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Bayan MH, Smalls T, Boudreau A, Mirza AW, Pasco C, Demko ZO, Rothman RE, Hsieh YH, Eshleman SH, Mostafa HH, Gonzalez-Jimenez N, Chavez PR, Emerson B, Delaney KP, Daugherty D, MacGowan RJ, Manabe YC, Hamill MM. Evaluating the impact of point-of-care HIV viral load assessment on linkage to care in Baltimore, MD: a randomized controlled trial. BMC Infect Dis 2023; 23:570. [PMID: 37658305 PMCID: PMC10474693 DOI: 10.1186/s12879-023-08459-7] [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: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Integration of a sensitive point-of-care (POC) HIV viral load (VL) test into screening algorithms may help detect acute HIV infection earlier, identify people with HIV (PWH) who are not virally suppressed, and facilitate earlier referral to antiretroviral therapy (ART), or evaluation for pre-exposure prophylaxis (PrEP). This report describes a randomized clinical trial sponsored by the Centers for Disease Control and Prevention (CDC): "Ending the HIV Epidemic Through Point-of-Care Technologies" (EHPOC). The study's primary aim is to evaluate the use of a POC HIV VL test as part of a testing approach and assess the impact on time to linkage to ART or PrEP. The study will recruit people in Baltimore, Maryland, including patients attending a hospital emergency department, patients attending an infectious disease clinic, and people recruited via community outreach. The secondary aim is to evaluate the performance characteristics of two rapid HIV antibody tests approved by the United States Food and Drug Administration (FDA). METHODS The study will recruit people 18 years or older who have risk factors for HIV acquisition and are not on PrEP, or PWH who are not taking ART. Participants will be randomly assigned to either the control arm or the intervention arm. Participants randomized to the control arm will only receive the standard-of-care (SOC) HIV screening tests. Intervention arm participants will receive a POC HIV VL test in addition to the SOC HIV diagnostic screening tests. Follow up will consist of an interim phone survey conducted at week-4 and an in-person week-12 visit. Demographic and behavioral information, and oral fluid and blood specimens will be collected at enrollment and at week-12. Survey data will be captured in a Research Electronic Data Capture (REDCap) database. Participants in both arms will be referred for either ART or PrEP based on their HIV test results. DISCUSSION The EHPOC trial will explore a novel HIV diagnostic technology that can be performed at the POC and provide viral assessment. The study may help inform HIV testing algorithms and contribute to the evidence to support same day ART and PrEP recommendations. TRIAL REGISTRATION NIH ClinicalTrials.gov NCT04793750. Date: 11 March 2021.
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Affiliation(s)
| | - Travis Smalls
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Alec Boudreau
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Agha W Mirza
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Courtney Pasco
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Zoe O Demko
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Richard E Rothman
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Heba H Mostafa
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Brian Emerson
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin P Delaney
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Yukari C Manabe
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
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Ma S, MacGowan RJ, Mermin JH, Owen SM, Manabe YC. Accelerating Human Immunodeficiency Virus Self-Testing in the United States: A Call to Action. Clin Infect Dis 2023; 76:1678-1680. [PMID: 36645722 PMCID: PMC10411923 DOI: 10.1093/cid/ciad025] [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: 10/27/2022] [Revised: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
Human immunodeficiency virus (HIV) self-testing has emerged as a tool to increase the proportion of people to know their status. Since the first HIV self-test was approved in 2012 by the US Food and Drug Administration (FDA), global access to HIV self-tests has been bolstered by public-private partnerships to ensure equitable access in low- and middle-income countries. However, no company has applied for FDA clearance in a decade. We highlight the potential benefits to reclassifying HIV self-tests from class III to class II.
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Affiliation(s)
- Stephany Ma
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robin J MacGowan
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan H Mermin
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Michele Owen
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Leung T, Sullivan S, MacGowan RJ, Chavez PR, Wall KM, Sanchez TH, Stephenson R, Hightow-Weidman L, Johnson JA, Smith A, Sharma A, Jones J, Hannah M, Trigg M, Luo W, Caldwell J, Sullivan PS. Engaging Black or African American and Hispanic or Latino Men Who Have Sex With Men for HIV Testing and Prevention Services Through Technology: Protocol for the iSTAMP Comparative Effectiveness Trial. JMIR Res Protoc 2023; 12:e43414. [PMID: 36607707 PMCID: PMC9862319 DOI: 10.2196/43414] [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: 10/11/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (MSM), particularly Black or African American MSM (BMSM) and Hispanic or Latino MSM (HLMSM), continue to be disproportionately affected by the HIV epidemic in the United States. Previous HIV self-testing programs have yielded high testing rates, although these studies predominantly enrolled White, non-Hispanic MSM. Mobile health tools can support HIV prevention, testing, and treatment. This protocol details an implementation study of mailing free HIV self-tests (HIVSTs) nested within a randomized controlled trial designed to assess the benefit of a mobile phone app for increasing the uptake of HIV prevention and other social services. OBJECTIVE This study was a comparative effectiveness trial of innovative recruitment and testing promotion strategies intended to effectively reach cisgender BMSM and HLMSM. We evaluated the use of a mobile app for increasing access to care. METHODS Study development began with individual and group consultations that elicited feedback from 3 core groups: HIV care practitioners and researchers, HIV service organization leaders from study states, and BMSM and HLMSM living in the study states. Upon completion of the formative qualitative work, participants from 11 states, based on the observed areas of highest rate of new HIV diagnoses among Black and Hispanic MSM, were recruited through social networking websites and smartphone apps. After eligibility was verified, participants consented and were randomized to the intervention arm (access to the Know@Home mobile app) or the control arm (referral to web resources). We provided all participants with HIVSTs. The evaluation of the efficacy of a mobile phone app to support linkage to posttest prevention services that included sexually transmitted infection testing, pre-exposure prophylaxis initiation, antiretroviral treatment, and acquisition of condoms and compatible lubricants has been planned. Data on these outcomes were obtained from several sources, including HIVST-reporting surveys, the 4-month follow-up survey, laboratory analyses of dried blood spot cards returned by the participant, and data obtained from the state health department surveillance systems. Where possible, relevant subgroup analyses were performed. RESULTS During the formative development phase, 9 consultations were conducted: 6 in-depth individual discussions and 3 group consultations. From February 2020 through February 2021, we enrolled 2093 MSM in the randomized controlled trial from 11 states, 1149 BMSM and 944 HLMSM. CONCLUSIONS This study was designed and implemented to evaluate the effectiveness of recruitment strategies to reach BMSM and HMSM and of a mobile app with regard to linkage to HIV prevention or treatment services. Data were also obtained to allow for the analyses of cost and cost-effectiveness related to study enrollment, HIV testing uptake, identification of previously undiagnosed HIV, sexually transmitted infection testing and treatment, and linkage to HIV prevention or treatment services. TRIAL REGISTRATION ClinicalTrials.gov (NCT04219878); https://clinicaltrials.gov/ct2/show/NCT04219878. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43414.
