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Hughes AJ, Nimbal V, Hsu L, Schwarcz S, Scheer S. Trends in Time Spent Viremic Among Persons Newly Diagnosed With HIV in San Francisco. J Acquir Immune Defic Syndr 2023; 94:107-115. [PMID: 37707298 PMCID: PMC10497196 DOI: 10.1097/qai.0000000000003237] [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: 12/08/2022] [Accepted: 05/18/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine trends in time spent viremic and initiation into antiretroviral treatment (ART) among persons newly diagnosed with HIV in San Francisco. METHODS Using HIV surveillance data, we included persons diagnosed with HIV during 2012-2020, a San Francisco resident at HIV diagnosis, alive 12 months after HIV diagnosis, and had ≥2 viral load tests within 12 months after diagnosis. Percent person-time spent (pPT) >200, pPT >1500, and pPT >10,000 copies per milliliter was calculated during the 12 months after HIV diagnosis. Multivariate regression models assessed the year of diagnosis and time spent above each viral threshold and year of diagnosis and ART initiation within 0-7 days (rapid), 8-365 days (delayed), or no ART initiation. RESULTS Of 2471 new HIV diagnoses in San Francisco from 2012 to 2020, 1921 (72%) were included. Newly diagnosed persons spent a mean of 40.4% pPT >200, 32.4% pPT >1,500%, and 23.4% pPT >10,000 copies per milliliter; 33.8% had rapid ART initiation, 57.3% delayed, and 9% had no ART initiation. After adjustment, persons diagnosed in years 2014-2015, 2016-2017, 2018-2019, and 2020 were associated with less time spent above all viral thresholds and lower risk of delayed or no ART initiation compared with those diagnosed in 2012-2013. Greater time above thresholds correlated with injection drug use, ages 25-29 and 30-39 years, and homelessness. CONCLUSIONS Percent time spent above each viremic level decreased significantly, whereas rapid ART initiation increased among newly diagnosed persons from 2014 through 2020 compared with 2012-2013. Population differences in time spent unsuppressed highlight the need for targeted interventions to reduce new HIV infections and improve health.
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Affiliation(s)
| | - Vani Nimbal
- San Francisco Department of Public Health, San Francisco, CA
| | - Ling Hsu
- San Francisco Department of Public Health, San Francisco, CA
| | - Sandra Schwarcz
- San Francisco Department of Public Health, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA
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Sachdev DD, Petersen M, Havlir DV, Schwab J, Enanoria WT, Nguyen TQ, Mercer MP, Scheer S, Bennett A, Tenner AG, Marks JD, Bobba N, Philip S, Colfax G. San Francisco's Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022. Public Health Rep 2023; 138:747-755. [PMID: 37408322 PMCID: PMC10323495 DOI: 10.1177/00333549231181353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
San Francisco implemented one of the most intensive, comprehensive, multipronged COVID-19 pandemic responses in the United States using 4 core strategies: (1) aggressive mitigation measures to protect populations at risk for severe disease, (2) prioritization of resources in neighborhoods highly affected by COVID-19, (3) timely and adaptive data-driven policy making, and (4) leveraging of partnerships and public trust. We collected data to describe programmatic and population-level outcomes. The excess all-cause mortality rate in 2020 in San Francisco was half that seen in 2019 in California as a whole (8% vs 16%). In almost all age and race and ethnicity groups, excess mortality from COVID-19 was lower in San Francisco than in California overall, with markedly diminished excess mortality among people aged >65 years. The COVID-19 response in San Francisco highlights crucial lessons, particularly the importance of community responsiveness, joint planning, and collective action, to inform future pandemic response and advance health equity.
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Affiliation(s)
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Diane V. Havlir
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua Schwab
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Trang Q. Nguyen
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Mary P. Mercer
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ayanna Bennett
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Andrea G. Tenner
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - James D. Marks
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - Naveena Bobba
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Susan Philip
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Grant Colfax
- San Francisco Department of Public Health, San Francisco, CA, USA
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3
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Scheer S, Orban O. Opportunities and Challenges in community-based inclusive science education. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
This research is part of a Horizon2020 funded project named C4S - Community for sciences. The project aims to implement co-created inclusive science activities with children 0-16 years and their families in vulnerable communities. Best practice strategies will be developed to promote the empowerment of children in vulnerable situations. In six European cities, community-based inclusive science activities will be realized and evaluated. What is the impact of inclusive science education on vulnerable communities' health in Europe? Why is community-based inclusive science education an urgent issue to improve health conditions of children and families?
Methods
Guided by the research questions this method includes an integrative literature review to explore barriers and facilitators to delivering inclusive science in European countries and a questionnaire delivered to 6 Hubs involved in the C4S project. The questionnaire identifies core elements of a community, e.g. “Joint action”, “social ties” and “Diversity”. Both the literature review and the community questionnaire are performed in co-creation with inclusive science activities.
Results
Preliminary findings of 214 bibliographical references show the importance and evidence of inclusive science education. When it comes to specific groups of people who are in vulnerable situations, only a few references could be identified. Most results are related to children with disabilities in comparison to children from ethnic minorities. However, ongoing discussions about intersectionality and decolonial theories were identified topics to answer our research questions.
Conclusions
The literature shows evidence about inclusive science but lack of specific information for specific target groups. Therefore, the questionnaire distributed to the Hubs may offer new perspectives and will lead to specific knowledge about communities' needs and resources to ensure inclusive science with and for children in vulnerable situations.
Key messages
• Inclusive and community-oriented science education is relevant to empower children in vulnerable situations.
• New perspectives and deeper knowledge about context specific factors that facilitate inclusive science education may contribute to sustainable health.
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Affiliation(s)
- S Scheer
- Health and Social Science, IB University of Applied Health and Social Science , Berlin, Germany
| | - O Orban
- Medical Faculty Department of Health Sciences, Lund University , Lund, Sweden
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Scheer S, Mondaca M. Unseen abilities – how refugee women with disabilities experience social participation. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the European context, refugee women especially those with physical disabilities are confronted by many unequal conditions that have an impact on their health and social wellbeing. To address these, it is important to understand refugees’ social participation and integration process. Furthermore, the purpose of the study is to identify refugee women's resources and their strengths in their everyday life that are related to current problems and needs.
Methods
This research project is embedded in occupational science theories which include the effect of social and environmental issues on an individual's health and wellbeing. An ethnographic, longitudinal study using visual and narrative methods was used to explore the phenomena of the everyday life and social participation possibilities of five refugee women with physical disabilities living in Stockholm, Sweden. Moreover, to illustrate the process of meaning-making, the frame of intersectionality was used within the whole research process.
Results
Through the lens of intersectionality, it was possible to determine gender, ableism, religion, and ethnicity issues as influencing factors concerning health and social participation. The women's narratives illustrate accessibility, e.g. public transport as a big resource in comparison to the country they came from. Still, to be a woman, a refugee, and having a disability at the same time is a challenge for social participation. One reason is less consideration of disabilities in the integration process. Having faith was mentioned as a safe place and using the public transport to independency. However, the women stress, that they want their abilities to be used instead of experiencing being limited by their disabilities.
Conclusions
In conclusion, the women emphasize being engaged in the hosting community. Health and social policymakers should consider the refugee women's voices to develop integration strategies with and not for refugee women with disabilities.
Key messages
• Through the lens of intersectionality, refugee women's narratives bring new insights about social participation.
• Refugee women with a disability want to engage in the hosting society and become active members.
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Affiliation(s)
- S Scheer
- Health and Social Science, IB University of Applied Health and Social Science , Berlin, Germany
| | - M Mondaca
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm, Sweden
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5
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Wilson EC, Hernandez CJ, Arayasirikul S, Scheer S, Trujillo D, Sicro S, Turner CM, McFarland W. In Their Own Words: How Trans Women Acquired HIV Infection. AIDS Behav 2022; 26:2091-2098. [PMID: 35031891 DOI: 10.1007/s10461-021-03555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
Despite high HIV prevalence, the reasons trans women acquire HIV are not well understood. Trans women are often mis-classified or aggregated with men who have sex with men (MSM) in epidemiologic studies and HIV surveillance data. Trans women enrolled in the 2019/2020 National HIV Behavioral Surveillance Study in San Francisco were asked an open-ended question about how they were infected with HIV. The most common responses were "Sex with a straight cisgender man partner when the respondent identified as a trans woman" (43.0%); "Sexual assault" (13.9%); "Injection drug use (IDU)" (10.1%); "IDU or sexual contact" (7.6%) and "Sex with a partner who injected drugs" (7.6%). Sex with a cisgender man partner prior to identifying as a trans women (MSM contact) was not mentioned by any respondent. HIV prevention strategies targeting MSM will fail to reach trans women and many of their cisgender men partners.
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Jackson A, Hernandez C, Scheer S, Sicro S, Trujillo D, Arayasirikul S, McFarland W, Wilson EC. Prevalence and Correlates of Violence Experienced by Trans Women. J Womens Health (Larchmt) 2022; 31:648-655. [PMID: 35576131 DOI: 10.1089/jwh.2021.0559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To measure the prevalence and correlates of intimate partner, physical, and sexual violence experienced by trans women. Materials and Methods: A National HIV Behavioral Surveillance (NHBS) Study of 201 trans women was conducted in San Francisco from July 2019 to February 2020 using respondent-driven sampling. Prevalence ratio tests were used to test differences in the prevalence of violence by demographic characteristics including housing status. Results: Among 201 trans women interviewed, 26.9% were currently homeless. In the past year, 59.7% had been homeless, 34.3% changed housing, 60.7% had a housing situation other than renting or owning. Experiences of violence were common: 36.8% experienced any form of violence, including sexual (16.9%), intimate partner (14.9%), and other physical (25.4%) in the past year. Experiences of violence were significantly associated with multiple measures of housing insecurity. Younger age, being misgendered, and substance use were also associated with experiences of violence. Conclusions: Trans women face dual crises in housing and violence. Affordable, subsidized, and safe housing has the potential to reduce the exposure and vulnerability to violence faced by trans women.
