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Kiti MC, Aguolu OG, Zelaya A, Chen HY, Ahmed N, Batross J, Liu CY, Nelson KN, Jenness SM, Melegaro A, Ahmed F, Malik F, Omer SB, Lopman BA. Changing social contact patterns among US workers during the COVID-19 pandemic: April 2020 to December 2021. Epidemics 2023; 45:100727. [PMID: 37948925 PMCID: PMC10730080 DOI: 10.1016/j.epidem.2023.100727] [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: 06/26/2023] [Revised: 10/21/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
Non-pharmaceutical interventions minimize social contacts, hence the spread of respiratory pathogens such as influenza and SARS-CoV-2. Globally, there is a paucity of social contact data from the workforce. In this study, we quantified two-day contact patterns among USA employees. Contacts were defined as face-to-face conversations, involving physical touch or proximity to another individual and were collected using electronic self-kept diaries. Data were collected over 4 rounds from 2020 to 2021 during the COVID-19 pandemic. Mean (standard deviation) contacts reported by 1456 participants were 2.5 (2.5), 8.2 (7.1), 9.2 (7.1) and 10.1 (9.5) across round 1 (April-June 2020), 2 (November 2020-January 2021), 3 (June-August 2021), and 4 (November-December 2021), respectively. Between round 1 and 2, we report a 3-fold increase in the mean number of contacts reported per participant with no major increases from round 2-4. We then modeled SARS-CoV-2 transmission at home, work, and community settings. The model revealed reduced relative transmission in all settings in round 1. Subsequently, transmission increased at home and in the community but remained exceptionally low in work settings. To accurately parameterize models of infection transmission and control, we need empirical social contact data that capture human mixing behavior across time.
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Affiliation(s)
- Moses C Kiti
- Rollins School of Public Health, Emory University, GA, USA.
| | - Obianuju G Aguolu
- Yale Institute for Global Health, Yale University, CT, USA; Yale School of Medicine, Yale University, CT, USA
| | - Alana Zelaya
- Rollins School of Public Health, Emory University, GA, USA
| | - Holin Y Chen
- Rollins School of Public Health, Emory University, GA, USA
| | - Noureen Ahmed
- Yale Institute for Global Health, Yale University, CT, USA
| | | | - Carol Y Liu
- Rollins School of Public Health, Emory University, GA, USA
| | | | | | - Alessia Melegaro
- DONDENA Centre for Research in Social Dynamics and Public Policy, Bocconi University, Italy
| | - Faruque Ahmed
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fauzia Malik
- Yale Institute for Global Health, Yale University, CT, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, CT, USA; Yale School of Medicine, Yale University, CT, USA
| | - Ben A Lopman
- Rollins School of Public Health, Emory University, GA, USA
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Hamilton DT, Wang LY, Hoover KW, Smith DK, Delaney KP, Li J, Hoyte T, Jenness SM, Goodreau SM. Potential contribution of PrEP uptake by adolescents 15-17 years old to achieving the "Ending the HIV Epidemic" incidence reduction goals in the US South. PLoS One 2023; 18:e0288588. [PMID: 37943869 PMCID: PMC10635552 DOI: 10.1371/journal.pone.0288588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 06/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The "Ending the HIV Epidemic" (EHE) initiative seeks to reduce new HIV infections in the U.S. by prioritizing federal resources towards highly impacted populations. Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are essential for reaching EHE goals. Adolescents are often at increased risk for HIV because they may lack agency in negotiating their sexual partnerships and may not have the same access to treatment and prevention as adults. This study estimates the potential contribution of expanded PrEP coverage among adolescents ages 15-17 to achieving the EHE goals in the South. METHODS An HIV-transmission model was built to simulate the HIV epidemic in the South. Increased ART and PrEP uptake were systematically varied with and without PrEP eligibility including individuals age<18. RESULTS Prioritizing PrEP for adolescents had a negligible impact on incidence. At 50% uptake among eligible adolescents and 90% ART coverage, including adolescents only improved the percentage of infections averted from 80.1% to 80.3%. In 10 of 15 scenarios explored, there was no reduction in new infections when PrEP eligibility was expanded to include adolescents age<18. At 95% ART coverage at the population-level incidence among adolescents declined by over 80%, but PrEP uptake among adolescents did not contribute to additional declines in incidence among adolescents. CONCLUSIONS Prioritizing PrEP for adolescents did not significantly contribute to reaching EHE incidence reductions goal. Focusing resources to specific adolescent populations at risk, such sexual minority males in high incidence settings, will remain an important public health goal outside the context of EHE.
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Affiliation(s)
- Deven T. Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | - Li Yan Wang
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Karen W. Hoover
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Dawn K. Smith
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Kevin P. Delaney
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Jingjing Li
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Tamika Hoyte
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Steven M. Goodreau
- Departments of Anthropology and Epidemiology, University of Washington, Seattle, Washington, United States of America
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Janulis P, Jenness SM, Risher K, Phillips G, Mustanski B, Birkett M. Substance use and variation in sexual partnership rates among young MSM and young transgender women: Disaggregating between and within-person associations. Drug Alcohol Depend 2023; 252:110968. [PMID: 37774516 PMCID: PMC10615872 DOI: 10.1016/j.drugalcdep.2023.110968] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Substance use has been extensively linked to sexual behavior and HIV/STI risk among men who have sex with men (MSM) and transgender women (TW). However, the impact of specific substances and on specific partnership types is not well characterized. The current study seeks to estimate the association between specific substances and partnership rates while carefully disaggregating between and within-person associations to characterize the nature of these associations and inform prevention interventions. METHODS Using data from a longitudinal cohort (n = 1159) of young MSM (YMSM) and young TW (YTW), we utilized a series of hybrid mixed effect models to estimate the associations between substance use (i.e., heavy episodic drinking [HED], marijuana, cocaine, ecstasy, methamphetamine, poppers, prescription stimulant, prescription painkiller, and prescription depressants) and partnerships (i.e., one-time, casual, and main). RESULTS Results from multivariable models indicated people using substances had higher one-time (HED, poppers) and casual (HED, methamphetamine, poppers) partnership rates. In addition, participants reported higher rates of one-time (HED, ecstasy, methamphetamine, poppers) and casual partners (HED, marijuana, cocaine, methamphetamines, poppers) during periods of substance use. CONCLUSION These findings confirm that the highest rates of sexual activity occur among YMSM-YTW using substances during periods of substance use. Yet, these findings should caution researchers against simplistic generalizations as these associations differ across substance and partnership types. Efforts to promote the health of MSM-YTW who use substances should carefully consider this complexity as interventions accounting for the unique cultural context of substance use in these populations are most likely to be successful.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States.
| | | | - Kathryn Risher
- Department of Public Health Sciences, Penn State College of Medicine, United States
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, United States; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
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Jenness SM, Wallrafen-Sam K, Schneider I, Kennedy S, Akiyama MJ, Spaulding AC. Dynamic Contact Networks of Residents of an Urban Jail in the Era of SARS-CoV-2. medRxiv 2023:2023.09.29.23296359. [PMID: 37873313 PMCID: PMC10593002 DOI: 10.1101/2023.09.29.23296359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background In custodial settings such as jails and prisons, infectious disease transmission is heightened by factors such as overcrowding and limited healthcare access. Specific features of social contact networks within these settings have not been sufficiently characterized, especially in the context of a large-scale respiratory infectious disease outbreak. The study aims to quantify contact network dynamics within the Fulton County Jail in Atlanta, Georgia, to improve our understanding respiratory disease spread to informs public health interventions. Methods As part of the Surveillance by Wastewater and Nasal Self-collection of Specimens (SWANSS) study, jail roster data were utilized to construct social contact networks. Rosters included resident details, cell locations, and demographic information. This analysis involved 6,702 residents over 140,901 person days. Network statistics, including degree, mixing, and turnover rates, were assessed across age groups, race/ethnicities, and jail floors. We compared outcomes for two distinct periods (January 2022 and April 2022) to understand potential responses in network structures during and after the SARS-CoV-2 Omicron variant peak. Results We found high cross-sectional network degree at both cell and block levels, indicative of substantial daily contacts. While mean degree increased with age, older residents exhibited lower degree during the Omicron peak, suggesting potential quarantine measures. Block-level networks demonstrated higher mean degrees than cell-level networks. Cumulative degree distributions for both levels increased from January to April, indicating heightened contacts after the outbreak. Assortative age mixing was strong, especially for residents aged 20-29. Dynamic network statistics illustrated increased degrees over time, emphasizing the potential for disease spread, albeit with a lower growth rate during the Omicron peak. Conclusions The contact networks within the Fulton County Jail presented ideal conditions for infectious disease transmission. Despite some reduction in network characteristics during the Omicron peak, the potential for disease spread remained high. Age-specific mixing patterns suggested unintentional age segregation, potentially limiting disease spread to older residents. The study underscores the need for ongoing monitoring of contact networks in carceral settings and provides valuable insights for epidemic modeling and intervention strategies, including quarantine, depopulation, and vaccination. This network analysis offers a foundation for understanding disease dynamics in carceral environments.
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Affiliation(s)
- Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Karina Wallrafen-Sam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Isaac Schneider
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shanika Kennedy
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Matthew J. Akiyama
- Divisions of General Internal Medicine & Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anne C. Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Janulis P, Goodreau SM, Morris M, Birkett M, Phillips G, Risher K, Mustanski B, Jenness SM. Partnership types and coital frequency as predictors of gonorrhea and chlamydia among young MSM and young transgender women. Int J STD AIDS 2023; 34:694-701. [PMID: 37146303 PMCID: PMC10524890 DOI: 10.1177/09564624231173728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Sexually transmitted infections pose a major public health challenge in the United States and this burden is especially acute in subpopulations like young men who have sex with men (YMSM) and young transgender women (YTW). Yet, the direct behavioral antecedents of these infections are not well understood making it difficult to identify the cause of recent increases in incidence. This study examines how variations in partnership rates and the number of condomless sex acts are associated with STI infections among YMSM-YTW. METHOD This study leveraged 3 years of data from a large longitudinal cohort of YMSM-YTW. A series of generalized linear mixed models examined the association between the number of condomless anal sex acts, number of one-time partners, number of casual partners, and number of main partners and chlamydia, gonorrhea, or any STI. RESULTS Results indicated the number of casual partners was associated with gonorrhea [aOR = 1.17 (95% CI: 1.08, 1.26)], chlamydia [aOR = 1.12 (95% CI: 1.05, 1.20)], and any STI [aOR = 1.14 (95% CI: 1.08, 1.21)] while the number of one-time partners was only associated with gonorrhea [aOR = 1.13 (95% CI: 1.02, 1.26)]. The number of condomless anal sex acts was not associated with any outcome. CONCLUSION These findings suggest the number of casual partners is a consistent predictor of STI infection among YMSM-YTW. This may reflect the quick saturation of risk within partnerships making the number of partners, rather than the number of acts, the more relevant factor for STI risk.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington, Seattle, WA, USA
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, WA, USA
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Kathryn Risher
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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Klumb C, Morris M, Goodreau SM, Jenness SM. Improving and Extending STERGM Approximations Based on Cross-Sectional Data and Tie Durations. J Comput Graph Stat 2023; 33:166-180. [PMID: 38455738 PMCID: PMC10917152 DOI: 10.1080/10618600.2023.2233593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/21/2023] [Indexed: 03/09/2024]
Abstract
Temporal exponential-family random graph models (TERGMs) are a flexible class of models for network ties that change over time. Separable TERGMs (STERGMs) are a subclass of TERGMs in which the dynamics of tie formation and dissolution can be separated within each discrete time step and may depend on different factors. The Carnegie et al. (2015) approximation improves estimation efficiency for a subclass of STERGMs, allowing them to be reliably estimated from inexpensive cross-sectional study designs. This approximation adapts to cross-sectional data by attempting to construct a STERGM with two specific properties: a cross-sectional equilibrium distribution defined by an exponential-family random graph model (ERGM) for the network structure, and geometric tie duration distributions defined by constant hazards for tie dissolution. In this paper we focus on approaches for improving the behavior of the Carnegie et al. approximation and increasing its scope of application. We begin with Carnegie et al.'s observation that the exact result is tractable when the ERGM is dyad-independent, and then show that taking the sparse limit of the exact result leads to a different approximation than the one they presented. We show that the new approximation outperforms theirs for sparse, dyad-independent models, and observe that the errors tend to increase with the strength of dependence for dyad-dependent models. We then develop theoretical results in the dyad-dependent case, showing that when the ERGM is allowed to have arbitrary dyad-dependent terms and some dyad-dependent constraints, both the old and new approximations are asymptotically exact as the size of the STERGM time step goes to zero. We note that the continuous-time limit of the discrete-time approximations has the desired cross-sectional equilibrium distribution and exponential tie duration distributions with the desired means. We show that our results extend to hypergraphs, and we propose an extension of the Carnegie et al. framework to dissolution hazards that depend on tie age.