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Affiliation(s)
| | - Stephen Sullivan
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Robin J MacGowan
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pollyanna R Chavez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kristin M Wall
- 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
| | - Rob Stephenson
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Lisa Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Jeffrey A Johnson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amanda Smith
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Akshay Sharma
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Marissa Hannah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Monica Trigg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wei Luo
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joanna Caldwell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Hutchinson AB, MacGowan RJ, Margolis AD, Adee MG, Wen W, Bowden CJ, Spaulding AC. Costs and Consequences of Eliminating a Routine, Point-Of-Care HIV Screening Program in a High-Prevalence Jail. Am J Prev Med 2021; 61:S32-S38. [PMID: 34686288 DOI: 10.1016/j.amepre.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aims to assess the public health impact of eliminating a longstanding routine HIV screening program and replacing it with targeted testing. In addition, costs, outcomes, and cost effectiveness of routine screening are compared with those of targeted testing in the Fulton County Jail, Atlanta, Georgia. METHODS A published mathematical model was used to assess the cost effectiveness and public health impact of routine screening (March 2013-February 2014) compared with those of targeted testing (January 2018-December 2018) from a health system perspective. Costs, outcomes, and other model inputs were derived from the testing programs and the published literature, and the cost effectiveness analysis was conducted from 2019 to 2020. RESULTS Routine screening identified 74 more new HIV infections over 1 year than targeted testing, resulting in an estimated 10 HIV transmissions averted and 45 quality-adjusted life-years saved, and was cost saving. The missed opportunity to diagnose infections because routine screening was eliminated resulted in an estimated 8.4 additional HIV transmissions and $3.7 million in additional costs to the healthcare system. CONCLUSIONS Routine HIV screening in high-prevalence jails is cost effective and has a larger impact on public health than targeted testing. Prioritizing sustained funding for routine, jail-based HIV screening programs in high-prevalence areas may be important to realizing the national HIV prevention goals.
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Affiliation(s)
- Angela B Hutchinson
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Robin J MacGowan
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew D Margolis
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Madeline G Adee
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wendy Wen
- Georgia Department of Public Health, Atlanta, Georgia
| | - Chava J Bowden
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anne C Spaulding
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Mizuno Y, Borkowf CB, Hirshfield S, Mustanski B, Sullivan PS, MacGowan RJ. Age- and Race/Ethnicity-Specific Sex Partner Correlates of Condomless Sex in an Online Sample of Hispanic/Latino, Black/African-American, and White Men Who Have Sex with Men. Arch Sex Behav 2020; 49:1903-1914. [PMID: 31845149 PMCID: PMC7295651 DOI: 10.1007/s10508-019-01534-8] [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] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
We sought to identify and compare correlates of condomless receptive anal intercourse with HIV-positive or unknown status partners (CRAI) for younger (< 25 years) and older (≥ 25 years) Hispanic/Latino, black/African-American, and white men who have sex with men (MSM). Baseline data from the Evaluation of Rapid HIV Self-Testing among MSM Project (eSTAMP), a randomized controlled trial with MSM (n = 2665, analytical sample size = 2421), were used. Potential correlates included participants' sociodemographic characteristics and HIV status as well as the characteristics of participants' partners. Younger Hispanic/Latino and black men were most likely to report having older sex partners (≥ 50% of partners being at least 5 years older), and having older partners was a significant correlate of CRAI among younger Hispanic/Latino and white men. Regardless of race/ethnicity, not knowing one's HIV status was a significant correlate of CRAI among younger men, whereas having a black sex partner was a significant correlate among older men. HIV prevention initiatives could address these and other correlates specific to race/ethnicity groups to target their prevention resources and messaging.
