1
|
A public health approach to monitoring HIV with resistance to HIV pre-exposure prophylaxis. PLoS One 2022; 17:e0272958. [PMID: 36037154 PMCID: PMC9423671 DOI: 10.1371/journal.pone.0272958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background The risk of HIV pre-exposure prophylaxis (PrEP) failure with sufficient medication adherence is extremely low but has occurred due to transmission of a viral strain with mutations conferring resistance to PrEP components tenofovir (TDF) and emtricitabine (FTC). The extent to which such strains are circulating in the population is unknown. Methods We used HIV surveillance data to describe primary and overall TDF/FTC resistance and concurrent viremia among people living with HIV (PLWH). HIV genotypes conducted for clinical purposes are reported as part of HIV surveillance. We examined the prevalence of HIV strains with mutations conferring intermediate to high level resistance to TDF/FTC, defining primary resistance (predominantly K65R and M184I/V mutations) among sequences reported within 3 months of HIV diagnosis and total resistance for sequences reported at any time. We examined trends in primary resistance during 2010–2019 and total resistance among all PLWH in 2019. We also monitored resistance with viremia (≥1,000 copies/mL) at the end of 2019 among PLWH. Results Between 2010 and 2019, 2,172 King County residents were diagnosed with HIV; 1,557 (72%) had a genotypic resistance test within three months; three (0.2%) had primary TDF/FTC resistance with both K65R and M184I/V mutations. Adding isolated resistance for each drug resulted in 0.3% with primary TDF resistance and 0.8% with primary FTC resistance. Of 7,056 PLWH in 2019, 4,032 (57%) had genotype results, 241 (6%) had TDF/FTC resistance and 15 (0.4% of those with a genotype result) had viremia and TDF/FTC resistance. Conclusions Primary resistance and viremia combined with TDF/FTC resistance are uncommon in King County. Monitoring trends in TDF/FTC resistance coupled with interventions to help ensure PLWH achieve and maintain viral suppression may help ensure that PrEP failure remains rare.
Collapse
|
2
|
Cannon CA, Ramchandani MS, Buskin S, Dombrowski J, Golden MR. Brief Report: Previous Preexposure Prophylaxis Use Among Men Who Have Sex With Men Newly Diagnosed With HIV Infection in King County, WA. J Acquir Immune Defic Syndr 2022; 90:504-507. [PMID: 35486544 PMCID: PMC9283245 DOI: 10.1097/qai.0000000000003010] [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: 01/13/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) discontinuations are common and are associated with subsequent HIV acquisition. The population-level impact of PrEP discontinuations is unknown. METHODS Public health staff routinely asked men who have sex with men (MSM) with newly diagnosed HIV infection about their history of PrEP use as part of partner notification interviews in King County, WA, from 2013 to 2021. We assessed trends in the proportion of MSM who ever took PrEP and described reasons for PrEP discontinuation. RESULTS A total of 1098 MSM were newly diagnosed with HIV during the study period; of whom, 797 (73%) were interviewed, and 722 responded to questions about their history of PrEP use. Ninety-four (13%) reported ever taking PrEP. The proportion of MSM who ever used PrEP before HIV diagnosis increased from 2.3% in 2014 to 26.6% in 2020-2021 ( P < 0.001 for trend). The median time from PrEP discontinuation to HIV diagnosis was 152 days, and median duration on PrEP was 214 days. Common reasons for stopping PrEP included self-assessment as being at low risk for HIV, side effects, and insurance issues. Nineteen men were on PrEP at the time of HIV diagnosis; mutations conferring emtricitabine/tenofovir resistance were identified in 8 (53%) of 15 men with available genotype data. CONCLUSION More than 25% of MSM with newly diagnosed HIV from 2020 to 2021 had ever used PrEP. More than 50% who discontinued PrEP were diagnosed <6 months after stopping. Strategies to preempt PrEP discontinuations, enhance retention, and facilitate resumption of PrEP are critical to decrease new HIV diagnoses.
