-0.72) and require further validation. Adherence to PrEP in the United States in men who have sex with men varied widely (22%-90%). CONCLUSIONS AND RELEVANCE In adults at increased risk of HIV infection, PrEP with oral tenofovir disoproxil fumarate monotherapy or tenofovir disoproxil fumarate/emtricitabine was associated with decreased risk of acquiring HIV infection compared with placebo or no PrEP, although effectiveness decreased with suboptimal adherence.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Christopher Evans
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Adam Hoverman
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Christina Sun
- Oregon Health & Science University-Portland State University School of Public Health, Portland
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Sara Grusing
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - P Todd Korthuis
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Oregon Health & Science University-Portland State University School of Public Health, Portland
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Freeborn K, Portillo C, Boyer CB, Santos GM. Misclassification of sexual health risks in a self-identified low risk cohort of men who have sex with men (MSM) enrolled in a community based PrEP program. AIDS Care 2019; 32:230-237. [PMID: 31129982 DOI: 10.1080/09540121.2019.1620167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
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Affiliation(s)
- Kellie Freeborn
- Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | | | - Cherie B Boyer
- San Francisco Division of Adolescent and Young Adult Medicine, Department of Pediatrics UCSF Benioff Children's Hospital San Francisco, University of California, San Francisco, CA, USA
| | - Glen Milo Santos
- School of Nursing, Department of Community Health Systems, University of California San Francisco, San Francisco, CA, USA
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Jayawardene W, Carter G, Agley J, Meyerson B, Garcia JR, Miller W. HIV pre-exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors. J Adv Nurs 2019; 75:2559-2569. [PMID: 30950528 DOI: 10.1111/jan.14019] [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: 11/07/2018] [Revised: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
AIMS To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses' uptake of HIV pre-exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once-daily pill, along with sexual risk reduction education. DESIGN Cross-sectional. METHODS During March-May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self-rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non-Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors. RESULTS Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence-based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence-based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors. CONCLUSION Barriers exist against pre-exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high-risk communities, whereas practice change is more effective when focused on changing providers' attitudes towards intervention. When planning a pre-exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success. IMPACT In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre-exposure prophylaxis implementation.
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Affiliation(s)
- Wasantha Jayawardene
- Institute for Research on Addictive Behavior, Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Gregory Carter
- School of Nursing, Indiana University Bloomington, Bloomington, Indiana
| | - Jon Agley
- Institute for Research on Addictive Behavior, Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Beth Meyerson
- Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, Indiana
| | - Justin R Garcia
- The Kinsey Institute and Department of Gender Studies, Indiana University Bloomington, Indiana University Bloomington, Bloomington, Indiana
| | - Wendy Miller
- School of Nursing Indianapolis, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana
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John SA, Rendina HJ, Starks TJ, Grov C, Parsons JT. Decisional Balance and Contemplation Ladder to Support Interventions for HIV Pre-Exposure Prophylaxis Uptake and Persistence. AIDS Patient Care STDS 2019; 33:67-78. [PMID: 30653348 DOI: 10.1089/apc.2018.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Fewer than 60,000 males-inclusive of all sexual identities-were prescribed HIV pre-exposure prophylaxis (PrEP) by mid-2017 in the United States. Efforts to increase PrEP uptake among gay, bisexual, and other men who have sex with men (GBM), in particular, are ongoing in research and practice settings, but few tools exist to support interventions. We aimed to develop and validate tools to support motivational interviewing interventions for PrEP. In 2017, a national sample of HIV-negative GBM of relatively high socioeconomic status (n = 786) was asked about sexual behaviors that encompass Centers for Disease Control and Prevention guidelines for PrEP use, a 35-item decisional-balance scale (i.e., PrEP-DB) assessing benefits and consequences of PrEP use, and questions assessing location on the motivational PrEP cascade and derivative-the PrEP contemplation ladder. Principal axis factoring with oblique promax rotation was used for PrEP-DB construct identification and item reduction. The final 20-item PrEP-DB performed well; eigenvalues indicating a 4-factor solution provided an adequate fit to the data. Factors included the following: health benefits (α = 0.91), health consequences (α = 0.82), social benefits (α = 0.72), and social consequences (α = 0.86). Ladder scores increased across the cascade (ρ = 0.89, p < 0.001), and health benefits (β = 0.50, p < 0.001) and health consequences (β = -0.37, p < 0.001) were more strongly associated with ladder location than social benefits (β = 0.05, p > 0.05) and social consequences (β = -0.05, p > 0.05) in the fully adjusted regression model. The PrEP-DB demonstrated good reliability and predictive validity, and the ladder had strong construct validity with the motivational PrEP cascade. PrEP uptake and persistence interventions and additional empirical work could benefit from the utility of these measures.