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Affiliation(s)
- Yuko Mizuno
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop US8-5, Atlanta, GA, 30329, USA.
| | - Craig B Borkowf
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop US8-5, Atlanta, GA, 30329, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Brian Mustanski
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Robin J MacGowan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE Mail Stop US8-5, Atlanta, GA, 30329, USA
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MacGowan RJ, Chavez PR, Mermin JH. Implementation of HIV Self-Testing Program in New York City-Reply. JAMA Intern Med 2020; 180:616-617. [PMID: 32250405 DOI: 10.1001/jamainternmed.2020.0125] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Shrestha RK, Chavez PR, Noble M, Sansom SL, Sullivan PS, Mermin JH, MacGowan RJ. Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States. J Int AIDS Soc 2020; 23:e25445. [PMID: 31960580 PMCID: PMC6970935 DOI: 10.1002/jia2.25445] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 07/10/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre-exposure prophylaxis. Internet distribution of HIV self-tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost-effectiveness of a self-testing programme. METHODS Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12-month trial of HIV self-testing in the United States. Participants were randomly assigned either to the self-testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self-testing participants received up to four self-tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow-up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self-testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self-test completed, cost per person tested, cost per new HIV diagnosis among those self-tested and cost per quality adjusted life year (QALY) saved. RESULTS A total of 2665 men were assigned either to the self-testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self-testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self-testing participants additionally distributed 2864 self-tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self-testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self-testing programme was $449,510. The cost per self-test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self-testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. CONCLUSIONS The HIV self-testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving.
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Affiliation(s)
- Ram K Shrestha
- Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaGAUSA
| | - Pollyanna R Chavez
- Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaGAUSA
| | | | - Stephanie L Sansom
- Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaGAUSA
| | - Patrick S Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Jonathan H Mermin
- Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaGAUSA
| | - Robin J MacGowan
- Centers for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaGAUSA
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MacGowan RJ, Chavez PR, Borkowf CB, Owen SM, Purcell DW, Mermin JH, Sullivan PS. Effect of Internet-Distributed HIV Self-tests on HIV Diagnosis and Behavioral Outcomes in Men Who Have Sex With Men: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:117-125. [PMID: 31738378 PMCID: PMC6865312 DOI: 10.1001/jamainternmed.2019.5222] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Undiagnosed HIV infection results in delayed access to treatment and increased transmission. Self-tests for HIV may increase awareness of infection among men who have sex with men (MSM). OBJECTIVE To evaluate the effect of providing HIV self-tests on frequency of testing, diagnoses of HIV infection, and sexual risk behaviors. DESIGN, SETTING, AND PARTICIPANTS This 12-month longitudinal, 2-group randomized clinical trial recruited MSM through online banner advertisements from March through August 2015. Those recruited were at least 18 years of age, reported engaging in anal sex with men in the past year, never tested positive for HIV, and were US residents with mailing addresses. Participants completed quarterly online surveys. Telephone call notes and laboratory test results were included in the analysis, which was completed from August 2017 through December 2018. INTERVENTIONS All participants had access to online web-based HIV testing resources and telephone counseling on request. Participants were randomized in a 1:1 ratio to the control group or a self-testing (ST) group, which received 4 HIV self-tests after completing the baseline survey with the option to replenish self-tests after completing quarterly surveys. At study completion, all participants were offered 2 self-tests and 1 dried blood spot collection kit. MAIN OUTCOMES AND MEASURES Primary outcomes were HIV testing frequency (tested ≥3 times during the trial) and number of newly identified HIV infections among participants in both groups and social network members who used the study HIV self-tests. Secondary outcomes included sex behaviors (eg, anal sex, serosorting). RESULTS Of 2665 participants, the mean (SD) age was 30 (9.6) years, 1540 (57.8%) were white, and 443 (16.6%) had never tested for HIV before enrollment. Retention rates at each time point were more than 54%, and 1991 (74.7%) participants initiated 1 or more follow-up surveys. More ST participants reported testing 3 or more times during the trial than control participants (777 of 1014 [76.6%] vs 215 of 977 [22.0%]; P < .01). The cumulative number of newly identified infections during the trial was twice as high in the ST participants as the control participants (25 of 1325 [1.9%] vs 11 of 1340 [0.8%]; P = .02), with the largest difference in HIV infections identified in the first 3 months (12 of 1325 [0.9%] vs 2 of 1340 [0.1%]; P < .01). The ST participants reported 34 newly identified infections among social network members who used the self-tests. CONCLUSIONS AND RELEVANCE Distribution of HIV self-tests provides a worthwhile mechanism to increase awareness of HIV infection and prevent transmission among MSM. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02067039.
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Affiliation(s)
| | | | - Craig B Borkowf
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David W Purcell
- Centers for Disease Control and Prevention, Atlanta, Georgia
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MacGowan RJ, Chavez PR, Gravens L, Wesolowski LG, Sharma A, McNaghten AD, Freeman A, Sullivan PS, Borkowf CB, Michele Owen S. Pilot Evaluation of the Ability of Men Who Have Sex with Men to Self-Administer Rapid HIV Tests, Prepare Dried Blood Spot Cards, and Interpret Test Results, Atlanta, Georgia, 2013. AIDS Behav 2018; 22:117-126. [PMID: 29058163 DOI: 10.1007/s10461-017-1932-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 11/28/2022]
Abstract
In the United States, an estimated 67% of new HIV diagnoses are among men who have sex with men (MSM), however 25% of HIV-positive MSM in the 2014 National HIV Behavioral Surveillance Survey were unaware of their infection. HIV self-testing (HIVST) with rapid diagnostic tests (RDTs) may facilitate access to HIV testing. We evaluated the ability of 22 MSM to conduct two HIV RDTs (OraQuick ® In-Home HIV Test and a home-use prototype of Sure Check ® HIV 1/2 Assay), interpret sample images of test results, and collect a dried blood spot (DBS) specimen. While some participants did not follow every direction, most participants were able to conduct HIVST and correctly interpret their results. Interpretation of panels of RDT images was especially difficult when the "control" line was missing, and 27% of DBS cards produced were rated as of bad quality. Modifications to the DBS instructions were necessary prior to evaluating the performance of these tests in real-world settings.
