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O’Grady TJ, Tesoriero JM, Yuan Y, Grisham TM, Seo SJ, Gonzalez CJ, Morne JE. Evaluation of Trends in Preexposure Prophylaxis Prescriptions During the First 6 Months of the COVID-19 Pandemic in New York State. JAMA Netw Open 2022; 5:e224065. [PMID: 35344048 PMCID: PMC8961317 DOI: 10.1001/jamanetworkopen.2022.4065] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This cohort study uses time-series models to estimate preexposure prophylaxis prescription trends during the first 6 months of the COVID-19 pandemic in New York State in 2020.
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Affiliation(s)
| | | | - Yingchao Yuan
- AIDS Institute, New York State Department of Health, Albany
| | | | - Seung Jun Seo
- AIDS Institute, New York State Department of Health, Albany
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Tesoriero JM, Swain CAE, Pierce JL, Zamboni L, Wu M, Holtgrave DR, Gonzalez CJ, Udo T, Morne JE, Hart-Malloy R, Rajulu DT, Leung SYJ, Rosenberg ES. COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State. JAMA Netw Open 2021; 4:e2037069. [PMID: 33533933 PMCID: PMC7859843 DOI: 10.1001/jamanetworkopen.2020.37069] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/19/2020] [Indexed: 12/17/2022] Open
Abstract
Importance New York State has been an epicenter for both the US coronavirus disease 2019 (COVID-19) and HIV/AIDS epidemics. Persons living with diagnosed HIV may be more prone to COVID-19 infection and severe outcomes, yet few studies have assessed this possibility at a population level. Objective To evaluate the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State. Design, Setting, and Participants This cohort study, conducted in New York State, including New York City, between March 1 and June 15, 2020, matched data from HIV surveillance, COVID-19 laboratory-confirmed diagnoses, and hospitalization databases to provide a full population-level comparison of COVID-19 outcomes between persons living with diagnosed HIV and persons living without diagnosed HIV. Exposures Diagnosis of HIV infection through December 31, 2019. Main Outcomes and Measures The main outcomes were COVID-19 diagnosis, hospitalization, and in-hospital death. COVID-19 diagnoses, hospitalizations, and in-hospital death rates comparing persons living with diagnosed HIV with persons living without dianosed HIV were computed, with unadjusted rate ratios and indirect standardized rate ratios (sRR), adjusting for sex, age, and region. Adjusted rate ratios (aRRs) for outcomes specific to persons living with diagnosed HIV were assessed by age, sex, region, race/ethnicity, transmission risk, and CD4+ T-cell count-defined HIV disease stage, using Poisson regression models. Results A total of 2988 persons living with diagnosed HIV (2109 men [70.6%]; 2409 living in New York City [80.6%]; mean [SD] age, 54.0 [13.3] years) received a diagnosis of COVID-19. Of these persons living with diagnosed HIV, 896 were hospitalized and 207 died in the hospital through June 15, 2020. After standardization, persons living with diagnosed HIV and persons living without diagnosed HIV had similar diagnosis rates (sRR, 0.94 [95% CI, 0.91-0.97]), but persons living with diagnosed HIV were hospitalized more than persons living without diagnosed HIV, per population (sRR, 1.38 [95% CI, 1.29-1.47]) and among those diagnosed (sRR, 1.47 [95% CI, 1.37-1.56]). Elevated mortality among persons living with diagnosed HIV was observed per population (sRR, 1.23 [95% CI, 1.07-1.40]) and among those diagnosed (sRR, 1.30 [95% CI, 1.13-1.48]) but not among those hospitalized (sRR, 0.96 [95% CI, 0.83-1.09]). Among persons living with diagnosed HIV, non-Hispanic Black individuals (aRR, 1.59 [95% CI, 1.40-1.81]) and Hispanic individuals (aRR, 2.08 [95% CI, 1.83-2.37]) were more likely to receive a diagnosis of COVID-19 than White individuals, but they were not more likely to be hospitalized once they received a diagnosis or to die once hospitalized. Hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29 [95% CI, 1.11-1.49]) and stage 3 (aRR, 1.69 [95% CI, 1.38-2.07]) relative to stage 1. Conclusions and Relevance In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.