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Affiliation(s)
- Chad Klumb
- Center for Studies in Demography and Ecology, University of Washington
| | | | - Steven M Goodreau
- Center for Studies in Demography and Ecology, University of Washington, Department of Anthropology, University of Washington
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Wallrafen-Sam K, Quesada MG, Lopman BA, Jenness SM. Modelling the Interplay between Responsive Individual Vaccination Decisions and the Spread of SARS-CoV-2. medRxiv 2023:2023.08.24.23294588. [PMID: 37662331 PMCID: PMC10473817 DOI: 10.1101/2023.08.24.23294588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The uptake of COVID-19 vaccines remains low despite their high effectiveness. Epidemic models that represent decision-making psychology can provide insight into the potential impact of vaccine promotion interventions in the context of the COVID-19 pandemic. We coupled a network-based mathematical model of SARS-CoV-2 transmission in Georgia, USA with a social-psychological vaccination decision-making model in which vaccine side effects, post-vaccination infections, and other unidentified community-level factors could "nudge" individuals towards vaccine resistance while hospitalization spikes could nudge them towards willingness. Combining an increased probability of hospitalization-prompted resistant-to-willing switches with a decreased probability of willing-to-resistant switches prompted by unidentified community-level factors increased vaccine uptake and decreased SARS-CoV-2 incidence by as much as 30.7% and 24.0%, respectively. The latter probability had a greater impact than the former. This illustrates the disease prevention potential of vaccine promotion interventions that address community-level factors influencing decision-making and anticipate the case curve instead of reacting to it.
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Affiliation(s)
- Karina Wallrafen-Sam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maria Garcia Quesada
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Benjamin A. Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Traeger MW, Mayer KH, Krakower DS, Gitin S, Jenness SM, Marcus JL. Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis 2023:ciad488. [PMID: 37595139 DOI: 10.1093/cid/ciad488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Doxycycline post-exposure prophylaxis (doxyPEP) reduces bacterial sexually transmitted infection (STI) incidence in people with HIV (PWH) or using HIV preexposure prophylaxis (PrEP). Given concerns about widespread antibiotic use, we identified doxyPEP prescribing strategies to minimize use while maximizing impact on STIs. METHODS We used electronic health records of gay and bisexual men (GBM), transgender women, and non-binary people assigned male sex at birth with ≥2 STI tests (chlamydia, gonorrhea, syphilis) at an LGBTQ-focused health center during 2015-2020. We defined 10 hypothetical doxyPEP prescribing strategies based on PrEP use, HIV status, or STI history. We estimated doxyPEP use and STI diagnoses averted in counterfactual scenarios in which people meeting prescribing criteria received doxyPEP, assuming STI rates during use would have been reduced by clinical trial efficacy estimates. RESULTS Among 10,546 individuals (94% GBM), rate of any STI was 35.9/100 person-years. Prescribing doxyPEP to all individuals would have averted 71% of STI diagnoses (number needed to treat for one year to avert one STI diagnosis, NNT = 3.9); prescribing to PrEP users/PWH (52%/12% of individuals) would have averted 60% of STI diagnoses (NNT = 2.9). Prescribing doxyPEP for 12 months after STI diagnosis would have reduced the proportion using doxyPEP to 38% and averted 39% of STI diagnoses (NNT = 2.4). Prescribing after concurrent or repeated STIs would have maximized efficiency (lowest NNTs) but prevented fewer STIs. CONCLUSIONS Prescribing doxyPEP to individuals with STIs, particularly concurrent or repeated STIs, could avert a substantial proportion of all STI diagnoses. The most efficient prescribing strategies are based on STI history rather than HIV status or PrEP use.
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Affiliation(s)
- Michael W Traeger
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Burnet Institute, Melbourne, Australia
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Sy Gitin
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States
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Kraft TS, Seabright E, Alami S, Jenness SM, Hooper P, Beheim B, Davis H, Cummings DK, Rodriguez DE, Cayuba MG, Miner E, de Lamballerie X, Inchauste L, Priet S, Trumble BC, Stieglitz J, Kaplan H, Gurven MD. Metapopulation dynamics of SARS-CoV-2 transmission in a small-scale Amazonian society. PLoS Biol 2023; 21:e3002108. [PMID: 37607188 PMCID: PMC10443873 DOI: 10.1371/journal.pbio.3002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
The severity of infectious disease outbreaks is governed by patterns of human contact, which vary by geography, social organization, mobility, access to technology and healthcare, economic development, and culture. Whereas globalized societies and urban centers exhibit characteristics that can heighten vulnerability to pandemics, small-scale subsistence societies occupying remote, rural areas may be buffered. Accordingly, voluntary collective isolation has been proposed as one strategy to mitigate the impacts of COVID-19 and other pandemics on small-scale Indigenous populations with minimal access to healthcare infrastructure. To assess the vulnerability of such populations and the viability of interventions such as voluntary collective isolation, we simulate and analyze the dynamics of SARS-CoV-2 infection among Amazonian forager-horticulturalists in Bolivia using a stochastic network metapopulation model parameterized with high-resolution empirical data on population structure, mobility, and contact networks. Our model suggests that relative isolation offers little protection at the population level (expected approximately 80% cumulative incidence), and more remote communities are not conferred protection via greater distance from outside sources of infection, due to common features of small-scale societies that promote rapid disease transmission such as high rates of travel and dense social networks. Neighborhood density, central household location in villages, and household size greatly increase the individual risk of infection. Simulated interventions further demonstrate that without implausibly high levels of centralized control, collective isolation is unlikely to be effective, especially if it is difficult to restrict visitation between communities as well as travel to outside areas. Finally, comparison of model results to empirical COVID-19 outcomes measured via seroassay suggest that our theoretical model is successful at predicting outbreak severity at both the population and community levels. Taken together, these findings suggest that the social organization and relative isolation from urban centers of many rural Indigenous communities offer little protection from pandemics and that standard control measures, including vaccination, are required to counteract effects of tight-knit social structures characteristic of small-scale populations.
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Affiliation(s)
- Thomas S. Kraft
- Department of Anthropology, University of Utah, Salt Lake City, Utah, United States of America
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Edmond Seabright
- School of Collective Intelligence, Mohammed VI Polytechnic University, Rabat, Morocco
- University of New Mexico, Department of Anthropology, Albuquerque, New Mexico, United States of America
| | - Sarah Alami
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
- School of Collective Intelligence, Mohammed VI Polytechnic University, Rabat, Morocco
| | - Samuel M. Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
| | - Paul Hooper
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | - Bret Beheim
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Helen Davis
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Daniel K. Cummings
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | | | | | - Emily Miner
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Lucia Inchauste
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Stéphane Priet
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Benjamin C. Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
- Center for Evolution and Medicine, Arizona State University, Tempe, Arizona, United States of America
| | | | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | - Michael D. Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
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Hamilton DT, Hoover KW, Smith DK, Delaney KP, Wang LY, Li J, Hoyte T, Jenness SM, Goodreau SM. Achieving the "Ending the HIV Epidemic in the U.S." incidence reduction goals among at-risk populations in the South. BMC Public Health 2023; 23:716. [PMID: 37081482 PMCID: PMC10116101 DOI: 10.1186/s12889-023-15563-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The "Ending the HIV Epidemic in the U.S." (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. METHODS We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. RESULTS New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. CONCLUSIONS Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach.
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Affiliation(s)
- Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, 206 Raitt Hall, UW, Box 353412, Seattle, WA, 98195-3412, USA.
| | - Karen W Hoover
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dawn K Smith
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kevin P Delaney
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingjing Li
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamika Hoyte
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, University of Washington, 206 Raitt Hall, UW, Box 353412, Seattle, WA, 98195-3412, USA
- Department of Anthropology, University of Washington, Seattle, WA, USA
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11
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Mann LM, Sanchez T, Stephenson R, Sullivan PS, Jenness SM. The Impact of the COVID-19 Pandemic on Sexual Behavior and HIV Prevention and Treatment Services Among U.S. Men Who Have Sex With Men in the Post-Lockdown Era. Am J Mens Health 2023; 17:15579883231168602. [PMID: 37081746 PMCID: PMC10119652 DOI: 10.1177/15579883231168602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Early in the COVID-19 pandemic, disruptions to sexual health services and changes to sexual behavior due to the first COVID-19 lockdowns were common among U.S. gay, bisexual, and other men who have sex with men (GBMSM). Less is known about the persistence of these changes after this initial lockdown period. These changes have long-term implications for HIV prevention for current and future pandemic periods. This study collected information on COVID-related impacts on sexual behavior and HIV-related health service disruptions from a cohort of U.S. GBMSM at three time points during the COVID-19 pandemic. We observed that COVID-related disruptions to sexual behavior continued from early lockdown periods through December 2020. Although early interruptions to pre-exposure prophylaxis (PrEP) access resolved in later 2020 and interruptions to antiretroviral therapy (ART) adherence were minimal, extended disruptions were observed in HIV testing, sexually transmitted infection (STI) testing, HIV care clinical visits, and HIV viral load testing. Although sexual behavior did not return to prepandemic levels in late 2020, the reduced access to HIV prevention, testing, and treatment services during this period could result in an overall increased HIV transmission rate, with long-term impacts to the trajectory of the U.S. HIV epidemic. Additional resources and programs are needed to address challenges created by the COVID-19 pandemic, as well as prepare for future potential pandemics and other disruptive events.