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Affiliation(s)
- Robin J MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA.
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
| | | | - Laura G Wesolowski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
| | | | - A D McNaghten
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
- Emory University, Atlanta, GA, USA
| | - Arin Freeman
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
| | | | - Craig B Borkowf
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
| | - S Michele Owen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, 1600 Clifton Rd., (MS E-37), Atlanta, GA, 30329-4027, USA
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10
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Sharma A, Chavez PR, MacGowan RJ, McNaghten AD, Mustanski B, Gravens L, Freeman AE, Sullivan PS. Willingness to distribute free rapid home HIV test kits and to test with social or sexual network associates among men who have sex with men in the United States. AIDS Care 2017; 29:1499-1503. [PMID: 28393612 DOI: 10.1080/09540121.2017.1313386] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 10/19/2022]
Abstract
Peer-driven HIV prevention strategies can be effective in identifying high-risk persons with undiagnosed infections. Besides individual self-testing, other potential uses of rapid home HIV test kits include distributing them, and testing with others within one's social or sexual networks. We sought to identify factors associated with the willingness to engage in these alternative activities among men who have sex with men (MSM) in the United States. From May to October 2014, we surveyed 828 HIV-negative or unknown status MSM about multiple aspects of rapid home HIV testing. A greater proportion indicated being likely to distribute free oral fluid (OF) tests compared to free finger-stick blood (FSB) tests (91% versus 79%), and almost three-fourths (72%) reported being likely to test with their friends or sex partners in the future. MSM not identifying as homosexual/gay were less willing to distribute OF tests, and those with lower educational attainment were more willing to distribute FSB tests. MSM unaware of their HIV status were less likely to report potentially testing with others using free rapid home HIV tests compared to those who were HIV-negative. Finally, MSM willing to self-test were more likely to report future test kit distribution, and those willing to distribute kits were more likely to report potentially testing with others. Engaging individuals with positive attitudes towards these strategies in prevention efforts could help increase HIV testing levels among MSM. A greater understanding of the potential public health impact of rapid home HIV test kits is necessary.
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Affiliation(s)
- Akshay Sharma
- a Department of Health Behavior and Biological Sciences , University of Michigan School of Nursing , Ann Arbor , USA
| | - Pollyanna R Chavez
- b Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , USA
| | - Robin J MacGowan
- b Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , USA
| | - A D McNaghten
- b Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , USA
| | - Brian Mustanski
- c Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences , Northwestern University , Chicago , USA
| | - Laura Gravens
- d Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , USA
| | - Arin E Freeman
- b Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , USA
| | - Patrick S Sullivan
- d Department of Epidemiology , Emory University Rollins School of Public Health , Atlanta , USA
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11
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Lucas KD, Eckert V, Behrends CN, Wheeler C, MacGowan RJ, Mohle-Boetani JC. Evaluation of Routine HIV Opt-Out Screening and Continuum of Care Services Following Entry into Eight Prison Reception Centers--California, 2012. MMWR Morb Mortal Wkly Rep 2016; 65:178-81. [PMID: 26914322 DOI: 10.15585/mmwr.mm6507a3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Early diagnosis of human immunodeficiency virus (HIV) infection and initiation of antiretroviral treatment (ART) improves health outcomes and prevents HIV transmission. Before 2010, HIV testing was available to inmates in the California state prison system upon request. In 2010, the California Correctional Health Care Services (CCHCS) integrated HIV opt-out screening into the health assessment for inmates entering California state prisons. Under this system, a medical care provider informs the inmate that an HIV test is routinely done, along with screening for sexually transmitted, communicable, and vaccine-preventable diseases, unless the inmate specifically declines the test. During 2012-2013, CCHCS, the California Department of Public Health, and CDC evaluated HIV screening, rates of new diagnoses, linkage to and retention in care, ART response, and post-release linkage to care among California prison inmates. All prison inmates are processed through one of eight specialized reception center facilities, where they undergo a comprehensive evaluation of their medical needs, mental health, and custody requirements for placement in one of 35 state prisons. Among 17,436 inmates who entered a reception center during April-September 2012, 77% were screened for HIV infection; 135 (1%) tested positive, including 10 (0.1%) with newly diagnosed infections. Among the 135 HIV-positive patient-inmates, 134 (99%) were linked to care within 90 days of diagnosis, including 122 (91%) who initiated ART. Among 83 who initiated ART and remained incarcerated through July 2013, 81 (98%) continued ART; 71 (88%) achieved viral suppression (<200 HIV RNA copies/mL). Thirty-nine patient-inmates were released on ART; 12 of 14 who were linked to care within 30 days of release were virally suppressed at that time. Only one of nine persons with a viral load test conducted between 91 days and 1 year post-release had viral suppression. Although high rates of viral suppression were achieved in prison, continuity of care in the community remains a challenge. An infrastructure for post-release linkage to care is needed to help ensure sustained HIV disease control.