Collapse
Affiliation(s)
- Chase A. Cannon
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Susan Buskin
- HIV/STD Program, Public Health – Seattle & King County, Seattle, WA
| | - Julia Dombrowski
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle & King County, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Matthew R. Golden
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health – Seattle & King County, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| |
Collapse
|
3
|
Hood JE, Kubiak RW, Avoundjian T, Kern E, Fagalde M, Collins HN, Meacham E, Baldwin M, Lechtenberg RJ, Bennett A, Thibault CS, Stewart S, Duchin JS, Golden MR. A Multifaceted Evaluation of a COVID-19 Contact Tracing Program in King County, Washington. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:334-343. [PMID: 35616571 PMCID: PMC9119327 DOI: 10.1097/phh.0000000000001541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Despite the massive scale of COVID-19 case investigation and contact tracing (CI/CT) programs operating worldwide, the evidence supporting the intervention's public health impact is limited. OBJECTIVE To evaluate the Public Health-Seattle & King County (PHSKC) CI/CT program, including its reach, timeliness, effect on isolation and quarantine (I&Q) adherence, and potential to mitigate pandemic-related hardships. DESIGN This program evaluation used descriptive statistics to analyze surveillance records, case and contact interviews, referral records, and survey data provided by a sample of cases who had recently ended isolation. SETTING The PHSKC is one of the largest governmental local health departments in the United States. It serves more than 2.2 million people who reside in Seattle and 38 other municipalities. PARTICIPANTS King County residents who were diagnosed with COVID-19 between July 2020 and June 2021. INTERVENTION The PHSKC integrated COVID-19 CI/CT with prevention education and service provision. RESULTS The PHSKC CI/CT team interviewed 42 900 cases (82% of cases eligible for CI/CT), a mean of 6.1 days after symptom onset and 3.4 days after SARS-CoV-2 testing. Cases disclosed the names and addresses of 10 817 unique worksites (mean = 0.8/interview) and 11 432 other recently visited locations (mean = 0.5/interview) and provided contact information for 62 987 household members (mean = 2.7/interview) and 14 398 nonhousehold contacts (mean = 0.3/interview). The CI/CT team helped arrange COVID-19 testing for 5650 contacts, facilitated grocery delivery for 7253 households, and referred 9127 households for financial assistance. End of I&Q Survey participants (n = 304, 54% of sampled) reported self-notifying an average of 4 nonhousehold contacts and 69% agreed that the information and referrals provided by the CI/CT team helped them stay in isolation. CONCLUSIONS In the 12-month evaluation period, CI/CT reached 42 611 households and identified thousands of exposure venues. The timing of CI/CT relative to infectiousness and difficulty eliciting nonhousehold contacts may have attenuated the intervention's effect. Through promotion of I&Q guidance and services, CI/CT can help mitigate pandemic-related hardships.
Collapse
Affiliation(s)
- Julia E. Hood
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Rachel W. Kubiak
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Tigran Avoundjian
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Eli Kern
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Meaghan Fagalde
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Hannah N. Collins
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Elizabeth Meacham
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Megan Baldwin
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Richard J. Lechtenberg
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Amy Bennett
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Christina S. Thibault
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Sarah Stewart
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Jeffrey S. Duchin
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| | - Matthew R. Golden
- Public Health—Seattle & King County, Seattle, Washington (Drs Hood, Kubiak, Avoundjian, Duchin, and Golden, Messrs Kern and Lechtenberg, and Mss Fagalde, Collins, Meacham, Baldwin, Bennett, Thibault, and Stewart); University of Washington, School of Public Health, Seattle, Washington (Drs Hood, Duchin, and Golden); University of Washington, School of Medicine, Seattle, Washington (Drs Duchin and Golden); Seattle University, College of Nursing, Seattle, Washington (Dr Hood); and Council of State and Territorial Epidemiologists, Applied Epidemiology Fellowship, Atlanta, Georgia (Ms Collins)
| |
Collapse
|
4
|
Golden MR, AugsJoost B, Bender M, Brady KA, Collins LS, Dombrowski JD, Ealey J, Garcia C, George D, Gilliard B, Harris T, Johnson C, Khosropour CM, Rumanes SF, Surita K, Tabidze I, Udeagu CCN, Walker-Baban C, Cramer NO. The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States. J Acquir Immune Defic Syndr 2022; 89:498-504. [PMID: 34974472 DOI: 10.1097/qai.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain. SETTING State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative. METHODS The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity. RESULTS Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019. CONCLUSIONS HIV case-finding resulting from APS in the United States is low.
