1
|
Westgard LK, Sato T, Bradford WS, Eaton EF, Pilcher F, Hale AJ, Singh D, Martin M, Appa AA, Meyer JP, Weimer MB, Barakat LA, Felsen UR, Akiyama MJ, Ridgway JP, Grussing ED, Thakarar K, White A, Mutelayi J, Krsak M, Montague BT, Nijhawan A, Balakrishnan H, Marks LR, Wurcel AG. National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals. Open Forum Infect Dis 2024; 11:ofae204. [PMID: 38746950 PMCID: PMC11093397 DOI: 10.1093/ofid/ofae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/10/2024] [Indexed: 06/02/2024] Open
Abstract
Background To end the HIV and hepatitis C virus (HCV) epidemics, people who use drugs (PWUD) need more opportunities for testing. While inpatient hospitalizations are an essential opportunity to test people who use drugs (PWUD) for HIV and HCV, there is limited research on rates of inpatient testing for HIV and HCV among PWUD. Methods Eleven hospital sites were included in the study. Each site created a cohort of inpatient encounters associated with injection drug use. From these cohorts, we collected data on HCV and HIV testing rates and HIV testing consent policies from 65 276 PWUD hospitalizations. Results Hospitals had average screening rates of 40% for HIV and 32% for HCV, with widespread heterogeneity in screening rates across facilities. State consent laws and opt-out testing policies were not associated with statistically significant differences in HIV screening rates. On average, hospitals that reflexed HCV viral load testing on HCV antibody testing did not have statistically significant differences in HCV viral load testing rates. We found suboptimal testing rates during inpatient encounters for PWUD. As treatment (HIV) and cure (HCV) are necessary to end these epidemics, we need to prioritize understanding and overcoming barriers to testing.
Collapse
Affiliation(s)
| | - Taisuke Sato
- Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Finlay Pilcher
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Andrew J Hale
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Devika Singh
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Marlene Martin
- Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- University of California, San Francisco, California, USA
| | - Ayesha A Appa
- University of California, San Francisco, California, USA
| | - Jaimie P Meyer
- Yale School of Medicine, New Haven, Connecticut, USA
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Melissa B Weimer
- Yale School of Medicine, New Haven, Connecticut, USA
- Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Uriel R Felsen
- Montefiore Medical Center, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew J Akiyama
- Montefiore Medical Center, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Emily D Grussing
- Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Maine Medical Center Research Institute, Portland, Maine, USA
- Maine Medical Center, Portland, Maine, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, Maine, USA
| | - Amy White
- Maine Medical Center Research Institute, Portland, Maine, USA
| | - John Mutelayi
- Maine Medical Center Research Institute, Portland, Maine, USA
| | - Martin Krsak
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Brian T Montague
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Ank Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Laura R Marks
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Alysse G Wurcel
- Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Hamdan S, Smyth E, Murphy ME, Grussing ED, Wei M, Guardado R, Wurcel A. Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital. AIDS Patient Care STDS 2022; 36:425-430. [PMID: 36301195 PMCID: PMC9700355 DOI: 10.1089/apc.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Ending the HIV epidemic requires increased testing, diagnosis, and linkage to care. In the past 10 years, rates of HIV have increased among people with substance use disorder (SUD). HIV testing is recommended during hospitalization. Despite rising rates of infections and recommendations, HIV testing remains suboptimal. This study sought to detect differences in HIV testing by race and ethnicity in people who use drugs (PWUD) admitted to Tufts Medical Center (TuftsMC). This study is a retrospective review of hospitalized PWUD admitted from January 1, 2017 to December 31, 2020. PWUD were identified through toxicology results, medication prescribed for SUD, and nursing intake questions. The primary outcome of interest was whether an HIV test was ordered during hospitalization. The indicator of interest was race and ethnicity. Of 13,486 PWUD admitted to TuftsMC, only 10% had an HIV test ordered. Compared with White patients, Black patients [adjusted odds ratio (AOR): 0.69, 95% confidence interval (CI) (0.59-0.83)] and Hispanic patients [AOR: 0.68, 95% CI (0.55-0.84)] had decreased odds of receiving an HIV test. Our report is the first to show racial and ethnic differences in HIV testing ordering for hospitalized PWUD. Without access to harm reduction tools and expanded systems-based testing strategies, the HIV epidemic will continue and disproportionately impact minoritized communities.