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Spaulding AC, MacGowan RJ, Copeland B, Shrestha RK, Bowden CJ, Kim MJ, Margolis A, Mustaafaa G, Reid LC, Heilpern KL, Shah BB. Costs of Rapid HIV Screening in an Urban Emergency Department and a Nearby County Jail in the Southeastern United States. PLoS One 2015; 10:e0128408. [PMID: 26053140 PMCID: PMC4459701 DOI: 10.1371/journal.pone.0128408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/26/2014] [Accepted: 04/27/2015] [Indexed: 11/29/2022] Open
Abstract
Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA) Jail in 2011. The two sites, four miles apart from one another, employed the same rapid HIV test. Ascertainment that cases were new differed by site; only the jail systematically checked identities against health department HIV registries. The program in the emergency department used dedicated HIV test counselors and made 242 diagnoses over a 40-month period at a cost of $2,981 per diagnosis. The jail program used staff nurses, and found 41 new HIV cases over 10.5 months at a cost of $6,688 per new diagnosis. Differences in methods for ascertainment of new diagnoses, previously undiagnosed HIV sero-positivity, and methodologies used for assessing program costs prevent concluding that one program was more economical than the other. Nonetheless, our findings show that testing in both venues yielded many new diagnoses, with the costs within the range reported in the literature.
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Affiliation(s)
- Anne C. Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Robin J. MacGowan
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Brittney Copeland
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America
| | - Ram K. Shrestha
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Chava J. Bowden
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Min J. Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andrew Margolis
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Genetha Mustaafaa
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Laurie C. Reid
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Katherine L. Heilpern
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America
| | - Bijal B. Shah
- Department of Emergency Medicine, Emory School of Medicine, Atlanta, GA, United States of America
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13
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Rizza SA, MacGowan RJ, Purcell DW, Branson BM, Temesgen Z. HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 2012; 87:915-24. [PMID: 22958996 PMCID: PMC3538498 DOI: 10.1016/j.mayocp.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
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Affiliation(s)
| | - Robin J. MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bernard M. Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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14
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VanHandel M, Beltrami JF, MacGowan RJ, Borkowf CB, Margolis AD. Newly identified HIV infections in correctional facilities, United States, 2007. Am J Public Health 2012; 102 Suppl 2:S201-4. [PMID: 22401522 DOI: 10.2105/ajph.2011.300614] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used Centers for Disease Control and Prevention HIV Counseling and Testing System data from 2007 to determine the percentage and characteristics of persons newly identified as HIV-positive in US correctional facilities. The newly identified HIV positivity was 0.7%, and 30% of detainees newly identified with HIV were categorized as having low-risk heterosexual contact or no acknowledged risk. Correctional facilities should provide detainees with routine opt-out HIV testing, unless the prevalence of previously undiagnosed HIV infection has been documented to be less than 0.1%.
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Affiliation(s)
- Michelle VanHandel
- Program Evaluation Branch, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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15
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Kacanek D, Eldridge GD, Nealey-Moore J, MacGowan RJ, Binson D, Flanigan TP, Fitzgerald CC, Sosman JM. Young incarcerated men's perceptions of and experiences with HIV testing. Am J Public Health 2007; 97:1209-15. [PMID: 17538063 PMCID: PMC1913089 DOI: 10.2105/ajph.2006.085886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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] [Indexed: 11/04/2022]
Abstract
We analyzed incarcerated men's perceptions of and experiences with HIV testing. Interviews were conducted with 105 men, aged 18 to 29 years, in 4 states. Most men had received an HIV test while incarcerated because it was convenient or free or because they thought it was mandatory. At most sites, men believed they were HIV-negative because they never received test results. Some men did not know the diseases for which they had been tested. Some men avoided HIV testing outside prison because they lacked time, lacked resources, feared knowing the results, or perceived themselves to not be at risk. HIV testing programs for young men inside or outside prison should address barriers to HIV testing, communicate the meaning and extent of testing, and improve notification of those with HIV-negative results.
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16
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Margolis AD, MacGowan RJ, Grinstead O, Sosman J, Kashif I, Flanigan TP. Unprotected Sex With Multiple Partners: Implications for HIV Prevention Among Young Men With a History of Incarceration. Sex Transm Dis 2006; 33:175-80. [PMID: 16505732 DOI: 10.1097/01.olq.0000187232.49111.48] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to describe preincarceration risk behaviors of young men and identify correlates of unprotected sex with multiple partners during the 3 months before incarceration. STUDY Data on preincarceration risk behaviors were obtained from 550 men, aged 18 to 29 years, in state prisons in California, Mississippi, Rhode Island, and Wisconsin. Correlates of unprotected sex with multiple partners were determined by logistic regression. RESULTS Of 550 participants, 71% had multiple sex partners, 65.1% had sex with a partner they perceived as risky, and 45.3% engaged in unprotected sex with multiple partners. Men who drank heavily (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.11-2.54) or who had a risky partner (OR, 3.90; 95% CI, 2.60-5.85) were more likely to report unprotected sex with multiple partners. Men who attended religious gatherings (OR, 0.66; 95% CI, 0.46-0.96) or lived in stable housing (OR, 0.69; 95% CI, 0.48-1.00) were less likely to report unprotected sex with multiple partners. CONCLUSIONS Most participants engaged in behaviors that could result in a sexually transmitted disease, including HIV. Prevention programs should address the relationship between heavy alcohol use and risky sexual behavior. Discharge planning should address housing needs. Faith-based community organizations may play an important role for some young men in their transition to the community.