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Affiliation(s)
- Laura M Mann
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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12
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Jones J, Jenness SM, Le Guillou A, Sullivan PS, Gift TL, Delaney KP, Chesson H. Estimated Number of Incident HIV Infections in Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia, Per Gonococcal or Chlamydial Infection, in the United States. Sex Transm Dis 2023; 50:83-85. [PMID: 36630415 PMCID: PMC10753989 DOI: 10.1097/olq.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Using a network model, we simulated transmission of HIV, gonorrhea, and chlamydia among men who have sex with men to estimate the number of HIV infections that can be attributed to gonorrhea and chlamydia, per gonococcal and chlamydial infection. This metric can inform future modeling and health economic studies.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin P. Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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13
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Kiti MC, Aguolu OG, Zelaya A, Chen HY, Ahmed N, Battross J, Liu CY, Nelson KN, Jenness SM, Melegaro A, Ahmed F, Malik F, Omer SB, Lopman BA. Changing social contact patterns among US workers during the COVID-19 pandemic: April 2020 to December 2021. medRxiv 2022:2022.12.19.22283700. [PMID: 36597545 PMCID: PMC9810228 DOI: 10.1101/2022.12.19.22283700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Non-pharmaceutical interventions minimize social contacts, hence the spread of SARS-CoV-2. We quantified two-day contact patterns among USA employees from 2020-2021 during the COVID-19 pandemic. Contacts were defined as face-to-face conversations, involving physical touch or proximity to another individual and were collected using electronic diaries. Mean (standard deviation) contacts reported by 1,456 participants were 2.5 (2.5), 8.2 (7.1), 9.2 (7.1) and 10.1 (9.5) across round 1 (April-June 2020), 2 (November 2020-January 2021), 3 (June-August 2021), and 4 (November-December 2021), respectively. Between round 1 and 2, we report a 3-fold increase in the mean number of contacts reported per participant with no major increases from round 2-4. We modeled SARS-CoV-2 transmission at home, work, and community. The model revealed reduced relative transmission in all settings in round 1. Subsequently, transmission increased at home and in the community but remained very low in work settings. Contact data are important to parameterize models of infection transmission and control. Teaser Changes in social contact patterns shape disease dynamics at workplaces in the USA.
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Affiliation(s)
- Moses C. Kiti
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Obianuju G. Aguolu
- Yale Institute for Global Health, Yale University, Connecticut, USA
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Alana Zelaya
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Holin Y. Chen
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Noureen Ahmed
- Yale Institute for Global Health, Yale University, Connecticut, USA
| | | | - Carol Y. Liu
- Rollins School of Public Health, Emory University, Georgia, USA
| | | | | | - Alessia Melegaro
- DONDENA Centre for Research in Social Dynamics and Public Policy, Bocconi University, Italy
| | - Faruque Ahmed
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fauzia Malik
- Yale Institute for Global Health, Yale University, Connecticut, USA
| | - Saad B. Omer
- Yale Institute for Global Health, Yale University, Connecticut, USA
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Georgia, USA
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14
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Chandra C, Morris M, Van Meter C, Goodreau SM, Sanchez T, Janulis P, Birkett M, Jenness SM. Comparing Sexual Network Mean Active Degree Measurement Metrics Among Men Who Have Sex With Men. Sex Transm Dis 2022; 49:808-814. [PMID: 36112005 PMCID: PMC9669154 DOI: 10.1097/olq.0000000000001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mean active degree is an important proxy measure of cross-sectional network connectivity commonly used in HIV/sexually transmitted infection epidemiology research. No current studies have compared measurement methods of mean degree using a cross-sectional study design for men who have sex with men (MSM) in the United States. We compared mean degree estimates based on reported ongoing main and casual sexual partnerships (current method) against dates of first and last sex (retrospective method). METHODS We used data from ARTnet, a cross-sectional survey of MSM in the United States (2017-2019). ARTnet collected data on the number and types of sexual partners in the past year, limited to the 5 most recent partners (data truncation). We quantified partnerships for months 0 to 12 before the survey date (retrospective method) and compared that with ongoing partnerships on the day of survey (current method). We used linear regression to understand the impact of truncated partnership data on mean degree estimation. RESULTS The retrospective method yielded similar degree estimates to the current for months proximate to the day of survey. The retrospective method mean degree systematically decreased as the month increased from 0 to 12 months before survey date. This was driven by data truncation: among participants with >5 partners in the past year compared with those with ≤5, the average change in main partnership degree between 12 and 0 months before survey date was -0.05 (95% confidence interval, -0.08 to -0.03) after adjusting for race/ethnicity, age, and education. The adjusted average change in casual partnership degree was -0.40 (95% confidence interval, -0.45 to -0.35). CONCLUSIONS The retrospective method underestimates mean degree for MSM in surveys with truncated partnership data, especially for casual partnerships. The current method is less prone to bias from partner truncation when the target population has high rate of partners per year.
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Affiliation(s)
- Christina Chandra
- Department of Epidemiology, Rollin School of Public Health, Emory University, Atlanta, GA
| | - Martina Morris
- Department of Sociology, University of Washington, Seattle, WA
| | - Connor Van Meter
- Department of Epidemiology, Rollin School of Public Health, Emory University, Atlanta, GA
| | | | - Travis Sanchez
- Department of Epidemiology, Rollin School of Public Health, Emory University, Atlanta, GA
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Samuel M. Jenness
- Department of Epidemiology, Rollin School of Public Health, Emory University, Atlanta, GA
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15
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Jenness SM, Le Guillou A, Lyles C, Bernstein KT, Krupinsky K, Enns EA, Sullivan PS, Delaney KP. The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study. Sex Transm Dis 2022; 49:801-807. [PMID: 36194831 PMCID: PMC9668377 DOI: 10.1097/olq.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (antiretroviral therapy [ART] and preexposure prophylaxis [PrEP]), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional partner services metrics of partner identified or HIV screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets. METHODS We used a stochastic network model of HIV/sexually transmitted infection transmission for men who have sex with men, calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed "index" patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly. RESULTS At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2% to 8% of infections, depending on the combination of improvements. CONCLUSIONS Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit.
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Affiliation(s)
| | | | | | - Kyle T. Bernstein
- STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Eva A. Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
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16
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Mann LM, Le Guillou A, Goodreau SM, Marcus JL, Sanchez T, Weiss KM, Jenness SM. Correlations between community-level HIV preexposure prophylaxis coverage and individual-level sexual behaviors among United States MSM. AIDS 2022; 36:2015-2023. [PMID: 35876641 PMCID: PMC9617766 DOI: 10.1097/qad.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate if community-level HIV PrEP coverage is correlated with individual sexual behaviors. DESIGN We used demographic, behavioral, and sexual network data from ARTnet, a 2017-2019 study of United States MSM. METHODS Multivariable regression models with a Bayesian modeling framework were used to estimate associations between area-level PrEP coverage and seven sexual behavior outcomes [number of total, main, and casual male partners (network degree); count of one-time partnerships; consistent condom use in one-time partnerships; and frequency of casual partnership anal sex (total and condomless)], controlling for individual PrEP use. RESULTS PrEP coverage ranged from 10.3% (Philadelphia) to 38.9% (San Francisco). Total degree was highest in Miami (1.35) and lowest in Denver (0.78), while the count of one-time partners was highest in San Francisco (11.7/year) and lowest in Detroit (1.5/year). Adjusting for individual PrEP use and demographics, community PrEP coverage correlated with total degree [adjusted incidence rate ratio (aIRR) = 1.73; 95% credible interval (CrI), 0.92-3.44], casual degree (aIRR = 2.05; 95% CrI, 0.90-5.07), and count of one-time partnerships (aIRR = 1.90; 95% CrI, 0.46-8.54). Without adjustment for individual PrEP use, these associations strengthened. There were weaker or no associations with consistent condom use in one-time partnerships (aIRR = 1.68; 95% CrI, 0.86-3.35), main degree (aIRR = 1.21; 95% CrI, 0.48-3.20), and frequency of casual partnership condomless anal sex (aIRR = 0.23; 95% CrI, 0.01-3.60). CONCLUSION Most correlations between community PrEP coverage and sexual behavior were explained by individual PrEP use. However, some residual associations remained after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level differences in sexual behaviors.
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Affiliation(s)
- Laura M Mann
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Adrien Le Guillou
- Department of Epidemiology, Emory University, Atlanta, Georgia
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Steven M Goodreau
- Department of Anthropology and Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Kevin M Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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17
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Maloney KM, Benkeser D, Sullivan PS, Kelley C, Sanchez T, Jenness SM. Sexual Mixing by HIV Status and Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men: Addressing Information Bias. Epidemiology 2022; 33:808-816. [PMID: 35895578 PMCID: PMC9561018 DOI: 10.1097/ede.0000000000001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Population-level estimates of sexual network mixing for parameterizing prediction models of pre-exposure prophylaxis (PrEP) effectiveness are needed to inform prevention of HIV transmission among men who have sex with men (MSM). Estimates obtained by egocentric sampling are vulnerable to information bias due to incomplete respondent knowledge. METHODS We estimated patterns of serosorting and PrEP sorting among MSM in the United States using data from a 2017-2019 egocentric sexual network study. Respondents served as proxies to report the HIV status and PrEP use of recent sexual partners. We contrasted results from a complete-case analysis (unknown HIV and PrEP excluded) versus a bias analysis with respondent-reported data stochastically reclassified to simulate unobserved self-reported data from sexual partners. RESULTS We found strong evidence of preferential partnering across analytical approaches. The bias analysis showed concordance between sexual partners of HIV diagnosis and PrEP use statuses for MSM with diagnosed HIV (39%; 95% simulation interval: 31, 46), MSM who used PrEP (32%; 21, 37), and MSM who did not use PrEP (83%; 79, 87). The fraction of partners with diagnosed HIV was higher among MSM who used PrEP (11%; 9, 14) compared with MSM who did not use PrEP (4%; 3, 5). Comparatively, across all strata of respondents, the complete-case analysis overestimated the fractions of partners with diagnosed HIV or PrEP use. CONCLUSIONS We found evidence consistent with HIV and PrEP sorting among MSM, which may decrease the population-level effectiveness of PrEP. Bias analyses can improve mixing estimates for parameterization of transmission models.