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Affiliation(s)
- Akira Jackson
- The Transgender Advocates for Justice and Accountability Coalition, San Leandro, California, USA
| | - Christopher Hernandez
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Sofia Sicro
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Dillon Trujillo
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Sean Arayasirikul
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin C Wilson
- Trans Research Unit for Equity, San Francisco Department of Public Health, San Francisco, California, USA
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Facente SN, Grebe E, Maher AD, Fox D, Scheer S, Mahy M, Dalal S, Lowrance D, Marsh K. Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review. JMIR Public Health Surveill 2022; 8:e34410. [PMID: 35275085 PMCID: PMC8956992 DOI: 10.2196/34410] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND HIV assays designed to detect recent infection, also known as "recency assays," are often used to estimate HIV incidence in a specific country, region, or subpopulation, alone or as part of recent infection testing algorithms (RITAs). Recently, many countries and organizations have become interested in using recency assays within case surveillance systems and routine HIV testing services to measure other indicators beyond incidence, generally referred to as "non-incidence surveillance use cases." OBJECTIVE This review aims to identify published evidence that can be used to validate methodological approaches to recency-based incidence estimation and non-incidence use cases. The evidence identified through this review will be used in the forthcoming technical guidance by the World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) on the use of HIV recency assays for identification of epidemic trends, whether for HIV incidence estimation or non-incidence indicators of recency. METHODS To identify the best methodological and field implementation practices for the use of recency assays to estimate HIV incidence and trends in recent infections for specific populations or geographic areas, we conducted a systematic review of the literature to (1) understand the use of recency testing for surveillance in programmatic and laboratory settings, (2) review methodologies for implementing recency testing for both incidence estimation and non-incidence use cases, and (3) assess the field performance characteristics of commercially available recency assays. RESULTS Among the 167 documents included in the final review, 91 (54.5%) focused on assay or algorithm performance or methodological descriptions, with high-quality evidence of accurate age- and sex-disaggregated HIV incidence estimation at national or regional levels in general population settings, but not at finer geographic levels for prevention prioritization. The remaining 76 (45.5%) described the field use of incidence assays including field-derived incidence (n=45), non-incidence (n=25), and both incidence and non-incidence use cases (n=6). The field use of incidence assays included integrating RITAs into routine surveillance and assisting with molecular genetic analyses, but evidence was generally weaker or only reported on what was done, without validation data or findings related to effectiveness of using non-incidence indicators calculated through the use of recency assays as a proxy for HIV incidence. CONCLUSIONS HIV recency assays have been widely validated for estimating HIV incidence in age- and sex-specific populations at national and subnational regional levels; however, there is a lack of evidence validating the accuracy and effectiveness of using recency assays to identify epidemic trends in non-incidence surveillance use cases. More research is needed to validate the use of recency assays within HIV testing services, to ensure findings can be accurately interpreted to guide prioritization of public health programming.
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Affiliation(s)
- Shelley N Facente
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.,Facente Consulting, Richmond, CA, United States.,Vitalant Research Institute, San Francisco, CA, United States
| | - Eduard Grebe
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.,Vitalant Research Institute, San Francisco, CA, United States.,South African Centre for Epidemiological Modeling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Andrew D Maher
- South African Centre for Epidemiological Modeling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Douglas Fox
- Facente Consulting, Richmond, CA, United States
| | | | - Mary Mahy
- Strategic Information Department, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - David Lowrance
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Kimberly Marsh
- Strategic Information Department, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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8
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Arayasirikul S, Turner C, Trujillo D, Sicro SL, Scheer S, McFarland W, Wilson EC. A global cautionary tale: discrimination and violence against trans women worsen despite investments in public resources and improvements in health insurance access and utilization of health care. Int J Equity Health 2022; 21:32. [PMID: 35241094 PMCID: PMC8896315 DOI: 10.1186/s12939-022-01632-5] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/11/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To determine if improvements in social determinants of health for trans women and decreases in transphobic discrimination and violence occurred over three study periods during which extensive local programs were implemented to specifically address longstanding inequities suffered by the transgender community. METHODS Interviewer-administered surveys from repeated cross-sectional Transwomen Empowered to Advance Community Health (TEACH) studies in 2010, 2013 and 2016-2017 in San Francisco collected experiences with transphobia violence and discrimination. Respondent-driven sampling was used to obtain a sample of participants who identified as a trans woman. RESULTS Violence due to gender identity was prevalent; in each study period, verbal abuse or harassment was reported by over 83% of participants, and physical abuse or harassment was reported by over 56%. Adverse social determinants of health including homelessness, living below the poverty limit, methamphetamine use, depression, PTSD, and anxiety all significantly increased from 2010 to 2016. When testing for trends, housing discrimination and physical violence were both more likely in 2016-2017 compared to the two earlier study periods. Housing discrimination (aOR 1.41, 95% CI 1.00-1.98) and physical violence due to gender identity/presentation (aOR 1.39, 95% CI 1.00-1.92) both significantly increased from 2010 to 2016. CONCLUSION Our findings are particularly alarming during a period when significant public health resources and community-based initiatives specifically for trans women were implemented and could have reasonably led us to expect improvements. Despite these efforts, physical violence and housing discrimination among trans women worsened during the study periods. To ensure future improvements, research and interventions need to shift the focus and burden from trans people to cisgender people who are the perpetuators of anti-trans sentiment, stigma, discrimination and victimization.
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Affiliation(s)
- Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA. .,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. .,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA, USA.
| | - Caitlin Turner
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Dillon Trujillo
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Sofia L. Sicro
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Susan Scheer
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA ,grid.266102.10000 0001 2297 6811Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 USA ,grid.266102.10000 0001 2297 6811Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA USA
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Wilson EC, Hernandez CJ, Scheer S, Trujillo D, Arayasirikul S, Sicro S, McFarland W. Improved PrEP Awareness and Use among Trans Women in San Francisco, California. AIDS Behav 2022; 26:596-603. [PMID: 34390435 PMCID: PMC8813678 DOI: 10.1007/s10461-021-03417-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
Transgender women face a serious risk of HIV infection. Despite this, there is limited knowledge and use of Pre-exposure prophylaxis (PrEP). We measured the continuity of prevention across services in the PrEP cascade and correlates of PrEP use among trans women in San Francisco enrolled in the 2019/20 National HIV Behavioral Surveillance Study. Knowledge and use of PrEP among trans women in San Francisco increased in recent years; almost all (94.0%) had heard about PrEP, 64.7% had discussed PrEP with a healthcare provider, and 44.8% had taken PrEP in the past 12 months. PrEP use was associated with participation in a PrEP demonstration project (aOR = 31.44, p = 0.001) and condomless receptive anal intercourse (aOR = 3.63, p = 0.024). Injection drug use was negatively associated (aOR = 0.19, p = 0.014). Efforts are needed to combat the gender-based stigma and discrimination faced by trans women, which can result in avoidance and mistrust of the medical system.
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Affiliation(s)
- Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA.
| | - Christopher J Hernandez
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Dillon Trujillo
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Sofia Sicro
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA, USA
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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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11
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Benbow ND, Mokotoff ED, Dombrowski JC, Wohl AR, Scheer S. The HIV Treat Pillar: An Update and Summary of Promising Approaches. Am J Prev Med 2021; 61:S39-S46. [PMID: 34686289 DOI: 10.1016/j.amepre.2021.05.028] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/22/2023]
Abstract
The Treat pillar of the Ending the HIV Epidemic in the U.S. plan calls for comprehensive strategies to enhance linkage to, and engagement in, HIV medical care to improve viral suppression among people with HIV and achieve the goal of 95% viral suppression by 2025. The U.S. has seen large increases in the proportion of people with HIV who have a suppressed viral load. Viral suppression has increased 41%, from 46% in 2010 to 65% in 2018. An additional increase of 46% is needed to meet the Ending the HIV Epidemic in the U.S. goal. The rate of viral suppression among those in care increased to 85% in 2018, highlighting the need to ensure sustained care for people with HIV. Greater increases in all steps along the HIV care continuum are needed for those disproportionately impacted by HIV, especially the young, sexual and racial/ethnic minorities, people experiencing homelessness, and people who inject drugs. Informed by systematic reviews and current research findings, this paper describes more recent promising practices that suggest an impact on HIV care outcomes. It highlights rapid linkage and treatment interventions; interventions that identify and re-engage people in HIV care through new collaborations among health departments, providers, and hospital systems; coordinated care and low-barrier clinic models; and telemedicine-delivered HIV care approaches. The interventions presented in this paper provide additional approaches that state and local jurisdictions can use to reach their local HIV elimination plans' goals and the ambitious Ending the HIV Epidemic in the U.S. Treat pillar targets by 2030.