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Affiliation(s)
- Steven A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - H. Jonathon Rendina
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Tyrel J. Starks
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, New York, New York
| | - Jeffrey T. Parsons
- Department of Psychology, Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, New York
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, New York
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Frasca K, Nassau T, McLaughlin C, Brady KA. Factors Associated with Recent HIV Testing among Men Who Have Sex with Men in Philadelphia: a Cross-Sectional Analysis of the National Behavioral Surveillance System Survey. AIDS Care 2018; 31:230-237. [PMID: 30304956 DOI: 10.1080/09540121.2018.1533228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The main objective of this study was to determine the demographic, geographic and socioeconomic characteristics of men who have sex with men (MSM) in Philadelphia that were associated with having a recent HIV test. We used data from the National HIV Behavioral Surveillance System (NHBS) surveys from 2011 and 2014 among MSM in Philadelphia, with the outcome of interest of having received an HIV test in the past twelve months. Of 1043 HIV-negative MSM, 70.2% had an HIV test. Multivariable analysis showed that seeing a medical provider (aOR: 1.73; p = .0039) or having heard of PrEP (aOR: 2.24; p < .0001) was associated with recent HIV testing. Those participants forty-five years of age or older (aOR 0.40, p = .0001) and those with Medicaid had lower rates of HIV testing (aOR 0.48, p = .002). Although over 80% of participants had seen a medical provider in the past year, only 50% had been offered an HIV test by a provider. Optimizing HIV testing through the expansion and increased awareness of PrEP, especially among older MSM, is critical. Further research is needed to delineate barriers that prevent MSM from utilizing medical providers for HIV testing and for those with Medicaid from receiving HIV testing.
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Affiliation(s)
- Katherine Frasca
- a Division of Infectious Diseases , University of Colorado , Denver , CO , USA
| | - Tanner Nassau
- b Philadelphia Department of Public Health , Philadelphia , PA , USA
| | - Carol McLaughlin
- c Division of Infectious Diseases , University of Pennsylvania , Philadelphia , PA , USA
| | - Kathleen A Brady
- b Philadelphia Department of Public Health , Philadelphia , PA , USA
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Shover CL, Javanbakht M, Shoptaw S, Bolan RK, Lee SJ, Parsons JT, Rendina J, Gorbach PM. HIV Preexposure Prophylaxis Initiation at a Large Community Clinic: Differences Between Eligibility, Awareness, and Uptake. Am J Public Health 2018; 108:1408-1417. [PMID: 30138062 PMCID: PMC6137770 DOI: 10.2105/ajph.2018.304623] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk. METHODS We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data. RESULTS Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated. CONCLUSIONS Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.