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Affiliation(s)
- Kevin M Maloney
- From the Department of Epidemiology, Emory University, Atlanta, GA
- Department of Population Health Sciences, Georgia State University, Atlanta, GA
| | - David Benkeser
- Department of Biostatistics, Emory University, Atlanta, GA
| | | | | | - Travis Sanchez
- From the Department of Epidemiology, Emory University, Atlanta, GA
| | - Samuel M Jenness
- From the Department of Epidemiology, Emory University, Atlanta, GA
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18
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Jones J, Le Guillou A, Gift TL, Chesson H, Bernstein K, Delaney K, Lyles C, Berruti A, Sullivan PS, Jenness SM. Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis. Sex Transm Dis 2022; 49:669-676. [PMID: 35921635 PMCID: PMC9481699 DOI: 10.1097/olq.0000000000001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. METHODS Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence. RESULTS Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. CONCLUSIONS Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kyle Bernstein
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kevin Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Cynthia Lyles
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Andres Berruti
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
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19
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Wheatley MM, Knowlton G, Kao SY, Jenness SM, Enns EA. Cost-Effectiveness of Interventions to Improve HIV Pre-exposure Prophylaxis Initiation, Adherence, and Persistence Among Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2022; 90:41-49. [PMID: 35090155 PMCID: PMC8986617 DOI: 10.1097/qai.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND To help achieve Ending the HIV Epidemic (EHE) goals of reducing new HIV incidence, pre-exposure prophylaxis (PrEP) use and engagement must increase despite multidimensional barriers to scale-up and limitations in funding. We investigated the cost-effectiveness of interventions spanning the PrEP continuum of care. SETTING Men who have sex with men in Atlanta, GA, a focal jurisdiction for the EHE plan. METHODS Using a network-based HIV transmission model, we simulated lifetime costs, quality-adjusted life years (QALYs), and infections averted for 8 intervention strategies using a health sector perspective. Strategies included a status quo (no interventions), 3 distinct interventions (targeting PrEP initiation, adherence, or persistence), and all possible intervention combinations. Cost-effectiveness was evaluated incrementally using a $100,000/QALY gained threshold. We performed sensitivity analyses on PrEP costs, intervention costs, and intervention coverage. RESULTS Strategies averted 0.2%-4.2% new infections and gained 0.0045%-0.24% QALYs compared with the status quo. Initiation strategies achieved 20%-23% PrEP coverage (up from 15% with no interventions) and moderate clinical benefits at a high cost, while adherence strategies were relatively low cost and low benefit. Under our assumptions, the adherence and initiation combination strategy was cost-effective ($86,927/QALY gained). Sensitivity analyses showed no strategies were cost-effective when intervention costs increased by 60% and the strategy combining all 3 interventions was cost-effective when PrEP costs decreased to $1000/month. CONCLUSION PrEP initiation interventions achieved moderate public health gains and could be cost-effective. However, substantial financial resources would be needed to improve the PrEP care continuum toward meeting EHE goals.
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Affiliation(s)
- Margo M Wheatley
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN; and
| | - Gregory Knowlton
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN; and
| | - Szu-Yu Kao
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN; and
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Eva A Enns
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN; and
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20
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Willebrand KS, Pischel L, Malik AA, Jenness SM, Omer SB. A review of COVID-19 transmission dynamics and clinical outcomes on cruise ships worldwide, January to October 2020. Euro Surveill 2022; 27:2002113. [PMID: 34991781 PMCID: PMC8739343 DOI: 10.2807/1560-7917.es.2022.27.1.2002113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BackgroundCruise ships provide an ideal setting for transmission of SARS-CoV-2, given the socially dense exposure environment.AimTo provide a comprehensive review of COVID-19 outbreaks on cruise ships.MethodsPubMed was searched for COVID-19 cases associated with cruise ships between January and October 2020. A list of cruise ships with COVID-19 was cross-referenced with the United States Centers for Disease Control and Prevention's list of cruise ships associated with a COVID-19 case within 14 days of disembarkation. News articles were also searched for epidemiological information. Narratives of COVID-19 outbreaks on ships with over 100 cases are presented.ResultsSeventy-nine ships and 104 unique voyages were associated with COVID-19 cases before 1 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (interquartile range (IQR): 1-17.8), with two notable outliers: the Diamond Princess and the Ruby Princess, which had 712 and 907 cases, respectively. The median attack rate for COVID-19 was 0.2% (IQR: 0.03-1.5), although this distribution was right-skewed with a mean attack rate of 3.7%; 25.9% (27/104) of voyages had at least one COVID-19-associated death. Outbreaks involving only crew occurred later than outbreaks involving guests and crew.ConclusionsIn the absence of mitigation measures, COVID-19 can spread easily on cruise ships in a susceptible population because of the confined space and high-density contact networks. This environment can create superspreader events and facilitate international spread.
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Affiliation(s)
- Kathryn S Willebrand
- Yale Institute of Global Health, New Haven, Connecticut, United States
- Yale School of Public Health, New Haven, Connecticut, United States
| | - Lauren Pischel
- Yale Institute of Global Health, New Haven, Connecticut, United States
- Yale School of Public Health, New Haven, Connecticut, United States
- Yale School of Medicine, Section of Infectious Diseases, New Haven, Connecticut, United States
| | - Amyn A Malik
- Yale Institute of Global Health, New Haven, Connecticut, United States
- Yale School of Medicine, Section of Infectious Diseases, New Haven, Connecticut, United States
| | - Samuel M Jenness
- Emory University Rollins School of Public Health, Atlanta, Georgia, United States
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, Connecticut, United States
- Yale School of Public Health, New Haven, Connecticut, United States
- Yale School of Medicine, Section of Infectious Diseases, New Haven, Connecticut, United States
- Yale School of Nursing, Orange, Connecticut, United States
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21
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Le Guillou A, Buchbinder S, Scott H, Liu A, Havlir D, Scheer S, Jenness SM. Population Impact and Efficiency of Improvements to HIV PrEP Under Conditions of High ART Coverage Among San Francisco Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2021; 88:340-347. [PMID: 34354011 PMCID: PMC8556308 DOI: 10.1097/qai.0000000000002781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Key components of Ending the HIV Epidemic (EHE) plan include increasing HIV antiretroviral therapy (ART) and HIV pre-exposure prophylaxis (PrEP) coverage. One complication to addressing this service delivery challenge is the wide heterogeneity of HIV burden and health care access across the United States. It is unclear how the effectiveness and efficiency of expanded PrEP will depend on different baseline ART coverage. METHODS We used a network-based model of HIV transmission for men who have sex with men (MSM) in San Francisco. Model scenarios increased varying levels of PrEP coverage relative under current empirical levels of baseline ART coverage and 2 counterfactual levels. We assessed the effectiveness of PrEP with the cumulative percentage of infections averted (PIA) over the next decade and efficiency with the number of additional person-years needed to treat (NNT) by PrEP required to avert one HIV infection. RESULTS In our projections, only the highest levels of combined PrEP and ART coverage achieved the EHE goals. Increasing PrEP coverage up to 75% showed that PrEP effectiveness was higher at higher baseline ART coverage. Indeed, the PIA was 61% in the lowest baseline ART coverage population and 75% in the highest. The efficiency declined with increasing ART (NNT range from 41 to 113). CONCLUSIONS Improving both PrEP and ART coverage would have a synergistic impact on HIV prevention even in a high baseline coverage city such as San Francisco. Efforts should focus on narrowing the implementation gaps to achieve higher levels of PrEP retention and ART sustained viral suppression.
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Affiliation(s)
- Adrien Le Guillou
- Department of Epidemiology, Emory University
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | | | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health
| | - Albert Liu
- Bridge HIV, San Francisco Department of Public Health
| | - Diane Havlir
- Department of Medicine, University of California San Francisco
| | - Susan Scheer
- Bridge HIV, San Francisco Department of Public Health
- HIV Epidemiology Section, San Francisco Department of Public Health
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22
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Liu CY, Berlin J, Kiti MC, Del Fava E, Grow A, Zagheni E, Melegaro A, Jenness SM, Omer SB, Lopman B, Nelson K. Rapid Review of Social Contact Patterns During the COVID-19 Pandemic. Epidemiology 2021; 32:781-791. [PMID: 34392254 PMCID: PMC8478104 DOI: 10.1097/ede.0000000000001412] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physical distancing measures aim to reduce person-to-person contact, a key driver of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. In response to unprecedented restrictions on human contact during the coronavirus disease 2019 (COVID-19) pandemic, studies measured social contact patterns under the implementation of physical distancing measures. This rapid review synthesizes empirical data on the changing social contact patterns during the COVID-19 pandemic. METHOD We conducted a systematic review using PubMed, Medline, Embase, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We descriptively compared the distribution of contacts observed during the pandemic to pre-COVID data across countries to explore changes in contact patterns during physical distancing measures. RESULTS We identified 12 studies reporting social contact patterns during the COVID-19 pandemic. Eight studies were conducted in European countries and eleven collected data during the initial mitigation period in the spring of 2020 marked by government-declared lockdowns. Some studies collected additional data after relaxation of initial mitigation. Most study settings reported a mean of between 2 and 5 contacts per person per day, a substantial reduction compared to pre-COVID rates, which ranged from 7 to 26 contacts per day. This reduction was pronounced for contacts outside of the home. Consequently, levels of assortative mixing by age substantially declined. After relaxation of initial mitigation, mean contact rates increased but did not return to pre-COVID levels. Increases in contacts post-relaxation were driven by working-age adults. CONCLUSION Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.
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Affiliation(s)
- Carol Y. Liu
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Juliette Berlin
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Moses C. Kiti
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Emanuele Del Fava
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - André Grow
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Emilio Zagheni
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Alessia Melegaro
- Department of Social and Political Sciences, Centre for Research on Social Dynamics and Public Policy and Covid Crisis Lab, Bocconi University, Milan, Italy
| | - Samuel M. Jenness
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Saad B. Omer
- Department of Epidemiology of Microbial Diseases, Yale Institute of Global Health, Yale University, CT
| | - Benjamin Lopman
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Kristin Nelson
- From the Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
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23
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Weiss KM, Prasad P, Sanchez T, Goodreau SM, Jenness SM. Association between HIV PrEP indications and use in a national sexual network study of US men who have sex with men. J Int AIDS Soc 2021; 24:e25826. [PMID: 34605174 PMCID: PMC8488229 DOI: 10.1002/jia2.25826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/13/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. United States Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP nonusers who are indicated and PrEP users who are not indicated. We sought to estimate current PrEP use among US men who have sex with men (MSM), characterize whether their PrEP use aligned with their current indications for PrEP, and assess whether the association between PrEP indications and PrEP use differed by demography or geography. METHODS Using data from a US web-based sexual network study of MSM between 2017 and 2019, we measured PrEP usage and assessed whether respondents met indications for PrEP. Log-binomial regression was used to estimate the relationship between PrEP indications and PrEP use, with adjustment for geography, age and race/ethnicity. RESULTS Of 3508 sexually active, HIV-negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among MSM meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about three times as likely to be currently using PrEP. This association varied slightly, but not significantly, by geographic region, age and race/ethnicity. CONCLUSIONS Indications for PrEP strongly predicted current PrEP use among US MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). PrEP underuse by those at greatest risk for HIV acquisition may limit the projected impact of PrEP implementation, despite reported increases in PrEP provision. This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk and to close the gap between indications and uptake.
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Affiliation(s)
- Kevin M. Weiss
- Department of EpidemiologyEmory UniversityAtlantaGAUSA,Icahn School of Medicine at Mount SinaiNew YorkNYUSA
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24
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Anderson EJ, Weiss KM, Morris MM, Sanchez TH, Prasad P, Jenness SM. HIV and Sexually Transmitted Infection Epidemic Potential of Networks of Men Who Have Sex With Men in Two Cities. Epidemiology 2021; 32:681-689. [PMID: 34172692 PMCID: PMC8338912 DOI: 10.1097/ede.0000000000001390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The speed with which a pathogen circulates in a sexual network is a function of network connectivity. Cross-sectional connectivity is a function of network features like momentary degree and assortative mixing. Temporal connectivity is driven by partner acquisition rates. The forward-reachable path (FRP) has been proposed as a summary measure of these two aspects of transmission potential. We use empirical data from San Francisco and Atlanta to estimate the generative parameters of the FRP and compare results to the HIV/sexually transmitted infection epidemics in each city. METHODS We used temporal exponential random graph models to estimate the generative parameters for each city's dynamic sexual network from survey data. We then simulated stochastic dynamic networks from the fitted models and calculated the FRP for each realization, overall, and stratified by partnership type and demographics. RESULTS The overall mean and median paths were higher in San Francisco than in Atlanta. The overall paths for each city were greater than the sum of the paths in each individual partnership network. In the casual partnership network, the mean path was highest in the youngest age group and lowest in the oldest age group, despite the fact that the youngest group had the lowest mean momentary degree and past-year partner counts. CONCLUSIONS The FRP by age group revealed the additional utility of the measure beyond the temporal and cross-sectional network connectivity measures. Other nonnetwork factors are still necessary to infer total epidemic potential for any specific pathogen.