Collapse
Affiliation(s)
- Sami Hamdan
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Emma Smyth
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Mingrui Wei
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Moura RJD, Romero GAS, Albuquerque A. Informed consent for HIV screening in the emergency departments and human rights in patient care: seeking the right balance. CIENCIA & SAUDE COLETIVA 2022; 27:2679-2688. [PMID: 35730838 DOI: 10.1590/1413-81232022277.18512021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.
Collapse
Affiliation(s)
- Rafael Jardim de Moura
- Núcleo de Medicina Tropical, Universidade de Brasília. Campus Universitário Darcy Ribeiro, Asa Norte. 70904-970 Brasília DF Brasil.
| | - Gustavo Adolfo Sierra Romero
- Núcleo de Medicina Tropical, Universidade de Brasília. Campus Universitário Darcy Ribeiro, Asa Norte. 70904-970 Brasília DF Brasil.
| | - Aline Albuquerque
- Programa de Pós-Graduação em Bioética, Faculdade de Ciências da Saúde, Universidade de Brasília. Brasília DF Brasil
| |
Collapse
|
4
|
Moura RJD, Romero GAS, Albuquerque A. Informed consent for HIV screening in the emergency departments and human rights in patient care: seeking the right balance. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.18512021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract HIV exceptionalism refers to the fact that the illness is so different from other diseases that testing needs a special approach to informed consent. HIV infected people often visit health clinics, especially emergency departments, years before receiving a diagnosis without being tested for HIV. There is considerable public interest in increasing HIV testing in emergency departments. However, because these departments are sensitive environments that primarily provide urgent and emergency care, a number of ethical questions have been raised about the appropriateness of these settings for the implementation of universal screening programs. Human rights in patient care therefore constitutes an essential theoretical framework for analyzing ethical and legal dilemmas that arise in clinical encounters, thus strengthening the application of human rights principles to the context of patient care.
Collapse
|
5
|
Petersen J, Monteiro M, Dalal S, Jhala D. Reducing False-Positive Results With Fourth-Generation HIV Testing at a Veterans Affairs Medical Center. Fed Pract 2021; 38:232-237. [PMID: 34177233 DOI: 10.12788/fp.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In 2006, the Centers for Disease Control and Prevention issued guidelines advocating routine HIV screening for all patients. However, false-positive results are a potential patient care threat for low-risk populations even with accurate screening assays. A reduction in HIV false-positive screening results can potentially be seen by switching from the third-generation to a more sensitive and specific fourth-generation screening assay. Methods We studied the impact on the false-positive screening rate of a change to a fourth-generation assay at a regional US Department of Veteran Affairs Medical Center. HIV screening tests performed by the laboratory from March 1, 2016 to February 28, 2017, prior to implementation of the new assay were compared with fourth-generation HIV screening tests performed from March 1, 2017 to February 28, 2018. Results Of 7,516 third-generation HIV screening tests reviewed, 52 were reactive on the screening assay; 24 were true positives, 28 were false positives. The following year 7,802 fourth-generation HIV screening tests were performed and 23 were reactive on the screening assay; 16 were true positives and 7 were false positives. The positive predictive value for the third-generation test was 46% and 70% for the fourth-generation test. Conclusions There were fewer false-positive results with testing with the more specific fourth- vs third-generation assay (0.09% vs 0.37%, respectively), which was statistically significant (P = .002). This reduction in false-positive screening would reduce the laboratory workload and would save an estimated $3,875 yearly and reduce the adverse effects of false-positive screening results for patients.