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Affiliation(s)
- Nanette D Benbow
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | | | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington; Public Health - Seattle & King County, Seattle, Washington
| | - Amy R Wohl
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California
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12
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Bacon O, Chin J, Cohen SE, Hessol NA, Sachdev D, Coffey S, Scheer S, Buchbinder S, Havlir DV, Hsu L. Decreased Time From Human Immunodeficiency Virus Diagnosis to Care, Antiretroviral Therapy Initiation, and Virologic Suppression during the Citywide RAPID Initiative in San Francisco. Clin Infect Dis 2021; 73:e122-e128. [PMID: 32449916 PMCID: PMC8561247 DOI: 10.1093/cid/ciaa620] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/22/2019] [Accepted: 05/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early virologic suppression (VS) after human immunodeficiency virus (HIV) infection improves individual health outcomes and decreases onward transmission. In San Francisco, immediate antiretroviral therapy (ART) at HIV diagnosis was piloted in 2013-2014 and expanded citywide in 2015 in a rapid start initiative to link all new diagnoses to care within 5 days and start ART at the first care visit. METHODS HIV providers and linkage navigators were trained on a rapid start protocol with sites caring for vulnerable populations prioritized. Dates of HIV diagnosis, first care visit, ART initiation, and VS were abstracted from the San Francisco Department of Public Health HIV surveillance registry. RESULTS During 2013-2017, among 1354 new HIV diagnoses in San Francisco, median days from diagnosis to first VS decreased from 145 to 76 (48%; P < .0001) and from first care visit to ART initiation decreased from 28 to 1 (96%; P < .0001). By 2017, 28% of new diagnoses had a rapid start, which was independently associated with Latinx ethnicity (AOR, 1.73; 95% CI, 1.15-2.60) and recent year of diagnosis (2017; AOR, 16.84; 95% CI, 8.03-35.33). Persons with a rapid ART start were more likely to be virologically suppressed within 12 months of diagnosis than those with a non-rapid start (RR, 1.17; 95% CI, 1.10-1.24). CONCLUSIONS During a multisector initiative to optimize ART initiation, median time from diagnosis to VS decreased by nearly half. Immediate ART at care initiation was achieved across many, but not all, populations, and was associated with improved suppression rates.
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Affiliation(s)
- Oliver Bacon
- San Francisco City Clinic, Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jennie Chin
- HIV Surveillance Unit, Applied Research, Community Health Epidemiology and Surveillance (ARCHES), San Francisco Department of Public Health, San Francisco, California, USA
| | - Stephanie E Cohen
- San Francisco City Clinic, Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Nancy A Hessol
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Darpun Sachdev
- San Francisco City Clinic, Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Susa Coffey
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Susan Scheer
- HIV Surveillance Unit, Applied Research, Community Health Epidemiology and Surveillance (ARCHES), San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Buchbinder
- BridgeHIV, San Francisco Department of Public Health, San Francisco, California, USA
| | - Diane V Havlir
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ling Hsu
- HIV Surveillance Unit, Applied Research, Community Health Epidemiology and Surveillance (ARCHES), San Francisco Department of Public Health, San Francisco, California, USA
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Sachdev DD, Cohen SE, Scheer S. Factors Contributing to Missing COVID-19 Cases During Contact Tracing-Reply. JAMA Intern Med 2021; 181:1015. [PMID: 33720284 DOI: 10.1001/jamainternmed.2021.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Darpun D Sachdev
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Stephanie E Cohen
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Susan Scheer
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
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14
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O'Keefe KJ, Pipkin S, Fatch R, Scheer S, Liegler T, McFarland W, Grant RM, Truong HHM. Non-B variants of HIV-1 in San Francisco, California. Infect Genet Evol 2021; 90:104677. [PMID: 33321227 PMCID: PMC10686190 DOI: 10.1016/j.meegid.2020.104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
The HIV-1 epidemic in the US has historically been dominated by subtype B. HIV subtype diversity has not been extensively examined in most US cities to determine whether non-B variants have become established, as has been observed in many other global regions. We describe the diversity of non-B variants and present evidence of local transmission of non-B HIV in San Francisco. Viral sequences collected from patients between 2000 and 2016 were matched to the San Francisco HIV/AIDS case registry. HIV subtype was determined using COMET. Phylogenies were reconstructed using the pol region of subtypes A, C, D, G, CRF01_AE, CRF02_AG, and CRF07_BC, with reference sequences from the LANL HIV database. Associations of non-B subtypes and circulating recombinant forms (CRFs) with patient characteristics were assessed using multivariable logistic regression. Out of 11,381 sequences, 10,669 were from 7235 registry cases, of which 141 (2%) had non-B subtypes and CRFs and 72 (1%) had unique recombinant forms. CRF01_AE (0.8%) and subtype C (0.5%) were the most prevalent non-B forms. The frequency of non-B subtypes and CRFs increased in San Francisco during years 2000-2016. Out of 146 transmission events involving non-B study sequences, 18% indicated local transmission within the study population and 74% appeared to be inward migration of the virus. Compared to 7016 cases with only subtype B, 141 cases with non-B sequences were more likely to be of non-US country of birth (aOR = 11.02; p < 0.001), of Asian/Pacific-Islander race/ethnicity (aOR = 3.17; p < 0.001), and diagnosed after 2009 (aOR = 4.81; p < 0.001). Results suggest that most non-B infections were likely acquired outside the US and that local transmission of non-B forms has occurred but so far has not produced extensive transmission networks. Thus, non-B variants were not widely established in San Francisco, an observation that differs from cities worldwide with more diverse epidemics.
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Affiliation(s)
- Kara J O'Keefe
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
| | - Sharon Pipkin
- Department of Public Health, San Francisco, CA 94102, USA.
| | - Robin Fatch
- Department of Epidemiology and Biostatistics, University of California, San Francisco 94158, USA.
| | - Susan Scheer
- Department of Public Health, San Francisco, CA 94102, USA.
| | - Teri Liegler
- Department of Medicine, University of California, San Francisco, CA 94158, USA
| | - Willi McFarland
- Department of Public Health, San Francisco, CA 94102, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco 94158, USA.
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
| | - Hong-Ha M Truong
- Department of Medicine, University of California, San Francisco, CA 94158, USA.
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15
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Spinelli MA, Hessol NA, Schwarcz SK, Scheer S, Gandhi M, Chin Hsu L. Disparities in Integrase Inhibitor Usage in the Modern HIV Treatment Era: A Population-Based Study in a US City. Open Forum Infect Dis 2021; 8:ofab139. [PMID: 34250184 PMCID: PMC8266565 DOI: 10.1093/ofid/ofab139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/18/2021] [Indexed: 11/14/2022] Open
Abstract
Integrase inhibitor–based (INSTI) antiretroviral therapy (ART) regimens are preferred for most people with HIV (PWH). We examined factors associated with INSTI use among PWH in San Francisco who started ART in 2009–2016. PWH who experienced homelessness were less likely, and older PWH were more likely, to use an INSTI.
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Affiliation(s)
- Matthew A Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nancy A Hessol
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Sandra K Schwarcz
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California, USA.,San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ling Chin Hsu
- San Francisco Department of Public Health, San Francisco, California, USA
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16
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Scheer S, LeSarre M, Liebi C, Havlir D, Buchbinder S. Progress in HIV care outcomes among Black men in San Francisco. Lancet HIV 2021; 8:e126. [PMID: 33662263 DOI: 10.1016/s2352-3018(21)00026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Susan Scheer
- HIV Epidemiology and Surveillance Section, San Francisco Department of Public Health, San Francisco, CA 94102, USA.
| | - Monique LeSarre
- Rafiki Coalition for Health and Wellness, San Francisco, CA, USA
| | - Courtney Liebi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA 94102, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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17
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Sachdev DD, Brosnan HK, Reid MJA, Kirian M, Cohen SE, Nguyen TQ, Scheer S. Outcomes of Contact Tracing in San Francisco, California-Test and Trace During Shelter-in-Place. JAMA Intern Med 2021; 181:381-383. [PMID: 33136116 PMCID: PMC7607488 DOI: 10.1001/jamainternmed.2020.5670] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This case series evaluates case investigation and contact tracing outcomes in San Francisco, California, during shelter-in-place restrictions during the COVID-19 pandemic.
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Affiliation(s)
- Darpun D Sachdev
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Hannah K Brosnan
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Michael J A Reid
- Institute for Global Health Sciences, University of California, San Francisco
| | - Michelle Kirian
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Stephanie E Cohen
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Trang Q Nguyen
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Susan Scheer
- Population Health Division, San Francisco Department of Public Health, San Francisco, California
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18
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Sachdev D, Mara E, Hsu L, Scheer S, Rutherford G, Enanoria W, Gandhi M. COVID-19 Susceptibility and Outcomes Among People Living With HIV in San Francisco. J Acquir Immune Defic Syndr 2021; 86:19-21. [PMID: 33044323 PMCID: PMC7727319 DOI: 10.1097/qai.0000000000002531] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Studies to examine whether HIV predisposes to a higher incidence of COVID-19 or more severe disease are accumulating. Initial studies from New York City suggested more severe disease among people living with HIV (PLWH), but this was during a time when hospitals were over-capacity and health systems stretched. This report presents the incidence and outcomes among PLWH with COVID-19 in San Francisco over the first 6 months of the pandemic. METHODS Community transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was first reported in San Francisco on March 5, 2020. This report examines the match of the San Francisco Department of Public Health COVID-19 testing database and the San Francisco Department of Public Health HIV Surveillance case registry from March 24, 2020, to September 3, 2020. RESULTS Among 4252 COVID-19 tests performed among PLWH, 4.5% (N = 193) were positive for COVID-19, compared with a 3.5% (N = 9626) positivity rate among the 272,555 people without HIV tested for COVID-19 (P < 0.001). The mean age of those infected with HIV/COVID-19 was 48 years (20-76), 38.9% White, 38.3% Latinx, 11.9% Black, and 91.2% were men. Only 54.6% of coinfected PLWH were housed, with the remainder marginally housed. The rate of severe illness with COVID-19 was not increased among PLWH. DISCUSSION In San Francisco, susceptibility to COVID-19 was increased among PLWH over the first 6 months of the pandemic, although clinical outcomes were similar to those without HIV. Homelessness and higher rates of congregate living situations among PLWH likely accounted for this disparity. Special efforts to house patients with marginal housing during the COVID-19 pandemic are needed.