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Affiliation(s)
- Andrew D Margolis
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Sosman JM, MacGowan RJ, Margolis AD, Eldridge E, Flanigan T, Vardaman J, Fitzgerald C, Kacanek D, Binson D, Seal DW, Gaydos CA. Screening for sexually transmitted diseases and hepatitis in 18-29-year-old men recently released from prison: feasibility and acceptability. Int J STD AIDS 2005; 16:117-22. [PMID: 15825246 DOI: 10.1258/0956462053057594] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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] [Indexed: 11/18/2022]
Abstract
Men entering prisons have high rates of sexually transmitted disease (STD), hepatitis, and HIV. This study sought to determine the acceptability and feasibility of screening for STD and hepatitis in young men released from prison. Participants were interviewed six months after release and offered free screening. Of 42 (56%) eligible men who participated in the qualitative interview, 33 (79%) provided at least a blood or urine specimen. Eight of 33 (24%) men tested had chlamydia, trichomoniasis, hepatitis B or C virus (HBV or HCV). Three of 32 (9%) had chlamydia, three of 32 (9%) had trichomoniasis, two of 28 (7%) had prior syphilis, and two of 28 (7%) had HCV. Of 28 tested for HBV, six (21%) were immune, two (7%) had chronic infection, and 20 (71%) were susceptible. Barriers to screening included lack of forewarning, inconvenience, and insufficient incentive. In conclusion, screening for STD and hepatitis among former inmates can be acceptable and feasible. Forewarning, reducing the time burden, and providing monetary incentives may increase screening rates.
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Affiliation(s)
- J M Sosman
- Department of Medicine, University of Wisconsin Medical School, Madison, WI 53705, USA.
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18
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MacGowan RJ, Margolis A, Gaiter J, Morrow K, Zack B, Askew J, McAuliffe T, Sosman JM, Eldridge GD. Predictors of risky sex of young men after release from prison. Int J STD AIDS 2003; 14:519-23. [PMID: 12935380 DOI: 10.1258/095646203767869110] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A longitudinal study of demographic and behavioural characteristics associated with risky sexual behaviours of young men after release from prison. One hundred and six men were interviewed in prison and at one week and six months after release. Overall, 37% reported a previous sexually transmitted disease (STD) diagnosis. In the 30 days before incarceration, 33% had had sex with a risky partner, and 59% had had multiple female sex partners. After release, 38 (36%) men reported having had risky sex (>or=2 female sex partners and unprotected vaginal sex): 12 (13%) at one week and 31 (34%) at six months. The only factor independently associated with risky sex was the use of alcohol/drugs before sex: one-week odds ratio (OR)=6.11 (95% confidence interval [CI]: 1.42-26.40), six-month OR=3.05 (95% CI: 1.30-9.42). Behavioural intervention programmes for incarcerated men should address drug and alcohol use and its contribution to higher risk for HIV and STDs.
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Affiliation(s)
- Robin J MacGowan
- Centers for Disease Control and Prevention, 1600 Clifton Rd, MSE-37, Atlanta, Georgia 30333, USA.
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MacGowan RJ, Sterk CE, Long A, Cheney R, Seeman M, Anderson JE. New needle and syringe use, and use of needle exchange programmes by street recruited injection drug users in 1993. Int J Epidemiol 1998; 27:302-8. [PMID: 9602414 DOI: 10.1093/ije/27.2.302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Needle exchange programmes (NEP) provide injection drug users (IDU) with sterile injection equipment and receive used needles in exchange. In this paper we describe the use of new syringes and NEP by IDU and characteristics associated with using NEP in 1993. METHODS Street-recruited IDU were interviewed in five US locations: Atlanta, Philadelphia, Chicago, New York City, and Los Angeles (LA) county. RESULTS Most (75-95%) reported it was easy to get a new syringe and for their last injection, 45-77% used a new syringe and 2-18% used a syringe previously used by another IDU. Use of NEP ranged from 8% to 16% in Chicago, Philadelphia, and LA County. In LA County not having injected 'speedball' in the last 30 days, last injection with a new syringe, and reporting it was very easy to get a new syringe were associated with NEP use. In Philadelphia, NEP use was associated with 'speedball' injection in the last 30 days, and in Chicago, not injecting with 'speedball' and injecting with cocaine were associated with NEP use. CONCLUSIONS In 1993, most street-recruited IDU in Chicago, Philadelphia, and LA County had not used NEP. Factors associated with NEP use were not consistent across sites. Dispersion of NEP and removal of legal barriers restricting access to sterile syringes may be more important in increasing the use of sterile syringes and NEP than client characteristics.