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Affiliation(s)
- James M. Tesoriero
- New York State Department of Health, Albany
- Department of Health Policy Management and Behavior, University at Albany School of Public Health, State University of New York, Rensselaer
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
| | | | | | | | - Meng Wu
- New York State Department of Health, Albany
| | - David R. Holtgrave
- Department of Health Policy Management and Behavior, University at Albany School of Public Health, State University of New York, Rensselaer
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
| | | | - Tomoko Udo
- Department of Health Policy Management and Behavior, University at Albany School of Public Health, State University of New York, Rensselaer
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Johanne E. Morne
- New York State Department of Health, Albany
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Rachel Hart-Malloy
- New York State Department of Health, Albany
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | | | | | - Eli S. Rosenberg
- Center for Collaborative HIV Research in Practice and Policy, University at Albany School of Public Health, State University of New York, Rensselaer
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
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Tesoriero JM, Swain CAE, Pierce JL, Zamboni L, Wu M, Holtgrave DR, Gonzalez CJ, Udo T, Morne JE, Hart-Malloy R, Rajulu DT, Leung SYJ, Rosenberg ES. Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: Results from a population-level match of HIV, COVID-19, and hospitalization databases. medRxiv 2020. [PMID: 33173901 DOI: 10.1101/2020.11.04.20226118] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND New York State (NYS) has been an epicenter for both COVID-19 and HIV/AIDS epidemics. Persons Living with diagnosed HIV (PLWDH) may be more prone to COVID-19 infection and severe outcomes, yet few population-based studies have assessed the extent to which PLWDH are diagnosed, hospitalized, and have died with COVID-19, relative to non-PLWDH. METHODS NYS HIV surveillance, COVID-19 laboratory confirmed diagnoses, and hospitalization databases were matched. COVID-19 diagnoses, hospitalization, and in-hospital death rates comparing PLWDH to non-PLWDH were computed, with unadjusted rate ratios (RR) and indirect standardized RR (sRR), adjusting for sex, age, and region. Adjusted RR (aRR) for outcomes among PLWDH were assessed by age/CD4-defined HIV disease stage, and viral load suppression, using Poisson regression models. RESULTS From March 1-June 7, 2020, PLWDH were more frequently diagnosed with COVID-19 than non-PLWDH in unadjusted (RR [95% confidence interval (CI)]: 1.43[1.38-1.48), 2,988 PLWDH], but not in adjusted comparisons (sRR [95% CI]: 0.94[0.91-0.97]). Per-population COVID-19 hospitalization was higher among PLWDH (RR [95% CI]: 2.61[2.45-2.79], sRR [95% CI]: 1.38[1.29-1.47], 896 PLWDH), as was in-hospital death (RR [95% CI]: 2.55[2.22-2.93], sRR [95%CI]: 1.23 [1.07-1.40], 207 PLWDH), albeit not among those hospitalized (sRR [95% CI]: 0.96[0.83-1.09]). Among PLWDH, hospitalization risk increased with disease progression from HIV Stage 1 to Stage 2 (aRR [95% CI]:1.27[1.09-1.47]) and Stage 3 (aRR [95% CI]: 1.54[1.24-1.91]), and for those virally unsuppressed (aRR [95% CI]: 1.54[1.24-1.91]). CONCLUSION PLWDH experienced poorer COVID-related outcomes relative to non-PLWDH, with 1-in-522 PLWDH dying with COVID-19, seemingly driven by higher rates of severe disease requiring hospitalization.
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Morne JE, Tesoriero JM, Martin EG, Birkhead GS, Holtgrave DR, Hagos K, Zucker H. Ending the HIV Epidemic: New York's Quest to Become the First State to Reduce HIV Prevalence. Public Health Rep 2020; 135:65S-74S. [PMID: 32735198 DOI: 10.1177/0033354920917403] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2014, New York State became the first jurisdiction to launch a statewide initiative to end AIDS by reducing the number of persons living with HIV for the first time since effective HIV treatment became available. The Ending the Epidemic (ETE) initiative encompasses (1) identifying and linking undiagnosed persons with HIV to care, (2) retaining persons with HIV in care, and (3) facilitating access to preexposure prophylaxis for persons at risk for acquiring HIV. We used a framework for public health program implementation to describe key characteristics of the ETE initiative, present progress toward 13 ETE target metrics, and identify areas in need of increased programming. We provide evidence suggesting that New York State is on track to end AIDS as an epidemic by the end of 2020. As of 2017, 76% of progress toward our primary ETE target had been achieved. Substantial progress on several additional metrics critical to decreasing HIV prevalence and to improving the health of persons living with HIV had also been achieved. Lessons learned included the following: (1) ETE-based programming should be tailored to each jurisdiction's unique political and social climate, HIV epidemiology, fiscal resources, and network of HIV service providers; (2) key stakeholders should be involved in developing ETE metrics and setting targets; (3) performance-based measurement and timely communication to key stakeholders in real time are essential; and (4) examining trends in HIV prevention and care metrics is important for developing realistic ETE timelines.