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Affiliation(s)
- Darpun Sachdev
- San Francisco Department of Public Health, Population Health Division, Disease Prevention and Control Branch, San Francisco, CA
| | - Elise Mara
- San Francisco Department of Public Health, Population Health Division, Applied Research, Community Health Epidemiology and Surveillance Branch, San Francisco, CA
| | - Ling Hsu
- San Francisco Department of Public Health, Population Health Division, Applied Research, Community Health Epidemiology and Surveillance Branch, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, Population Health Division, Applied Research, Community Health Epidemiology and Surveillance Branch, San Francisco, CA
| | - George Rutherford
- Division of Epidemiology and Biostatistics, Department of Medicine, University of California San Francisco, San Francisco, CA; and
| | - Wayne Enanoria
- Division of Epidemiology and Biostatistics, Department of Medicine, University of California San Francisco, San Francisco, CA; and
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
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19
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Sachdev DD, Mara E, Hughes AJ, Antunez E, Kohn R, Cohen S, Scheer S. "Is a Bird in the Hand Worth 5 in the Bush?": A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco. Open Forum Infect Dis 2020; 7:ofaa369. [PMID: 32995350 PMCID: PMC7505526 DOI: 10.1093/ofid/ofaa369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Health departments utilize HIV surveillance data to identify people with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective, and efficient method of identifying PWH for re-linkage is unknown. Methods We evaluated referral and care continuum outcomes among PWH identified using 3 D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurements in the 12 months after re-linkage. Results After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the numbers of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance, and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. Conclusions PWH referred by providers were more likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression, and durable viral suppression.
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Affiliation(s)
- Darpun D Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Elise Mara
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Alison J Hughes
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin Antunez
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Robert Kohn
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Stephanie Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
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Wilson EC, Turner CM, Arayasirikul S, Lightfoot M, Scheer S, Raymond HF, Liu A. Disparities in the PrEP continuum for trans women compared to MSM in San Francisco, California: results from population-based cross-sectional behavioural surveillance studies. J Int AIDS Soc 2020; 23 Suppl 3:e25539. [PMID: 32602642 PMCID: PMC7325513 DOI: 10.1002/jia2.25539] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/27/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Although transgender women (trans women) often are conflated with men who have sex with men (MSM) in HIV research and services, there are distinct population differences that are important for implementing effective HIV prevention. Our objective was to examine pre-exposure prophylaxis (PrEP) disparities between the two populations and compare individual, social and structural factors that influence differences between MSM and trans women along the PrEP continuum. METHODS We analysed data from two population-based studies, one with trans women (Trans*National Study, 2016 - 18) and the other with MSM (National HIV Behavioral Surveillance, 2017). Trans women were recruited via respondent-driven sampling and MSM using time location sampling. Key indicators of the PrEP continuum were evaluated, including awareness, health insurance, provider discussions, recent use and adherence. Associations were also examined for PrEP continuum indicators and structural barriers (e.g. employment, homelessness). RESULTS Transwomen were more likely than MSM to be Latino/a (30.4% vs. 25.8%; prevalence ratio (PR)=1.08, 95% CI 1.02 to 1.14) or African American (7.1% vs. 4.5%; PR = 1.12, 1.02 to 1.24), live at or below the poverty limit (70.7% vs. 15.8%; PR = 1.47; 1.41 to 1.53), be unemployed (50.1% vs. 26.3%; PR = 1.18, 1.13 to 1.24), be homeless (8.4% vs. 3.5%; PR = 1.15, 1.06 to 1.25) and to have less than a college degree (PR = 1.41, 1.34 to 1.48). Trans women were more likely than MSM to have health insurance (95.7% vs. 89.7%, PR = 1.17, 1.06 to 1.28), but less likely than MSM to have heard of PrEP (79.1% vs. 96.7%; PR = 0.77, 0.73 to 0.81), talked with a provider about PrEP (35.5% vs. 54.9%; PR = 0.87, 0.83 to 0.91) and less likely than MSM to have used PrEP in the past six months (14.6% vs. 39.8%; PR = 0.80, 0.76 to 0.84). Among PrEP users, trans women were less likely to report being adherent to PrEP than MSM (70.4% vs. 87.4%; PR = 0.80, 0.70 to 0.91). CONCLUSIONS We found PrEP disparities for trans women compared to MSM and the need for differentiated implementation strategies to meet the specific PrEP barriers trans women face. Inclusion of trans women's HIV risks is needed in CDC guidance for PrEP. Interventions to increase trans women's awareness of PrEP including at the provider and community level are also needed. Finally, programming that addresses trans women's barriers to housing and income is also needed to reduce PrEP disparities.
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Affiliation(s)
- Erin C Wilson
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
| | - Caitlin M Turner
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
| | - Sean Arayasirikul
- Center for Public Health ResearchSan Francisco Department of Public HealthSan FranciscoCAUSA
| | - Marguerita Lightfoot
- Division of Prevention ScienceCenter for AIDS Prevention StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Susan Scheer
- HIV EpidemiologySan Francisco Department of Public HealthSan FranciscoCAUSA
| | | | - Albert Liu
- Bridge HIVSan Francisco Department of Public HealthSan FranciscoCAUSA
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21
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Mera R, Scheer S, Carter C, Das M, Asubonteng J, McCallister S, Baeten J. Estimation of new HIV diagnosis rates among high-risk, PrEP-eligible individuals using HIV surveillance data at the Metropolitan Statistical Area level in the United States. J Int AIDS Soc 2020; 22:e25433. [PMID: 31860171 PMCID: PMC7086379 DOI: 10.1002/jia2.25433] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION New HIV diagnoses have fallen in the past decade due to increased HIV testing, earlier diagnosis, earlier antiretroviral treatment, improved linkage to care and engagement in care, and the recent increased uptake of pre-exposure prophylaxis (PrEP). We propose a novel method to compute the rate of new HIV diagnoses at the Metropolitan Statistical Area (MSA) level in the US to support the evaluation of comprehensive treatment and prevention efforts over time. METHODS The number of new HIV diagnoses, number of individuals with a PrEP indication and aggregated person-time exposed to PrEP during the years 2012 to 2017 were used to compute a new HIV diagnosis rate for people at risk of HIV excluding those already on PrEP for the 105 MSAs in the US with published HIV surveillance data. In our calculation of person-time with a PrEP indication, time-at-risk excluded time on PrEP and time after an HIV diagnosis. We used a multivariate Poisson regression model to estimate HIV diagnosis rates by year and location. RESULTS From 2012 to 2017, the aggregate HIV diagnoses rate among high-risk individuals with an indication for PrEP in the 105 MSAs decreased from 4.14 per 100 person-years (PY) (95% CI 4.10 to 4.19) to 3.26 per 100 PY (95% CI 3.22 to 3.30). For the 25 US MSAs that overlapped with an ongoing large randomized clinical trial of PrEP in men who have sex with men (MSM), the HIV diagnosis rate from 2012 to 2017 decreased from 4.86 per 100 PY (95% CI 4.80 to 4.93) to 3.61 per 100 PY (95% CI 3.56 to 3.66), a decline that was more rapid than in non-study MSAs (IRR for trial site 1.19, 95% CI 1.18 to 1.20). CONCLUSIONS We propose a model to estimate the background HIV diagnosis rate in people at risk for HIV and with a PrEP indication in US MSAs (excluding those on PrEP) using publically available surveillance data which can evaluate trends over time. Data generated using this methodology could be used by policy makers and local HIV prevention specialists to evaluate and monitor their prevention efforts for the population at risk in their communities.
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Affiliation(s)
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | | | | | | | - Jared Baeten
- Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, WA, USA
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22
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Hessol NA, Eng M, Vu A, Pipkin S, Hsu LC, Scheer S. A longitudinal study assessing differences in causes of death among housed and homeless people diagnosed with HIV in San Francisco. BMC Public Health 2019; 19:1440. [PMID: 31675932 PMCID: PMC6825332 DOI: 10.1186/s12889-019-7817-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/21/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.
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Affiliation(s)
- Nancy A Hessol
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA.
| | - Monica Eng
- Department of Clinical Pharmacy, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94118, USA
| | - Annie Vu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Sharon Pipkin
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Ling C Hsu
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Susan Scheer
- Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
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Hughes AJ, Scheer S. Evidence of Sexually Transmitted Disease Testing Outside of Primary Human Immunodeficiency Virus Care for People Living With Human Immunodeficiency Virus in San Francisco, California. Clin Infect Dis 2019; 66:485-486. [PMID: 29020231 DOI: 10.1093/cid/cix795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Susan Scheer
- San Francisco Department of Public Health, California
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Wei SC, Messina L, Hood J, Hughes A, Jaenicke T, Johnson K, Mena L, Scheer S, Udeagu CC, Wohl A, Robertson M, Prejean J, Chen M, Tang T, Bertolli J, Johnson CH, Skarbinski J. Methods to include persons living with HIV not receiving HIV care in the Medical Monitoring Project. PLoS One 2019; 14:e0219996. [PMID: 31369574 PMCID: PMC6675081 DOI: 10.1371/journal.pone.0219996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/18/2019] [Accepted: 07/05/2019] [Indexed: 11/18/2022] Open
Abstract
The Medical Monitoring Project (MMP) is an HIV surveillance system that provides national estimates of HIV-related behaviors and clinical outcomes. When first implemented, MMP excluded persons living with HIV not receiving HIV care. This analysis will describe new case-surveillance-based methods to identify and recruit persons living with HIV who are out of care and at elevated risk for mortality and ongoing HIV transmission. Stratified random samples of all persons living with HIV were selected from the National HIV Surveillance System in five public health jurisdictions from 2012–2014. Sampled persons were located and contacted through seven different data sources and five methods of contact to collect interviews and medical record abstractions. Data were weighted for non-response and case reporting delay. The modified sampling methodology yielded 1159 interviews (adjusted response rate, 44.5%) and matching medical record abstractions for 1087 (93.8%). Of persons with both interview and medical record data, 264 (24.3%) would not have been included using prior MMP methods. Significant predictors were identified for successful contact (e.g., retention in care, adjusted Odds Ratio [aOR] 5.02; 95% Confidence Interval [CI] 1.98–12.73), interview (e.g. moving out of jurisdiction, aOR 0.24; 95% CI: 0.12–0.46) and case reporting delay (e.g. rural residence, aOR 3.18; 95% CI: 2.09–4.85). Case-surveillance-based sampling resulted in a comparable response rate to existing MMP methods while providing information on an important new population. These methods have since been adopted by the nationally representative MMP surveillance system, offering a model for public health program, research and surveillance endeavors seeking inclusion of all persons living with HIV.