Collapse
Affiliation(s)
- Jeffrey Petersen
- and are Staff Pathologists; is a Medical Technologist; and is the Chief of Pathology and Laboratory Medicine; all at the Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center. is an Assistant Professor of Clinical Pathology and Laboratory Medicine; Sharvari Dalal is an Adjunct Assistant Professor of Clinical Pathology and Laboratory Medicine; and Darshana Jhala is a Professor; all at the University of Pennsylvania Perelman School of Medicine in Philadelphia
| | - Maria Monteiro
- and are Staff Pathologists; is a Medical Technologist; and is the Chief of Pathology and Laboratory Medicine; all at the Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center. is an Assistant Professor of Clinical Pathology and Laboratory Medicine; Sharvari Dalal is an Adjunct Assistant Professor of Clinical Pathology and Laboratory Medicine; and Darshana Jhala is a Professor; all at the University of Pennsylvania Perelman School of Medicine in Philadelphia
| | - Sharvari Dalal
- and are Staff Pathologists; is a Medical Technologist; and is the Chief of Pathology and Laboratory Medicine; all at the Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center. is an Assistant Professor of Clinical Pathology and Laboratory Medicine; Sharvari Dalal is an Adjunct Assistant Professor of Clinical Pathology and Laboratory Medicine; and Darshana Jhala is a Professor; all at the University of Pennsylvania Perelman School of Medicine in Philadelphia
| | - Darshana Jhala
- and are Staff Pathologists; is a Medical Technologist; and is the Chief of Pathology and Laboratory Medicine; all at the Department of Pathology and Laboratory Medicine, Corporal Michael J. Crescenz Veteran Affairs Medical Center. is an Assistant Professor of Clinical Pathology and Laboratory Medicine; Sharvari Dalal is an Adjunct Assistant Professor of Clinical Pathology and Laboratory Medicine; and Darshana Jhala is a Professor; all at the University of Pennsylvania Perelman School of Medicine in Philadelphia
| |
Collapse
|
6
|
Gökengin D, Wilson-Davies E, Nazlı Zeka A, Palfreeman A, Begovac J, Dedes N, Tarashenko O, Stevanovic M, Patel R. 2021 European guideline on HIV testing in genito-urinary medicine settings. J Eur Acad Dermatol Venereol 2021; 35:1043-1057. [PMID: 33666276 DOI: 10.1111/jdv.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Testing for HIV is critical for early diagnosis of HIV infection, providing long-term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito-Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
Collapse
Affiliation(s)
- D Gökengin
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ege University, Izmir, Turkey.,Ege University HIV/AIDS Research and Practice Center, Izmir, Turkey
| | - E Wilson-Davies
- Southampton Specialist Virology Center, University Hospitals Southampton, Southampton, UK
| | - A Nazlı Zeka
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Dokuz Eylül University, Izmir, Turkey
| | - A Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Dedes
- Positive Voice, Athens, Greece
| | - O Tarashenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - M Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia
| | - R Patel
- Solent NHS Trust, Southampton, UK
| |
Collapse
|
7
|
Felsen UR, Tlamsa A, Moir L, Shukla S, Thompson D, Weiss JM, Heo M, Litwin AH. Comparing Routine HIV and Hepatitis C Virus Screening to Estimate the Effect of Required Consent on HIV Screening Rates Among Hospitalized Patients. Public Health Rep 2021; 137:102-109. [PMID: 33673778 PMCID: PMC8721757 DOI: 10.1177/0033354921999170] [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: 02/03/2023] Open
Abstract
OBJECTIVES Routine screening for HIV and hepatitis C virus (HCV) among specified age cohorts is recommended. New York State requires consent before screening for HIV but not HCV. We sought to estimate the effect of the consent requirement on screening rates for HIV. METHODS We performed a retrospective study of patients hospitalized in 2015-2016 at a tertiary care hospital in the Bronx, New York, during a period when prompts in the electronic health record facilitated screening for HIV and HCV among specified age cohorts. We compared proportions of patients eligible for screening for HIV and/or HCV who underwent screening and used generalized estimating equations and a meta-analytic weighted average to estimate an adjusted risk difference between undergoing HIV screening and undergoing HCV screening. RESULTS Among 11 938 hospitalized patients eligible for HIV and/or HCV screening, 38.5% underwent screening for HIV and 59.1% underwent screening for HCV. The difference in screening rates persisted after adjusting for patient and admission characteristics (adjusted risk difference = 22.0%; 95% CI, 20.6%-23.4%). CONCLUSIONS Whereas the requirement for consent was the only difference in the processes of screening for HIV compared with screening for HCV, differences in how the 2 viruses are perceived may also have contributed to the difference in screening rates. Nevertheless, our findings suggest that requiring consent continues to impede progress toward the public health goal of routine HIV screening.