Collapse
Affiliation(s)
- Matthew R Golden
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | | | | | | | - Lyell S Collins
- Nevada Division of Public and Behavioral Health, Las Vegas, NV
| | - Julia D Dombrowski
- Center for AIDS and STD
- Division of Allergy and Infectious Diseases
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Jamila Ealey
- Georgia Department of Public Health, Atlanta, GA
| | | | - Dan George
- Florida Department of Health, Tallahassee, FL
| | - Bernard Gilliard
- South Carolina Department of Health and Environmental Control, Columbia, SC
| | | | | | - Christine M Khosropour
- Center for AIDS and STD
- Department of Epidemiology, University of Washington
- Public Health-Seattle and King County, Seattle, WA
| | - Sophia F Rumanes
- County of Los Angeles, Department of Public Health Division of HIV and STD Programs, Los Angeles, CA
| | - Karen Surita
- HIV/STD Prevention and Care Unit, Texas Department of State Health Services, Austin, TX
| | | | - Chi-Chi N Udeagu
- Bureau of Hepatitis, HIV and STIs, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - Cherie Walker-Baban
- STD Control Program, Philadelphia Department of Public Health, Philadelphia, PA; and
| | | |
Collapse
|
5
|
Buskin SE, Erly SJ, Glick SN, Lechtenberg RJ, Kerani RP, Herbeck JT, Dombrowski JC, Bennett AB, Slaughter FA, Barry MP, Neme S, Quinnan-Hostein L, Bryan A, Golden MR. Detection and Response to an HIV Cluster: People Living Homeless and Using Drugs in Seattle, Washington. Am J Prev Med 2021; 61:S160-S169. [PMID: 34686286 DOI: 10.1016/j.amepre.2021.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The HIV epidemic in King County, Washington has traditionally been highly concentrated among men who have sex with men, and incidence has gradually declined over 2 decades. In 2018, King County experienced a geographically concentrated outbreak of HIV among heterosexual people who inject drugs. METHODS Data sources to describe the 2018 outbreak and King County's response were partner services interview data, HIV case reports, syringe service program client surveys, hospital data, and data from a rapid needs assessment of homeless individuals and people who inject drugs. In 2020, the authors examined the impact of delays in molecular sequence analyses and cluster member size thresholds, for identifying genetically similar clusters, on the timing of outbreak identification. RESULTS In 2018, the health department identified a North Seattle cluster, growing to 30 people with related HIV infections diagnosed in 2008-2019. In total, 70% of cluster members were female, 77% were people who inject drugs, 87% were homeless, and 27% reported exchanging sex. Intervention activities included a rapid needs assessment, 2,485 HIV screening tests in a jail and other outreach settings, provision of 87,488 clean syringes in the outbreak area, and public communications. A lower cluster size threshold and more rapid receipt and analyses of data would have identified this outbreak 4-16 months earlier. CONCLUSIONS This outbreak shows the vulnerability of people who inject drugs to HIV infection, even in areas with robust syringe service programs and declining HIV epidemics. Although molecular HIV surveillance did not identify this outbreak, it may have done so with a lower threshold for defining clusters and more rapid receipt and analyses of HIV genetic sequences.
