1
|
Sullivan PS, DuBose SN, Castel AD, Hoover KW, Juhasz M, Guest JL, Le G, Whitby S, Siegler AJ. Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis. Lancet Reg Health Am 2024; 33:100738. [PMID: 38659491 PMCID: PMC11041841 DOI: 10.1016/j.lana.2024.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Background PrEP was approved for HIV prevention in the US in 2012; uptake has been slow. We describe relative equity with the PrEP Equity Ratio (PER), a ratio of PrEP-to-Need Ratios (PnRs). Methods We used commercial pharmacy data to enumerate PrEP users by race and ethnicity, sex, and US Census region from 2012 to 2021. We report annual race and ethnicity-, sex-, and region-specific rates of PrEP use and PnR, a metric of PrEP equity, to assess trends. Findings PrEP use increased for Black, Hispanic and White Americans from 2012 to 2021. By 2021, the rate of PrEP use per population was similar in Black and White populations but slightly lower among Hispanic populations. PnR increased from 2012 to 2021 for all races and ethnicities and regions; levels of PrEP use were inconsistent across regions and highly inequitable by race, ethnicity, and sex. In all regions, PnR was highest for White and lowest for Black people. Inequity in PrEP use by race and ethnicity, as measured by the PER, grew early after availability of PrEP and persisted at a level substantially below equitable PrEP use. Interpretation From 2012 to 2021, PrEP use increased among Americans, but PrEP equity for Black and Hispanic Americans decreased. The US South lagged all regions in equitable PrEP use. Improved equity in PrEP use will be not only just, but also impactful on the US HIV epidemic; persons most at-risk of acquiring HIV should have the highest levels of access to PrEP. Prevention programs should be guided by PrEP equity, not PrEP equality. Funding National Institutes of Health, Gilead Sciences.
Collapse
Affiliation(s)
| | | | - Amanda D. Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Karen W. Hoover
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Le
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shamaya Whitby
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J. Siegler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
2
|
Mallipeddi VP, Levy M, Byrne M, Monroe A, Happ LP, Moeng LR, Castel AD, Horberg M, Wilcox R. Evaluation of New Hypertension Guidelines on the Prevalence and Control of Hypertension in a Clinical HIV Cohort: A Community-Based Study. AIDS Res Hum Retroviruses 2024; 40:223-234. [PMID: 37526367 DOI: 10.1089/aid.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
The prevalence and control of hypertension (HTN) among people with HIV (PWH) have not been widely studied since the release of newer 2017 ACC/AHA guidelines ("new guidelines"). To address this research gap, we evaluated and compared the prevalence and control of HTN using both 2003 JNC 7 ("old guidelines") and new guidelines. We identified 3,206 PWH with HTN from the DC Cohort study in Washington, DC, between January 2018 and June 2019. We defined HTN using International Classification of Diseases (ICD)-9/-10 diagnosis codes for HTN or ≥2 blood pressure (BP) measurements obtained at least 1 month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors, and co-morbidities associated with HTN control using multivariable logistic regression [adjusted odds ratio (aOR); 95% confidence interval (CI)]. The prevalence of HTN was 50.9% per old versus 62.2% per new guidelines. Of the 3,206 PWH with HTN, 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP 130-139/80-89 mm Hg, and 1,123 (35.0%) had a BP ≥140/≥90 mm Hg. After adjusting for socio-demographics, cardiovascular risk factors, and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (aOR: 1.42; 95% CI: 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (aOR 1.49; 95% CI: 1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (aOR 1.21; 95% CI: 1.00-1.47), being unemployed (aOR 1.42; 95% CI: 1.11-1.83), and diabetes (aOR 1.35; 95% CI: 1.13-1.63). In a large urban cohort of PWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Our data suggest that more aggressive HTN control is warranted among PWH, with additional attention to younger patients and non-Hispanic Black patients.
Collapse
Affiliation(s)
- Vishnu Priya Mallipeddi
- Department of Cardiovascular Sciences, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Matthew Levy
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Letumile Rodgers Moeng
- Department of Internal Medicine, Division of Infectious Diseases, Howard University, Washington, District of Columbia, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Ronald Wilcox
- Department of Internal Medicine, Division of Infectious Diseases, Howard University, Washington, District of Columbia, USA
| |
Collapse
|
3
|
Barth SK, Saulters KJ, Balba GP, Monroe AK, Horberg MA, Kumar PN, Greenberg AE, Castel AD. Mixed Methods Analysis of Telehealth Experience, Satisfaction, and Quality of Care During the COVID Pandemic Among Persons with HIV in Washington, DC. AIDS Behav 2024; 28:912-923. [PMID: 37872460 PMCID: PMC10923106 DOI: 10.1007/s10461-023-04198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
The purpose of this study is to describe telehealth experiences and quality of HIV care provided to an urban population of people with HIV (PWH) in Washington, DC. We used self-reported survey data from a cohort of PWH in the DC Cohort longitudinal study linked to medical records (October 26, 2020-December 31, 2021). Analyses followed a mixed-methods approach, including prevalence estimates and multivariable logistic regression of telehealth use by demographic and HIV characteristics. We measured primary motivation, modes of engagement, and telehealth satisfaction. Qualitative responses to open-ended questions were coded using collaborative coding. A framework developed by the National Quality Forum (NQF) was applied to the results. Among 978 participants, 69% reported using telehealth for HIV care during the pandemic. High school graduates were less likely to use telehealth compared to those with college education (aOR 0.69, 95% CI 0.48, 0.98). PWH with > 1 co-morbid condition were more likely to use telehealth compared to those without (aOR 1.42, 95% CI 1.02, 1.95). The majority reported satisfaction with telehealth (81%). Qualitative analysis of telehealth satisfaction found that most responses were related to access to care and technology, effectiveness, and patient experience. PWH using telehealth during the pandemic were satisfied with their experience though use differed demographically. Telehealth was used effectively to overcome barriers to care engagement, including transportation, costs, and time. As we transition away from the emergency pandemic responses, it will be important to determine how this technology can be used in the future in an equitable manner to further strengthen HIV care engagement.
Collapse
Affiliation(s)
- Shannon K Barth
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
| | - Kacie J Saulters
- Department of Internal Medicine, University of Maryland Capital Region Health, Largo, MD, USA
| | - Gayle P Balba
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA
| |
Collapse
|
4
|
Byrne M, Monroe AK, Doshi RK, Horberg MA, Castel AD. A Latent Class Analysis of Substance Use and Longitudinal HIV RNA Patterns Among PWH in DC Cohort. AIDS Behav 2024; 28:682-694. [PMID: 38319460 PMCID: PMC10952057 DOI: 10.1007/s10461-023-04257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
People with HIV (PWH) with substance use disorders (SUD) have worse health outcomes than PWH without SUD. Our objective was to characterize substance use patterns and their impact on longitudinal HIV RNA trajectories among those enrolled in an observational study of PWH in care in Washington, DC. Substance use by type (alcohol, cannabis, opioid, stimulant, hallucinogen, inhalant, sedative) was used to identify shared patterns of substance use using Latent Class Analysis (LCA). A multinomial logistic regression model evaluated the association between the resulting substance use classes and the membership probability in longitudinal HIV RNA trajectory groups. There were 30.1% of participants with at least one substance reported. LCA resulted in a three-class model: (1) Low-Level Substance Use, (2) Opioid Use, and (3) Polysubstance. The Opioid and Polysubstance Use classes were more likely to have a mental health diagnosis (45.4% and 53.5%; p < 0.0001). Members in the Opioid Use class were older (median age of 54.9 years (IQR 50.3-59.2) than both the Polysubstance and Low-Level Substance Use Classes (p < 0.0001). There were 3 HIV RNA trajectory groups: (1) Undetectable, (2) Suppressed, and (3) Unsuppressed HIV RNA over 18 months of follow-up. The probability of being in the unsuppressed HIV RNA group trajectory when a member of the Opioid Use or Polysubstance Use classes was 2.5 times and 1.5 times greater than the Low-Level Substance Use class, respectively. The Opioid Use and Polysubstance Use classes, with higher-risk drug use, should be approached with more targeted HIV-related care to improve outcomes.
Collapse
Affiliation(s)
- Morgan Byrne
- George Washington University, Washington, DC, USA.
| | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | | |
Collapse
|
5
|
Andersen EW, Kulie P, Castel AD, Lucar J, Benator D, Greenberg AE, Monroe A. Mpox Awareness, Risk Reduction, and Vaccine Acceptance among People with HIV in Washington, DC. Pathogens 2024; 13:124. [PMID: 38392862 PMCID: PMC10891655 DOI: 10.3390/pathogens13020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
People with HIV (PWH) are disproportionally affected by mpox and at risk of severe complications. We assessed mpox knowledge, adoption of preventive behaviors, and vaccination attitudes among PWH enrolled in a longitudinal HIV cohort in Washington, DC, the DC Cohort. We conducted uni- and multivariable analyses comparing participants by vaccination status and HIV risk group, and multinomial regression to identify factors associated with vaccine acceptance. Among 430 PWH, 378 (87.9%) were aware of mpox. Among 373 participants with vaccination status data, 101 (27.1%) were vaccinated, 129 (34.6%) planned to vaccinate, and 143 (38.3%) did not plan to vaccinate. The three vaccination groups differed significantly by age, race, education, HIV risk group, recent STI status, and level of mpox worry (all p < 0.05). A higher proportion of men who have sex with men (MSM) reported limiting their number of sexual partners compared to non-MSM (p < 0.0001). Multinomial regression models comparing vaccinated to unvaccinated PWH found age, education, mode of HIV transmission/gender, and survey period were significantly associated with vaccination status (all p < 0.05). High levels of mpox awareness were observed among this cohort of PWH with more MSM employing risk reduction behaviors and being vaccinated. Ensuring that PWH, regardless of gender, sexual orientation, or age, understand the risks of mpox may improve vaccination uptake.
Collapse
Affiliation(s)
- Elisabeth W. Andersen
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Paige Kulie
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Jose Lucar
- Division of Infectious Diseases, The George Washington School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Debra Benator
- The Washington DC Veterans Affairs Administration, Washington, DC 20422, USA;
| | - Alan E. Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (E.W.A.); (P.K.); (A.E.G.); (A.M.)
| |
Collapse
|
6
|
O’Connor LF, Byrne M, Baskaran A, Andersen EW, Horberg MA, Benator DA, Lucar J, Denyer RV, Lee R, Castel AD, Monroe AK. Characterizing Indicators of Engagement in HIV-Associated Healthcare and Clinical Outcomes among People with HIV and Mpox in Washington, DC: A Nested Case-Control Study of the DC Cohort. Pathogens 2024; 13:117. [PMID: 38392854 PMCID: PMC10892472 DOI: 10.3390/pathogens13020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
The high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.