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Affiliation(s)
- Stanley C. Wei
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Lauren Messina
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Julia Hood
- Prevention Division, Public Health Seattle and King County, Seattle, Washington, United States of America
| | - Alison Hughes
- HIV Epidemiology and Surveillance Section, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Thomas Jaenicke
- Office of Infectious Disease, Washington State Department of Health, Tumwater, Washington, United States of America
| | - Kendra Johnson
- STD/HIV Office, Mississippi State Department of Health, Jackson, Mississippi, United States of America
| | - Leandro Mena
- STD/HIV Office, Mississippi State Department of Health, Jackson, Mississippi, United States of America
| | - Susan Scheer
- HIV Epidemiology and Surveillance Section, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Chi-Chi Udeagu
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, New York, United States of America
| | - Amy Wohl
- Program Evaluation Unit, Los Angeles County Department of Public Health, Los Angeles, California, United States of America
| | - McKaylee Robertson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - Joseph Prejean
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mi Chen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tian Tang
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanne Bertolli
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher H. Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Truong HHM, Pipkin S, Grant RM, Liegler T, O'Keefe KJ, Scheer S. Increased uptake of early initiation of antiretroviral therapy and baseline drug resistance testing in San Francisco between 2001 and 2015. PLoS One 2019; 14:e0213167. [PMID: 30870438 PMCID: PMC6417784 DOI: 10.1371/journal.pone.0213167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Early initiation of antiretroviral therapy (eiART) can improve clinical outcomes for persons with HIV and reduce onward transmission risk. Baseline drug resistance testing (bDRT) can inform regimen selection upon subsequent treatment initiation. We examined the uptake of eiART and bDRT within 3 months and 30 days of HIV diagnosis. Methods We analyzed a population-based sample from the San Francisco Department of Public Health HIV/AIDS Case Registry of newly-diagnosed HIV/non-AIDS individuals between 2001 and 2015 who received care at publicly-funded facilities (N = 3,124). Results Uptake of eiART within 3 months of diagnosis increased significantly from 2001 to 2015 (p<0.001), peaking at 74% in 2015. bDRT uptake also increased significantly (p<0.001), peaking at 55% in 2012. eiART uptake was observed to be significantly associated with gender, age, race/ethnicity and transmission risk. There were no significant differences observed in demographic and risk characteristics of persons receiving bDRT in the more recent years. Of 990 persons diagnosed between 2010 and 2015, eiART uptake within 30 days of diagnosis increased from 13% to 38% (p<0.001); bDRT uptake increased from 35% to 39% but the change was not significant (p = 0.141). Conclusions Observed increases in eiART and bDRT uptake from 2010 to 2015 may reflect the adoption of treatment as prevention and a local public health policy statement in 2010 recommending treatment initiation at time of diagnosis irrespective of CD4 count. Concerns about stigma may underlie disparities in eiART, however such concerns would not bear as directly on a provider-initiated laboratory test like bDRT.
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Affiliation(s)
- Hong-Ha M Truong
- Department of Medicine, University of California, San Francisco, United States of America.,Gladstone Institute of Virology and Immunology, San Francisco, United States of America
| | - Sharon Pipkin
- Department of Public Health, San Francisco, United States of America
| | - Robert M Grant
- Department of Medicine, University of California, San Francisco, United States of America.,Gladstone Institute of Virology and Immunology, San Francisco, United States of America
| | - Teri Liegler
- Department of Medicine, University of California, San Francisco, United States of America
| | - Kara J O'Keefe
- Department of Public Health, San Francisco, United States of America
| | - Susan Scheer
- Department of Public Health, San Francisco, United States of America
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26
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Cohen SE, Sachdev D, Lee SA, Scheer S, Bacon O, Chen MJ, Okochi H, Anderson PL, Kearney MF, Coffey S, Scott H, Grant RM, Havlir D, Gandhi M. Acquisition of tenofovir-susceptible, emtricitabine-resistant HIV despite high adherence to daily pre-exposure prophylaxis: a case report. Lancet HIV 2018; 6:S2352-3018(18)30288-1. [PMID: 30503324 PMCID: PMC6541554 DOI: 10.1016/s2352-3018(18)30288-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 04/08/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate is highly protective against HIV infection. We report a case of tenofovir-susceptible, emtricitabine-resistant HIV acquisition despite high adherence to daily PrEP. METHODS Adherence to PrEP was assessed by measuring concentrations of emtricitabine and tenofovir disoproxil fumarate or their metabolites in plasma, dried blood spots, and hair. After seroconversion, genotypic and phenotypic resistance of the acquired virus was determined by standard clinical tests and by single-genome sequencing of proviral genomes. HIV partner services identified the likely transmission partner. FINDINGS A 21-year-old Latino man tested positive for HIV infection 13 months after PrEP initiation. He had a negative HIV antibody test, but detectable HIV RNA with 559 copies per mL. He reported good adherence to daily PrEP. He was linked to care and immediately started antiretroviral therapy, at which point his RNA was 1544 copies per mL and his HIV antibody test was positive. The HIV genotype revealed Met184Val, Leu74Val, Leu100Ile, and Lys103Asn mutations in reverse transcriptase, and the phenotype showed susceptibility to tenofovir disoproxil fumarate and resistance to emtricitabine. Segmental hair analysis of tenofovir disoproxil fumarate concentrations measured in 1 cm segments of hair from the scalp indicated consistently high adherence to PrEP in each of the 6 months before HIV diagnosis (0·0672-0·0889 ng/mg). Concentrations of tenofovir diphosphate (1012 fmol per punch) and emtricitabine triphosphate (0·266 fmol per punch) in a dried blood spot indicated high adherence over the preceding 6 weeks. Concentrations of emtricitabine (870·5 ng/mL) and tenofovir disoproxil fumarate (188·2 ng/mL) measured in plasma 3 months before HIV seroconversion confirmed adherence in the days preceding that visit. The likely transmission partner was not engaged in HIV primary care and had a similar viral genotype. INTERPRETATION Acquisition of HIV virus that is susceptible to tenofovir disoproxil fumarate, but resistant to emtricitabine can occur despite high adherence to PrEP. Quarterly screening for HIV and sexually transmitted diseases facilitates early diagnosis in people on PrEP; when combined with prompt linkage to care and partner services this can prevent onward transmission of HIV. FUNDING US National Institutes of Health.
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Affiliation(s)
- Stephanie E Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA.
| | - Darpun Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Sulggi A Lee
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Oliver Bacon
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Miao-Jung Chen
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Hideaki Okochi
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Peter L Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Mary F Kearney
- HIV Dynamics and Replication Program, National Cancer Institute at Frederick, Frederick, MD, USA
| | - Susa Coffey
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Grant
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
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Cohen SE, Sachdev D, Lee S, Scheer S, Bacon O, Chen MJ, Norvell CO, Okochi H, Anderson P, Coffey S, Scott H, Havlir D, Gandhi M. 1298. Acquisition of TDF-Susceptible HIV Despite High Level Adherence to Daily TDF/FTC PrEP as Measured by Dried Blood Spot (DBS) and Segmental Hair Analysis: A Case Report. Open Forum Infect Dis 2018. [PMCID: PMC6252599 DOI: 10.1093/ofid/ofy210.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (TFV) disoproxil fumarate (FTC/TDF) is highly protective against HIV infection. We report the second case of acquisition of TDF-susceptible HIV despite high adherence to PrEP, confirmed by drug level testing. Methods PrEP adherence was assessed by measuring FTC/TDF metabolites in dried blood spots (DBS) and FTC/TFV concentrations in segments of scalp hair. Genotypic and phenotypic resistance were evaluated. HIV partner services (PS) and HIV sequences reported to HIV surveillance with a genetic distance ≤1.5% (by HIV-Trace) identified likely transmission partners. Results A 21-year-old Latino man presented 13 months after PrEP initiation. He was HIV negative by rapid HIV antibody (Ab) and HIV RNA pooling (detection limit ~40 copies/mL) at PrEP initiation and at months 3, 6, and 10. At the 13-month visit, he was asymptomatic and his rapid HIV Ab was negative. Five days later, his HIV RNA was reported as positive (559 copies/mL). He was notified of the result, linked to care and immediately started antiretroviral treatment (ART), at which point his RNA was 1544 copies/mL and his HIV Ab test was positive. The HIV genotype had M184V, L74V and K103N mutations and phenotypic susceptibility to TDF. TFV/FTC levels by LC-MS/MS measured in 1 cm segments of hair collected at ART initiation indicated consistently high PrEP adherence in each of the preceding 6 months. TFV-diphosphate and FTC-triphosphate levels in DBS collected 2 days after ART initiation were 1012 fmol/punch and 0.266 pmol/punch, confirming high adherence over the preceding 6 weeks. Between PrEP initiation and HIV acquisition, he had 1 episode of urethral chlamydia and three episodes of urethral gonorrhea. The likely transmission partner, named during PS, had no history of viral suppression in HIV surveillance and harbored the same resistance mutations, with a genetic distance between the two patients of 0.66%. The partner was re-linked to care and had a current HIV RNA of 15,130 copies/mL. Conclusion Acquisition of TDF-susceptible HIV infection can occur despite high PrEP adherence. Quarterly HIV and STD screening of patients on PrEP, combined with prompt linkage to care and PS for those diagnosed with HIV, facilitates early diagnosis and prevents further transmission of HIV. Disclosures S. E. Cohen, Gilead: Investigator in PrEP study for which Gilead donated drug, donated study drug and paid for drug testing during the PrEP demo project, of which I was a co-PI (the study has ended). S. Lee, Viiv Healthcare: Investigator, Research grant. Gilead Sciences: Investigator, Research grant. P. Anderson, Gilead: Consultant and Investigator, funds were paid to the institution for contract work and grant support and Research support. D. Havlir, Gilead: Investigator, Gilead Sciences provides antiretroviral therapy for a NIH funded study that she is conducting and Research support.
