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Wurcel AG, Guardado R, Grussing ED, Koutoujian PJ, Siddiqi K, Senst T, Assoumou SA, Freund KM, Beckwith CG. Racial differences in testing for infectious diseases: An analysis of jail intake data. PLoS One 2023; 18:e0288254. [PMID: 38117818 PMCID: PMC10732427 DOI: 10.1371/journal.pone.0288254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/11/2023] [Indexed: 12/22/2023] Open
Abstract
HIV and hepatitis C virus (HCV) testing for all people in jail is recommended by the CDC. In the community, there are barriers to HIV and HCV testing for minoritized people. We examined the relationship between race and infectious diseases (HIV, HCV, syphilis) testing in one Massachusetts jail, Middlesex House of Corrections (MHOC). This is a retrospective analysis of people incarcerated at MHOC who opted-in to infectious diseases testing between 2016-2020. Variables of interest were race/ethnicity, self-identified history of psychiatric illness, and ever having experienced restrictive housing. Twenty-three percent (1,688/8,467) of people who were incarcerated requested testing at intake. Of those, only 38% received testing. Black non-Hispanic (25%) and Hispanic people (30%) were more likely to request testing than white people (19%). Hispanic people (16%, AOR 1.69(1.24-2.29) were more likely to receive a test result compared to their white non-Hispanic (8%, AOR 1.54(1.10-2.15)) counterparts. Black non-Hispanic and Hispanic people were more likely to opt-in to and complete infectious disease testing than white people. These findings could be related to racial disparities in access to care in the community. Additionally, just over one-third of people who requested testing received it, underscoring that there is room for improvement in ensuring testing is completed. We hope our collaborative efforts with jail professionals can encourage other cross-disciplinary investigations.
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Affiliation(s)
- Alysse G. Wurcel
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Rubeen Guardado
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
| | - Emily D. Grussing
- Department of Medicine Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | | | - Kashif Siddiqi
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Thomas Senst
- Middlesex Sheriff’s Office, Medford, MA, United States of America
| | - Sabrina A. Assoumou
- Boston University School of Medicine, Boston, MA, United States of America
- Boston Medical Center, Boston, MA, United States of America
| | - Karen M. Freund
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Curt G. Beckwith
- The Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
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Townes A, Kota KK, Dailey AF, Henny KD. Racial/ethnic disparities in estimated undiagnosed HIV infection among adolescents and adults in the United States, 2017-2021. AIDS 2023; 37:1912-1914. [PMID: 37646592 PMCID: PMC11299193 DOI: 10.1097/qad.0000000000003665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In 2021, there were an estimated 153 500 persons aged at least 13 years with undiagnosed HIV infection. Estimated rates among Black/African American, Hispanic/Latino, and White persons were used to assess disparity trends from 2017 to 2021. Rates decreased across two absolute and relative disparity measures. Despite these declines, Black and Hispanic persons had rates 8.3 and 4.2 times the rate of White persons in 2021. Increased testing and innovative efforts are needed to address HIV-related disparities.
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Affiliation(s)
- Ashley Townes
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Andre F. Dailey
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kirk D. Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lucas JA, Marino M, Datta R, Chan BL, Heintzman JD. Ethnicity, Language, and HIV Screening in Older Adult Safety-Net Patients. Am J Prev Med 2023; 65:112-116. [PMID: 36754743 PMCID: PMC10293068 DOI: 10.1016/j.amepre.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION HIV screening should occur for all adults at least once by age 65 years. Older adults have low screening rates. Latinos, with historically low screening rates, have worse HIV outcomes than non-Hispanic White patients. Electronic health record data from a multistate network of community health centers were used to examine whether there are differences in HIV screening for Latino (English and Spanish preferring) and non-Hispanic White older adults. METHODS Data were from the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network of PCORnet from 21 states in 2012-2021 among an open cohort of patients aged 50-65 years. Relative odds of ever having received HIV screening comparing Latinos with non-Hispanic Whites using generalized estimating equation logistic regression modeling were calculated, adjusting for relevant patient-level covariates. Analyses were conducted in 2022. RESULTS Among 251,645 patients, the covariate-adjusted odds of ever receiving HIV screening were 18% higher for English-preferring Latino patients (OR=1.18, 95% CI=1.11, 1.25) and 32% higher for Spanish-preferring Latinos than for non-Hispanic Whites (OR=1.32, 95% CI=1.24, 1.42). CONCLUSIONS Latinos seen in community health centers, regardless of language spoken, are more likely to be screened at least once for HIV than non-Hispanic Whites. This increased screening may be due at least in part to the community health center setting, a setting known to mitigate disparities, as well as due to participation efforts by community health centers in public health campaigns. Future research can prioritize understanding the cause of this relative advantage.
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Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brian L Chan
- OCHIN, Inc., Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - John D Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon
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Townes A, Gaul Z, Henny KD. Sexual health discussion practices and HIV clinical care provided by primary care providers in the Southeast United States, K-BAP Study (2017-2018). Fam Pract 2023; 40:39-46. [PMID: 35899789 PMCID: PMC11299194 DOI: 10.1093/fampra/cmac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Research underscores the importance of providers having routine discussions with patients about their sexual health. We examined the occurrences and association of routine sexual health discussion practices and human immunodeficiency virus (HIV) clinical care among primary care providers (PCPs) in areas with high HIV prevalence. METHODS We analysed data collected between April and August 2017 from an online survey that assessed PCPs knowledge, behaviours, attitudes, and practices of HIV-related care in 6 Southeast US jurisdictions (Atlanta, Baltimore, Baton Rouge, District of Columbia, Miami, and New Orleans). RESULTS Among PCPs, we found that 39.2% routinely obtained sexual health histories, 78.5% offered HIV testing, and 16.0% ever prescribed preexposure prophylaxis (PrEP). Based on adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), the proportion of PCPs who routinely obtained sexual histories was higher among female PCPs (aPR = 1.47, 95% CI 1.04, 2.08), PCPs who had a patient population that was >50% men who have sex with men (MSM) (aPR = 1.94, 95% CI 1.72, 2.18), offered HIV testing (aPR = 3.60, 95% CI 2.23, 5.79), and ever prescribed PrEP (aPR = 1.43, 95% CI 1.06, 1.93). CONCLUSION Improving patient-provider discussions are needed to reduce HIV-related service barriers for disproportionately affected populations. PRACTICE IMPLICATIONS Routine discussions can reduce barriers to important HIV prevention and care services and help reduce disparities among patients living in highly prevalent HIV locations.