Collapse
Affiliation(s)
- Uriel R. Felsen
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA,Uriel R. Felsen, MD, MPH, MS, Albert Einstein College of Medicine and Montefiore Medical Center, Department of Medicine, 111 E 210th St, Bronx, NY 10467, USA.
| | - Aileen Tlamsa
- Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Lorlette Moir
- Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, NH, USA
| | - Shuchin Shukla
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA,Department of Family Medicine, Mountain Area Health Education Center, Asheville, NC, USA
| | - Devin Thompson
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jeffrey M. Weiss
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Alain H. Litwin
- Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA,Clemson University School of Health Research, Clemson, SC, USA,Prisma Health, Greenville, SC, USA
| |
Collapse
|
8
|
Krueger A, Johnson C, Heitgerd J, Patel D, Harris N. State Trends in HIV Testing Among US Adults Aged 18-64 Years, 2011-2017. Public Health Rep 2020; 135:501-510. [PMID: 32579861 DOI: 10.1177/0033354920931833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES HIV testing identifies persons living with HIV and can lead to treatment, decreased risk behaviors, and reduced transmission. The objective of our study was to describe state-level trends in HIV testing in the general US adult population aged 18-64 years, for both ever tested for HIV and tested for HIV in the previous 12 months. METHODS Using 2011-2017 Behavioral Risk Factor Surveillance System data, we estimated the percentage of the state population, plus the District of Columbia, aged 18-64 years ever tested for HIV and tested for HIV in the previous 12 months. The 50 states and the District of Columbia were grouped according to the estimated prevalence of HIV in 2011. We used orthogonal contrasts to calculate P values for linear trends. RESULTS The percentage of the population ever tested for HIV increased significantly in 23 states during 2011-2017, whereas the percentage tested for HIV in the previous 12 months increased significantly in 8 states. In 2017, the mean percentage ever tested for HIV in states with a high prevalence of HIV was 8.6 percentage points higher than the mean percentage in states with a low prevalence of HIV (48.5% vs 39.9%); the mean increase in the percentage ever tested was highest (11.4%) in states with a low prevalence of HIV. CONCLUSION Enhanced efforts by states to make HIV testing simple, accessible, and routine are needed to reduce the number of persons who are not aware of their infection.
Collapse
Affiliation(s)
- Amy Krueger
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.,School of Health Sciences, University of Tampere, Finland
| | - Christopher Johnson
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Heitgerd
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deesha Patel
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Norma Harris
- 1242Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
9
|
Patel D, Johnson CH, Krueger A, Maciak B, Belcher L, Harris N, DiNenno EA. Trends in HIV Testing Among US Adults, Aged 18-64 Years, 2011-2017. AIDS Behav 2020; 24:532-539. [PMID: 31595375 DOI: 10.1007/s10461-019-02689-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In 2006, Centers for Disease Control and Prevention (CDC) recommended HIV screening in healthcare or clinical settings for all persons aged 13-64 years and annual rescreening for populations at high risk for HIV. We used the Behavioral Risk Factor Surveillance System to describe the prevalence and trends of ever tested for HIV and tested for HIV in the past 12 months among US adults. The percentage of ever tested increased from 42.9% in 2011 to 45.9% in 2017; testing in the past 12 months increased from 13.2% in 2011 to 14.8% in 2017. Despite these increases, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations. Increasing the prevalence of routine HIV screening and rescreening among individuals at high risk will reduce the number of undiagnosed persons with HIV infection and thus prevent new HIV infections-a key strategy in the Ending the HIV Epidemic initiative.
Collapse
Affiliation(s)
- Deesha Patel
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Christopher H Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Krueger
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Maciak
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Belcher
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Norma Harris
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A DiNenno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|