Collapse
Affiliation(s)
- Lauren F. O’Connor
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Morgan Byrne
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Anuja Baskaran
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Elisabeth W. Andersen
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD 20852, USA
| | - Debra A. Benator
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Jose Lucar
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Rachel V. Denyer
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Rachel Lee
- District of Columbia Veterans Affairs Medical Center, Washington, DC 20422, USA
- School of Medicine & Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Amanda D. Castel
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Anne K. Monroe
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| |
Collapse
|
7
|
Stewart B, Byrne M, Levy M, Horberg MA, Monroe AK, Castel AD. The Association of Mental Health and Substance Use With Retention in HIV Care Among Black Women in Washington, District of Columbia. Womens Health Issues 2024:S1049-3867(23)00204-9. [PMID: 38184379 DOI: 10.1016/j.whi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Black women with HIV are impacted by mental health and substance use disorders alongside barriers to care. The impact of these disorders on retention in care, a crucial step of the HIV care continuum, has not been well-studied. We examined the association between these disorders and retention in care over a 2-year period. METHODS Data from January 1, 2011, to June 30, 2019, were obtained from the DC Cohort, an observational HIV study in Washington, District of Columbia. We examined the associations between mental health (i.e., mood-related or trauma-related) or substance use disorders, separately, on not being retained in HIV care over a 2-year interval post-enrollment among non-Hispanic Black women with HIV. Multivariate logistic regression with adjusted odds ratios (aORs) for sociodemographic and clinical variables was used to quantify the association of 1) having a confirmed mental health or substance use disorder and 2) not being retained in care. RESULTS Among the 2,181 women in this analysis, 690 (31.64%) were not retained in care. The prevalence of a mood-related disorder (39.84%) was higher compared with a substance use (16.19%) or trauma-related disorder (7.75%). Age per a 10-year increase (aOR 0.87; confidence interval [CI] 0.80, 0.94) and a mood-related disorder diagnosis (aOR 0.72; CI: 0.59, 0.88) were inversely associated with not being retained in care. CONCLUSION Mood-related disorders were prevalent among Black women with HIV in Washington, District of Columbia, but were not associated with worse retention in care. Future studies should examine key facilitators for Black women with HIV and coexisting mood-related disorders and how they impact retention in care.
Collapse
Affiliation(s)
- Bianca Stewart
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| |
Collapse
|
8
|
Towers SA, Gemechu NB, Nagaraj NC, Landry MM, Beane P, Sardon GA, Weiss EC, Liu CM, Park DE, Aziz M, Goldman LR, Vyas AN, McDonnell KA, Castel AD. SARS-CoV-2 surveillance and outbreak response on an urban American college campus. J Am Coll Health 2024; 72:319-327. [PMID: 35259074 DOI: 10.1080/07448481.2022.2034834] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/27/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The George Washington University (GW) in Washington, D.C., USA established the Public Health Laboratory and Campus COVID-19 Support Team (CCST) to develop and implement its SARS-CoV-2 surveillance testing and outbreak response for the 2020-2021 academic year. PARTICIPANTS AND METHODS Approximately 4,000 GW members had access to campus for living accommodations, limited in-person instruction, athletics, research, and university operations. The outbreak response included daily risk assessment surveys, weekly surveillance testing, symptomatic and voluntary testing, case investigation, and contact tracing. RESULTS Between August 17 - November 24, 2020, 42,350 SARS-CoV-2 PCR tests were performed, and 194 (0.46%) of tests were positive. Surveillance testing identified 59 (30.4%); voluntary testing 97 (50%); and symptomatic testing 30 (15.5%) of the cases, respectively. CONCLUSIONS Robust testing of asymptomatic people and rapid isolation and quarantine of members who are exposed or infected effectively limited the spread of SARS-CoV-2 during the Fall 2020 semester.
Collapse
Affiliation(s)
- Steven A Towers
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | | | - Nitasha C Nagaraj
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Megan M Landry
- Office of the Dean, George Washington University, Washington, DC, USA
| | - Patrick Beane
- Office of the Dean, George Washington University, Washington, DC, USA
| | - Gary A Sardon
- Office of the Dean, George Washington University, Washington, DC, USA
| | - Emily C Weiss
- Office of the Dean, George Washington University, Washington, DC, USA
| | - Cindy M Liu
- Department of Environmental and Occupational Health, George Washington University, Washington, DC, USA
| | - Daniel E Park
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Maliha Aziz
- Department of Environmental and Occupational Health, George Washington University, Washington, DC, USA
| | - Lynn R Goldman
- Office of the Dean, George Washington University, Washington, DC, USA
- Department of Environmental and Occupational Health, George Washington University, Washington, DC, USA
| | - Amita N Vyas
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Karen A McDonnell
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University, Washington, DC, USA
| |
Collapse
|
9
|
Harp R, Byrne M, Monroe A, Castel AD. Housing, HIV outcomes, and related comorbidities in persons living with HIV in Washington, DC. AIDS Care 2023; 35:1874-1884. [PMID: 36449782 PMCID: PMC10227182 DOI: 10.1080/09540121.2022.2151557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
Housing instability can hinder the ability of people with HIV (PWH) to maintain engagement in care, adhere to antiretroviral (ART) regimens, and achieve viral suppression. This analysis examined the association between housing instability and HIV outcomes, as well as the association between housing status and substance use disorders, mental health disorders, and sexually transmitted infections. Multivariable logistic regressions were performed using data from the DC Cohort, a longitudinal cohort of PWH. Among 8622 PWH, unstably housed PWH were significantly more likely to be prescribed ART (aOR: 1.4; 95%CI: 1.1, 1.8) yet were significantly less likely to be virally suppressed (aOR: 0.6; 95%CI: 0.5, 0.8). Unstably housed PWH were also significantly more likely to have a substance use or mental health disorder, which may inhibit PWH's ability to achieve viral suppression. Efforts to end the HIV epidemic should address housing to ensure treatment is optimized for key populations.
Collapse
Affiliation(s)
- Rachel Harp
- Department of Epidemiology, Milken Institute School of Public Health of the George Washington University, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health of the George Washington University, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health of the George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health of the George Washington University, Washington, DC, USA
| |
Collapse
|
10
|
Doshi RK, Hull S, Broun A, Boyani S, Moch D, Visconti AJ, Castel AD, Baral S, Colasanti J, Rodriguez AE, Jones J, Coffey S, Monroe AK. Lessons learned from U.S. rapid antiretroviral therapy initiation programs. Int J STD AIDS 2023; 34:945-955. [PMID: 37461333 PMCID: PMC11000141 DOI: 10.1177/09564624231185622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US. PURPOSE The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S. RESEARCH DESIGN This was a qualitative design involving semi-structured interviews. STUDY SAMPLE The study sample was comprised of the medical leadership of nine US HIV clinics that were early implementers of R-ART. DATA COLLECTION AND ANALYSIS In-depth, semi-structured interviews were performed. The Consolidated Framework for Implementation Research (CFIR) was used to guide thematic analysis. RESULTS We identified three main content areas: strong scientific rationale for R-ART, buy-in from multiple key stakeholders, and the condensed timeline of R-ART. The CFIR construct of Evidence Strength and Quality was cited as an important factor in R-ART implementation. Buy-in from key stakeholders and immediate access to medications ensured the success of R-ART implementation. Patient acceptance of the condensed timeline for ART initiation was facilitated when presented in a patient-centered manner, including empathetic communication and addressing other patient needs concurrently. The condensed timeline of R-ART presented logistical challenges and opportunities for the development of intense patient-provider relationships. CONCLUSIONS Results from the analysis showed that R-ART implementation should address the following: 1) logistical planning to implement HIV treatment with a condensed timeline 2) patients' mixed reactions to a new HIV diagnosis and 3) the high cost of HIV medications.
Collapse
Affiliation(s)
- Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Shawnika Hull
- Rutgers University School of Communication and Information, New Brunswick, NJ, USA
| | - Aaron Broun
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Saanjh Boyani
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Darryl Moch
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Adam J Visconti
- The HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), District of Columbia Department of Health, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Joyce Jones
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susa Coffey
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| |
Collapse
|
11
|
Barish N, Barth S, Monroe AK, Greenberg AE, Castel AD. Site assessment survey to assess the impact of the COVID-19 pandemic on HIV clinic site services and strategies for mitigation in Washington, DC. BMC Health Serv Res 2023; 23:1130. [PMID: 37858238 PMCID: PMC10588010 DOI: 10.1186/s12913-023-10069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has created substantial interruptions in healthcare presenting challenges for people with chronic illnesses to access care and treatment services. We aimed to assess the impact of the pandemic on HIV care delivery by characterizing the pandemic-related impact on HIV clinic-level services and the mitigation strategies that were developed to address them. METHODS The data comes from a site assessment survey conducted in the DC Cohort, an observational clinical cohort of PWH receiving care at 14 HIV outpatient clinics in Washington, D.C. Frequency counts and prevalence estimates of clinic-level survey responses about the impact of care delivery, COVID-19 testing, and vaccinations and mitigation strategies are presented. RESULTS Clinics reported an increase in temporary clinic closures (n = 2), reduction in clinic hours (n = 5), telehealth utilization (n = 10), adoption of multi-month dispensation of antiretroviral (ARV) medication (n = 11) and alternative drug delivery via postal/courier service, home/community delivery or pick-up (n = 11). Clinics utilized strategies for PWH who were lost to follow-up during the pandemic including offering care to persons with any income level and insurance status (n = 9), utilizing e-prescribing for auto refills even if the patient missed visits (n = 8), and utilization of the regional health information exchange to check for hospitalizations of PWH lost to follow-up (n = 8). Most social services offered before the pandemic remained available during the pandemic; however, some support services were modified. CONCLUSIONS Our findings demonstrate the extent of pandemic-era disruptions and the use of clinic-level mitigation strategies among urban HIV clinics. These results may help prepare for future pandemic or public health emergencies that disrupt healthcare delivery and access.
Collapse
Affiliation(s)
- Nicole Barish
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 5 th floor, Washington, DC, 20052, USA.
| | - Shannon Barth
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 5 th floor, Washington, DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 5 th floor, Washington, DC, 20052, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 5 th floor, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 5 th floor, Washington, DC, 20052, USA
| |
Collapse
|
12
|
Castel AD, Barth S, Wilbourn BC, Horberg M, Monroe AK, Greenberg AE. Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC. J Acquir Immune Defic Syndr 2023; 94:124-134. [PMID: 37368934 PMCID: PMC10529778 DOI: 10.1097/qai.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC. METHODS We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed. RESULTS Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001). CONCLUSIONS This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.
Collapse
Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Shannon Barth
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Brittany C Wilbourn
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | | | - Anne K Monroe
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| |
Collapse
|
13
|
Jones J, Butler G, Woody M, Castel AD, Kulie P, Sheets M, Scheim AI, Reisner SL, Valencia R, Wang M, Stekler JD, Sullivan PS, Stephenson R. Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation. JMIR Form Res 2023; 7:e51055. [PMID: 37733430 PMCID: PMC10557014 DOI: 10.2196/51055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. OBJECTIVE This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. METHODS Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. RESULTS Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. CONCLUSIONS There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people.
Collapse
Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Gareth Butler
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Meaghan Woody
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Amanda D Castel
- Department of Epidemiology, George Washington University, Washington, DC, DC, United States
| | - Paige Kulie
- Department of Epidemiology, George Washington University, Washington, DC, DC, United States
| | - Martha Sheets
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, United States
| | - Sari L Reisner
- Department of Epidemiology, Harvard University, Boston, MA, United States
| | - Rachel Valencia
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Minglun Wang
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Joanne D Stekler
- Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems Populations, and Leadership, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
14
|
Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
Collapse
Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| |
Collapse
|
15
|
Monroe AK, Kulie PE, Byrne ME, Wilbourn BC, Barth SK, Resnik JB, Huebner DM, Horberg MA, Castel AD, Greenberg AE. Psychosocial impacts of the COVID-19 pandemic from a cross-sectional Survey of people living with HIV in Washington, DC. AIDS Res Ther 2023; 20:27. [PMID: 37161481 PMCID: PMC10169119 DOI: 10.1186/s12981-023-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND COVID-19 has not only taken a staggering toll in terms of cases and lives lost, but also in its psychosocial effects. We assessed the psychosocial impacts of the COVID-19 pandemic in a large cohort of people with HIV (PWH) in Washington DC and evaluated the association of various demographic and clinical characteristics with psychosocial impacts. METHODS From October 2020 to December 2021, DC Cohort participants were invited to complete a survey capturing psychosocial outcomes influenced by the COVID-19 pandemic. Some demographic variables were also collected in the survey, and survey results were matched to additional demographic data and laboratory data from the DC Cohort database. Data analyses included descriptive statistics and multivariable logistic regression models to evaluate the association between demographic and clinical characteristics and psychosocial impacts, assessed individually and in overarching categories (financial/employment, mental health, decreased social connection, and substance use). RESULTS Of 891 participants, the median age was 46 years old, 65% were male, and 76% were of non-Hispanic Black race/ethnicity. The most commonly reported psychosocial impact categories were mental health (78% of sample) and financial/employment (56% of sample). In our sample, older age was protective against all adverse psychosocial impacts. Additionally, those who were more educated reported fewer financial impacts but more mental health impacts, decreased social connection, and increased substance use. Males reported increased substance use compared with females. CONCLUSIONS The COVID-19 pandemic has had substantial psychosocial impacts on PWH, and resiliency may have helped shield older adults from some of these effects. As the pandemic continues, measures to aid groups vulnerable to these psychosocial impacts are critical to help ensure continued success towards healthy living with HIV.