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Affiliation(s)
- Stephanie E Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California
| | - Darpun Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California
| | - Sulggi Lee
- Division of HIV, Infectious Diseases and Global Medicine, UCSF, San Francisco, California
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California
| | - Oliver Bacon
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California
| | - Miao-Jung Chen
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California
| | | | - Hideaki Okochi
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, UCSF, San Francisco, California
| | - Peter Anderson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Susa Coffey
- Division of HIV, Infectious Diseases and Global Medicine, UCSF, San Francisco, California
| | - Hyman Scott
- Division of HIV, Infectious Diseases and Global Medicine, UCSF, San Francisco, California
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, UCSF, San Francisco, California
| | - Monica Gandhi
- Medicine, Division of HIV, Infectious Diseases and Global Medicine, UCSF, San Francisco, California
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Hessol NA, Whittemore H, Vittinghoff E, Hsu LC, Ma D, Scheer S, Schwarcz SK. Incidence of first and second primary cancers diagnosed among people with HIV, 1985-2013: a population-based, registry linkage study. Lancet HIV 2018; 5:e647-e655. [PMID: 30245004 DOI: 10.1016/s2352-3018(18)30179-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer survivors are at increased risk for subsequent primary cancers. People living with HIV are at increased risk for AIDS-defining and non-AIDS-defining cancers, but little is known about their risk of first versus second primary cancers. We identified first and second primary cancers that occurred in above population expected numbers among people diagnosed with HIV in San Francisco, and compared first and second cancer incidence across five time periods that corresponded to important advances in antiretroviral therapy. METHODS In this population-based study, we used the San Francisco HIV/AIDS case registry to identify people aged 16 years and older who were diagnosed with HIV/AIDS in San Francisco (CA, USA) between Jan 1, 1990, and Dec 31, 2010. We computer-matched records from the registry with the California Cancer Registry to identify primary cancers diagnosed between Jan 1, 1985, and Dec 31, 2013. We calculated year, age, sex, and race adjusted standardised incidence ratios with exact 95% CIs and trends in incidence of first and second AIDS-defining and non-AIDS-defining cancers from 1985 to 2013. FINDINGS Of the 22 623 people diagnosed with HIV between Jan 1, 1990, and Dec 31, 2010, we identified 5655 incident primary cancers. We excluded 48 cancers with invalid cancer sequence numbers and 1062 in-situ anal cancers, leaving 4545 incident primary cancers, comprising 4144 first primary cancers, 372 second primary cancers, 26 third primary cancers, and three fourth or later primary cancers. First primary cancer standardised incidence ratios were elevated for Kaposi sarcoma (127, 95% CI 121-132), non-Hodgkin lymphoma (17·2, 16·1-18·4), invasive cervical cancer (8·0, 4·1-11·9), anal cancer (46·7, 39·7-53·6), vulvar cancer (13·3, 6·1-20·6), Hodgkin's lymphoma (10·4, 8·4-12·5), eye and orbit cancer (4·2, 1·4-6·9), lip cancer (3·8, 1·3-6·2), penile cancer (3·8, 1·4-6·1), liver cancer (3·0, 2·3-3·7), miscellaneous cancer (2·3, 1·7-3·0), testicular cancer (2·0, 1·4-2·6), tongue cancer (1·9, 1·1-2·7), and lung cancer (1·3, 95% CI 1·1-1·6). Second primary cancer risks were increased for Kaposi sarcoma (28·0, 95% CI 20·2-35·9), anal cancer (17·0, 10·2-23·8), non-Hodgkin lymphoma (11·1, 9·3-12·8), Hodgkin's lymphoma (5·4, 1·1-9·7), and liver cancer (3·6, 1·4-5·8). We observed lower first primary cancer standardised incidence ratios for prostate cancer (0·6, 95% CI 0·5-0·7), colon cancer (0·6, 0·4-0·8), and pancreatic cancer (0·6, 0·3-1·0), and lower second primary cancer standardised incidence ratios for testicular cancer (0·3, 0·0-0·9), kidney cancer (0·4, 0·0-0·9), and prostate cancer (0·6, 0·2-0·9). First and second primary AIDS-defining cancer incidence declined, and second primary non-AIDS-defining cancer incidence increased over time. INTERPRETATION Because of an increased risk for both first and second primary cancers, enhanced cancer prevention, screening, and treatment efforts are needed for people living with HIV both before and after initial cancer diagnosis. FUNDING University of California San Francisco and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Nancy A Hessol
- Departments of Medicine, University of California San Francisco, San Francisco, CA, USA; Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| | - Hannah Whittemore
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Ling C Hsu
- Department of Public Health, San Francisco, CA, USA
| | - Danning Ma
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- Department of Public Health, San Francisco, CA, USA
| | - Sandra K Schwarcz
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Department of Public Health, San Francisco, CA, USA
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Scheer S, Hsu L, Schwarcz S, Pipkin S, Havlir D, Buchbinder S, Hessol NA. Trends in the San Francisco Human Immunodeficiency Virus Epidemic in the "Getting to Zero" Era. Clin Infect Dis 2018; 66:1027-1034. [PMID: 29099913 PMCID: PMC6248750 DOI: 10.1093/cid/cix940] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/31/2017] [Indexed: 12/17/2022] Open
Abstract
Background San Francisco has launched interventions to reduce new human immunodeficiency virus (HIV) infections and HIV-associated morbidity and mortality during the San Francisco "Getting to Zero" era. We measured recent changes in HIV care indicators to assess the success of these interventions. Methods San Francisco residents with newly diagnosed HIV infection, diagnosed from 2009 to 2014, were included. We measured temporal changes from HIV diagnosis to (1) linkage to care in within ≤3 months, (2) initiation of antiretroviral therapy (ART) within ≤12 months, (3) viral suppression within ≤12 months, (4) development of AIDS within ≤3 months, (5) death within ≤12 months, and (6) retention in care 6-12 months after linkage. Kaplan-Meier analyses stratified by year of HIV diagnosis measured time from diagnosis to linkage, ART initiation, viral suppression, AIDS, and death. Results Overall, the number of new diagnoses declined from 473 in 2009 to 329 in 2014. The proportion of new diagnoses among men (P = .005), Latinos and Asian/Pacific Islanders (P = .02), and men who have sex with men (P = .003) increased. ART initiation and viral suppression ≤12 months after diagnosis increased (P < .001), while the proportion with AIDS diagnosed ≤3 months after HIV diagnosis declined (P < .001). Time to ART initiation and time to viral suppression were significantly shorter in more recent years of diagnosis (P < .001). Time from HIV to AIDS diagnosis was significantly longer in more recent years (P < .001). Retention in care did not significantly change. Conclusions In San Francisco new HIV diagnoses have declined and HIV care indicators have improved during the Getting to Zero era. Continued success requires attention to vulnerable populations and monitoring to adjust programmatic priorities.
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Affiliation(s)
- Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health
| | - Ling Hsu
- HIV Epidemiology Section, San Francisco Department of Public Health
| | - Sandra Schwarcz
- HIV Epidemiology Section, San Francisco Department of Public Health
| | - Sharon Pipkin
- HIV Epidemiology Section, San Francisco Department of Public Health
| | - Diane Havlir
- Department of Medicine, University of California
| | - Susan Buchbinder
- Department of Medicine, University of California
- Department of Epidemiology and Biostatistics, University of California
- Bridge HIV, San Francisco Department of Public Health
| | - Nancy A Hessol
- Department of Medicine, University of California
- Department of Clinical Pharmacy, University of California
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30
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Padilla M, Mattson CL, Scheer S, Udeagu CCN, Buskin SE, Hughes AJ, Jaenicke T, Wohl AR, Prejean J, Wei SC. Locating People Diagnosed With HIV for Public Health Action: Utility of HIV Case Surveillance and Other Data Sources. Public Health Rep 2018; 133:147-154. [PMID: 29486143 PMCID: PMC5871141 DOI: 10.1177/0033354918754541] [Citation(s) in RCA: 8] [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: 11/16/2022] Open
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. MATERIALS AND METHODS The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. RESULTS Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed <1 year ago were more likely to have accurate contact information in HIV case surveillance than were PLWH diagnosed ≥1 year ago ( P = .002), and the benefit from using additional data sources was greater for PLWH with more longstanding HIV infection ( P < .001). PRACTICE IMPLICATIONS When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection.
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Affiliation(s)
- Mabel Padilla
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Chi-Chi N. Udeagu
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | - Alison J. Hughes
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Amy Rock Wohl
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Joseph Prejean
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stanley C. Wei
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hessol NA, Ma D, Scheer S, Hsu LC, Schwarcz SK. Changing temporal trends in non-AIDS cancer mortality among people diagnosed with AIDS: San Francisco, California, 1996-2013. Cancer Epidemiol 2017; 52:20-27. [PMID: 29175052 DOI: 10.1016/j.canep.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/19/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) has reduced AIDS-defining cancer (ADC) mortality, but its effect on non-AIDS-defining cancer (NADC) mortality is unclear. To help inform cancer prevention and screening, we evaluated trends in NADC mortality among people with AIDS (PWA) in the ART era. METHODS This retrospective cohort study analyzed AIDS surveillance data, including causes of death from death certificates, for PWA in San Francisco who died in 1996-2013. Proportional mortality ratios (PMRs), and year, age, race, sex-adjusted standardized mortality ratios (SMRs) were calculated for 1996-1999, 2000-2005, and 2006-2013, corresponding to advances in ART. RESULTS The study included 5822 deceased PWA of whom 90% were male and 68% were aged 35-54 at time of death. Over time, the PMRs significantly decreased for ADCs (2.6%, 1.4%, 1.2%) and increased for NADCs (4.3%, 7.0%, 12.3%). For all years combined (1996-2013) and compared to the California population, significantly elevated SMRs were observed for these cancers: all NADCs combined (2.1), anal (58.4), Hodgkin lymphoma (10.5), liver (5.2), lung/larynx (3.0), rectal (5.2), and tongue (4.7). Over time, the SMRs for liver cancer (SMR 19.8, 11.2, 5.0) significantly decreased while the SMRs remained significantly elevated over population levels for anal (SMR 123, 48.2, 45.5), liver (SMR 19.8, 11.2, 5.0), and lung/larynx cancer (SMR 5.3, 4.7, 3.6). CONCLUSION A decline in ADC PMRs and increase in NADC PMRs represent a shift in the cancer burden, likely due to ART use. Moreover, given their elevated SMRs, anal, liver, and lung/larynx cancer remain targets for improved cancer prevention, screening, and treatment.