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Affiliation(s)
- Chelsea L Shover
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Marjan Javanbakht
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Steven Shoptaw
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Robert K Bolan
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Sung-Jae Lee
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jeffrey T Parsons
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Jonathon Rendina
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
| | - Pamina M Gorbach
- Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine
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Wahome E, Thiong’o AN, Mwashigadi G, Chirro O, Mohamed K, Gichuru E, Mwambi J, Price MA, Graham SM, Sanders EJ. An Empiric Risk Score to Guide PrEP Targeting Among MSM in Coastal Kenya. AIDS Behav 2018; 22:35-44. [PMID: 29767324 DOI: 10.1007/s10461-018-2141-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Men who have sex with men (MSM), who have heterogeneous HIV-acquisition risks are not specifically targeted in Kenyan pre-exposure prophylaxis (PrEP) guidelines. We used data from an open cohort, which followed 753 initially HIV-negative MSM participants for more than 1378.5 person-years, to develop an empiric risk score for targeting PrEP delivery. Independent predictors of incident HIV-1 infection in this cohort were an age of 18-24 years, having only male sex partners, having receptive anal intercourse, having any unprotected sex, and having group sex. Poisson model coefficients were used to assign a numeric score to each statistically significant predictor. A risk score of ≥ 1 corresponded to an HIV-1 incidence of ≥ 2.2 [95% confidence interval (CI) 1.2-4.1] and identified 81.3% of the cohort participants as being at high risk for HIV-1 acquisition. The area under the receiver operating characteristic curve was 0.76 (95% CI 0.71-0.80). This empiric risk score may help Kenyan health care providers to assess HIV-1 acquisition risk and encourage PrEP uptake by high-risk MSM.
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Tomkins A, George R, Kliner M. Sexualised drug taking among men who have sex with men: a systematic review. Perspect Public Health 2018; 139:23-33. [PMID: 29846139 DOI: 10.1177/1757913918778872] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS: Sexualised drug taking is increasingly reported on national and international levels. We aim to review existing evidence of the relationship between recreational drug use (RDU) and sexual intercourse among men who have sex with men (MSM). METHODS: We reviewed published abstracts and full articles identified from Cochrane, MEDLINE and Embase databases from November 2010 to 2017. We included any existing studies investigating RDU in MSM and at least one of the following: high-risk sexual practices, sexually transmitted infections (STIs) or barriers to accessing specialist support. RESULTS: In total, 112 studies were included. Of them, 38 studies specifically reported the prevalence of chemsex-related drug use. Links with sexualised drug taking and high-risk sexual practices including condomless sex and group sex were reported by several studies. Recreational drug use in the sexual setting appears linked to the acquisition of STIs, including hepatitis C, syphilis and gonorrhoea. Reports of adverse mental health outcomes are increasingly described, with several studies documenting chemsex-related inpatient admission. A paucity of research addressing barriers to those accessing specialist drug support services was identified. CONCLUSION: This review demonstrates the complex interplay between recreational drug use, high-risk sexual practices and STIs. It identifies the description of adverse mental health outcomes in the chemsex setting, thus highlighting the need for a multidisciplinary approach across specialties in the management of those adversely affected. Finally, it illuminates the need for future research into perceived barriers of those who require access to support services to ensure timely and comprehensive support provision.
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Affiliation(s)
- Andrew Tomkins
- Manchester University Hospitals NHS Foundation Trust, The Hathersage Centre, Manchester M13 9WL, UK.,The Northern Integrated Contraception, Sexual Health & HIV Service, Manchester, UK
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Merav Kliner
- Public Health England North West, Manchester, UK
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Sales JM, Steiner RJ, Brown JL, Swartzendruber A, Patel AS, Sheth AN. PrEP Eligibility and Interest Among Clinic- and Community-Recruited Young Black Women in Atlanta, Georgia, USA. Curr HIV Res 2018. [PMID: 30062969 DOI: 10.2174/1570162×16666180731143756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Atlanta has been identified as an HIV "hot spot" for Black women and ranks 5th in the US with new infections. Yet little is known about PrEP eligibility or interest among young Black women in Atlanta. METHODS A convenience sample of 1,261 Black women (ages 14-24 years) were recruited from two settings: community venues and sexual health clinics. They provided self-reported sexual behavior data and specimens for laboratory testing for chlamydia (CT) and gonorrhea (GC) infections. For each woman, the number of key self-reported behavioral HIV risk factors was calculated (0-6 factors for the clinic sample, 0-3 factors for the community sample). A single item assessed PrEP interest in the community sample only. RESULTS Bacterial STI positivity, an indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, 20.1% reported no behavioral risk indicators and 47.2% reported > 2 behavioral indicators. Of the 117 STI positive women from the community sample, 21.4% reported no behavioral risk indicators. 60.7% of the community sample reported they would be likely or very likely to use PrEP if available. CONCLUSION Young Black women in Atlanta, whether sampled from community or sexual health settings, are at substantial risk for HIV infection and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.
