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Kuruc JD, Cope AB, Sampson LA, Gay CL, Ashby RM, Foust EM, Brinson M, Barnhart JE, Margolis D, Miller WC, Leone PA, Eron JJ. Ten Years of Screening and Testing for Acute HIV Infection in North Carolina. J Acquir Immune Defic Syndr 2016; 71:111-9. [PMID: 26761274 PMCID: PMC4712730 DOI: 10.1097/qai.0000000000000818] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe demographic and behavioral characteristics of persons with acute HIV infection (AHI) over time. METHODS We conducted a retrospective assessment of AHI identified through the Screening and Tracing Active Transmission (STAT) program from 2003 to 2012 in North Carolina (NC). AHI was identified using pooled nucleic acid amplification for antibody negative samples and individual HIV-1 RNA for antibody indeterminate samples. The STAT program provides rapid notification and evaluation. We compared STAT-collected demographic and risk characteristics with all persons requesting tests and all non-AHI diagnoses from the NC State Laboratory of Public Health. RESULTS The STAT Program identified 236 AHI cases representing 3.4% (95% confidence interval: 3.0% to 3.9%) of all HIV diagnoses. AHI cases were similar to those diagnosed during established HIV. On pretest risk-assessments, AHI cases were predominately black (69.1%), male (80.1%), young (46.8% < 25 years), and men who have sex with men (MSM) (51.7%). Per postdiagnosis interviews, the median age decreased from 35 (interquartile range 25-42) to 27 (interquartile range 22-37) years, and the proportion <25 years increased from 23.8% to 45.2% (trend P = 0.04) between 2003 and 2012. AHI men were more likely to report MSM risk post-diagnosis than on pretest risk-assessments (64%-82.9%; P < 0.0001). Post-diagnosis report of MSM risk in men with AHI increased from 71.4% to 96.2%. CONCLUSIONS In NC, 3.4% of individuals diagnosed with HIV infection have AHI. AHI screening provides a real-time source of incidence trends, improves the diagnostic yield of HIV testing, and offers an opportunity to limit onward transmission.
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Affiliation(s)
- JoAnn D. Kuruc
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anna B. Cope
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lynne A. Sampson
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Cynthia L. Gay
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rhonda M. Ashby
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Evelyn M. Foust
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Myra Brinson
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - John E. Barnhart
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - David Margolis
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William C. Miller
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Peter A. Leone
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joseph J. Eron
- Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Wu H, Hightow-Weidman LB, Gay CL, Zhang X, Beagle S, Hall L, Jackson T, Marmorino J, Do AN, Peters PJ. Unreported Male Sex Partners Among Men with Newly Diagnosed HIV Infection - North Carolina, 2011-2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1037-41. [PMID: 26401589 DOI: 10.15585/mmwr.mm6437a2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Human immunodeficiency virus (HIV) prevention interventions, such as preexposure prophylaxis (PrEP), are often targeted to men who have sex with men (MSM) who self-report high-risk behaviors. Data from a prospective study evaluating methods to detect acute HIV infection among a primarily young (aged <25 years) and black or African American (African American) population from North Carolina were analyzed. In the study, participants were asked about risk behaviors during pretest counseling (at the time of testing) and then during a partner services interview (at HIV diagnosis). Participants whose disclosure of sexual risk behaviors during pretest counseling was different from their disclosure of sexual risk behaviors during their partner services interview were identified, and factors associated with these discordant responses were examined. Among 113 HIV-infected men, 26 (23.0%) did not disclose male sex partners at pretest counseling, but subsequently did disclose this information during their partner services interview. When compared with men who disclosed having male partners at pretest counseling, these 26 MSM who did not disclose male partners during pretest counseling were found to have a similar number of male partners during contact tracing, but were more likely to have a female partner (30.8% versus 6.9%). In addition, the proportions of MSM found to have at least one HIV-infected partner were similar for both groups (MSM who disclosed having male partners during pretest counseling and those who did not). To better customize HIV prevention interventions for MSM, HIV prevention programs might consider using novel strategies to accurately assess risk in this population.
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Monteiro SS, Brandão E, Vargas E, Mora C, Soares P, Daltro E. Discursos sobre sexualidade em um Centro de Testagem e Aconselhamento (CTA). CIENCIA & SAUDE COLETIVA 2014; 19:137-46. [DOI: 10.1590/1413-81232014191.1906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/05/2012] [Indexed: 11/22/2022] Open
Abstract
Frente à centralidade da via sexual na transmissão do HIV, o trabalho analisa os discursos sobre sexualidade entre profissionais de saúde e usuários em um Centro de Testagem e Aconselhamento (CTA), do Estado do Rio de Janeiro. A metodologia envolveu observação direta do aconselhamento individual pré-teste e a realização de 384 questionários e 14 entrevistas com usuários. Observou-se que o aconselhamento é caracterizado pelo preenchimento do formulário de vigilância epidemiológica, havendo imprecisões na coleta e registro das práticas sexuais dos usuários, decorrentes da falta de estrutura do serviço. Durante o aconselhamento, as orientações ao usuário sobre DST/Aids foram centradas no tipo/número de parceiros sexuais, nos riscos ao HIV e no uso do preservativo. Tal abordagem não favorece o diálogo sobre a trajetória sexual do usuário, suas dúvidas e demandas relativas à sexualidade e a Aids. Os dados dos questionários e entrevistas revelaram a pouca familiaridade dos usuários em relação às categorias homo, hetero e bissexual. Recomenda-se: desvincular o aconselhamento do preenchimento do formulário SI-CTA; incorporar na formação dos aconselhadores os significados e diversidade das experiências sexuais dos sujeitos; investir na estrutura organizacional do serviço.
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Torrone EA, Thomas JC, Maman S, Pettifor AE, Kaufman JS, Sena AC, Hightow-Weidman LB. Risk behavior disclosure during HIV test counseling. AIDS Patient Care STDS 2010; 24:551-61. [PMID: 20718688 DOI: 10.1089/apc.2010.0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Individualized risk assessments during HIV testing are an integral component of prevention counseling, a currently recommended behavioral intervention for patients in high-risk settings. Additionally, aggregate risk assessment data are the source of aggregate behavioral statistics that inform prevention programs and allocation of resources. Consequently, inaccurate or incomplete risk behavior disclosure during test counseling may impact the efficacy of the counseling intervention, as well as bias aggregate behavioral statistics. To quantify client-reported accuracy during the risk assessment and identify barriers and facilitators to risk behavior disclosure, we interviewed young men accessing HIV testing services in a southeastern United States city using mixed methodology. Data were collected from August 2007 to April 2008. Based on data collected via an audio and computer-assisted self-interview (n = 203), over 30% of men reported that they were not accurate during the risk assessment. Participants reported numerous interpersonal facilitators to complete disclosure. During qualitative interviews (n = 25), participants revealed that many did not understand the purpose of the risk assessment. Findings suggest that risk assessments completed during HIV test counseling may be incomplete. Modifications to the risk assessment process, including better explaining the role of the risk assessment in prevention counseling, may increase the validity of the data.
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Affiliation(s)
- Elizabeth Ann Torrone
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - James C. Thomas
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Suzanne Maman
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Audrey E. Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Arlene C. Sena
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
- Durham County Health Department, Durham, North Carolina
| | - Lisa B. Hightow-Weidman
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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