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Affiliation(s)
- Nancy A Hessol
- Departments of Clinical Pharmacy and of Medicine, University of California, 3333 California Street, Suite 420, San Francisco, CA, 94143-0613, USA.
| | - Danning Ma
- Department of Clinical Pharmacy, University of California, 3333 California Street, San Francisco, CA, 94143-0613, USA
| | - Susan Scheer
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
| | - Ling C Hsu
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
| | - Sandra K Schwarcz
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102-6012, USA
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Burrows K, Antignano F, Bramhall M, Chenery A, Scheer S, Korinek V, Underhill TM, Zaph C. The transcriptional repressor HIC1 regulates intestinal immune homeostasis. Mucosal Immunol 2017; 10:1518-1528. [PMID: 28327618 DOI: 10.1038/mi.2017.17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023]
Abstract
The intestine is a unique immune environment that must respond to infectious organisms but remain tolerant to commensal microbes and food antigens. However, the molecular mechanisms that regulate immune cell function in the intestine remain unclear. Here we identify the POK/ZBTB family transcription factor hypermethylated in cancer 1 (HIC1, ZBTB29) as a central component of immunity and inflammation in the intestine. HIC1 is specifically expressed in immune cells in the intestinal lamina propria (LP) in the steady state and mice with a T-cell-specific deletion of HIC1 have reduced numbers of T cells in the LP. HIC1 expression is regulated by the Vitamin A metabolite retinoic acid, as mice raised on a Vitamin A-deficient diet lack HIC1-positive cells in the intestine. HIC1-deficient T cells overproduce IL-17A in vitro and in vivo, and fail to induce intestinal inflammation, identifying a critical role for HIC1 in the regulation of T-cell function in the intestinal microenvironment under both homeostatic and inflammatory conditions.
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Affiliation(s)
- K Burrows
- The Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - F Antignano
- The Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Bramhall
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia.,Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - A Chenery
- The Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Scheer
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia.,Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - V Korinek
- Department of Cell and Developmental Biology, Institute of Molecular Genetics, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - T M Underhill
- The Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cellular &Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Zaph
- The Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Infection and Immunity Program, Monash Biomedicine Discovery Institute, Clayton, Victoria, Australia.,Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
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Abstract
Data from Medical Monitoring Project was used to determine if partner type is associated with condomless anal sex (CAS) and insertive condomless anal sex (ICAS) among HIV-positive men who have sex with men. Participants reported HIV status and PrEP use of up to five anal sex partners. Partner type was categorized as HIV-positive, HIV status unknown, HIV-negative on PrEP or HIV-negative not on PrEP. To account for correlation of multiple observations per participant, generalized estimating equations were used to calculate adjusted prevalence ratios and 95% confidence intervals of CAS and ICAS. Condom use during anal sex and insertive anal sex varied based on partner type. There was a higher prevalence of CAS and ICAS in partnerships with HIV-positive partners or HIV-negative partners on PrEP compared to HIV-negative partners not on PrEP.
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Hughes AJ, Chen YH, Scheer S, Raymond HF. A Novel Modeling Approach for Estimating Patterns of Migration into and out of San Francisco by HIV Status and Race among Men Who Have Sex with Men. J Urban Health 2017; 94:350-363. [PMID: 28337575 PMCID: PMC5481213 DOI: 10.1007/s11524-017-0145-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the early 1980s, men who have sex with men (MSM) in San Francisco were one of the first populations to be affected by the human immunodeficiency virus (HIV) epidemic, and they continue to bear a heavy HIV burden. Once a rapidly fatal disease, survival with HIV improved drastically following the introduction of combination antiretroviral therapy in 1996. As a result, the ability of HIV-positive persons to move into and out of San Francisco has increased due to lengthened survival. Although there is a high level of migration among the general US population and among HIV-positive persons in San Francisco, in- and out-migration patterns of MSM in San Francisco have, to our knowledge, never been described. Understanding migration patterns by HIV serostatus is crucial in determining how migration could influence both HIV transmission dynamics and estimates of the HIV prevalence and incidence. In this article, we describe methods, results, and implications of a novel approach for indirect estimation of in- and out-migration patterns, and consequently population size, of MSM by HIV serostatus and race in San Francisco. The results suggest that the overall MSM population and all the MSM subpopulations studied decreased in size from 2006 to 2014. Further, there were differences in migration patterns by race and by HIV serostatus. The modeling methods outlined can be applied by others to determine how migration patterns contribute to HIV-positive population size and output from these models can be used in a transmission model to better understand how migration can impact HIV transmission.
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Affiliation(s)
- Alison J Hughes
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.
| | - Yea-Hung Chen
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Scheer
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA
| | - H Fisher Raymond
- San Francisco Department of Public Health, Van Ness Ave., Suite 500, San Francisco, CA, 94102, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Scheer S, Chen MJ, Parisi MK, Yoshida-Cervantes M, Antunez E, Delgado V, Moss NJ, Buchacz K. The RSVP Project: Factors Related to Disengagement From Human Immunodeficiency Virus Care Among Persons in San Francisco. JMIR Public Health Surveill 2017; 3:e25. [PMID: 28473307 PMCID: PMC5438443 DOI: 10.2196/publichealth.7325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/25/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the United States, an estimated two-thirds of persons with human immunodeficiency virus (HIV) infection do not achieve viral suppression, including those who have never engaged in HIV care and others who do not stay engaged in care. Persons with an unsuppressed HIV viral load might experience poor clinical outcomes and transmit HIV. Objective The goal of the Re-engaging Surveillance-identified Viremic Persons (RSVP) project in San Francisco, CA, was to use routine HIV surveillance databases to identify, contact, interview, and reengage in HIV care persons who appeared to be out of care because their last HIV viral load was unsuppressed. We aimed to interview participants about their HIV care and barriers to reengagement. Methods Using routinely collected HIV surveillance data, we identified persons with HIV who were out of care (no HIV viral load and CD4 laboratory reports during the previous 9-15 months) and with their last plasma HIV RNA viral load >200 copies/mL. We interviewed the located persons, at baseline and 3 months later, about whether and why they disengaged from HIV care and the barriers they faced to care reengagement. We offered them assistance with reengaging in HIV care from the San Francisco Department of Public Health linkage and navigation program (LINCS). Results Of 282 persons selected, we interviewed 75 (26.6%). Of these, 67 (89%) reported current health insurance coverage, 59 (79%) had ever been prescribed and 45 (60%) were currently taking HIV medications, 59 (79%) had seen an HIV provider in the past year, and 34 (45%) had missed an HIV appointment in the past year. Reasons for not seeing a provider included feeling healthy, using alcohol or drugs, not having enough money or health insurance, and not wanting to take HIV medicines. Services needed to get to an HIV medical care appointment included transportation assistance, stable living situation or housing, sound mental health, and organizational help and reminders about appointments. A total of 52 (69%) accepted a referral to LINCS. Additionally, 64 (85%) of the persons interviewed completed a follow-up interview 3 months later and, of these, 62 (97%) had health insurance coverage and 47 (73%) reported having had an HIV-related care appointment since the baseline interview. Conclusions Rather than being truly out of care, most participants reported intermittent HIV care, including recent HIV provider visits and health insurance coverage. Participants also frequently reported barriers to care and unmet needs. Health department assistance with HIV care reengagement was generally acceptable. Understanding why people previously in HIV care disengage from care and what might help them reengage is essential for optimizing HIV clinical and public health outcomes.
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Affiliation(s)
- Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Miao-Jung Chen
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Maree Kay Parisi
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Maya Yoshida-Cervantes
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Erin Antunez
- Disease Prevention and Control, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Viva Delgado
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Nicholas J Moss
- Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, Oakland, CA, United States
| | - Kate Buchacz
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Jain J, Santos GM, Scheer S, Gibson S, Crouch PC, Kohn R, Chang W, Carrico AW. Rates and Correlates of Syphilis Reinfection in Men Who Have Sex with Men. LGBT Health 2016; 4:232-236. [PMID: 27991843 DOI: 10.1089/lgbt.2016.0095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined rates and correlates of syphilis reinfection in men who have sex with men (MSM). METHODS From 2012 to 2015, time to reinfection was assessed in 323 MSM receiving initial treatment for syphilis in San Francisco. RESULTS One in five men was reinfected (71/323; 22%). The rate of syphilis reinfection was greater among HIV-infected men (adjusted hazard ratio [aHR] = 1.96; 95% confidence interval [95% CI] = 1.16-3.31) and ketamine users (aHR = 2.76; 95% CI = 1.09-7.00). CONCLUSION Expanded prevention efforts are needed with HIV-infected and substance-using MSM to reduce the burden of reinfection in this population.