Collapse
Affiliation(s)
- Anne K. Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Paige E. Kulie
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Morgan E. Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Brittany C. Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Shannon K. Barth
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Jenna B. Resnik
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - David M. Huebner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Alan E. Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - the DC Cohort Executive Committee
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Kaiser Permanente Mid Atlantic States, Rockville, MD, USA
| |
Collapse
|
16
|
Aronson B, Kulie P, Castel AD, Powell NN, McCarthy M. Evaluating Patient Perceptions on PrEP Screening and Referral in the Acute Care Setting. AIDS Behav 2023; 27:1024-1029. [PMID: 36219272 DOI: 10.1007/s10461-022-03839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV is highly effective, yet uptake has been limited. We measured PrEP knowledge, eligibility, and referral willingness among patients receiving emergency or acute care in Washington, DC. We surveyed HIV-negative patients with STI-related complaints on HIV risk behaviors, PrEP knowledge, eligibility, and willingness for PrEP referral. Among 174 participants, 70% were PrEP unaware and 33% were PrEP eligible. Most participants (81%) supported learning more, 64% would consider taking PrEP, and 28% agreed to immediate referral. Willingness to learn more about PrEP suggests referral from non-traditional settings may increase uptake. Further evaluation of this approach is warranted.
Collapse
Affiliation(s)
- Benjamin Aronson
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, 20052, Washington, D.C, USA
| | - Paige Kulie
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, 20052, Washington, D.C, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, 20052, Washington, D.C, USA.
| | - Natasha N Powell
- Department of Emergency Medicine, The George Washington Medical Faculty Associates, Washington, DC, USA
- Department of Health Policy, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Melissa McCarthy
- Department of Health Policy, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| |
Collapse
|
17
|
Jaurretche M, Byrne M, Happ LP, Levy M, Horberg M, Greenberg A, Castel AD, Monroe AK. HIV care continuum outcomes among recently diagnosed people with HIV (PWH) in Washington, DC. Epidemiol Infect 2023; 151:e45. [PMID: 36715051 PMCID: PMC10052391 DOI: 10.1017/s0950268823000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The Ending the HIV Epidemic initiative aims to decrease new HIV infections and promote test-and-treat strategies. Our aims were to establish a baseline of HIV outcomes among newly diagnosed PWH in Washington, DC (DC), a 'hotspot' for the HIV epidemic. We also examined sociodemographic and clinical factors associated with retention in care (RIC), antiretroviral therapy (ART) initiation and viral suppression (VS) among newly diagnosed PWH in the DC Cohort from 2011-2016. Among 455 newly diagnosed participants, 92% were RIC at 12 months, ART was initiated in 65% at 3 months and 91% at 12 months, VS in at least 17% at 3 months and 82% at 12 months and 55% of those with VS at 12 months had sustained VS for an additional 12 months. AIDS diagnosis was associated with RIC (aOR 2.99; 1.13-2.28), ART initiation by 3 months (aOR 2.58; 1.61-4.12) and VS by 12 months (aOR4.87; 1.69-14.03). This analysis contributes to our understanding of the HIV treatment dynamics of persons with recently diagnosed HIV infection in a city with a severe HIV epidemic.
Collapse
Affiliation(s)
- Maria Jaurretche
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Lindsey Powers Happ
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Alan Greenberg
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | |
Collapse
|
18
|
Zigo L, Wilkinson A, Landry M, Castel AD, Vyas A, McDonnell K, Nagaraj NC, Goldman LR. Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study (Preprint). JMIR Form Res 2022; 7:e45003. [PMID: 37040562 PMCID: PMC10176128 DOI: 10.2196/45003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the U.S Centers for Disease Control and Prevention required ten days of isolation after a positive test result. In December 2021, this was reduced to a minimum of five days with symptom improvement followed by five days of mask-wearing. As a result, several Institutions of Higher Education, including the George Washington University, required persons testing positive for SARS-CoV-2 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after five days or to maintain a ten-day isolation period in the absence of a negative RAT and/or presence of continued symptoms. Rapid antigen tests (RATs) are a tool that can be used both to shorten isolation periods and to ensure that persons testing positive for SARS-CoV-2 remain in isolation if infectious. OBJECTIVE The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation. METHODS In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analysis examined the odds of uploading a RAT by campus residential living status (on/off-campus), student/employee designation, age, and days in isolation. RESULTS Seventy-six percent (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5, 45.4% (55/121) on day 6, 47.1% (99/210) on day 7, and 11.1% (7/63) on day ten or above. Adjusted logistic regression modeling indicated cases living on-campus had increased odds of uploading a RAT (OR 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69), and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to a lack of symptoms and timely submission, resulting in a total of 1,547 days of lost productivity saved compared to all being in isolation for ten days. CONCLUSIONS Rapid antigen tests are beneficial as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals' lives. CLINICALTRIAL
Collapse
Affiliation(s)
- Liliana Zigo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Alyson Wilkinson
- Office of the Dean, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Megan Landry
- Office of the Dean, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Amita Vyas
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Karen McDonnell
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Nitasha Chaudhary Nagaraj
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Lynn R Goldman
- Office of the Dean, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| |
Collapse
|
19
|
Monroe AK, Xiao J, Greenberg AE, Levy ME, Temprosa M, Resnik JB, Castel AD. Risk of Severe COVID-19 Disease and the Pandemic's Impact on Service Utilization Among a Longitudinal Cohort of Persons with HIV-Washington, DC. AIDS Behav 2022; 26:3289-3299. [PMID: 35416594 PMCID: PMC9005919 DOI: 10.1007/s10461-022-03662-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
People with HIV (PWH) have a high burden of medical comorbidities, potentially putting them at increased risk for severe COVID-19. Additionally, during the COVID-19 pandemic, HIV care delivery has been restructured and the impact on HIV outcomes is unknown. The objectives of this study were first, to examine the risk of severe COVID-19 among PWH, using a definition incorporating clinical risk factors, and second, to examine the pandemic's impact on HIV care. We used data from the DC Cohort, a large cohort of people receiving HIV care in Washington, DC. We found that a high proportion of participants across all age groups qualified as increased (58%) or high risk (34%) for severe COVID-19. Between 2019 and 2020, encounters increased (17.7%, increasing to 23.5% of active DC Cohort participants had an encounter) while laboratory utilization decreased (14.4%, decreasing to 11.4% of active DC Cohort participants had an HIV RNA test performed). Implications of our work include the importance of protecting vulnerable people with HIV from acquiring COVID-19 and potentially manifesting severe complications through strategies including vaccination. Additionally, acknowledging that HIV service delivery will likely be changed long-term by the pandemic, adaptation is required to ensure continued progress towards 90-90-90 goals.
Collapse
Affiliation(s)
- Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA.
| | - Jiayang Xiao
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
| | - Matt E Levy
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Westat, Rockville, MD, USA
| | - Marinella Temprosa
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jenna B Resnik
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
| |
Collapse
|
20
|
Koay WLA, Xiao J, Temprosa M, Happ LP, Monroe AK, Castel AD, Rakhmanina NY, Kharfen M, Talwalkar A, Serlin M, Kumar P, Bhandaru V, Bezabeh T, Grover N, Mele L, Reamer S, Sapozhnikova A, Strylewicz G, Barth S, Byrne M, Greenberg A, Jaurretche M, Kulie P, Peterson J, Stewart B, Wilbourn B, Ma Y, Akselrod H, Gajjala JL, Rana S, Horberg M, Fernandez R, Hebou A, Taylor D, Dieffenbach C, Masur H, Bordon J, Teferi G, Benator D, Ruiz ME, Abbott S. Short Communication:Outcomes of Dual Versus Triple Antiretroviral Drug Regimens Among Virally Suppressed Adults in the DC Cohort. AIDS Res Hum Retroviruses 2022; 38:451-454. [PMID: 35352966 PMCID: PMC9225828 DOI: 10.1089/aid.2021.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study explored virological outcomes of two-drug (2DRs) and three-drug (3DRs) antiretroviral regimens in adults with HIV in the DC Cohort. We analyzed 310 treatment-experienced adults with sustained HIV RNA ≤50 copies/mL at baseline, 53 of whom switched to 2DRs and 257 continued 3DRs. Adults on 2DRs and 3DRs had similar demographics (median age 53.3 years, 76.8% cisgender male, 76.1% Black). Adults on 2DRs had more participants with ≥2 comorbidities (62.3% vs. 42.8%, p = .019), had a longer time since HIV diagnosis (median years 20.4 vs. 13.2, p = .017), and received the regimen of interest for a shorter duration (median years 1.3 vs. 3.3, p < .001) compared with adults on 3DRs. Adults receiving 2DRs had a higher, although nonsignificant, risk for virological failure (two consecutive HIV RNA ≥50 copies/mL) at 24 months follow-up than adults on 3DRs (6.7% vs. 1.7%, respectively; p = .10). Future analysis of the effectiveness of 2DRs is needed.
Collapse
Affiliation(s)
- Wei Li Adeline Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Jiayang Xiao
- Department of Biostatistics and Bioinformatics and Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Marinella Temprosa
- Department of Biostatistics and Bioinformatics and Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Lindsey P Happ
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.,Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Monroe AK, Polyak CS, Castel AD, Esber AL, Byrne ME, Maswai J, Owuoth J, Maganga L, Bahemana E, Adamu Y, Iroezindu M, Kibuuka H, Kiweewa F, Greenberg AE, Crowell TA, Ake JA. Clinical similarities and differences between two large HIV cohorts in the United States and Africa. PLoS One 2022; 17:e0262204. [PMID: 35377881 PMCID: PMC8979457 DOI: 10.1371/journal.pone.0262204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Washington, DC, and sub-Saharan Africa are both affected by generalized HIV epidemics. However, care for persons living with HIV (PLWH) and clinical outcomes may differ in these geographically and culturally diverse areas. We compared patient and clinical site characteristics among adult persons living with HIV (PLWH) enrolled in two longitudinal HIV cohort studies—the African Cohort Study (AFRICOS) and the DC Cohort. Methods The DC Cohort is a clinic-based city-wide longitudinal cohort comprised of PLWH attending 15 HIV clinics in Washington, DC. Patients’ socio-demographic characteristics, clinical evaluations, and laboratory data are retrospectively collected from electronic medical records and limited manual chart abstraction. AFRICOS is a prospective observational cohort of PLWH and uninfected volunteers attending 12 select HIV care and treatment facilities in Nigeria, Kenya, Uganda and Tanzania. AFRICOS study participants are a subset of clinic patients who complete protocol-specific visits every 6 months with history and physical examination, questionnaire administration, and blood/sputum collection for ascertainment of HIV outcomes and comorbidities, and neurocognitive and functional assessments. Among participants aged ≥ 18 years, we generated descriptive statistics for demographic and clinical characteristics at enrollment and follow up and compared them using bivariable analyses. Results The study sample included 2,774 AFRICOS and 8,420 DC Cohort participants who enrolled from January 2013 (AFRICOS)/January 2011 (DC Cohort) through March 2018. AFRICOS participants were significantly more likely to be women (58.8% vs 27.1%) and younger (83.3% vs 61.1% aged < 50 years old) and significantly less likely to be MSM (only 0.1% of AFRICOS population reported MSM risk factor) than DC Cohort. Similar rates of current viral suppression (about 75% of both samples), hypertension, hepatitis B coinfection and alcohol use were observed. However, AFRICOS participants had significantly higher rates of CD4<200 and tuberculosis and significantly lower rates of obesity, DM, hepatitis C coinfection and syphilis. Conclusions With similar viral suppression outcomes, but many differences between our cohorts noted, the combined sample provides unique opportunities to assess and compare HIV care and treatment outcomes in the U.S. and sub-Saharan Africa. Comparing these two cohorts may inform care and treatment practices and may pave the way for future pathophysiologic analyses.