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Affiliation(s)
- Ashley Townes
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zaneta Gaul
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
- Social & Scientific Systems, Silver Spring, MD, United States
| | - Kirk D. Henny
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Bunting SR, Hunt B, Boshara A, Jacobs J, Johnson AK, Hazra A, Glick N. Examining the Correlation Between PrEP Use and Black:White Disparities in HIV Incidence in the Ending the HIV Epidemic Priority Jurisdictions. J Gen Intern Med 2023; 38:382-389. [PMID: 35678988 PMCID: PMC9905374 DOI: 10.1007/s11606-022-07687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION HIV incidence remains high in the U.S. as do disparities in new HIV diagnosis between White and Black populations and access to preventive therapies like pre-exposure prophylaxis (PrEP). The federal Ending the HIV Epidemic (EHE) initiative was developed to prioritize resources to 50 jurisdictions with high HIV incidence. METHODS We conducted secondary analyses of data (2013-2019) from the CDC, Census Bureau, and AIDSVu to evaluate the correlation between PrEP use, HIV incidence, and HIV incidence disparities. We compared the PrEP-to-need ratio (PnR) with the ratio of Black and White HIV incidence rates in 46 EHE counties. Subsequent analyses were performed for the seven states that contained multiple EHE counties. RESULTS These 46 counties represented 25.9% of the U.S. population in 2019. HIV incidence ranged from 10.5 in Sacramento County, CA, to 59.6 in Fulton County, GA (per 100,000). HIV incidence disparity ranged from 1.5 in Orleans Parish, LA, to 12.1 in Montgomery County, MD. PnR ranged from 26.8 in New York County, NY, to 1.46 in Shelby County, TN. Change in HIV incidence disparities and percent change in PnR were not significantly correlated (ρ = 0.06, p = 0.69). Change in overall HIV incidence was significantly correlated with increase in PnR (ρ = -0.42, p = 0.004). CONCLUSIONS PrEP has the potential to significantly decrease HIV incidence; however, this benefit has not been conferred equally. Within EHE priority counties, we found significant HIV incidence disparities between White and Black populations. PrEP has decreased overall HIV incidence, but does not appear to have decreased HIV incidence disparity.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA.
| | - Bijou Hunt
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Arianna Boshara
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Amy K Johnson
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nancy Glick
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
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Iqbal K, Dong X, Zhu W, Wiener J, Dominguez KL, Tanner MR, Kourtis AP, Singh S, Hoover KW. Decreased Human Immunodeficiency Virus Diagnosis Rates Among Black and Hispanic or Latino Men Who Have Sex With Men in US Jurisdictions Supported by the THRIVE Demonstration Project, 2014-2019. Clin Infect Dis 2023; 76:307-314. [PMID: 36124683 PMCID: PMC10999974 DOI: 10.1093/cid/ciac774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV). In the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project, 7 community collaboratives were developed to provide comprehensive HIV prevention services for these populations. METHODS We analyzed National HIV Surveillance System data to determine the number of HIV diagnoses for each year from 2014 to 2019 among Black, Hispanic/Latino, and White MSM in 7 THRIVE-eligible Metropolitan Statistical Areas (MSAs) that were awarded funding and 12 THRIVE-eligible MSAs that were not awarded funding. We used generalized linear Poisson regression models to estimate adjusted estimated annual percentage changes (EAPCs) with 95% confidence intervals for HIV diagnosis rates controlling for HIV prevalence, viral suppression, HIV testing rates, preexposure prophylaxis (PrEP) prescription rates, poverty, education, and insurance status. RESULTS We found larger estimated decreases in HIV diagnosis rates in THRIVE jurisdictions compared with non-THRIVE jurisdictions. The adjusted EAPC among Black MSM was -8.2 (-11.7 to -4.6) in THRIVE MSAs compared with -4.2 (-7.8 to -0.4) in non-THRIVE MSAs. The adjusted EAPC among Hispanic/Latino MSM was -8.6 (-12.2 to -4.8) in THRIVE MSAs compared with -2.6 (-5.1 to -0.1)in non-THRIVE MSAs. The adjusted EAPC among White MSM was -7.6 (-12.0 to -3.1) in THRIVE MSAs compared with 5.9 (1.8-10.1) in non-THRIVE MSAs. CONCLUSIONS The THRIVE community collaborative model was associated with a decrease in HIV diagnoses among Black and Hispanic/Latino MSM. To achieve the goals of the US Ending the HIV Epidemic initiative, effective interventions aimed to increase PrEP use need to be focused on Black and Hispanic/Latino MSM.
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Affiliation(s)
- Kashif Iqbal
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xueyuan Dong
- Social and Scientific Systems, Inc., a DLH Holdings company, Atlanta, Georgia, USA
| | - Weiming Zhu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Wiener
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kenneth L Dominguez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary R Tanner
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonia Singh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W Hoover
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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