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Affiliation(s)
- J M Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, United States
| | - R J Steiner
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, United States
| | - J L Brown
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - A Swartzendruber
- College of Public Health, University of Georgia, Athens, Georgia, United States
| | - A S Patel
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, United States
| | - A N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, United States
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Sales J, Steiner R, Brown J, Swartzendruber A, Patel A, Sheth A. PrEP Eligibility and Interest Among Clinic- and Community-Recruited Young Black Women in Atlanta, Georgia, USA. Curr HIV Res 2018; 16:250-255. [PMID: 30062969 PMCID: PMC6352727 DOI: 10.2174/1570162x16666180731143756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Atlanta has been identified as an HIV "hot spot" for Black women and ranks 5th in the US with new infections. Yet little is known about PrEP eligibility or interest among young Black women in Atlanta. METHODS A convenience sample of 1,261 Black women (ages 14-24 years) were recruited from two settings: community venues and sexual health clinics. They provided self-reported sexual behavior data and specimens for laboratory testing for chlamydia (CT) and gonorrhea (GC) infections. For each woman, the number of key self-reported behavioral HIV risk factors was calculated (0-6 factors for the clinic sample, 0-3 factors for the community sample). A single item assessed PrEP interest in the community sample only. RESULTS Bacterial STI positivity, an indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, 20.1% reported no behavioral risk indicators and 47.2% reported > 2 behavioral indicators. Of the 117 STI positive women from the community sample, 21.4% reported no behavioral risk indicators. 60.7% of the community sample reported they would be likely or very likely to use PrEP if available. CONCLUSION Young Black women in Atlanta, whether sampled from community or sexual health settings, are at substantial risk for HIV infection and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.
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Affiliation(s)
- J.M. Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - R.J. Steiner
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - J.L. Brown
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - A. Swartzendruber
- College of Public Health, University of Georgia, Athens, Georgia, USA
| | - A.S. Patel
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - A.N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
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Robineau O, Velter A, Barin F, Boelle PY. HIV transmission and pre-exposure prophylaxis in a high risk MSM population: A simulation study of location-based selection of sexual partners. PLoS One 2017; 12:e0189002. [PMID: 29190784 PMCID: PMC5708822 DOI: 10.1371/journal.pone.0189002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/16/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE In France, indications for pre-exposure prophylaxis (PrEP) for HIV prevention are based on individual-level risk factors for HIV infection. However, the risk of HIV infection may also depend on characteristics of sexual partnerships. Here we study how place-based selection of partners change transmission and the overall efficiency of PrEP. METHODS We used the PREVAGAY survey of sexual behavior and HIV serostatus in men who have sex with men (MSM) in a Parisian district to look for associations between sexual network characteristics and HIV infection. We then simulated HIV transmission in a high-risk MSM population. We used information about venues visited to meet casual sexual partners (clubs, backrooms or saunas) to define sexual networks. We then simulated HIV transmission in these networks and assessed the impact of PrEP in this population. RESULTS In the PREVAGAY study, we found that HIV serostatus changed with the type of venues visited, in addition to other individual risk factors. In simulations, we found similar differences in HIV incidence when the choice of venues visited was not random. The use of PrEP allowed reducing incidence, irrespective of the venues visited by PrEP users. However, with the same amount of PrEP, the number of infections adverted could almost double depending on network structure and venues visited by PrEP users. CONCLUSION This study shows that characteristics of the sexual network structure can strongly impact the effectiveness of PrEP interventions. These should be considered further to refine individual risk assessment and maximize the effect of individual-based prevention policies.
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Affiliation(s)
- Olivier Robineau
- Sorbonne Universités - Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM U1136, Paris, France
- Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier Gustave Dron, Tourcoing, France
- Département des maladies infectieuses, Univ Lille 2, Lille, France
| | | | - Francis Barin
- Université François-Rabelais, INSERM UMR966, Tours, France
- Centre Hospitalier Régional Universitaire, Centre National de Référence du VIH, Tours, France
| | - Pierre-Yves Boelle
- Sorbonne Universités - Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM U1136, Paris, France
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