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Affiliation(s)
| | - Kevin M. Weiss
- Department of Epidemiology, Emory University, Atlanta,
GA
| | | | | | - Pragati Prasad
- Department of Epidemiology, Emory University, Atlanta,
GA
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25
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Jenness SM, Willebrand KS, Malik AA, Lopman BA, Omer SB. Dynamic network strategies for SARS-CoV-2 control on a cruise ship. Epidemics 2021; 37:100488. [PMID: 34438256 PMCID: PMC8372454 DOI: 10.1016/j.epidem.2021.100488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
SARS-CoV-2 outbreaks have occurred on several nautical vessels, driven by the high-density contact networks on these ships. Optimal strategies for prevention and control that account for realistic contact networks are needed. We developed a network-based transmission model for SARS-CoV-2 on the Diamond Princess outbreak to characterize transmission dynamics and to estimate the epidemiological impact of outbreak control and prevention measures. This model represented the dynamic multi-layer network structure of passenger-passenger, passenger-crew, and crew-crew contacts, both before and after the large-scale network lockdown imposed on the ship in response to the disease outbreak. Model scenarios evaluated variations in the timing of the network lockdown, reduction in contact intensity within the sub-networks, and diagnosis-based case isolation on outbreak prevention. We found that only extreme restrictions in contact patterns during network lockdown and idealistic clinical response scenarios could avert a major COVID-19 outbreak. Contact network changes associated with adequate outbreak prevention were the restriction of passengers to their cabins, with limited passenger-crew contacts. Clinical response strategies required for outbreak prevention may be infeasible in many cruise settings: early mass screening with an ideal PCR test (100 % sensitivity) and immediate case isolation upon diagnosis. Personal protective equipment (e.g., facemasks) had limited impact in this environment because the majority of transmissions after the ship lockdown occurred between passengers in cabins where masks were not consistently used. Public health restrictions on optional leisure activities like these should be considered until longer-term effective solutions such as a COVID-19 vaccine become widely available.
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Affiliation(s)
- Samuel M Jenness
- Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
| | - Kathryn S Willebrand
- Yale Institute of Global Health, New Haven, CT, 06510, USA; Yale School of Public Health, New Haven, CT, 06510, USA
| | - Amyn A Malik
- Yale Institute of Global Health, New Haven, CT, 06510, USA; Yale School of Medicine, New Haven, CT, 06510, USA
| | - Benjamin A Lopman
- Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, CT, 06510, USA; Yale School of Public Health, New Haven, CT, 06510, USA; Yale School of Medicine, New Haven, CT, 06510, USA; Yale School of Nursing, Orange, CT, 06477, USA
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26
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Jenness SM, Knowlton G, Smith DK, Marcus JL, Anderson EJ, Siegler AJ, Jones J, Sullivan PS, Enns E. A decision analytics model to optimize investment in interventions targeting the HIV preexposure prophylaxis cascade of care. AIDS 2021; 35:1479-1489. [PMID: 33831910 PMCID: PMC8243826 DOI: 10.1097/qad.0000000000002909] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among MSM. Interventions can address these gaps but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact. DESIGN We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model. METHODS The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome, given intervention costs from a payer perspective. RESULTS From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions. CONCLUSION Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs.
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Affiliation(s)
| | - Gregory Knowlton
- Division of Health Policy and Management, University of Minnesota
| | - Dawn K. Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | | | | | | | - Jeb Jones
- Department of Epidemiology, Emory University
| | | | - Eva Enns
- Division of Health Policy and Management, University of Minnesota
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27
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Janulis P, Goodreau SM, Birkett M, Phillips G, Morris M, Mustanski B, Jenness SM. Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women. J Acquir Immune Defic Syndr 2021; 87:e214-e221. [PMID: 33675616 PMCID: PMC8192435 DOI: 10.1097/qai.0000000000002679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remain rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. METHODS Data for this study were obtained from a longitudinal cohort study of young men who have sex with men and transgender women in Chicago. Participants provided sexual network data every 6 months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. RESULTS Results indicated substantial between-person and within-person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively associated with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. CONCLUSIONS Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young men who have sex with men and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should use these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
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28
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Maloney KM, Le Guillou A, Driggers RA, Sarkar S, Anderson EJ, Malik AA, Jenness SM. Projected Impact of Concurrently Available Long-Acting Injectable and Daily-Oral Human Immunodeficiency Virus Preexposure Prophylaxis: A Mathematical Model. J Infect Dis 2021; 223:72-82. [PMID: 32882043 DOI: 10.1093/infdis/jiaa552] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Long-acting injectable (LAI) human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP. METHODS The reference model represents the current HIV epidemiology and DO-PrEP coverage (15% among those with behavioral indications for PrEP) among men who have sex with men in the southeastern United States. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP. RESULTS Compared with the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% simulation interval, -7.3% to 14.5%) of infections would be averted over 10 years. The impact of LAI-PrEP is slightly greater than that of the DO-PrEP-only regimen, based on assumptions of higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% simulation interval, 6.7%-26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved. CONCLUSIONS If LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence is greater for LAI-PrEP.
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Affiliation(s)
- Kevin M Maloney
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Adrien Le Guillou
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | | | - Supriya Sarkar
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,ViiV Healthcare, Research Triangle, North Carolina, USA
| | - Emeli J Anderson
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Amyn A Malik
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Yale Institute for Global Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
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29
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Jenness SM, Le Guillou A, Chandra C, Mann LM, Sanchez T, Westreich D, Marcus JL. Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19-Related Sexual Distancing and Clinical Service Interruption. J Infect Dis 2021; 223:1019-1028. [PMID: 33507308 PMCID: PMC7928867 DOI: 10.1093/infdis/jiab051] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. METHODS We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19-related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment). RESULTS A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, -227 cases), but have net protective effect for STIs (-23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases. CONCLUSIONS Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.
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Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Laura M Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA
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30
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Lopman B, Liu CY, Le Guillou A, Handel A, Lash TL, Isakov AP, Jenness SM. A modeling study to inform screening and testing interventions for the control of SARS-CoV-2 on university campuses. Sci Rep 2021; 11:5900. [PMID: 33723312 PMCID: PMC7960702 DOI: 10.1038/s41598-021-85252-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/03/2020] [Accepted: 02/22/2021] [Indexed: 12/16/2022] Open
Abstract
University administrators face decisions about how to safely return and maintain students, staff and faculty on campus throughout the 2020-21 school year. We developed a susceptible-exposed-infectious-recovered (SEIR) deterministic compartmental transmission model of SARS-CoV-2 among university students, staff, and faculty. Our goals were to inform planning at our own university, Emory University, a medium-sized university with around 15,000 students and 15,000 faculty and staff, and to provide a flexible modeling framework to inform the planning efforts at similar academic institutions. Control strategies of isolation and quarantine are initiated by screening (regardless of symptoms) or testing (of symptomatic individuals). We explored a range of screening and testing frequencies and performed a probabilistic sensitivity analysis. We found that among students, monthly and weekly screening can reduce cumulative incidence by 59% and 87%, respectively, while testing with a 2-, 4- and 7-day delay between onset of infectiousness and testing results in an 84%, 74% and 55% reduction in cumulative incidence. Smaller reductions were observed among staff and faculty. Community-introduction of SARS-CoV-2 onto campus may be controlled with testing, isolation, contract tracing and quarantine. Screening would need to be performed at least weekly to have substantial reductions beyond disease surveillance. This model can also inform resource requirements of diagnostic capacity and isolation/quarantine facilities associated with different strategies.
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Affiliation(s)
- Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Carol Y Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Andreas Handel
- College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | | | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Westreich D, Jenness SM, Marcus JL. To Contact Tracing... and Beyond! Clin Infect Dis 2021; 72:724-725. [PMID: 32492132 PMCID: PMC7884804 DOI: 10.1093/cid/ciaa717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Cassels S, Mwenda KM, Biney AAE, Jenness SM. Is It the Timing? Short-Term Mobility and Coital Frequency in Agbogbloshie, Ghana. Arch Sex Behav 2021; 50:589-600. [PMID: 32989638 PMCID: PMC7889649 DOI: 10.1007/s10508-020-01815-7] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Short-term mobility is often associated with increased sexual risk behavior. Mobile individuals often have higher rates of sexual risk behavior compared to non-mobile individuals, but the reasons why are not clear. Using monthly retrospective panel data from 202 men and 282 women in Agbogbloshie, Ghana, we tested whether short-term mobility was associated with changes in coital frequency, and whether the association was due to the act of travel in the given month (e.g., enabling higher risk behavior), the reason for travel, or an individual's travel propensity at other times in the year. Overnight travel specifically to visit family or friends, or for education, health, or other reasons, was associated with increased coital frequency for men. However, men with higher travel propensities had lower overall coital frequency and the act of traveling enabled more sex only for the most frequent male travelers. Men who seldom traveled had much higher coital frequency, but the act of traveling was not associated with additional sex acts. For women, travel for education, health, or other reasons increased coital frequency. Occasional female travelers had slightly more sex acts compared to non-mobile women, and the act of traveling for these women was associated with slight increases in coital frequency, supporting the enabling hypothesis. Highly mobile women had fewer sex acts per month on average. Our findings suggest that mobility characteristics measured on a broad temporal scale, as well as the reason for mobility, are important to understand the relationship between short-term mobility and sexual behavior.
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Affiliation(s)
- Susan Cassels
- Department of Geography, University of California, Santa Barbara, CA, 93106-4060, USA.
| | - Kevin M Mwenda
- Spatial Structures in the Social Sciences, Brown University, Providence, RI, USA
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Vermeer W, Hjorth A, Jenness SM, Brown H, Wilensky U. Leveraging Modularity During Replication of High-Fidelity Models: Lessons from Replicating an Agent-Based Model for HIV Prevention. J Artif Soc Soc Simul 2020; 23:7. [PMID: 33204215 PMCID: PMC7668565 DOI: 10.18564/jasss.4352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
High-fidelity models are increasingly used to predict, and guide decision making. Prior work has emphasized the importance of replication in ensuring reliable modeling, and has yielded important replication strategies. However, this work is based on relatively simple theory generating models, and its lessons might not translate to high-fidelity models used for decision support. Using NetLogo we replicate a recently published high-fidelity model examining the effects of a HIV biomedical intervention. We use a modular approach to build our model from the ground up, and provide examples of the replication process investigating the replication of two sub-modules as well as the overall simulation experiment. For the first module, we achieved numerical identity during replication, whereas we obtained distributional equivalence in replicating the second module. We achieved relational equivalence among the overall model behaviors, with a 0.98 correlation across the two implementations for our outcome measure even without strictly following the original model in the formation of the sexual network. Our results show that replication of high-fidelity models is feasible when following a set of systematic strategies that leverage the modularity, and highlight the role of replication standards, modular testing, and functional code in facilitating such strategies.