Collapse
Affiliation(s)
- Susan E Buskin
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington.
| | - Steven J Erly
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Office of Infectious Disease, Division of Disease Control and Health Statistics, Washington State Department of Health, Tumwater, Washington
| | - Sara N Glick
- HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Richard J Lechtenberg
- HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington
| | - Roxanne P Kerani
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, Washington
| | - Julia C Dombrowski
- HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Amy B Bennett
- HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington
| | - Francis A Slaughter
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington
| | - Michael P Barry
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington
| | - Santiago Neme
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; University of Washington Medical Center - Northwest, Seattle, Washington
| | - Laura Quinnan-Hostein
- University of Washington Medical Center - Northwest, Seattle, Washington; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Andrew Bryan
- University of Washington Medical Center - Northwest, Seattle, Washington; Department of Laboratory Medicine & Pathology, University of Washington Medicine, University of Washington, Seattle, Washington
| | - Matthew R Golden
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington; HIV/STD Program, Prevention Division, Public Health-Seattle & King County, Seattle, Washington; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
6
|
The Potential Impact of One-Time Routine HIV Screening on Prevention and Clinical Outcomes in the United States: A Model-Based Analysis. Sex Transm Dis 2021; 47:306-313. [PMID: 32044862 DOI: 10.1097/olq.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND US guidelines recommend routine human immunodeficiency virus (HIV) screening of all adults and adolescents at least once. The population-level impact of this strategy is unclear and will vary across the country. METHODS We constructed a static linear model to estimate the optimal ages and incremental impact of adding 1-time routine HIV screening to risk-based, prenatal, symptom-based, and partner notification testing. Using surveillance data and published studies, we parameterized the model at the national level and for 2 settings representing subnational variability in the rates and distribution of infection: King County, WA and Philadelphia County, PA. Screening strategies were evaluated in terms of the percent of tests that result in new diagnoses (test positivity), cumulative person-years of undiagnosed infection, and the number of symptomatic HIV/acquired immune deficiency syndrome cases. RESULTS Depending on the frequency of risk-based screening, routine screening test positivity was maximized at ages 30 to 34 years in the national model. The optimal age for routine screening was higher in a setting with a lower proportion of cases among men who have sex with men. Across settings, routine screening resulted in incremental reductions of 3% to 8% in years of undiagnosed infection and 3% to 11% in symptomatic cases, compared with reductions of 36% to 69% and 41% to 76% attributable to risk-based screening. CONCLUSIONS Although routine HIV screening may contribute meaningfully to increased case detection in persons not captured by targeted testing programs in some settings, this strategy will have a limited impact on population-level outcomes. Our findings highlight the importance of a multipronged testing strategy with continued investment in risk-based screening programs.
Collapse
|
7
|
Wamuti B, Contesse MG, Maingi P, Macharia P, Abuna F, Sambai B, Ng'ang'a A, Spiegel H, Richardson B, Cherutich P, Bukusi D, Farquhar C. Factors Associated With Poor Linkage to Human Immunodeficiency Virus Care Among Index Clients and Sex Partners Receiving Human Immunodeficiency Virus Assisted Partner Services in Kenya. Sex Transm Dis 2020; 47:610-616. [PMID: 32815902 PMCID: PMC7447121 DOI: 10.1097/olq.0000000000001222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) assisted partner services (aPS) has been recommended as a strategy to increase HIV case finding. We evaluated factors associated with poor linkage to HIV care among newly diagnosed HIV-positive individuals (index clients) and their partners after receiving aPS in Kenya. METHODS In a cluster randomized trial conducted between 2013 and 2015, 9 facilities were randomized to immediate aPS (intervention). Linkage to care-defined as HIV clinic registration, and antiretroviral therapy (ART) initiation were self-reported. Antiretroviral therapy was only offered to those with CD4 less than 500 during this period. We estimated linkage to care and ART initiation separately for index clients and their partners using log-binomial generalized estimating equation models with exchangeable correlation structure and robust standard errors. RESULTS Overall, 550 index clients and 621 sex partners enrolled, of whom 46% (284 of 621) were HIV-positive. Of the 284, 264 (93%) sex partners returned at 6 weeks: 120 newly diagnosed and 144 whom had known HIV-positive status. Among the 120 newly diagnosed, only 69% (83) linked to care at 6 weeks, whereas among the 18 known HIV-positive sex partners not already in care at baseline, 61% (11) linked. Newly diagnosed HIV-positive sex partners who were younger and single were less likely to link to care (P < 0.05 for all). CONCLUSION Only two thirds of newly diagnosed, and known HIV-positive sex partners not in care linked to care after receiving aPS. The HIV aPS programs should optimize HIV care for newly diagnosed HIV-positive sex partners, especially those who are younger and single.