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Affiliation(s)
- R J MacGowan
- Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Atlanta, GA 30333, USA
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20
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Brackbill RM, MacGowan RJ, Rugg D. HIV infection risks, behaviors and methadone treatment: client-reported HIV infection in a follow-up study of injecting drug users in New England. Am J Drug Alcohol Abuse 1997; 23:397-411. [PMID: 9261488 DOI: 10.3109/00952999709016885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is wide variation in reported risk factors for HIV incidence among injecting drug users by community. Available HIV seroprevalence and incidence data indicate that nearly 60% of HIV infection is associated with injecting drug use in Connecticut and 48% in Massachusetts. Using 12-month follow-up data on 354 initially HIV-negative New England (Massachusetts and Connecticut) methadone treatment clients, we assessed the association between baseline drug use practices, sexual behavior, partner behaviors, and client-reported HIV infection during follow-up. Variables that predicted client-reported positive HIV antibody test results were modeled by Cox proportional hazards regression. HIV infection among those tested was 14.2 per 100 person years (PY) [95% Confidence interval (CI) = 9.5 to 21.3]. For each injection the relative risk (RR) was 1.1 (95% CI = 1.1 to 1.2), for males 3.0 (95% CI = 1.2 to 7.3), for blacks 5.0 (95% CI = 1.6 to 15.5), for Hispanics 3.6 (95% CI = 1.2 to 10.5). Men who used more than one unclean needle per day and had an HIV-infected steady partner had an RR of 28.4 (95% CI = 4.4 to 176.4). For women, using speedball (RR = 6.1, 95% CI = 1.2 to 38.8) and being black (RR = 4.4, 95% CI = 1.0 to 19.8) predicted self-reported HIV infection; having a steady partner who ever injected increased this risk substantially (RR = 65.3, 95% CI = 4.0 to 1046.5). These findings for IDUs in Massachusetts and Connecticut indicate that risk factors for HIV infection for men are consistent with expected transmission by unclean needles with an HIV-infected partner, but a preference for using speedball predicted HIV infection among women IDUs.
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Affiliation(s)
- R M Brackbill
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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21
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Wolitski RJ, MacGowan RJ, Higgins DL, Jorgensen CM. The effects of HIV counseling and testing on risk-related practices and help-seeking behavior. AIDS Educ Prev 1997; 9:52-67. [PMID: 9241398] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In an earlier review of the behavioral effects of HIV counseling and testing (HIV CT), Higgins and colleagues (1991) found that the evidence regarding the ability of HIV CT to influence HIV-risk related practices was largely inconclusive. This article reviews 35 domestic and international studies published since that time to reassess the scientific data regarding the ability of HIV CT to motivate changes in risk-related practices and to promote help-seeking behavior. The studies identified for this review were grouped into four categories according to subject population: (1) men who have sex with men, (2) injection and other drug users, (3) women and heterosexual couples, and (4) mixed samples recruited from sexually transmitted disease (STD) clinics and other settings. Findings from the studies reviewed were generally mixed--many provided at least some evidence supporting the ability of HIV CT to motivate risk-reducing and help-seeking behavior, but others did not. The pattern of results varied substantially across, and within, study populations and were often limited by considerable methodological weaknesses.
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Affiliation(s)
- R J Wolitski
- Behavioral Intervention Research Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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22
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MacGowan RJ, Fichtner RR, Swanson N, Collier C, Kroliczak A, Cole G. Factors associated with client-reported HIV infection among clients entering methadone treatment. AIDS Educ Prev 1997; 9:205-217. [PMID: 9241388] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To determine demographic and behavioral factors associated with client-reported HIV infection among new enrollees in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut, we examined ethnographic data and interview data from MMTP clients (N = 674). Clients responded to questions about behaviors in the 30 days before drug treatment. ETHNOGRAPH was used to analyze qualitative data, and logistic regression analysis was used to identify variables associated with client-reported HIV infection. Statistical significance was set at p < .05. The client-reported HIV infection rate was 20% (132/674). Odds ratios for factors associated with client-reported HIV infection were being white (0.53), increase in age (1.07), use of non-injected heroin (0.12), use of injected heroin (6.24), cocaine injection (1.78), sharing of "works" with strangers (2.15), and "safer sex" behavior (4.04). Additionally, 35% of those who did not use illicit drugs reported being seropositive. The qualitative data suggested HIV positive clients were concerned about protecting sex partners, and learning of HIV infection motivated some to stop using drugs. Although some clients engaged in low-risk behaviors, others did not, therefore the potential for HIV transmission among injection drug users (IDUs) in Connecticut and Massachusetts exists. HIV prevention and drug treatment program personnel should reinforce and build on the low-risk behaviors that are acceptable and adopted by some in this population.
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Affiliation(s)
- R J MacGowan
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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MacGowan RJ, Brackbill RM, Rugg DL, Swanson NM, Weinstein B, Couchon A, Scibak J, Molde S, McLaughlin P, Barker T, Voigt R. Sex, drugs and HIV counseling and testing: a prospective study of behavior-change among methadone-maintenance clients in New England. AIDS 1997; 11:229-35. [PMID: 9030371 DOI: 10.1097/00002030-199702000-00014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine whether changes in injecting drug use and sexual behavior over a 12-month follow-up are associated with HIV counseling and testing (C and T) of injecting drug users in methadone maintenance treatment programs (MMTP) in Massachusetts and Connecticut. METHODS Clients were invited to participate in a longitudinal study involving five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were number of drug injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episodes. Data analyses included multiple regression, odds ratios, and quantitative analysis of text-based data. RESULTS Subjects reported reductions in both injecting drug use and sexual behavior Primary associations with reduced injecting drug use were remaining in the MMTP and attending HIV-positive support groups. A reduction in high-risk sexual behavior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associated with an HIV-positive test result. Inconsistent condom use was associated with enrollment in the MMTP where condoms were available only upon request and abstinence and monogamy between uninfected partners were promoted. CONCLUSIONS Injecting drug users who self-select to participate in MMTP and HIV C and T, two public health HIV-prevention interventions, reduce their HIV-risk behaviors. Clients should be encouraged to remain in MMTP and HIV-infected clients should attend support groups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.