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Affiliation(s)
- Wouter Vermeer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N lakeshore Dr, Chicago, IL 60611, United States
| | - Arthur Hjorth
- Center for Hybrid Intelligence, Department of Management, Aarhus University Fuglesangs Allé 4, Aarhus V, DK - 8210, Denmark
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1520 Clifton Road, Atlanta, GA 30322, United States
| | - Hendrick Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N lakeshore Dr, Chicago, IL 60611, United States
| | - Uri Wilensky
- School of Social Policy and Education, Northwestern University, 2120 Campus Dr Evanston, IL 60208, United States
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Jenness SM, Guillou AL, Chandra C, Mann LM, Sanchez T, Westreich D, Marcus JL. Projected HIV and Bacterial STI Incidence Following COVID-Related Sexual Distancing and Clinical Service Interruption. medRxiv 2020:2020.09.30.20204529. [PMID: 33024979 PMCID: PMC7536881 DOI: 10.1101/2020.09.30.20204529] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The global COVID-19 pandemic has the potential to indirectly impact the transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). Studies have already documented reductions in sexual activity ("sexual distancing") and interruptions in HIV/STI services, but it is unknown what combined impact these two forces will have on HIV/STI epidemic trajectories. METHODS We adapted a network-based model of co-circulating HIV, gonorrhea, and chlamydia for a population of approximately 103,000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-related sexual distancing in casual and one-time partnership networks and service interruption within four service categories (HIV screening, HIV PrEP, HIV ART, and STI treatment). RESULTS A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM: -227 cases), but have net protective effect for STIs (-23,800 cases). Greater relative reductions and longer durations of service interruption would increase HIV and STI incidence, while greater relative reductions and longer durations of sexual distancing would decrease incidence of both. If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57,500 STI cases. CONCLUSIONS The counterbalancing impact of sexual distancing and clinical service interruption depends on the infection and the extent and durability of these COVID-related changes. If sexual behavior rebounds while service interruption persists, we project an excess of hundreds of HIV cases and thousands of STI cases just among Atlanta MSM over the next 5 years. Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID pandemic on the HIV/STI epidemic.
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Affiliation(s)
- Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital
| | - Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Laura M. Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
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Abstract
SARS-CoV-2 outbreaks have occurred on several nautical vessels, driven by the high-density contact networks on these ships. Optimal strategies for prevention and control that account for realistic contact networks are needed. We developed a network-based transmission model for SARS-CoV-2 on the Diamond Princess outbreak to characterize transmission dynamics and to estimate the epidemiological impact of outbreak control and prevention measures. This model represented the dynamic multi-layer network structure of passenger-passenger, passenger-crew, and crew-crew contacts, both before and after the large-scale network lockdown imposed on the ship in response to the disease outbreak. Model scenarios evaluated variations in the timing of the network lockdown, reduction in contact intensity within the sub-networks, and diagnosis-based case isolation on outbreak prevention. We found that only extreme restrictions in contact patterns during network lockdown and idealistic clinical response scenarios could avert a major COVID-19 outbreak. Contact network changes associated with adequate outbreak prevention were the restriction of passengers to their cabins, with limited passenger-crew contacts. Clinical response strategies required for outbreak prevention included early mass screening with an ideal PCR test (100% sensitivity) and immediate case isolation upon diagnosis. Public health restrictions on optional leisure activities like these should be considered until longer-term effective solutions such as a COVID-19 vaccine become widely available.
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Affiliation(s)
- Samuel M. Jenness
- Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Kathryn S. Willebrand
- Yale Institute of Global Health, New Haven, CT 06510, USA
- Yale School of Public Health, New Haven, CT 06510, USA
| | - Amyn A. Malik
- Yale Institute of Global Health, New Haven, CT 06510, USA
- Yale School of Medicine, New Haven, CT 06510, USA
| | - Benjamin A. Lopman
- Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Saad B. Omer
- Yale Institute of Global Health, New Haven, CT 06510, USA
- Yale School of Public Health, New Haven, CT 06510, USA
- Yale School of Medicine, New Haven, CT 06510, USA
- Yale School of Nursing, Orange, CT 06477, USA
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Chandra C, Weiss KM, Kelley CF, Marcus JL, Jenness SM. Gaps in Sexually Transmitted Infection Screening among Men who Have Sex with Men in PrEP Care in the United States. Clin Infect Dis 2020; 73:e2261-e2269. [PMID: 32702116 DOI: 10.1093/cid/ciaa1033] [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] [Received: 03/11/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The U.S. Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using HIV preexposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified. METHODS We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the U.S., stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent ("always" or "sometimes") exposure site-specific STI screening during PrEP care. RESULTS Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], 0.76-0.98) and rectal STIs (aPR, 0.76; 95% CI, 0.62-0.93) during PrEP care. CONCLUSIONS Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.
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Affiliation(s)
- Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kevin M Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Colleen F Kelley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Julia L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Nelson KN, Gandhi NR, Mathema B, Lopman BA, Brust JCM, Auld SC, Ismail N, Omar SV, Brown TS, Allana S, Campbell A, Moodley P, Mlisana K, Shah NS, Jenness SM. Modeling Missing Cases and Transmission Links in Networks of Extensively Drug-Resistant Tuberculosis in KwaZulu-Natal, South Africa. Am J Epidemiol 2020; 189:735-745. [PMID: 32242216 PMCID: PMC7443195 DOI: 10.1093/aje/kwaa028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/26/2020] [Indexed: 11/14/2022] Open
Abstract
Patterns of transmission of drug-resistant tuberculosis (TB) remain poorly understood, despite over half a million incident cases worldwide in 2017. Modeling TB transmission networks can provide insight into drivers of transmission, but incomplete sampling of TB cases can pose challenges for inference from individual epidemiologic and molecular data. We assessed the effect of missing cases on a transmission network inferred from Mycobacterium tuberculosis sequencing data on extensively drug-resistant TB cases in KwaZulu-Natal, South Africa, diagnosed in 2011-2014. We tested scenarios in which cases were missing at random, missing differentially by clinical characteristics, or missing differentially by transmission (i.e., cases with many links were under- or oversampled). Under the assumption that cases were missing randomly, the mean number of transmissions per case in the complete network needed to be larger than 20, far higher than expected, to reproduce the observed network. Instead, the most likely scenario involved undersampling of high-transmitting cases, and models provided evidence for super-spreading. To our knowledge, this is the first analysis to have assessed support for different mechanisms of missingness in a TB transmission study, but our results are subject to the distributional assumptions of the network models we used. Transmission studies should consider the potential biases introduced by incomplete sampling and identify host, pathogen, or environmental factors driving super-spreading.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Neel R Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Barun Mathema
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York
| | - Sara C Auld
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Department of Medical Microbiology, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Shaheed Vally Omar
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tyler S Brown
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Salim Allana
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Angie Campbell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pravi Moodley
- National Health Laboratory Service, Johannesburg, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service, Johannesburg, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - N Sarita Shah
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Nelson KN, Jenness SM, Mathema B, Lopman BA, Auld SC, Shah NS, Brust JCM, Ismail N, Omar SV, Brown TS, Allana S, Campbell A, Moodley P, Mlisana K, Gandhi NR. Social Mixing and Clinical Features Linked With Transmission in a Network of Extensively Drug-resistant Tuberculosis Cases in KwaZulu-Natal, South Africa. Clin Infect Dis 2020; 70:2396-2402. [PMID: 31342067 PMCID: PMC7245156 DOI: 10.1093/cid/ciz636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/06/2019] [Accepted: 07/10/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading infectious cause of death globally, and drug-resistant TB strains pose a serious threat to controlling the global TB epidemic. The clinical features, locations, and social factors driving transmission in settings with high incidences of drug-resistant TB are poorly understood. METHODS We measured a network of genomic links using Mycobacterium tuberculosis whole-genome sequences. RESULTS Patients with 2-3 months of cough or who spent time in urban locations were more likely to be linked in the network, while patients with sputum smear-positive disease were less likely to be linked than those with smear-negative disease. Associations persisted using different thresholds to define genomic links and irrespective of assumptions about the direction of transmission. CONCLUSIONS Identifying factors that lead to many transmissions, including contact with urban areas, can suggest settings instrumental in transmission and indicate optimal locations and groups to target with interventions.
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Affiliation(s)
- Kristin N Nelson
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Samuel M Jenness
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Barun Mathema
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Sara C Auld
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - N Sarita Shah
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa
- University of Pretoria, South Africa
| | - Shaheed Vally Omar
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tyler S Brown
- Massachusetts General Hospital, Infectious Diseases Division, Boston
| | - Salim Allana
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Angie Campbell
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pravi Moodley
- National Health Laboratory Service, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Koleka Mlisana
- National Health Laboratory Service, Durban, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Neel R Gandhi
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
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Jones J, Dominguez K, Stephenson R, Stekler JD, Castel AD, Mena LA, Jenness SM, Siegler AJ, Sullivan PS. A Theoretically Based Mobile App to Increase Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16231. [PMID: 32130178 PMCID: PMC7060494 DOI: 10.2196/16231] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 01/26/2023] Open
Abstract
Background HealthMindr is a mobile phone HIV prevention app for men who have sex with men (MSM). In a previous pilot study, HealthMindr was found to be acceptable among users and to demonstrate preliminary effectiveness for increasing pre-exposure prophylaxis (PrEP) uptake among MSM. PrEP is a highly effective HIV prevention intervention; however, uptake remains low. Objective The aim of this study will be to assess the efficacy of a mobile app for increasing PrEP uptake among MSM in the southern United States. Methods In this randomized controlled trial, we will assess the efficacy of HealthMindr for increasing PrEP uptake among MSM in the following three southern US cities: Atlanta, Georgia; Jackson, Mississippi; and Washington, DC. In total, 657 men will be recruited and randomized to intervention and control arms in a 2:1 ratio. Participants in the intervention arm will receive access to the full HealthMindr app, with information and resources about PrEP (eg, frequently asked questions, risk assessment tool, and PrEP provider locator), other HIV prevention information, ability to order free HIV/sexually transmitted infection test kits, and additional resources related to substance use and mental health. Participants in the control arm will use the HealthMindr app but will only have access to the study timeline and a message center to communicate with study staff. Participants will complete quarterly surveys to assess self-reported PrEP uptake over 12 months of follow-up. Self-reported PrEP uptake will be verified by dried blood spot testing and/or uploading a photograph of a PrEP prescription. Results Participant recruitment began in January 2020. Conclusions This trial will determine whether the HealthMindr app can increase PrEP uptake among MSM in the southern United States. Trial Registration ClinicalTrials.gov NCT03763942; https://clinicaltrials.gov/ct2/show/NCT03763942 International Registered Report Identifier (IRRID) PRR1-10.2196/16231
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Karen Dominguez
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Joanne D Stekler
- Division of Allergy & Infectious Diseases, School of Medicine, University of Washington, Seattle, WA, United States
| | - Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Leandro A Mena
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Abstract
BACKGROUND Mandatory vaccination has been effective in maintaining high vaccination coverage in countries such as the United States. However, there are no peer-reviewed analyses of the association between mandates and both coverage and subsequent incidence of vaccine-preventable disease in Europe. METHODS Using data from the European Centre for Disease Prevention and Control and the World Health Organization, we evaluated the relationship between country-level mandatory vaccination policies and (1) measles and pertussis vaccine coverage and (2) the annual incidence of these diseases in 29 European countries. Multivariate negative binomial and linear regression models were used to quantify these associations. RESULTS Mandatory vaccination was associated with a 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination. Mandatory vaccination was only associated with decreased measles incidence for countries without nonmedical exemptions (adjusted incidence rate ratio = 0.14; 95% CI: 0.05 to 0.36). We did not find a significant association between mandatory vaccination and pertussis incidence. CONCLUSIONS Mandatory vaccination and the magnitude of fines were associated with higher vaccination coverage. Moreover, mandatory vaccination was associated with lower measles incidence for countries with mandatory vaccination without nonmedical exemptions. These findings can inform legislative policies aimed at increasing vaccination coverage.