Collapse
Affiliation(s)
- Anne K. Monroe
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America
- * E-mail:
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Amanda D. Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America
| | - Allahna L. Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Morgan E. Byrne
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- U.S. Army Medical Research Directorate – Africa, Kericho, Kenya
| | - John Owuoth
- U.S. Army Medical Research Directorate – Africa, Kisumu, Kenya
- HJF Medical Research International, Kisumu, Kenya
| | - Lucas Maganga
- National Institute for Medical Research - Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- HJF Medical Research International, Mbeya, Tanzania
| | - Yakubu Adamu
- U.S. Army Medical Research Directorate – Africa, Abuja, Nigeria
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- HJF Medical Research International, Abuja, Nigeria
| | - Hannah Kibuuka
- Makerere University-Walter Reed Project, Kampala, Uganda
| | | | - Alan E. Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington DC, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | | |
Collapse
|
22
|
Drab R, Wolfe JR, Chavanduka TMD, Bonar EE, Guest JL, Hightow-Weidman L, Castel AD, Horvath KJ, Sullivan PS, Stephenson R, Bauermeister J. Constructing a web-based health directory for adolescent men who have sex with men: Strategies for development and resource verification. J Community Psychol 2022; 50:1597-1615. [PMID: 34716596 PMCID: PMC8916971 DOI: 10.1002/jcop.22738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Online health directories are increasingly used to locate health services and community resources, providing contact and service information that assists users in identifying resources that may meet their health and wellness needs. However, service locations require additional vetting when directories plan to refer vulnerable populations. As a tool included as part of a trial of a mobile life skills intervention for cisgender adolescent men who have sex with men (AMSM; ages 13-18), we constructed and verified resources for an online resource directory focused on linking young people to LGBTQ+ friendly and affirming local health and community social services resources. We collected information for 2301 individual directory listings through database and internet searches. To ensure the listings aligned with the project's focus of supporting young sexual minority men, we developed multiple data verification assessments to ensure community appropriateness resulting in verification of 1833 resources suitable for inclusion in our locator tool at project launch (March 2018). We offer lessons learned and future directions for researchers and practitioners who may benefit from adapting our processes and strategies for building culturally-tailored resource directories for vulnerable populations.
Collapse
Affiliation(s)
- Ryan Drab
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - James R. Wolfe
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Tanaka MD Chavanduka
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
| | - Erin E. Bonar
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
- Department of Psychiatry, School of Medicine, Addiction Center, Ann Arbor, Michigan, US
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, US
| | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, US
- Emory University School of Medicine, Emory University, Atlanta, Georgia, US
| | | | - Amanda D. Castel
- Milken Institute School of Public Health, George Washington University, Washington, D.C., US
| | | | | | - Rob Stephenson
- The School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, US
| | | |
Collapse
|
23
|
Byrne M, Akselrod H, Monroe AK, Horberg M, Lucar J, Castel AD, Denyer R, Doshi R, Secco A, Squires L, Schroeter S, Benator D. Identifying geographic areas of Washington DC with increased potential for sexual HIV transmission among People with HIV with STIs and concurrent elevated HIV RNA: Data from the DC Cohort. Open Forum Infect Dis 2022; 9:ofac139. [PMID: 35450084 PMCID: PMC9017371 DOI: 10.1093/ofid/ofac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/17/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The U=U (Undetectable=Untransmittable) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from DC Cohort Longitudinal HIV Study (DC Cohort), a city-wide cohort of persons with HIV (PWH).
Methods
DC Cohort participants ages ≥13 were included in the study period between April 1, 2016 and March 31, 2018. Potential for sexual HIV transmission was defined as the proportion of participants with incident sexually transmitted infection (STI - gonorrhea, chlamydia, syphilis) and with HIV RNA ≥200 copies/mL from 9 months prior to 3 months after STI diagnosis. We performed geographic information system (GIS) analysis to determine the ZIP codes with the highest potential for sexual HIV transmission.
Results
Of 3,467 participants, 367 (10.6%) had at least one incident STI, with 89.4% residing in 11 of the 20 residential ZIP codes in DC. Of the 367 participants with an incident STI, at least one HIV RNA was available for 348 (94.8%). 97 (27.9%) of individuals with an incident STI had HIV RNA ≥200 copies/ml in the defined time window. Of these 97, 66 (68.0%) resided in 5 of the 20 DC ZIP codes.
Conclusions
In DC, 5 ZIP codes of residence accounted for the majority of the estimated potential for HIV transmission among participants in the DC Cohort. These results support focused neighborhood-level interventions to help end the HIV epidemic.
Collapse
Affiliation(s)
- Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Jose Lucar
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rachel Denyer
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Rupali Doshi
- DC Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC ,USA
| | | | - Leah Squires
- Department of Psychology, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Stefanie Schroeter
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Debra Benator
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | | |
Collapse
|
24
|
Levy ME, Waters A, Sen S, Castel AD, Plankey M, Molock S, Asch F, Goparaju L, Kassaye S. Psychosocial stress and neuroendocrine biomarker concentrations among women living with or without HIV. PLoS One 2021; 16:e0261746. [PMID: 34941922 PMCID: PMC8699620 DOI: 10.1371/journal.pone.0261746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Women living with HIV (WLWH) experience psychosocial stress related to social-structural vulnerabilities. To investigate neuroendocrine pathways linking stress and increased cardiovascular disease risk among WLWH, we evaluated associations between psychosocial stress (i.e., perceived stress, posttraumatic stress, and experiences of race- and gender-based harassment) and a composite neuroendocrine biomarker index among WLWH and women without HIV. METHODS In 2019-2020, Women's Interagency HIV Study participants in Washington, DC completed a questionnaire and provided blood and 12-hour overnight urine samples for testing of serum dehydroepiandrosterone sulfate (DHEA-S) and urinary free cortisol, epinephrine, and norepinephrine. Psychosocial stress was measured using the Perceived Stress Scale, PTSD Checklist-Civilian Version, and Racialized Sexual Harassment Scale. Latent profile analysis was used to classify participants into low (38%), moderate (44%), and high (18%) stress groups. Composite biomarker index scores between 0-4 were assigned based on participants' number of neuroendocrine biomarkers in high-risk quartiles (≥75th percentile for cortisol, epinephrine, and norepinephrine and ≤25th percentile for DHEA-S). We evaluated associations between latent profile and composite biomarker index values using multivariable linear regression, adjusting for socio-demographic, behavioral, metabolic, and HIV-related factors. RESULTS Among 90 women, 62% were WLWH, 53% were non-Hispanic Black, and median age was 55 years. In full multivariable models, there was no statistically significant association between psychosocial stress and composite biomarker index values among all women independent of HIV status. High (vs. low) psychosocial stress was positively associated with higher mean composite biomarker index values among all monoracial Black women (adjusted β = 1.32; 95% CI: 0.20-2.43), Black WLWH (adjusted β = 1.93; 95% CI: 0.02-3.83) and Black HIV-negative women (adjusted β = 2.54; 95% CI: 0.41-4.67). CONCLUSIONS Despite a null association in the overall sample, greater psychosocial stress was positively associated with higher neuroendocrine biomarker concentrations among Black women, highlighting a plausible mechanism by which psychosocial stress could contribute to cardiovascular disease risk.
Collapse
Affiliation(s)
- Matthew E. Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Westat, Rockville, Maryland, United States of America
- * E-mail:
| | - Ansley Waters
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Division of Clinical Epidemiology, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia, United States of America
| | - Sabyasachi Sen
- Division of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC, United States of America
| | - Federico Asch
- Cardiovascular Core Laboratories and Cardiac Imaging Research, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Washington, DC, United States of America
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| |
Collapse
|
25
|
Monroe AK, Levy ME, Greenberg AE, Keruly JC, Moore RD, Horberg MA, Kulie P, Mohanraj BS, Kumar PN, Castel AD. Integrase Inhibitor Prescribing Disparities in the DC and Johns Hopkins HIV Cohorts. Open Forum Infect Dis 2021; 8:ofab338. [PMID: 34631925 PMCID: PMC8496514 DOI: 10.1093/ofid/ofab338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Integrase inhibitors (INSTIs) are recommended by expert panels as initial therapy
for people with HIV. Because there can be disparities in prescribing and uptake
of novel and/or recommended therapies, this analysis assessed potential INSTI
prescribing disparities using a combined data set from the Johns Hopkins HIV
Clinical Cohort and the DC Cohort. We performed multivariable logistic
regression to identify factors associated with ever being prescribed an INSTI.
Disparities were noted, including clinic location, age, and being transgender.
Identifying disparities may allow clinicians to focus their attention on these
individuals and ensure that therapy decisions are grounded in valid clinical
reasons.
Collapse
Affiliation(s)
- Anne K Monroe
- The George Washington University, Washington, DC, USA
| | | | | | - Jeanne C Keruly
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard D Moore
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Paige Kulie
- The George Washington University, Washington, DC, USA
| | | | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
| | | | | |
Collapse
|
26
|
Stephenson R, Walsh AR, Chavanduka TMD, Sallabank G, Horvath KJ, Castel AD, Bonar EE, Hightow-Weidman L, Bauermeister JA, Sullivan PS. Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic. PLoS One 2021; 16:e0249740. [PMID: 34506488 PMCID: PMC8432816 DOI: 10.1371/journal.pone.0249740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. METHODS We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). RESULTS There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0-14.33 per 10,000 youth aged 13-24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county's available LGBTQ+ youth-friendly HIV service providers and their HIV burden. CONCLUSIONS As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth.
Collapse
Affiliation(s)
- Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Alison R. Walsh
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Tanaka M. D. Chavanduka
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Erin E. Bonar
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States of America
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jose A. Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| |
Collapse
|
27
|
Koay WLA, Dirajlal-Fargo S, Levy ME, Kulie P, Monroe A, Castel AD, Rakhmanina NY. Integrase Strand Transfer Inhibitors and Weight Gain in Children and Youth With Perinatal Human Immunodeficiency Virus in the DC Cohort. Open Forum Infect Dis 2021; 8:ofab308. [PMID: 34295943 PMCID: PMC8291625 DOI: 10.1093/ofid/ofab308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
We conducted a retrospective analysis of 38 children and youth with human immunodeficiency virus (aged 0-19 years) in the United States and report an increased rate of change of BMI-for-age z score after initiating integrase strand transfer inhibitors (+0.19 z score units/year [95% confidence interval, .01-.37]; P = .036) for a median follow-up of 527.5 days.