Collapse
Affiliation(s)
- Beatrice Wamuti
- From the Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Peter Maingi
- Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital
| | | | - Felix Abuna
- From the Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Betsy Sambai
- From the Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Hans Spiegel
- Kelly Government Solutions, Contractor to Division of AIDS, PMPRB/Prevention Sciences Program, Division of AIDS, NIAID, NIH, Rockville, MD
| | | | | | - David Bukusi
- Voluntary Counseling and Testing (VCT) and HIV Prevention Unit, Kenyatta National Hospital
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, WA
- Global Health
- Medicine, University of Washington, Seattle, WA
| |
Collapse
|
8
|
Avoundjian T, Dombrowski JC, Golden MR, Hughes JP, Guthrie BL, Baseman J, Sadinle M. Comparing Methods for Record Linkage for Public Health Action: Matching Algorithm Validation Study. JMIR Public Health Surveill 2020; 6:e15917. [PMID: 32352389 PMCID: PMC7226047 DOI: 10.2196/15917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Many public health departments use record linkage between surveillance data and external data sources to inform public health interventions. However, little guidance is available to inform these activities, and many health departments rely on deterministic algorithms that may miss many true matches. In the context of public health action, these missed matches lead to missed opportunities to deliver interventions and may exacerbate existing health inequities. Objective This study aimed to compare the performance of record linkage algorithms commonly used in public health practice. Methods We compared five deterministic (exact, Stenger, Ocampo 1, Ocampo 2, and Bosh) and two probabilistic record linkage algorithms (fastLink and beta record linkage [BRL]) using simulations and a real-world scenario. We simulated pairs of datasets with varying numbers of errors per record and the number of matching records between the two datasets (ie, overlap). We matched the datasets using each algorithm and calculated their recall (ie, sensitivity, the proportion of true matches identified by the algorithm) and precision (ie, positive predictive value, the proportion of matches identified by the algorithm that were true matches). We estimated the average computation time by performing a match with each algorithm 20 times while varying the size of the datasets being matched. In a real-world scenario, HIV and sexually transmitted disease surveillance data from King County, Washington, were matched to identify people living with HIV who had a syphilis diagnosis in 2017. We calculated the recall and precision of each algorithm compared with a composite standard based on the agreement in matching decisions across all the algorithms and manual review. Results In simulations, BRL and fastLink maintained a high recall at nearly all data quality levels, while being comparable with deterministic algorithms in terms of precision. Deterministic algorithms typically failed to identify matches in scenarios with low data quality. All the deterministic algorithms had a shorter average computation time than the probabilistic algorithms. BRL had the slowest overall computation time (14 min when both datasets contained 2000 records). In the real-world scenario, BRL had the lowest trade-off between recall (309/309, 100.0%) and precision (309/312, 99.0%). Conclusions Probabilistic record linkage algorithms maximize the number of true matches identified, reducing gaps in the coverage of interventions and maximizing the reach of public health action.