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Affiliation(s)
- Olivia M. Vaz
- Departments of Epidemiology, Emory University, Atlanta, Georgia
| | - Mallory K. Ellinǵson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paul Weiss
- Biostatistics and Bioinformatics, Emory University, Atlanta, Georgi
| | | | - Azucena Bardají
- Hospital Clinic, Barcelona Institute for Global Health, Universitat de Barcelona, Barcelona, Spain
| | - Robert A. Bednarczyk
- Departments of Epidemiology, Emory University, Atlanta, Georgia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Emory Vaccine Center, Emory University, Atlanta, Georgia,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Saad B. Omer
- Departments of Epidemiology, Emory University, Atlanta, Georgia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Emory Vaccine Center, Emory University, Atlanta, Georgia,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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41
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Weiss KM, Goodreau SM, Morris M, Prasad P, Ramaraju R, Sanchez T, Jenness SM. Egocentric sexual networks of men who have sex with men in the United States: Results from the ARTnet study. Epidemics 2020; 30:100386. [PMID: 32004795 PMCID: PMC7089812 DOI: 10.1016/j.epidem.2020.100386] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/13/2023] Open
Abstract
In this paper, we present an overview and descriptive results from one of the first egocentric network studies of men who have sex with men (MSM) from across the United States: the ARTnet study. ARTnet was designed to support prevention research for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) that are transmitted across partnership networks. ARTnet implemented a population-based egocentric network study design that sampled egos from the target population and asked them to report on the number, attributes, and timing of their sexual partnerships. Such data provide the foundation needed for parameterizing stochastic network models that are used for disease projection and intervention planning. ARTnet collected data online from 2017 to 2019, with a final sample of 4904 participants who reported on 16198 sexual partnerships. The aims of this paper were to characterize the joint distribution of three network parameters needed for modeling: degree distributions, assortative mixing, and partnership age, with heterogeneity by partnership type (main, casual and one-time), demography, and geography. Participants had an average of 1.19 currently active partnerships ("mean degree"), which was higher for casual partnerships (0.74) than main partnerships (0.45). The mean rate of one-time partnership acquisition was 0.16 per week (8.5 partners per year). Main partnerships lasted 272.5 weeks on average, while casual partnerships lasted 133.0 weeks. There was strong but heterogenous assortative mixing by race/ethnicity for all groups. The mean absolute age difference for all partnership types was 9.5 years, with main partners differing by 6.3 years compared to 10.8 years for casual partners. Our analysis suggests that MSM may be at sustained risk for HIV/STI acquisition and transmission through high network degree of sexual partnerships. The ARTnet network study provides a robust and reproducible foundation for understanding the dynamics of HIV/STI epidemiology among U.S. MSM and supporting the implementation science that seeks to address persistent challenges in HIV/STI prevention.
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Affiliation(s)
- Kevin M Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, Washington, United States
| | - Pragati Prasad
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Ramya Ramaraju
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States.
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42
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Weiss KM, Jones JS, Anderson EJ, Gift T, Chesson H, Bernstein K, Workowski K, Tuite A, Rosenberg ES, Sullivan PS, Jenness SM. Optimizing Coverage vs Frequency for Sexually Transmitted Infection Screening of Men Who Have Sex With Men. Open Forum Infect Dis 2019; 6:ofz405. [PMID: 31667198 PMCID: PMC6814280 DOI: 10.1093/ofid/ofz405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
Background The incidence of bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) has increased substantially despite availability of effective antibiotics. The US Centers for Disease Control and Prevention (CDC) recommends annual screening for all sexually active (SA) MSM and more frequent screening for high-risk (HR) MSM. The population-level benefits of improved coverage vs increased frequency of STI screening among SA vs HR MSM are unknown. Methods We used a network transmission model of gonorrhea (NG) and chlamydia (CT) among MSM to simulate the implementation of STI screening across different scenarios, starting with the CDC guidelines at current coverage levels. Counterfactual model scenarios varied screening coverage and frequency for SA MSM and HR MSM (MSM with multiple recent partners). We estimated infections averted and the number needed to screen to prevent 1 new infection. Results Compared with current recommendations, increasing the frequency of screening to biannually for all SA MSM and adding some HR screening could avert 72% of NG and 78% of CT infections over 10 years. Biannual screening of 30% of HR MSM at empirical coverage levels for annual SA screening could avert 76% of NG and 84% of CT infections. Other scenarios, including higher coverage among SA MSM and increasing frequency for HR MSM, averted fewer infections but did so at a lower number needed to screen. Conclusions The optimal screening scenarios in this model to reduce STI incidence among MSM included more frequent screening for all sexually active MSM and higher coverage of screening for HR men with multiple partners.
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Affiliation(s)
- Kevin M Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Jeb S Jones
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Emeli J Anderson
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Thomas Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Harrell Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kyle Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Workowski
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Eli S Rosenberg
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Department of Epidemiology and Biostatistics, University at Albany, Albany, New York, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA.,Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
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43
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Jones J, Guest JL, Sullivan PS, Kramer MR, Jenness SM, Sales JM. Concordance between monetary and sexual delay discounting in men who have sex with men. Sex Health 2019; 15:214-222. [PMID: 29212590 DOI: 10.1071/sh17111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/15/2017] [Indexed: 11/23/2022]
Abstract
Background Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men who have sex with men. METHODS Participants completed an online survey, including the Monetary Choice Questionnaire and the Sexual Discounting Task. Linear regression models were used to assess the association between monetary and sexual discount rates. RESULTS Sexual discount rates did not predict monetary discount rates. There was a substantial amount of clustering of sexual discount rates, requiring sexual discounting data to be categorised. CONCLUSIONS Monetary and sexual delay discounting are distinct processes that are not necessarily associated within individuals, and monetary delay discounting is not an appropriate proxy measure for sexual impulsivity. Data from the Sexual Discounting Task are typically rank-transformed for analysis. These data suggest that this might be an invalid method of analysis. Future studies should investigate the distribution of their data to determine if it is appropriate to analyse sexual discounting data as a continuous measure.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Jodie L Guest
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Michael R Kramer
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA 30322
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road, Atlanta, GA 30322
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44
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Siegler AJ, Brock JB, Hurt CB, Ahlschlager L, Dominguez K, Kelley CF, Jenness SM, Wilde G, Jameson SB, Bailey-Herring G, Mena LA. An Electronic Pre-Exposure Prophylaxis Initiation and Maintenance Home Care System for Nonurban Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13982. [PMID: 31199326 PMCID: PMC6592500 DOI: 10.2196/13982] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly efficacious for preventing HIV but has not yet been brought to scale among at-risk persons. In several clinical trials in urban areas, technology-based interventions have shown a positive impact on PrEP adherence. In rural and small-town areas in the United States, which often do not have geographically proximal access to PrEP providers, additional support may be needed. This may be particularly true for younger persons who are more likely to face multiple barriers to accessing PrEP services. Home-based care, accomplished through a tailored mobile phone app, specimen self-collection (SSC), and interactive video consultations, could increase both PrEP initiation and persistence in care. OBJECTIVE The goal of this study is to assess the initiation and persistence in PrEP care for those randomized to a home-care intervention (electronic PrEP, ePrEP) relative to those assigned to the standard of care (control) condition. We will conduct additional assessments, including quantitative and qualitative analyses, to contextualize trial results and facilitate scale-up. METHODS This 2-arm, randomized controlled trial will enroll young men who have sex with men (YMSM) aged between 18 and 24 years from rural areas of Georgia, Mississippi, and North Carolina. The trial will seek to recruit a diverse sample, targeting 50% participation among highly impacted groups of black or Latino men who have sex with men. Intervention participants will receive a study app that incorporates a messaging platform, a scheduling and milestone-based tracking system for PrEP care progress, electronic behavioral surveys, and interactive video consultations with a clinician. Complemented by SSC kits mailed to laboratories for standard PrEP-related monitoring, the ePrEP system will allow participants to access PrEP care without leaving their homes. YMSM randomized to the control condition will receive a listing of nearest local PrEP providers to receive standard PrEP care. Both groups will complete quarterly electronic surveys. The primary outcome, assessed at 6 and 12 months after randomization, will be the difference in the proportion of intervention versus control participants that achieve protective levels of the active metabolite of oral PrEP (tenofovir diphosphate in dried blood spots). RESULTS Enrollment will begin in May 2019, with study completion in 2022. CONCLUSIONS This trial will determine whether home PrEP care provided through an app-based platform is an efficacious means of expanding access to PrEP care for a diverse group of YMSM in rural and small-town areas of the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT03729570; https://clinicaltrials.gov/ct2/show/NCT03729570 (Archived by WebCite at http://www.webcitation.org/78RE2Qizf). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/13982.