Collapse
Affiliation(s)
- Wei Li A Koay
- Department of Infectious Diseases, Children’s National Hospital, Washington, District of Columbia, USA
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Sahera Dirajlal-Fargo
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Pediatric Infectious Diseases, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Matthew E Levy
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- Westat, Rockville, Maryland, USA
| | - Paige Kulie
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Anne Monroe
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Natella Y Rakhmanina
- Department of Infectious Diseases, Children’s National Hospital, Washington, District of Columbia, USA
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| |
Collapse
|
28
|
Castel AD, Wilbourn B, Trexler C, D'Angelo LD, Greenberg D. A Digital Gaming Intervention to Improve HIV Testing for Adolescents and Young Adults: Protocol for Development and a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e29792. [PMID: 34185022 PMCID: PMC8277397 DOI: 10.2196/29792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Two strategies of the US Ending the HIV Epidemic initiative are early diagnosis of infections via widespread testing and prevention of new infections using pre-exposure prophylaxis (PrEP). These strategies are particularly important for adolescents and young adults (AYAs) who are disproportionately affected by HIV, particularly if they identify as Black and/or lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+). This study will develop and test an interactive life-simulation game in which players can enact real-life behaviors and receive their HIV risk profile to improve HIV testing and PrEP access among AYAs aged 13-24 years in Washington, DC. Objective This mixed methods study aims to determine the acceptability of an interactive, enhanced life-simulation game prototype among AYAs, conduct a pilot test of the gaming intervention among a small cohort of AYAs to ensure game usability and acceptability, and evaluate the efficacy of the game in a randomized controlled study with AYAs at risk for HIV in Washington, DC. Methods This research protocol will be conducted in 3 phases. A formative phase will involve surveys and focus groups (n=64) with AYAs living in the DC area. These focus groups will allow researchers to understand youth preferences for game enhancement. The second phase will consist of a pilot test (n=10) of the gaming intervention. This pilot test will allow researchers to modify the game based on formative results and test the planned recruitment and data collection strategy with intended end users. The third phase will consist of a randomized controlled study among 300 AYAs to examine the efficacy of the life-simulation game compared with app-based HIV educational materials on HIV and PrEP in changing HIV testing, knowledge, risk behaviors, and PrEP access. Participants will have unlimited access to either the life-simulation game or the educational app for 3 months from the time of enrollment. Study assessments will occur at enrollment and at 1, 3, and 6 months post enrollment via e-surveys. At 6 months, a subset of intervention participants (n=25) will participate in in-depth exit interviews regarding their experience being in the study. Results Institutional review board approval was received on February 5, 2020. This project is currently recruiting participants for the formative phase. Conclusions This interactive life-simulation intervention aims to increase HIV testing and PrEP access among AYAs in the DC area. In this intervention, players can enact real-life behaviors and receive their HIV risk profile to promote HIV testing and PrEP seeking. Such an intervention has great potential to improve knowledge of HIV and PrEP among AYAs, increase motivation and self-efficacy related to HIV testing and PrEP use, and decrease individual and structural barriers that often preclude engagement in HIV prevention services. Trial Registration ClinicalTrials.gov NCT04917575; https://clinicaltrials.gov/ct2/show/NCT04917575 International Registered Report Identifier (IRRID) PRR1-10.2196/29792
Collapse
Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Brittany Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Connie Trexler
- Adolescent Clinical Research, Children's National Hospital, Washington, DC, United States
| | - Lawrence D D'Angelo
- Division of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC, United States
| | | |
Collapse
|
29
|
Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H, Dorsey K, Peterson J, Kharfen M, Castel AD. Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav 2021; 25:1954-1967. [PMID: 33537918 DOI: 10.1007/s10461-020-03125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.
Collapse
Affiliation(s)
| | - Meredith Haddix
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anya Agopian
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hannah Yellin
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Farah Mouhanna
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hibo Abdi
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kerri Dorsey
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - James Peterson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Amanda D Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
- Department of Epidemiology, The Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, USA.
| |
Collapse
|
30
|
George JM, Kuriakose SS, Monroe A, Hou Q, Byrne M, Pau AK, Masur H, Hadigan C, Castel AD, Horberg MA. Utilization of Direct Oral Anticoagulants in People Living with Human Immunodeficiency Virus: Observational Data from the District of Columbia Cohort. Clin Infect Dis 2021; 71:e604-e613. [PMID: 32179901 DOI: 10.1093/cid/ciaa284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people living with human immunodeficiency virus (PWH) are not well described. The coadministration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic interactions. METHODS A longitudinal cohort study was conducted using the D.C. Cohort Database in Washington, D.C., from January 2011 to March 2017, to describe oral anticoagulant prescribing among PWH ≥ 18 years old and the prevalence of DOAC use with RTV or COBI. Data collection included demographic and clinical characteristics, ARV and anticoagulant prescriptions, and International Classification of Diseases Ninth and Tenth Edition diagnosis codes. RESULTS Among 8315 PWH, there were 236 anticoagulant prescriptions (96 DOAC, 140 warfarin) for 206 persons. PWH prescribed anticoagulants were predominantly Black (82%) and male (82%), with a mean age at anticoagulant initiation of 56 years. DOAC use increased from 3% of total anticoagulant prescribing in 2011 to 43% in 2016, accounting for 64% of all newly recorded anticoagulant prescriptions by 2016. There were 19 bleeding events recorded among 16 individuals. Despite the Food and Drug Administration label recommendation to avoid rivaroxaban with boosted ARVs, 41% remained on boosted ARVs after rivaroxaban initiation. CONCLUSIONS DOAC use increased substantially in PWH by 2016. Although rivaroxaban is not recommended with RTV or COBI, concomitant use was recorded in 41% of rivaroxaban recipients in this cohort. As DOAC usage increases, clinicians need to be aware of potential DOAC/ARV interactions in order to select the most appropriate oral anticoagulant and monitoring plan for PWH.
Collapse
Affiliation(s)
- Jomy M George
- Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Safia S Kuriakose
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Anne Monroe
- Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Qingjiang Hou
- Population Health-Research, Cerner Corporation, Kansas City, Missouri, USA
| | - Morgan Byrne
- Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Alice K Pau
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry Masur
- Clinical Center Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Colleen Hadigan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | | |
Collapse
|
31
|
Segarra L, Simmens SJ, Castel AD, Kharfen M, Masur H, Greenberg AE. Highly variable trends in rates of newly diagnosed HIV cases in U.S. hotspots, 2008-2017. PLoS One 2021; 16:e0250179. [PMID: 33872328 PMCID: PMC8054999 DOI: 10.1371/journal.pone.0250179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
The U.S. Ending the HIV Epidemic (EHE) initiative was announced in early 2019 and rapidly became a focal point for domestic HIV prevention and treatment programs. Using publicly available data from CDC, we examined historical trends in the average annual percent change (AAPC) in HIV diagnosis rates for the 57 EHE high incidence “hotspots” using Joinpoint analysis. We then assessed the ecologic association of various hotspot characteristics with changes in these rates over time using a multivariable regression model. From 2008–2017, the overall rate of newly diagnosed HIV cases in the U.S. declined from 19 to 14 per 100,000 persons, with the AAPC declining significantly in the U.S. overall (-3.1%; 95% CI: -3.7, -2.4) and in the 57 hotspots (-3.3%; 95% CI: -4.6, -2.8). There were large (AAPC <-5.0), moderate (-5.0 to -2.5) and small (-2.5 to 0.0) rates of decline in 14, 19 and 17 hotspots respectively, with increasing trends (AAPC >0.0) noted in seven hotspots. In the multivariable regression analysis, higher initial HIV diagnosis rate and location in the Northeast region were significantly associated with declining AAPC rates whereas no significant differences were found by hotspot gender, age, or race/ethnicity distribution. This analysis demonstrates that the rate of decline in HIV diagnosis rates in hotspots across the U.S. has been highly variable. Further exploration is warranted to assess the correlation between programmatic factors such as HIV testing and antiretroviral therapy and pre-exposure prophylaxis coverage with HIV trends across the hotspots.
Collapse
Affiliation(s)
- Lorena Segarra
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Samuel J. Simmens
- Department of Biostatistics and Bioinformatics, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Michael Kharfen
- HIV/AIDS, Hepatitis, STD & TB Administration, DC Department of Health, Washington, DC, United States of America
| | - Henry Masur
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan E. Greenberg
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
- * E-mail:
| |
Collapse
|
32
|
Sullivan PS, Satcher Johnson A, Pembleton ES, Stephenson R, Justice AC, Althoff KN, Bradley H, Castel AD, Oster AM, Rosenberg ES, Mayer KH, Beyrer C. Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses. Lancet 2021; 397:1095-1106. [PMID: 33617774 DOI: 10.1016/s0140-6736(21)00395-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/09/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
The HIV epidemic in the USA began as a bicoastal epidemic focused in large cities but, over nearly four decades, the epidemiology of HIV has changed. Public health surveillance data can inform an understanding of the evolution of the HIV epidemic in terms of the populations and geographical areas most affected. We analysed publicly available HIV surveillance data and census data to describe: current HIV prevalence and new HIV diagnoses by region, race or ethnicity, and age; trends in HIV diagnoses over time by HIV acquisition risk and age; and the distribution of HIV prevalence by geographical area. We reviewed published literature to explore the reasons for the current distribution of HIV cases and important disparities in HIV prevalence. We identified opportunities to improve public health surveillance systems and uses of data for planning and monitoring public health responses. The current US HIV epidemic is marked by geographical concentration in the US South and profound disparities between regions and by race or ethnicity. Rural areas vary in HIV prevalence; rural areas in the South are more likely to have a high HIV prevalence than rural areas in other US Census regions. Ongoing disparities in HIV in the South are probably driven by the restricted expansion of Medicaid, health-care provider shortages, low health literacy, and HIV stigma. HIV diagnoses overall declined in 2009-18, but HIV diagnoses among individuals aged 25-34 years increased during the same period. HIV diagnoses decreased for all risk groups in 2009-18; among men who have sex with men (MSM), new diagnoses decreased overall and for White MSM, remained stable for Black MSM, and increased for Hispanic or Latino MSM. Surveillance data indicate profound and ongoing disparities in HIV cases, with disproportionate impact among people in the South, racial or ethnic minorities, and MSM.
Collapse
Affiliation(s)
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Amy C Justice
- School of Medicine, Yale University, West Haven, CT, USA
| | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather Bradley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Alexandra M Oster
- Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eli S Rosenberg
- School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Kenneth H Mayer
- Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Chris Beyrer
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
33
|
Jaurretche M, Levy M, Castel AD, Happ LP, Monroe AK, Wyche KF. Factors Influencing Successful Recruitment of Racial and Ethnic Minority Patients for an Observational HIV Cohort Study in Washington, DC. J Racial Ethn Health Disparities 2021; 9:767-778. [PMID: 33721291 DOI: 10.1007/s40615-021-01015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 01/07/2023]
Abstract
The process of recruiting racial and ethnic minority persons living with HIV (PLWH) is important for research studies to ensure inclusivity of underrepresented groups. To understand factors associated with recruitment of minority PLWH, this study examined the recruitment process of PLWH for an observational study of their routine medical care at 14 clinics in Washington, DC. Research assistant (RA) recruiters were interviewed to assess their consenting processes and strategies. Data were collected on clinic services, patient demographics, and recruitment logs of patient approaches for obtaining informed consent resulting in agreement or refusal. A median of 96% of eligible patients was approached to obtain consent, yielding a median consent rate of 78% across all sites. A total of 8438 patients consented and 1326 refused study participation. Clinical sites with more comprehensive services had higher consent rates. black/African American and Hispanic/Latinx PLWH consented or refused study participation in similar proportions, while significantly more white patients enrolled than refused. More men, compared with women, enrolled than refused study participation. The most frequent reasons for refusing study participation were the lack of interest in research (33.2%) and no specific reason provided (28%). RAs identified that effective recruitment strategies used culturally sensitive approaches, built rapport with patients, and obtained provider support for the study. Recruitment strategies that are gender sensitive to address the disparity of underrepresentation of women, address perceived barriers, and examine clinic-specific services are needed to maximize research participation for minority PLWH to improve prevention and health outcomes.