Collapse
Affiliation(s)
- Tigran Avoundjian
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, United States
| | - Julia C Dombrowski
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, United States.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Matthew R Golden
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, United States.,Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Janet Baseman
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Mauricio Sadinle
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
9
|
Flash MJE, Garland WH, Martey EB, Schackman BR, Oksuzyan S, Scott JA, Jeng PJ, Rubio M, Losina E, Freedberg KA, Kulkarni SP, Hyle EP. Cost-effectiveness of a Medical Care Coordination Program for People With HIV in Los Angeles County. Open Forum Infect Dis 2019; 6:ofz537. [PMID: 31909083 PMCID: PMC6935680 DOI: 10.1093/ofid/ofz537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background The Los Angeles County (LAC) Division of HIV and STD Programs implemented a medical care coordination (MCC) program to address the medical and psychosocial service needs of people with HIV (PWH) at risk for poor health outcomes. Methods Our objective was to evaluate the impact and cost-effectiveness of the MCC program. Using the CEPAC-US model populated with clinical characteristics and costs observed from the MCC program, we projected lifetime clinical and economic outcomes for a cohort of high-risk PWH under 2 strategies: (1) No MCC and (2) a 2-year MCC program. The cohort was stratified by acuity using social and clinical characteristics. Baseline viral suppression was 33% in both strategies; 2-year suppression was 33% with No MCC and 57% with MCC. The program cost $2700/person/year. Model outcomes included quality-adjusted life expectancy, lifetime medical costs, and cost-effectiveness. The cost-effectiveness threshold for the incremental cost-effectiveness ratio (ICER) was $100 000/quality-adjusted life-year (QALY). Results With MCC, life expectancy increased from 10.07 to 10.94 QALYs, and costs increased from $311 300 to $335 100 compared with No MCC (ICER, $27 400/QALY). ICERs for high/severe, moderate, and low acuity were $30 500/QALY, $25 200/QALY, and $77 400/QALY. In sensitivity analysis, MCC remained cost-effective if 2-year viral suppression was ≥39% even if MCC costs increased 3-fold. Conclusions The LAC MCC program improved survival and was cost-effective. Similar programs should be considered in other settings to improve outcomes for high-risk PWH.
Collapse
Affiliation(s)
- Moses J E Flash
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wendy H Garland
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Emily B Martey
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Sona Oksuzyan
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Justine A Scott
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip J Jeng
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Marisol Rubio
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Elena Losina
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kenneth A Freedberg
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sonali P Kulkarni
- Division of HIV and STD Programs, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Emily P Hyle
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Gray A, Macapagal K, Mustanski B, Fisher CB. Surveillance studies involving HIV testing are needed: Will at-risk youth participate? Health Psychol 2019; 39:21-28. [PMID: 31512922 DOI: 10.1037/hea0000804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescent males who have sex with males (AMSMs) account for high numbers of new HIV diagnoses. To date, surveillance data have been limited to diagnosed cases of HIV, resulting in an underestimation of risk and burden among AMSMs unwilling or unable to access HIV testing. This study identified facilitators and barriers to AMSMs' participation in future surveillance studies involving HIV testing. METHOD AMSMs (n = 198) aged 14 to 17 years participated. The majority identified as non-Hispanic White or Latinx, had a least 1 male sex partner, and self-reported HIV negative. Participants read an online survey beginning with a vignette describing a hypothetical HIV surveillance study requiring HIV testing. They then completed questions assessing likelihood to participate, perceived research benefits and risks, attitudes toward HIV risk, prior HIV health services, and parental awareness of sexual orientation. RESULTS Approximately 40% indicated strong willingness to participate. Willingness was positively related to perceived HIV risk, free access to HIV testing, counseling and referral if testing positive, confidentiality protections, and lack of access to a trusted physician. Having to tell others if one tested positive for HIV and requirements for guardian permission were significant participation barriers. CONCLUSIONS Inclusion of HIV testing in surveillance studies is essential for accurate estimation of HIV incidence and prevalence among AMSMs. Successful recruitment of sexual minority youth into sexual health surveillance research will require procedures tailored to youth's health care needs and concerns, including adequate HIV counseling, referral to treatment if seropositive, and attention to concerns regarding guardian permission. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|