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Affiliation(s)
- Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James B Brock
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren Ahlschlager
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Karen Dominguez
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Gretchen Wilde
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel B Jameson
- Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Gina Bailey-Herring
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Leandro A Mena
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
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45
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Jones J, Weiss K, Mermin J, Dietz P, Rosenberg ES, Gift TL, Chesson H, Sullivan PS, Lyles C, Bernstein KT, Jenness SM. Proportion of Incident Human Immunodeficiency Virus Cases Among Men Who Have Sex With Men Attributable to Gonorrhea and Chlamydia: A Modeling Analysis. Sex Transm Dis 2019; 46:357-363. [PMID: 31095100 PMCID: PMC6530490 DOI: 10.1097/olq.0000000000000980] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 11/27/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are associated with an increased risk of human immunodeficiency virus (HIV) acquisition and transmission. We estimated the proportion of HIV incidence among men who have sex with men attributable to infection with the 2 most common bacterial STIs, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). METHODS We used a stochastic, agent-based model of a sexual network of MSM with cocirculating HIV, NG, and CT infections. Relative risk (RR) multipliers, specific to anatomic site of infection, modified the risk of HIV transmission and acquisition based on STI status. We estimated the effect of NG and CT on HIV incidence overall and on HIV acquisition and HIV transmission separately. Each scenario was simulated for 10 years. The population attributable fraction (PAF) was determined for each combination of RRs by comparing the incidence in the final year of a scenario to a scenario in which the RRs associated with NG and CT were set to 1.0. RESULTS Overall, 10.2% (interquartile range [IQR], 7.9-12.4) of HIV infections were attributable to NG/CT infection. Then in sensitivity analyses, the PAF for HIV transmission ranged from 3.1% (IQR, 0.5-5.2) to 20.4% (IQR, 17.8-22.5) and the PAF for HIV acquisition ranged from 2.0% (IQR, -0.7 to 4.3) to 13.8% (IQR, 11.7-16.0). CONCLUSIONS Despite challenges in estimating the causal impact of NG/CT on HIV risk, modeling is an alternative approach to quantifying plausible ranges of effects given uncertainty in the biological cofactors. Our estimates represent idealized public health interventions in which STI could be maximally prevented, setting targets for real-world STI interventions that seek to reduce HIV incidence.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Kevin Weiss
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Jonathan Mermin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia Dietz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany, Albany, New York
| | - Thomas L. Gift
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harrell Chesson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Cynthia Lyles
- Centers for Disease Control and Prevention, Atlanta, Georgia
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46
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Hamilton DT, Rosenberg ES, Jenness SM, Sullivan PS, Wang LY, Dunville RL, Barrios LC, Aslam M, Goodreau SM. Modeling the joint effects of adolescent and adult PrEP for sexual minority males in the United States. PLoS One 2019; 14:e0217315. [PMID: 31116802 PMCID: PMC6530873 DOI: 10.1371/journal.pone.0217315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/06/2019] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective and safe intervention approved for use to prevent HIV transmission. PrEP scale-up strategies and clinical practice are currently being informed by modeling studies, which have estimated the impact of PrEP in adult and adolescent MSM populations separately. This partitioning may miss important effects or yield biased estimates by excluding dependencies between populations. Methods We combined two published models of HIV transmission among adults and adolescent MSM. We simulated an HIV epidemic among MSM aged 13–39 without PrEP, with PrEP for adult MSM ages (19–39) and with the addition of PrEP for adolescents ages (16–18), comparing percent of incident infections averted (impact), the number of person-years on PrEP per infection averted (efficiency), and changes in prevalence. Results PrEP use among eligible 19–39 year old MSM averted 29.0% of infections and reduced HIV prevalence from 23.2% to 17.0% over ten years in the population as a whole. Despite being ineligible for PrEP in this scenario, prevalence among sexually active 18 year-olds declined from 6.0% to 4.3% due to reduced transmissions across age cohorts. The addition of PrEP for adolescents ages 16–18 had a small impact on the overall epidemic, further reducing overall prevalence from 17.0% to 16.8%; however prevalence among the sexually active 18 year-olds further declined from 4.3% to 3.8%. Conclusions PrEP use among adults may significantly reduce HIV prevalence among MSM and may also have significant downstream effects on HIV incidence among adolescents; PrEP targeting adolescents remains an important intervention for HIV prevention.
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Affiliation(s)
- Deven T. Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, United States of America
| | - Samuel M. Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard L. Dunville
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisa C. Barrios
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Maria Aslam
- Program and Performance Improvement Office National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Steven M. Goodreau
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
- Department of Anthropology, University of Washington, Seattle, Washington, United States of America
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47
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Jenness SM, Maloney KM, Smith DK, Hoover KW, Goodreau SM, Rosenberg ES, Weiss KM, Liu AY, Rao DW, Sullivan PS. Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States. Am J Epidemiol 2019; 188:743-752. [PMID: 30312365 DOI: 10.1093/aje/kwy230] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.
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Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Albany, New York
| | - Kevin M Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Darcy W Rao
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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48
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Ebert CD, Astale T, Sata E, Zerihun M, Nute AW, Stewart AEP, Gessese D, Ayenew G, Ayele Z, Melak B, Chanyalew M, Gashaw B, Tadesse Z, Callahan EK, Jenness SM, Nash SD. Population coverage and factors associated with participation following a mass drug administration of azithromycin for trachoma elimination in Amhara, Ethiopia. Trop Med Int Health 2019; 24:493-501. [PMID: 30674087 PMCID: PMC6850572 DOI: 10.1111/tmi.13208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Mass drug administration (MDA) with azithromycin is a core component of the WHO‐recommended strategy to eliminate trachoma as a public health problem, but low participation rates in MDA campaigns may undermine the effectiveness of this intervention. We explored factors associated with individual MDA participation at the individual, head of household and household levels in Amhara, Ethiopia. Methods We conducted four district‐level, multilevel cluster random coverage surveys to collect data on self‐reported MDA participation and predictors. Random‐effects logistic regression modelling was used to identify correlates of MDA participation while adjusting for nesting of individuals at the household and village level. Results The district‐level self‐reported participation in the trachoma MDA ranged from 78.5% to 86.9%. Excellent and fair health status (Odds ratio [OR] = 5.77; 95% Confidence interval [CI]: 3.04, 10.95; OR = 7.08; 95% CI: 3.47, 14.46), advanced knowledge of the MDA campaign (OR = 2.93; 95% CI: 2.04, 4.21) and knowledge of trachoma (OR = 1.60; 95% CI: 1.17, 2.19) were all positively associated with MDA participation. When excluding heads of household from the model, correlates retained similar positive associations to participation, in addition to the head of household participation (OR = 3.34; 95% CI: 2.46, 4.54). Conclusions To increase the impact of MDA campaigns, MDA mobilisation strategies—including comprehensive trachoma and azithromycin messaging and MDA campaign awareness—should target heads of household, those in poorer health and older age groups.
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Affiliation(s)
- Caleb D Ebert
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tigist Astale
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Eshetu Sata
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Mulat Zerihun
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Andrew W Nute
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
| | | | - Demelash Gessese
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Gedefaw Ayenew
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Zebene Ayele
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Berhanu Melak
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | - Melsew Chanyalew
- Health Promotion and Disease Prevention Core Process, The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Bizuayehu Gashaw
- Directorate, The Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Zerihun Tadesse
- Trachoma Control Program, The Carter Center, Addis Ababa, Ethiopia
| | | | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott D Nash
- Trachoma Control Program, The Carter Center, Atlanta, GA, USA
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49
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Hamilton DT, Goodreau SM, Jenness SM, Sullivan PS, Wang LY, Dunville RL, Barrios LC, Rosenberg ES. Potential Impact of HIV Preexposure Prophylaxis Among Black and White Adolescent Sexual Minority Males. Am J Public Health 2018; 108:S284-S291. [PMID: 30383415 PMCID: PMC6215365 DOI: 10.2105/ajph.2018.304471] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Accepted: 03/28/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the potential impact of preexposure prophylaxis (PrEP) on the HIV epidemic among Black and White adolescent sexual minority males (ASMM). METHODS We used a network model and race-specific data from recent trials to simulate HIV transmission among a population of Black and White 13- to 18-year-old ASMM over 20 years. We estimated the number of infections prevented (impact) and the number needed to treat to prevent an infection (efficiency) under multiple coverage and adherence scenarios. RESULTS At modeled coverage and adherence, PrEP could avert 3% to 20% of infections among Black ASMM and 8% to 51% among White ASMM. A larger number, but smaller percentage, of infections were prevented in Black ASMM in all scenarios examined. PrEP was more efficient among Black ASMM (number needed to treat to avert an infection = 25-32) compared with White ASMM (146-237). CONCLUSIONS PrEP can reduce HIV incidence among both Black and White ASMM but is far more efficient for Black ASMM because of higher incidence. Public Health Implications. Black ASMM communities suffer disproportionate HIV burden; despite imperfect adherence, PrEP programs could prevent HIV efficiently in these communities.
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Affiliation(s)
- Deven T Hamilton
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Steven M Goodreau
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Samuel M Jenness
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Patrick S Sullivan
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Li Yan Wang
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Richard L Dunville
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Lisa C Barrios
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Eli S Rosenberg
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
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Luo W, Katz DA, Hamilton DT, McKenney J, Jenness SM, Goodreau SM, Stekler JD, Rosenberg ES, Sullivan PS, Cassels S. Development of an Agent-Based Model to Investigate the Impact of HIV Self-Testing Programs on Men Who Have Sex With Men in Atlanta and Seattle. JMIR Public Health Surveill 2018; 4:e58. [PMID: 29959112 PMCID: PMC6045793 DOI: 10.2196/publichealth.9357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/13/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the United States HIV epidemic, men who have sex with men (MSM) remain the most profoundly affected group. Prevention science is increasingly being organized around HIV testing as a launch point into an HIV prevention continuum for MSM who are not living with HIV and into an HIV care continuum for MSM who are living with HIV. An increasing HIV testing frequency among MSM might decrease future HIV infections by linking men who are living with HIV to antiretroviral care, resulting in viral suppression. Distributing HIV self-test (HIVST) kits is a strategy aimed at increasing HIV testing. Our previous modeling work suggests that the impact of HIV self-tests on transmission dynamics will depend not only on the frequency of tests and testers' behaviors but also on the epidemiological and testing characteristics of the population. OBJECTIVE The objective of our study was to develop an agent-based model to inform public health strategies for promoting safe and effective HIV self-tests to decrease the HIV incidence among MSM in Atlanta, GA, and Seattle, WA, cities representing profoundly different epidemiological settings. METHODS We adapted and extended a network- and agent-based stochastic simulation model of HIV transmission dynamics that was developed and parameterized to investigate racial disparities in HIV prevalence among MSM in Atlanta. The extension comprised several activities: adding a new set of model parameters for Seattle MSM; adding new parameters for tester types (ie, regular, risk-based, opportunistic-only, or never testers); adding parameters for simplified pre-exposure prophylaxis uptake following negative results for HIV tests; and developing a conceptual framework for the ways in which the provision of HIV self-tests might change testing behaviors. We derived city-specific parameters from previous cohort and cross-sectional studies on MSM in Atlanta and Seattle. Each simulated population comprised 10,000 MSM and targeted HIV prevalences are equivalent to 28% and 11% in Atlanta and Seattle, respectively. RESULTS Previous studies provided sufficient data to estimate the model parameters representing nuanced HIV testing patterns and HIV self-test distribution. We calibrated the models to simulate the epidemics representing Atlanta and Seattle, including matching the expected stable HIV prevalence. The revised model facilitated the estimation of changes in 10-year HIV incidence based on counterfactual scenarios of HIV self-test distribution strategies and their impact on testing behaviors. CONCLUSIONS We demonstrated that the extension of an existing agent-based HIV transmission model was sufficient to simulate the HIV epidemics among MSM in Atlanta and Seattle, to accommodate a more nuanced depiction of HIV testing behaviors than previous models, and to serve as a platform to investigate how HIV self-tests might impact testing and HIV transmission patterns among MSM in Atlanta and Seattle. In our future studies, we will use the model to test how different HIV self-test distribution strategies might affect HIV incidence among MSM.
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Affiliation(s)
- Wei Luo
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, United States
| | - David A Katz
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States
| | - Jennie McKenney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, Department of Anthropology, University of Washington, Seattle, WA, United States
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Eli S Rosenberg
- School of Public Health, Epidemiology and Biostatistics, Rensselaer, Albany, NY, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Susan Cassels
- Department of Geography, University of California Santa Barbara, Santa Barbara, CA, United States
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