Collapse
Affiliation(s)
- Maria Jaurretche
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Matthew Levy
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA.,Westat, Rockville, MD, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Lindsey Powers Happ
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Anne K Monroe
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Karen F Wyche
- School of Nursing, The George Washington University, Washington, DC, USA.
| | | |
Collapse
|
34
|
Koay WLA, Zhang J, Manepalli KV, Griffith CJ, Castel AD, Scott RK, Ferrer KT, Rakhmanina NY. Prevention of Perinatal HIV Transmission in an Area of High HIV Prevalence in the United States. J Pediatr 2021; 228:101-109. [PMID: 32971142 PMCID: PMC7752838 DOI: 10.1016/j.jpeds.2020.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the uptake of perinatal HIV preventive interventions by the risk of perinatal HIV transmission in mother-infant pairs in a high-HIV prevalence area in the US. STUDY DESIGN This was a retrospective cohort study of mother-infant pairs with perinatal HIV exposure during 2013-2017 managed at a subspecialty pediatric HIV program in Washington, DC. We collected demographic data, maternal HIV history, delivery mode, maternal and infant antiretroviral drug (ARV) use, and infant HIV test results. We compared the uptake of recommended preventive interventions in low-risk (ie, mothers on antiretroviral therapy [ART] with viral suppression) and high-risk (mothers without ART or viral suppression) mother-infant pairs using the Pearson chi-square, Fisher exact, and Wilcoxon rank-sum tests and logistic regression. RESULTS We analyzed 551 HIV-exposed infants (HEIs) and 542 mothers living with HIV. The majority of mothers received ARVs (95.5%), had HIV RNA ≤1000 copies/mL before delivery (81.9%), and received intrapartum zidovudine (ZDV; 65.5%). The majority of all HEIs were low risk (82.6%) and received postpartum ARVs (98.9%). Among the low-risk infants, 53.2% were delivered via cesarean delivery (CD), and 62.9% and 96.5% were administered intrapartum and postpartum ZDV, respectively. Among high-risk infants, 84.4% were delivered via CD, 78.1% received intrapartum ZDV, and 62.5% received combination ART. Nine high-risk infants acquired HIV perinatally. CONCLUSION In an area of high HIV prevalence in the US, a large proportion of low-risk HEIs received intrapartum ZDV and were delivered via CD. We also observed missed opportunities for the prevention of perinatal HIV transmission.
Collapse
Affiliation(s)
- Wei Li A Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC.
| | - Jiaqi Zhang
- Columbian College of Arts and Sciences, The George Washington University, Washington, DC; R&D Biostatistics, Abbott US, Abbott Park, IL
| | - Krishna V Manepalli
- Division of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Caleb J Griffith
- Division of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Amanda D Castel
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC; Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Rachel K Scott
- MedStar Health Research Institute & Washington Hospital Center, Washington, DC; School of Medicine, Georgetown University, Washington, DC
| | - Kathleen T Ferrer
- Division of Infectious Diseases, Children's National Hospital, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC; Elizabeth Glaser Pediatrics AIDS Foundation, Washington, DC
| |
Collapse
|
35
|
Kulie P, Castel AD, Zheng Z, Powell NN, Srivastava A, Chandar S, McCarthy ML. Targeted Screening for HIV Pre-Exposure Prophylaxis Eligibility in Two Emergency Departments in Washington, DC. AIDS Patient Care STDS 2020; 34:516-522. [PMID: 33296271 DOI: 10.1089/apc.2020.0228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective method to prevent HIV acquisition in high-risk individuals. This cross-sectional survey study estimated the proportion of patients who were PrEP eligible among a targeted sample of emergency department (ED) patients with chief complaints indicative of HIV risk. Research assistants screened a convenience sample of adult patients who presented to two hospital EDs in Washington, DC, during a 6-month period with genitourinary, substance use, or intentional injury-related complaints. Patients with these complaints who reported being sexually active within the past 6 months and HIV negative completed a computer-assisted survey that included questions on sexual practices and partners, substance use, and attitudes and knowledge about PrEP. We used the Centers for Disease Control and Prevention (CDC) clinical guidelines to determine whether PrEP use was indicated. We report differences in PrEP eligibility by demographic characteristics, knowledge, and attitudes. Of the 410 participants, the majority were black (85%), and heterosexual females (72%). PrEP use was indicated in 20% (N = 84), most commonly because of condomless sex with a person of unknown HIV status (82%) and/or a sexually transmitted infection (STI) diagnosis (41%). One-third (34%) of participants had heard of PrEP. Overall, 36% of the sample (N = 148) wanted to learn more about PrEP while in the ED. The percentage who wanted to learn more about PrEP was higher among PrEP-eligible patients (52%) compared with PrEP-ineligible patients (32%). Using CDC criteria, targeted screening identified that a substantial proportion of ED patients are PrEP eligible based on their self-reported behaviors.
Collapse
Affiliation(s)
- Paige Kulie
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Amanda D. Castel
- Department of Epidemiology and Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Zhaonian Zheng
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Natasha N. Powell
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Sandhya Chandar
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Melissa L. McCarthy
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
36
|
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of COVID-19, was first detected in China in December 2019 and has rapidly spread throughout the world. Globally, the impact of COVID-19 has been severe with more than half a million deaths over 6 months; in contrast, the HIV pandemic has resulted in over 32 million deaths worldwide over 40 years. This paper reviews the current epidemiology of COVID-19, summarizes its relationship to HIV, identifies synergies in our response, and suggests actions that can be taken to curtail the spread of COVID-19 among persons living with HIV (PLWH). Our understanding of the epidemiology, clinical presentation, prevention, and treatment of COVID-19 has evolved rapidly as they did with HIV. Epidemiologically, there are similarities between the two viruses including asymptomatic spread, disproportionate impact on persons of color, need for rapid diagnostic testing, and lack of a cure or vaccine. PLWH do not appear generally to have an increased incidence of COVID-19 infection or a more severe course of disease. Clinical trials to identify potential treatment and prevention options for COVID-19 have included antiretrovirals used to treat HIV that have not been efficacious. Public health responses overlap between the two pandemics including the need for behavior change and containment strategies such as contact tracing. As the SARS-CoV-2 pandemic evolves, the path forward to controlling, preventing, and treating COVID-19 can be informed by lessons learned from HIV as we seek to control the spread of both viral pandemics.
Collapse
Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Brittany Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| |
Collapse
|
37
|
Monroe AK, Happ LP, Rayeed N, Ma Y, Jaurretche MJ, Terzian AS, Trac K, Horberg MA, Greenberg AE, Castel AD. Clinic-Level Factors Associated With Time to Antiretroviral Initiation and Viral Suppression in a Large, Urban Cohort. Clin Infect Dis 2020; 71:e151-e158. [PMID: 31701144 PMCID: PMC7583410 DOI: 10.1093/cid/ciz1098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using the results of a site assessment survey performed at clinics throughout Washington, DC, we studied the impact of clinic-level factors on antiretroviral therapy (ART) initiation and viral suppression (VS) among people living with human immunodeficiency virus (HIV; PLWH). METHODS This was a retrospective analysis from the District of Columbia (DC) Cohort, an observational, clinical cohort of PLWH from 2011-2018. We included data from PLWH not on ART and not virally suppressed at enrollment. Outcomes were ART initiation and VS (HIV RNA < 200 copies/mL). A clinic survey captured information on care delivery (eg, clinical services, adherence services, patient monitoring services) and clinic characteristics (eg, types of providers, availability of evenings/weekends sessions). Multivariate marginal Cox regression models were generated to identify those factors associated with the time to ART initiation and VS. RESULTS Multiple clinic-level factors were associated with ART initiation, including retention in care monitoring and medication dispensing reviews (adjusted hazard ratios [aHRs], 1.34 to 1.40; P values < .05 for both). Furthermore, multiple factors were associated with VS, including retention in HIV care monitoring, medication dispensing reviews, and the presence of a peer interventionist (aHRs, 1.35 to 1.72; P values < .05 for all). In multivariable models evaluating different combinations of clinic-level factors, enhanced adherence services (aHR, 1.37; 95% confidence interval [CI], 1.18-1.58), medication dispensing reviews (aHR, 1.22; 95% CI, 1.10-1.36), and the availability of opioid treatment (aHR, 1.26; 95% CI, 1.01-1.57) were all associated with the time to VS. CONCLUSIONS The observed association between clinic-level factors and ART initiation/VS suggests that the presence of specific clinic services may facilitate the achievement of HIV treatment goals.
Collapse
Affiliation(s)
- Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lindsey P Happ
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Yan Ma
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Maria J Jaurretche
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Arpi S Terzian
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kevin Trac
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| |
Collapse
|
38
|
Sullivan PS, Woodyatt C, Koski C, Pembleton E, McGuinness P, Taussig J, Ricca A, Luisi N, Mokotoff E, Benbow N, Castel AD, Do AN, Valdiserri RO, Bradley H, Jaggi C, O'Farrell D, Filipowicz R, Siegler AJ, Curran J, Sanchez TH. A Data Visualization and Dissemination Resource to Support HIV Prevention and Care at the Local Level: Analysis and Uses of the AIDSVu Public Data Resource. J Med Internet Res 2020; 22:e23173. [PMID: 33095177 PMCID: PMC7654504 DOI: 10.2196/23173] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/25/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AIDSVu is a public resource for visualizing HIV surveillance data and other population-based information relevant to HIV prevention, care, policy, and impact assessment. OBJECTIVE The site, AIDSVu.org, aims to make data about the US HIV epidemic widely available, easily accessible, and locally relevant to inform public health decision making. METHODS AIDSVu develops visualizations, maps, and downloadable datasets using results from HIV surveillance systems, other population-based sources of information (eg, US Census and national probability surveys), and other data developed specifically for display and dissemination through the website (eg, pre-exposure prophylaxis [PrEP] prescriptions). Other types of content are developed to translate surveillance data into summarized content for diverse audiences using infographic panels, interactive maps, local and state fact sheets, and narrative blog posts. RESULTS Over 10 years, AIDSVu.org has used an expanded number of data sources and has progressively provided HIV surveillance and related data at finer geographic levels, with current data resources providing HIV prevalence data down to the census tract level in many of the largest US cities. Data are available at the county level in 48 US states and at the ZIP Code level in more than 50 US cities. In 2019, over 500,000 unique users consumed AIDSVu data and resources, and HIV-related data and insights were disseminated through nearly 4,000,000 social media posts. Since AIDSVu's inception, at least 249 peer-reviewed publications have used AIDSVu data for analyses or referenced AIDSVu resources. Data uses have included targeting of HIV testing programs, identifying areas with inequitable PrEP uptake, including maps and data in academic and community grant applications, and strategically selecting locations for new HIV treatment and care facilities to serve high-need areas. CONCLUSIONS Surveillance data should be actively used to guide and evaluate public health programs; AIDSVu translates high-quality, population-based data about the US HIV epidemic and makes that information available in formats that are not consistently available in surveillance reports. Bringing public health surveillance data to an online resource is a democratization of data, and presenting information about the HIV epidemic in more visual formats allows diverse stakeholders to engage with, understand, and use these important public health data to inform public health decision making.