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Affiliation(s)
- Johanne E Morne
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA.,1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA
| | - James M Tesoriero
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA.,1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA
| | - Erika G Martin
- 1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA.,1084 Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, Albany, NY, USA
| | - Guthrie S Birkhead
- 1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA.,1084 School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - David R Holtgrave
- 1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA.,1084 School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Karen Hagos
- 1094 AIDS Institute, New York State Department of Health, Albany, NY, USA.,1084 Center for Collaborative HIV Research in Practice and Policy, State University of New York, Albany, NY, USA
| | - Howard Zucker
- 1094 New York State Department of Health, Albany, NY, USA
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Rosenberg ES, Tesoriero JM, Rosenthal EM, Chung R, Barranco MA, Styer LM, Parker MM, John Leung SY, Morne JE, Greene D, Holtgrave DR, Hoefer D, Kumar J, Udo T, Hutton B, Zucker HA. Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York. Ann Epidemiol 2020; 48:23-29.e4. [PMID: 32648546 DOI: 10.1101/2020.05.25.20113050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 05/20/2023]
Abstract
PURPOSE New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS We conducted a statewide seroprevalence study in a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first poststratification weighting and then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing the number of diagnoses by the number of estimated infection-experienced adults. RESULTS Based on 1887 of 15,101 (12.5%) reactive results, estimated cumulative incidence through March 29 was 14.0% (95% confidence interval [CI]: 13.3%-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City 22.7% (95% CI: 21.5%-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, P < .0001). An estimated 8.9% (95% CI: 8.4%-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults aged 55 years or older (11.3%, 95% CI: 10.4%-12.2%). CONCLUSIONS From the largest U.S. serosurvey to date, we estimated >2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained less than herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.
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Affiliation(s)
- Eli S Rosenberg
- University at Albany School of Public Health, State University of New York, Rensselaer.
| | | | - Elizabeth M Rosenthal
- University at Albany School of Public Health, State University of New York, Rensselaer
| | | | - Meredith A Barranco
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY
| | | | | | | | - David R Holtgrave
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Dina Hoefer
- New York State Department of Health, Albany, NY
| | | | - Tomoko Udo
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Brad Hutton
- New York State Department of Health, Albany, NY
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Rosenberg ES, Tesoriero JM, Rosenthal EM, Chung R, Barranco MA, Styer LM, Parker MM, John Leung SY, Morne JE, Greene D, Holtgrave DR, Hoefer D, Kumar J, Udo T, Hutton B, Zucker HA. Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York. Ann Epidemiol 2020; 48:23-29.e4. [PMID: 32648546 PMCID: PMC7297691 DOI: 10.1016/j.annepidem.2020.06.004] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS We conducted a statewide seroprevalence study in a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first poststratification weighting and then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing the number of diagnoses by the number of estimated infection-experienced adults. RESULTS Based on 1887 of 15,101 (12.5%) reactive results, estimated cumulative incidence through March 29 was 14.0% (95% confidence interval [CI]: 13.3%-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City 22.7% (95% CI: 21.5%-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, P < .0001). An estimated 8.9% (95% CI: 8.4%-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults aged 55 years or older (11.3%, 95% CI: 10.4%-12.2%). CONCLUSIONS From the largest U.S. serosurvey to date, we estimated >2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained less than herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.
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Affiliation(s)
- Eli S Rosenberg
- University at Albany School of Public Health, State University of New York, Rensselaer.
| | | | - Elizabeth M Rosenthal
- University at Albany School of Public Health, State University of New York, Rensselaer
| | | | - Meredith A Barranco
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY
| | | | | | | | - David R Holtgrave
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Dina Hoefer
- New York State Department of Health, Albany, NY
| | | | - Tomoko Udo
- University at Albany School of Public Health, State University of New York, Rensselaer
| | - Brad Hutton
- New York State Department of Health, Albany, NY
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Flanigan CA, Leung SYJ, Rowe KA, Levey WK, King A, Sommer JN, Morne JE, Zucker HA. Evaluation of the Impact of Mandating Health Care Providers to Offer Hepatitis C Virus Screening to All Persons Born During 1945-1965 - New York, 2014. MMWR Morb Mortal Wkly Rep 2017; 66:1023-1026. [PMID: 28957037 PMCID: PMC5657676 DOI: 10.15585/mmwr.mm6638a3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Approximately 75% of all hepatitis C virus (HCV) infections in the United States and 73% of HCV-associated mortality occur in persons born during 1945-1965, placing this birth cohort at increased risk for liver cancer and other HCV-related liver disease (1). In the United States, an estimated 2.7 million persons are living with HCV infection, and it is estimated that up to 75% of these persons do not know their status. Since 2012, CDC has recommended that persons born during 1945-1965 receive one-time HCV testing. To increase the number of persons tested for HCV and to ensure timely diagnosis and linkage to care, in 2014, New York enacted a hepatitis C testing law that requires health care providers to offer HCV antibody screening to all persons born during 1945-1965 who are receiving services in primary care settings or as hospital inpatients, and to refer persons with positive HCV antibody tests for follow-up health care, including an HCV diagnostic test (i.e., HCV RNA).* The New York State Department of Health (NYSDOH) used survey data from clinical laboratories and Medicaid claims and encounter data, and state and New York City (NYC) HCV surveillance data to assess the number of persons tested for HCV and number of persons with newly diagnosed HCV infections who were linked to care. During the first year of the HCV law implementation, there was a 51% increase in specimens submitted for HCV testing to surveyed clinical laboratories; testing rates among active Medicaid clients increased 52%, and linkage to care among persons with newly diagnosed HCV infection increased approximately 40% in New York and 11% in NYC. These findings highlight the potential for state laws to promote HCV testing and the utility of HCV surveillance and Medicaid claims data to monitor the quality of HCV testing and linkage to care for HCV-infected persons.
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