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Affiliation(s)
- R J MacGowan
- National Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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MacGowan RJ, Swanson NM, Brackbill RM, Rugg DL, Barker T, Molde S. Retention in methadone maintenance treatment programs, Connecticut and Massachusetts, 1990-1993. J Psychoactive Drugs 1996; 28:259-65. [PMID: 8895111 DOI: 10.1080/02791072.1996.10472487] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.
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Affiliation(s)
- R J MacGowan
- Centers for Disease Control and Prevention, National Center HIV/STD/TB Prevention, Atlanta, Georgia 30333, USA
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Abstract
BACKGROUND Counseling and testing for HIV infection is performed at many sites, including drug treatment centers. The actual cost of providing HIV counseling and testing at drug treatment sites, based upon empirical data collection, has not been reported. The average lifetime medical cost for an HIV-infected individual is $56,000. This study provides both a systematic method for estimating HIV counseling and testing costs and actual cost results. These results can be compared with the medical costs associated with HIV infection. METHODS At three publicly funded methadone treatment centers, we collected cost data on the provision of HIV counseling and testing. We obtained provider service times for HIV counseling and testing components, provider salaries and fringe rates, laboratory costs, and support costs at each center. RESULTS The average cost of HIV counseling and testing is $215 per client entering HIV counseling and testing and $341 per client made aware of HIV serostatus. The total direct cost of providing HIV counseling and testing is $41 for an HIV-negative client who completes the process and $57 for an HIV-positive client; the support costs add an additional $175 per client. CONCLUSIONS Existing methadone maintenance treatment clinics planning to add HIV counseling and testing can expect costs in a range of $189 to $242 per person entering HIV counseling and testing (1991 dollars). Using an average lifetime cost of HIV infection ($56,000) and the average cost per person entering HIV counseling and testing ($215), if more than 1 person in 260 changes his or her behavior to prevent one additional HIV infection, the ratio of medical care savings to costs of counseling and testing would be greater than 1.0, a cost-saving prevention strategy.
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Affiliation(s)
- R D Gorsky
- Department of Health Management and Policy, University of New Hampshire, Durham 03824, USA
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26
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MacGowan RJ, MacGowan CA, Serdula MK, Lane JM, Joesoef RM, Cook FH. Breast-feeding among women attending women, infants, and children clinics in Georgia, 1987. Pediatrics 1991; 87:361-6. [PMID: 2000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Breast-feeding is an important determinant of the health and nutritional status of children, particularly in lower socioeconomic populations. A major goal of the Georgia Special Supplemental Food Program for Women, Infants, and Children (WIC) is to increase the practice of breast-feeding among the women it serves. Breast-feeding practices were determined among a random sample of 404 women from a cohort of 2010 who attended WIC prenatal clinics in Georgia in 1986 and were expected to deliver in February 1987. Respondents were interviewed 6 months postpartum. Of these women, 24% initially breast-fed, but only 6% continued for 6 months or longer. The initiation of breast-feeding was associated with greater maternal education and with being married. The adjusted odds of breast-feeding for mothers who were married or living as married were 3.0 (95% confidence interval, 1.7 to 5.3) times greater than for mothers who were not married or living as married. Mothers with more than 12 years, 12 years, or 10 to 11 years of education were 5.2 (1.8 to 15.3), 2.7 (1.0 to 6.9), and 2.5 (0.9 to 6.9) times more likely, respectively, to breast-feed than mothers with 9 or fewer years of education. After adjustment was made for marital status and education, the remaining variables (ethnicity, parity, age, and employment status) did not influence the initiation of breast-feeding in this low-income population. The need for vigorous promotion of breast-feeding by the Georgia WIC program is emphasized by the low rate of initiation and short duration of breast-feeding in this low-income population.
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Affiliation(s)
- R J MacGowan
- Division of Public Health, Emory University, Atlanta, Georgia
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Rugg DL, MacGowan RJ, Stark KA, Swanson NM. Evaluating the CDC program for HIV counseling and testing. Public Health Rep 1991; 106:708-13. [PMID: 1659720 PMCID: PMC1580339] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Centers for Disease Control is conducting two investigations of the outcomes of HIV counselling and testing services offered persons at high risk for infection with the human immunodeficiency virus (HIV). One investigation is a trial conducted at sexually transmitted disease clinics where an enhanced version of HIV counseling and testing is compared with a standard version. The other investigation is a longitudinal study of the effects of HIV counseling and testing in drug treatment programs that use methadone therapy. In the evaluation, comparisons are being made of different ways of offering HIV counseling and testing and of the effectiveness of the program among persons who know their HIV serostatus and those who do not. The outcome variables include self-reported sexual and drug-using behaviors, together with corroborating laboratory tests, drug treatment compliance, mental health effects, and services utilization. Methodological, practical, and sociopolitical challenges were encountered in the evaluations. Possible solutions to the problems are described. The authors conclude that the designs of the evaluations were appropriate, but that considerable resources are required to carry them out. In settings with low levels of resources, thorough evaluation of the process and an assessment of the immediate outcomes may be the most appropriate evaluation strategy. As HIV counseling and testing are of fundamental importance to national and international HIV prevention efforts, their evaluation is a critical issue.
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