Collapse
Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cory Woodyatt
- Oregon Health & Science University, Portland, OR, United States
| | | | - Elizabeth Pembleton
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Alexandra Ricca
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute for Public Health, George Washington University, Washington, DC, United States
| | - Ann N Do
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ronald O Valdiserri
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Heather Bradley
- Department of Epidemiology, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Chandni Jaggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Rebecca Filipowicz
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James Curran
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
39
|
Wallace DE, Horberg MA, Benator DA, Greenberg AE, Castel AD, Monroe AK, Happ LP. Diabetes mellitus control in a large cohort of people with HIV in care-Washington, D.C. AIDS Care 2020; 33:1464-1474. [PMID: 32811173 DOI: 10.1080/09540121.2020.1808160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With more effective antiretroviral therapy (ART), people with HIV (PWH) are living longer and have more chronic diseases, including diabetes mellitus (DM). The prevalence of DM has been estimated in PWH previously, however there is less research regarding DM control. Our objectives were to determine the prevalence of DM and DM control and determine factors associated with DM control in a large urban cohort of PWH in care. We examined DC Cohort participants aged ≥18 years old to determine DM prevalence and to assess DM control (HbA1c measurement <7.0%). Demographic, clinical, and HIV-related factors associated with DM control were identified using multivariate logistic regression. The cohort of 5876 participants was predominantly male (71.3%), Non-Hispanic Black (78.1%) and had a median age of 52.0 years. DM prevalence was 17.4% (1023/5876). Among participants with recent HbA1c data available (39.9%) the proportion with DM control was 60.0% (245/408). In multivariate analysis, higher BMI (aOR: 0.47; 95% CI 0.28, 0.79) and use of non-insulin DM medication (aOR 0.43, 95% CI 0.25, 0.73) or insulin (aOR 0.010, 95% CI 0.04,0.24) compared to no medication use. Our findings suggest that individuals on medication for their DM likely need enhanced support to reach their treatment goals.
Collapse
Affiliation(s)
- David E Wallace
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Debra A Benator
- Division of Infectious Disease, Veterans Affairs Medical Center, Washington, DC, USA.,Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | -
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| |
Collapse
|
40
|
Mouhanna F, Castel AD, Sullivan PS, Kuo I, Hoffman HJ, Siegler AJ, Jones JS, Mera Giler R, McGuinness P, Kramer MR. Small-area spatial-temporal changes in pre-exposure prophylaxis (PrEP) use in the general population and among men who have sex with men in the United States between 2012 and 2018. Ann Epidemiol 2020; 49:1-7. [PMID: 32951802 DOI: 10.1016/j.annepidem.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Oral emtricitabine/tenofovir disoproxil fumarate was approved for use as pre-exposure prophylaxis (PrEP) by the U.S. Food and Drug Administration in 2012. We used national pharmacy data to examine trends of PrEP use in U.S. counties from 2012 to 2018. METHODS Using multi-level small-area spatio-temporal modeling, we calculated the estimated annual percentage change (EAPC) in prevalence of PrEP use in the general population from 2012 to 2018. We also used a proxy measure for prevalence of PrEP use among men who have sex with men (MSM) to evaluate trends of use among MSM, the PrEP use-to-MSM ratio (PmR) or number of male PrEP users per 1000 MSM population. RESULTS The prevalence of PrEP use and PmR increased (EAPC range: (+26.9%, +71.0%) and (+28.4%, +158.7%), respectively) in all counties with varying magnitude of increase. Counties of the Midwest and the upper South and upper West had the slowest increase in prevalence of PrEP use (EAPC range: (+26.9%; +52.9%)). Counties of the northern part of the South had the lowest PmR (EAPC range: (+28.4%; +76.0%)). Counties of the most populous core-based statistical areas had a relatively faster increase in population prevalence of PrEP use but slower increase in PmR. CONCLUSIONS All counties in the U.S. have witnessed an increase in PrEP use with important geographic variabilities. Identifying areas with slow improvement in PrEP use, as well as "model counties" with the fastest pace of progress in PrEP coverage, is critical to inform local and state-level policies and program evaluation for PrEP scale up, particularly among MSM at higher risk for HIV.
Collapse
Affiliation(s)
- Farah Mouhanna
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Heather J Hoffman
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Aaron J Siegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb S Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| |
Collapse
|
41
|
Levy ME, Anastos K, Levine SR, Plankey M, Castel AD, Molock S, Sen S, Asch FM, Milam J, Aouizerat B, Weber KM, Golub ET, Kaplan RC, Kassaye S. Depression and Psychosocial Stress Are Associated With Subclinical Carotid Atherosclerosis Among Women Living With HIV. J Am Heart Assoc 2020; 9:e016425. [PMID: 32564652 PMCID: PMC7670495 DOI: 10.1161/jaha.120.016425] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To identify reasons for increased atherosclerotic risk among women living with HIV (WLWH), we evaluated the associations between psychosocial risk factors (depressive symptoms, perceived stress, and posttraumatic stress disorder symptoms) and subclinical atherosclerosis among WLWH and HIV-negative women. Methods and Results Carotid artery focal plaque (localized intima-media thickness >1.5 mm) was measured using B-mode ultrasound imaging in 2004-2005 and 2010-2012 in the Women's Interagency HIV Study. We created psychosocial risk groups using latent class analysis and defined prevalent plaque at the final measurement. We also examined repeated semiannual depression measures with respect to focal plaque formation throughout follow-up. The associations between latent class and prevalent plaque, and between depressive symptom persistence and plaque formation, were assessed separately by HIV status using multivariable logistic regression. Among 700 women (median age 47 years), 2 latent classes were identified: high (n=163) and low (n=537) psychosocial risk, with corresponding prevalence of depression (65%/13%), high stress (96%/12%), and probable posttraumatic stress disorder (46%/2%). Among WLWH, plaque prevalence was 23% and 11% in high versus low psychosocial risk classes (adjusted odds ratio [aOR], 2.12; 95% CI, 1.11-4.05) compared with 9% and 9% among HIV-negative women (aOR, 1.07; 95% CI, 0.24-4.84), respectively. New plaque formation occurred among 17% and 9% of WLWH who reported high depressive symptoms at ≥45% versus <45% of visits (aOR, 1.96; 95% CI, 1.06-3.64), compared with 9% and 7% among HIV-negative women (aOR, 0.82; 95% CI, 0.16-4.16), respectively. Conclusions Psychosocial factors were independent atherosclerotic risk factors among WLWH. Research is needed to determine whether interventions for depression and psychosocial stress can mitigate the increased risk of atherosclerosis for WLWH.
Collapse
Affiliation(s)
- Matthew E Levy
- Department of Epidemiology Milken Institute School of Public Health at the George Washington University Washington DC
| | - Kathryn Anastos
- Department of Medicine Albert Einstein College of Medicine Bronx NY.,Department of Epidemiology & Population Health Albert Einstein College of Medicine Bronx NY
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine State University of New York Downstate Health Sciences University Brooklyn NY.,Department of Neurology Kings County Hospital Center Brooklyn NY
| | - Michael Plankey
- Department of Medicine Georgetown University Medical Center Washington DC
| | - Amanda D Castel
- Department of Epidemiology Milken Institute School of Public Health at the George Washington University Washington DC
| | - Sherry Molock
- Department of Psychology The George Washington University Washington DC
| | - Sabyasachi Sen
- Division of Endocrinology George Washington University School of Medicine and Health Sciences Washington DC
| | - Federico M Asch
- Cardiovascular Core Laboratories and Cardiac Imaging Research MedStar Health Research Institute MedStar Heart and Vascular Institute Washington DC
| | - Joel Milam
- Department of Preventive Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Bradley Aouizerat
- New York University School of Dentistry and Bluestone Center for Clinical Research New York NY
| | | | - Elizabeth T Golub
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Robert C Kaplan
- Department of Epidemiology & Population Health Albert Einstein College of Medicine Bronx NY
| | - Seble Kassaye
- Department of Medicine Georgetown University Medical Center Washington DC
| |
Collapse
|
42
|
Levy ME, Monroe AK, Horberg MA, Benator DA, Castel AD. Is low-level viraemia associated with serum lipid profiles among HIV controllers? HIV Med 2020; 21:e14-e16. [PMID: 32311819 DOI: 10.1111/hiv.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - M A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - D A Benator
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - A D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | | |
Collapse
|
43
|
Opoku J, Doshi RK, Castel AD, Sorensen I, Horberg M, Allston A, Kharfen M, Greenberg AE. Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study. JMIR Public Health Surveill 2020; 6:e16061. [PMID: 32293567 PMCID: PMC7191350 DOI: 10.2196/16061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022] Open
Abstract
Background HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.
Collapse
Affiliation(s)
- Jenevieve Opoku
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Rupali K Doshi
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States.,Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Ian Sorensen
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Michael Horberg
- Kaiser Permanente Medical Group, Rockville, MD, United States
| | - Adam Allston
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Michael Kharfen
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| |
Collapse
|
44
|
Levy ME, Ma Y, Magnus M, Younes N, Castel AD. Cholesterol-lowering effect of statin therapy in a clinical HIV cohort: an application of double propensity score adjustment. Ann Epidemiol 2020; 44:8-15. [PMID: 32204991 PMCID: PMC7190432 DOI: 10.1016/j.annepidem.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Propensity score matching (PSM) is often used to estimate the average treatment effect among the treated (ATT) using observational data. We demonstrate how the use of "double propensity score adjustment" can reduce residual confounding and avoid bias due to incomplete matching compared with traditional PSM methods. METHODS The DC Cohort is an observational clinical HIV cohort in Washington, DC. We compared the mean percent change in non-high-density lipoprotein cholesterol (non-HDL-C) concentration after 3-12 months between participants treated and participants not treated with statin therapy between 2011 and 2018. We conducted traditional PSM procedures (optimal, nearest neighbor, and nearest neighbor caliper matching) and double propensity score adjustment. RESULTS Among 202 treated and 1252 untreated participants, the ATT was -14.5% (95% CI: -18.4, -10.6) after optimal matching (202 matched pairs; 15/22 covariates balanced), -14.9% (-18.9, -11.0) after nearest neighbor matching (202 matched pairs; 17/22 covariates balanced), and -12.0% (-16.5, -7.5) after nearest neighbor caliper matching (153 matched pairs; 21/22 covariates balanced). After double propensity score adjustment, the ATT was -13.0% (-16.0, -10.1). CONCLUSIONS In PSM analyses, double propensity score adjustment is a readily accessible alternative approach for estimating ATTs when sufficient covariate balance between treatment groups cannot be achieved without excluding treated participants.
Collapse
Affiliation(s)
- Matthew E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC.
| | - Yan Ma
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Naji Younes
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| |
Collapse
|
45
|
Jones J, Dominguez K, Stephenson R, Stekler JD, Castel AD, Mena LA, Jenness SM, Siegler AJ, Sullivan PS. A Theoretically Based Mobile App to Increase Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16231. [PMID: 32130178 PMCID: PMC7060494 DOI: 10.2196/16231] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 01/26/2023] Open
Abstract
Background HealthMindr is a mobile phone HIV prevention app for men who have sex with men (MSM). In a previous pilot study, HealthMindr was found to be acceptable among users and to demonstrate preliminary effectiveness for increasing pre-exposure prophylaxis (PrEP) uptake among MSM. PrEP is a highly effective HIV prevention intervention; however, uptake remains low. Objective The aim of this study will be to assess the efficacy of a mobile app for increasing PrEP uptake among MSM in the southern United States. Methods In this randomized controlled trial, we will assess the efficacy of HealthMindr for increasing PrEP uptake among MSM in the following three southern US cities: Atlanta, Georgia; Jackson, Mississippi; and Washington, DC. In total, 657 men will be recruited and randomized to intervention and control arms in a 2:1 ratio. Participants in the intervention arm will receive access to the full HealthMindr app, with information and resources about PrEP (eg, frequently asked questions, risk assessment tool, and PrEP provider locator), other HIV prevention information, ability to order free HIV/sexually transmitted infection test kits, and additional resources related to substance use and mental health. Participants in the control arm will use the HealthMindr app but will only have access to the study timeline and a message center to communicate with study staff. Participants will complete quarterly surveys to assess self-reported PrEP uptake over 12 months of follow-up. Self-reported PrEP uptake will be verified by dried blood spot testing and/or uploading a photograph of a PrEP prescription. Results Participant recruitment began in January 2020. Conclusions This trial will determine whether the HealthMindr app can increase PrEP uptake among MSM in the southern United States. Trial Registration ClinicalTrials.gov NCT03763942; https://clinicaltrials.gov/ct2/show/NCT03763942 International Registered Report Identifier (IRRID) PRR1-10.2196/16231
Collapse
Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Karen Dominguez
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Joanne D Stekler
- Division of Allergy & Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, United States
| | - Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Leandro A Mena
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
46
|
Gibson KM, Jair K, Castel AD, Bendall ML, Wilbourn B, Jordan JA, Crandall KA, Pérez-Losada M. A cross-sectional study to characterize local HIV-1 dynamics in Washington, DC using next-generation sequencing. Sci Rep 2020; 10:1989. [PMID: 32029767 PMCID: PMC7004982 DOI: 10.1038/s41598-020-58410-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/31/2019] [Indexed: 11/08/2022] Open
Abstract
Washington, DC continues to experience a generalized HIV-1 epidemic. We characterized the local phylodynamics of HIV-1 in DC using next-generation sequencing (NGS) data. Viral samples from 68 participants from 2016 through 2017 were sequenced and paired with epidemiological data. Phylogenetic and network inferences, drug resistant mutations (DRMs), subtypes and HIV-1 diversity estimations were completed. Haplotypes were reconstructed to infer transmission clusters. Phylodynamic inferences based on the HIV-1 polymerase (pol) and envelope genes (env) were compared. Higher HIV-1 diversity (n.s.) was seen in men who have sex with men, heterosexual, and male participants in DC. 54.0% of the participants contained at least one DRM. The 40-49 year-olds showed the highest prevalence of DRMs (22.9%). Phylogenetic analysis of pol and env sequences grouped 31.9-33.8% of the participants into clusters. HIV-TRACE grouped 2.9-12.8% of participants when using consensus sequences and 9.0-64.2% when using haplotypes. NGS allowed us to characterize the local phylodynamics of HIV-1 in DC more broadly and accurately, given a better representation of its diversity and dynamics. Reconstructed haplotypes provided novel and deeper phylodynamic insights, which led to networks linking a higher number of participants. Our understanding of the HIV-1 epidemic was expanded with the powerful coupling of HIV-1 NGS data with epidemiological data.
Collapse
Grants
- P30 AI117970 NIAID NIH HHS
- U01 AI069503 NIAID NIH HHS
- UM1 AI069503 NIAID NIH HHS
- This study was supported by the DC Cohort Study (U01 AI69503-03S2), a supplement from the Women’s Interagency Study for HIV-1 (410722_GR410708), a DC D-CFAR pilot award, and a 2015 HIV-1 Phylodynamics Supplement award from the District of Columbia for AIDS Research, an NIH funded program (AI117970), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Collapse
Affiliation(s)
- Keylie M Gibson
- Computational Biology Institute, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - Kamwing Jair
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Matthew L Bendall
- Computational Biology Institute, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Brittany Wilbourn
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Jeanne A Jordan
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Keith A Crandall
- Computational Biology Institute, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- Department of Biostatistics and Bioinformatics, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Marcos Pérez-Losada
- Computational Biology Institute, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- Department of Biostatistics and Bioinformatics, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Campus Agrário de Vairão, Vairão, Portugal
| |
Collapse
|
47
|
Wilbourn B, Howell TH, Castel AD, D'Angelo L, Trexler C, Carr R, Greenberg D. Development, Refinement, and Acceptability of Digital Gaming to Improve HIV Testing Among Adolescents and Young Adults at Risk for HIV. Games Health J 2020; 9:53-63. [PMID: 31560218 PMCID: PMC7038573 DOI: 10.1089/g4h.2018.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Adolescents and young adults (AYAs) account for >20% of new HIV diagnoses in the United States, yet >50% are unaware of their infection. Digital gaming is widespread among youth and has proven efficacious in other disease areas; thus, we sought to determine whether a life-and-dating simulation game to increase HIV testing would be acceptable among AYAs. Materials and Methods: Focus groups and surveys were administered to health care providers and AYAs in Washington, DC. AYAs were shown a life-and-dating simulation game that incorporated the Centers for Disease Control and Prevention Risk Estimator tool to demonstrate the potential HIV risk of selected behaviors and a zipcode-level HIV testing locator. Thematic analysis was used to identify general gaming themes and game acceptance. Descriptive statistics were used to summarize response frequencies and Likert scales were used to evaluate game acceptability. Results: Providers, some of whom (38%, n = 5/13) had significant experience caring for youth living with or at increased risk for HIV, advised against the game forcing youth to disclose sexual identity or labeling youth "at risk." AYAs (n = 46) found the initial and revised versions of the game to be highly acceptable: youth thought the game was interesting [mean (standard deviation, SD) = 4.8/5 (0.4)]; liked playing games about HIV-related behaviors [mean (SD) = 4.8/5 (0.5)]; and would share the game to help friends get tested for HIV [mean = 4.6/5 (0.8)]. Conclusions: This study suggests that a digital game to improve HIV testing is acceptable among youth. An efficacy trial is planned to determine the impact of the game on improving HIV testing.
Collapse
Affiliation(s)
- Brittany Wilbourn
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Tyriesa Howard Howell
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
| | - Amanda D. Castel
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Lawrence D'Angelo
- Burgess Clinic, Children's National Health System, Washington, District of Columbia
| | - Connie Trexler
- Burgess Clinic, Children's National Health System, Washington, District of Columbia
| | - Rashida Carr
- Burgess Clinic, Children's National Health System, Washington, District of Columbia
| | | |
Collapse
|
48
|
Sullivan PS, Mouhanna F, Mera R, Pembleton E, Castel AD, Jaggi C, Jones J, Kramer MR, McGuinness P, McCallister S, Siegler AJ. Methods for county-level estimation of pre-exposure prophylaxis coverage and application to the U.S. Ending the HIV Epidemic jurisdictions. Ann Epidemiol 2020; 44:16-30. [PMID: 32088073 DOI: 10.1016/j.annepidem.2020.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/27/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Pre-exposure prophylaxis (PrEP) is a pillar of the US Department of Health and Human Services "Ending the HIV Epidemic" (EHE) initiative in 50 EHE jurisdictions (48 U.S. counties and two U.S. cities) and seven U.S. states with high numbers of HIV diagnoses rates in rural areas. Current data systems do not provide data on PrEP uptake in counties or cities. METHODS We report on PrEP users at the county level. Data from a large, commercial pharmacy database were used; we applied the U.S. Census Bureau's method to allocate PrEP users within a ZIP3 into counties and validated the results. We report counts and rates of PrEP users in 2018 for all EHE jurisdictions. We used joinpoint regression to model the estimated annual percent change in PrEP use for each jurisdiction and state. RESULTS 93,156 people in the 50 EHE jurisdictions used PrEP in 2018; 94% were men and 39% were aged 25-34 years. There was more than an 80-fold difference in the range of rates of PrEP use per 100,000 population among the EHE jurisdictions (range: 8-644 per 100,000 population; median 93 per 100,000 population). PrEP use increased from 2012 to 2018 in all EHE counties and states. At current rates of growth of PrEP use, 94% of EHE counties and jurisdictions will reach their National HIV/AIDS Strategy goals of a 500% increase in PrEP use in 2020. EHE states had less variation in rates of PrEP use (range: 29-51/100,000 population; median 32/100,000 population). CONCLUSIONS At the outset of a major U.S. government program to reduce HIV infections, rates of PrEP use are highly variable among the 50 EHE jurisdictions. Data from commercial prescription databases will be a useful public resource to understand progress in promoting use of PrEP as part of the EHE initiative and evaluating progress in PrEP use across health jurisdictions.
Collapse
Affiliation(s)
- Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Farah Mouhanna
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC; Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Elizabeth Pembleton
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Chandni Jaggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pema McGuinness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Aaron J Siegler
- Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
49
|
Levy ME, Monroe AK, Horberg MA, Benator DA, Molock S, Doshi RK, Powers Happ L, Castel AD. Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort. J Acquir Immune Defic Syndr 2019; 82:329-341. [PMID: 31356466 PMCID: PMC6791752 DOI: 10.1097/qai.0000000000002138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH). SETTING The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC. METHODS Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations. RESULTS Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder). CONCLUSIONS PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
Collapse
Affiliation(s)
- Matthew E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Debra A Benator
- Infectious Diseases Section, Veterans Affairs Medical Center, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC
| | - Rupali K Doshi
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| |
Collapse
|
50
|
Saafir-Callaway B, Castel AD, Lago L, Olejemeh C, Lum G, Frison L, Kharfen M. Longitudinal outcomes of HIV- infected persons re-engaged in care using a community-based re-engagement approach. AIDS Care 2019; 32:76-82. [PMID: 31129991 DOI: 10.1080/09540121.2019.1619662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Re-engaging people living with HIV (PLWH) who are out of care (OOC) is of utmost importance to ending the HIV epidemic in the U.S. We used DC Department of Health (DCDOH) HIV surveillance data to determine whether re-engaging PLWH results in improved long-term clinical outcomes. PLWH identified as OOC for 6-12 months at both the clinic-level and using DCDOH data were targeted for re-engagement efforts through Recapture Blitz (RB). Uni- and bivariate analyses were conducted comparing engagement in care (EIC), CD4 counts, and viral suppression (VS) at 6, 12, and 18-months post-re-engagement between persons re-engaged through RB and those not re-engaged via RB. Of the 569 PLWH contacted; 57 were re-engaged through RB, 46 were not but may have reengaged on their own. Compared to those not re-engaged via RB, at 18-months of follow-up, more PLWH re-engaged through RB were EIC (71.9% vs. 56.5%) and VS (52.6% vs. 30.4%). Higher proportions of PLWH re-engaged through RB were virally suppressed at 6, 12, and 18-months (p = 0.0238, p = 0.0347, p = 0.0238, respectively). Combining surveillance and clinical data to identify persons OOC allowed for successful re-engagement and improved longer-term outcomes post-re-engagement, underscoring the importance of re-engagement efforts to improve rates of retention and viral suppression.
Collapse
Affiliation(s)
- Brittani Saafir-Callaway
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Lena Lago
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| | - Christie Olejemeh
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| | - Garret Lum
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| | - Lawrence Frison
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health, HIV AIDS, Hepatitis, STD, TB Administration, Washington, DC, USA
| |
Collapse
|