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Affiliation(s)
- Jennifer Jain
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Glenn-Milo Santos
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California.,2 San Francisco Department of Public Health , San Francisco, California
| | - Susan Scheer
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Steve Gibson
- 3 San Francisco AIDS Foundation , San Francisco, California
| | | | - Robert Kohn
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Walter Chang
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Adam W Carrico
- 4 Department of Public Health Sciences, University of Miami School of Medicine , Miami, Florida
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Raymond HF, Scheer S, Santos GM, McFarland W. Examining progress toward the UNAIDS 90-90-90 framework among men who have sex with men, San Francisco, 2014. AIDS Care 2016; 28:1177-80. [PMID: 26916991 DOI: 10.1080/09540121.2016.1153593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has published treatment goals toward ending the HIV epidemic. The worldwide goals are 90% of HIV-infected individuals diagnosed, 90% of those diagnosed taking anti-retroviral treatment and 90% of those on anti-retroviral treatment virally suppressed. In light of the UNAIDS goals and that five years have passed since the adoption of early HIV treatment, we examined the progress toward the 90-90-90 indicators among men who have sex with men (MSM) in San Francisco in 2014. Our data suggest that overall MSM have not yet reached the 90-90-90 goals. Our data also suggest that Black and Latino MSM are further from the goals than White MSM.
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Affiliation(s)
- H Fisher Raymond
- a Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.,b San Francisco Department of Public Health , San Francisco , CA , USA
| | - Susan Scheer
- b San Francisco Department of Public Health , San Francisco , CA , USA
| | - Glenn-Milo Santos
- a Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.,b San Francisco Department of Public Health , San Francisco , CA , USA
| | - Willi McFarland
- a Epidemiology and Biostatistics , University of California , San Francisco , CA , USA.,b San Francisco Department of Public Health , San Francisco , CA , USA
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Delaney KP, Rurangirwa J, Facente S, Dowling T, Janson M, Knoble T, Vu A, Hu YW, Kerndt PR, King J, Scheer S. Using a Multitest Algorithm to Improve the Positive Predictive Value of Rapid HIV Testing and Linkage to HIV Care in Nonclinical HIV Test Sites. J Acquir Immune Defic Syndr 2016; 71:78-86. [PMID: 26284530 PMCID: PMC4728707 DOI: 10.1097/qai.0000000000000807] [Citation(s) in RCA: 4] [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 Use of a rapid HIV testing algorithm (RTA) in which all tests are conducted within one client appointment could eliminate off-site confirmatory testing and reduce the number of persons not receiving confirmed results. METHODS An RTA was implemented in 9 sites in Los Angeles and San Francisco; results of testing at these sites were compared with 23 sites conducting rapid HIV testing with off-site confirmation. RTA clients with reactive results on more than 1 rapid test were considered HIV+ and immediately referred for HIV care. The positive predictive values (PPVs) of a single rapid HIV test and the RTA were calculated compared with laboratory-based confirmatory testing. A Poisson risk regression model was used to assess the effect of RTA on the proportion of HIV+ persons linked to HIV care within 90 days of a reactive rapid test. RESULTS The PPV of the RTA was 100% compared with 86.4% for a single rapid test. The time between testing and receipt of RTA results was on average 8 days shorter than laboratory-based confirmatory testing. For risk groups other than men who had sex with men, the RTA increased the probability of being in care within 90 days compared with standard testing practice. CONCLUSIONS The RTA increased the PPV of rapid testing to 100%, giving providers, clients, and HIV counselors timely information about a client's HIV-positive serostatus. Use of RTA could reduce loss to follow-up between testing positive and confirmation and increase the proportion of HIV-infected persons receiving HIV care.
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Affiliation(s)
- Kevin P. Delaney
- Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Jacqueline Rurangirwa
- Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA
| | - Shelley Facente
- HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
| | - Teri Dowling
- HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
| | - Mike Janson
- Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA
| | - Thomas Knoble
- HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
| | - Annie Vu
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA
| | - Yunyin W. Hu
- Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA
| | - Peter R. Kerndt
- Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA
| | - Jan King
- Department of Public Health, County of Los Angeles, Los Angeles, CA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA
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Abstract
Nationally heterosexuals are an HIV prevention priority. In addition to case based HIV surveillance, behavioral surveillance surveys are conducted among heterosexuals living in high AIDS morbidity neighborhoods. We report on risk behaviors and HIV prevalence among "high-risk" heterosexuals in San Francisco. National HIV Behavioral Surveillance System is coordinated by the CDC and implemented in 21 health jurisdictions. The studies were conducted in 2006, 2010 and 2013 in San Francisco. Respondent driven sampling was used to sample participants. Eligible persons were 18-50 years old and had sex with at least one opposite gender partner in the past year. We obtained samples of 371, 421, 165 heterosexuals in 2007, 2010 and 2013, respectively. Some demographics varied across the 3 years. Residential neighborhoods changed, homelessness and healthcare coverage increased. Binge drinking, cocaine and heroin use increased while methamphetamine use declined. There were no changes in numbers of partners, unprotected vaginal intercourse or unprotected anal intercourse. Commercial sex work increased. Even with "fine tuning" of eligibility criteria to attempt to find heterosexual HIV cases, we estimate that HIV prevalence was 0.3, 0.2 and 2.4 % in 2007, 2010 and 2013 respectively. The increase was not statistically significant. For the present, effective prevention among persons in the populations most severely affected by HIV remains the priority, for their own benefit and to prevent transmission to other vulnerable populations to which they may be connected.
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Fuqua V, Scott H, Scheer S, Hecht J, Snowden JM, Raymond HF. Trends in the HIV Epidemic Among African American Men Who Have Sex with Men, San Francisco, 2004-2011. AIDS Behav 2015; 19:2311-6. [PMID: 25686574 DOI: 10.1007/s10461-015-1020-3] [Citation(s) in RCA: 6] [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: 11/29/2022]
Abstract
African American men who have sex with men have been disproportionately affected by the HIV epidemic in the United States and remain to this day one of the groups with highest HIV prevalence and incidence. Our goal was to clarify the current state of HIV risk, sexual behaviors, and structural/network-network level factors that affect black MSM's population risk of HIV, enabling the formulation of targeted and up-to-date public health messages/campaigns directed at this vulnerable population. Our approach maximized the use of local data through a process of synthesis and triangulation of multiple independent and overlapping sources of information that are sometimes separately published and often not examined side-by-side. Among African American MSM, we observed stable HIV incidence despite increases in reported individual risk behavior and STDs. An increasing proportion of African American MSM are reporting HIV testing in the past 6 months and seroadaptive behaviors, which may play a role in this observed decline in HIV among MSM in San Francisco, California. Our analysis suggests that currently the HIV epidemic is stable among African American MSM in San Francisco. However, we suggest that the observed stability is due to factors prohibiting expansion of new infections rather than decreasing risks for HIV infection among African American MSM.
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Affiliation(s)
- V Fuqua
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - H Scott
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - S Scheer
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA
| | - J Hecht
- San Francisco AIDS Foundation, San Francisco, CA, USA
| | - J M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - H Fisher Raymond
- San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, USA.
- Epidemiology and Biostatistics, University of California, San Francisco, USA.
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Christopoulos KA, Scheer S, Steward WT, Barnes R, Hartogensis W, Charlebois ED, Morin SF, Truong HHM, Geng EH. Examining clinic-based and public health approaches to ascertainment of HIV care status. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S56-62. [PMID: 25867779 PMCID: PMC4495955 DOI: 10.1097/qai.0000000000000571] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinic-based tracing efforts and public health surveillance data can provide different information about HIV care status for the same patients. The relative yield and how best to use these sources to identify and reengage out-of-care patients is unknown. METHODS At a large public HIV clinic in San Francisco, we selected a 10% random sample of active patients who were at least 210 days "late" for an HIV primary care visit as of April 1, 2013, for clinic-based outreach. Patients were considered out of care if they did not have an HIV primary care visit in the 210 days before April 1, 2013. We then matched the sample with the San Francisco Department of Public Health HIV surveillance registry. Patients with a CD4 or viral load result in the 210-day period were classified as in care. We compared results from both sources and estimated the cumulative incidence of disengagement from care for the full cohort of clinic patients. RESULTS Of 940 patients lost to follow-up, 95 were sampled. Clinic tracing found 60 (63%) in care, 23 (24%) not located, 9 (10%) out of care, 2 (2%) incarcerated, and 1 (1%) had died. Of 42 individuals surveillance classified as out of care, tracing found 22 (52%) were in care. Of 52 patients found to be in care by surveillance, 12 (23%) were out of care by clinic tracing or unable to be located. The naive estimate of the cumulative incidence of disengagement from care at 3 years for the active clinic cohort was 41.1% [95% confidence interval (CI): 37.6 to 44.5]. The use of surveillance data reduced this estimate to 12.7% (95% CI: 18.2 to 25.4), and when further corrected using tracing outcomes, the estimate dropped to only 6.4% (95% CI: 3.4 to 9.4). CONCLUSIONS Clinic-based tracing and surveillance data together provide a better understanding of care status than either method alone. Using surveillance data to inform clinic-based outreach efforts may be an effective strategy, although tracing efforts are most likely to be successful if conducted in real time.
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Affiliation(s)
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health
| | - Wayne T. Steward
- Center for AIDS Prevention Studies, University of California San Francisco
| | - Revery Barnes
- Department of Family Medicine, University of California Los Angeles
| | - Wendy Hartogensis
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco
| | | | - Stephen F. Morin
- Center for AIDS Prevention Studies, University of California San Francisco
| | - Hong-Ha M. Truong
- Center for AIDS Prevention Studies, University of California San Francisco
| | - Elvin H. Geng
- HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco
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Hughes AJ, Mattson CL, Scheer S, Beer L, Skarbinski J. Discontinuation of antiretroviral therapy among adults receiving HIV care in the United States. J Acquir Immune Defic Syndr 2014; 66:80-9. [PMID: 24326608 PMCID: PMC5091800 DOI: 10.1097/qai.0000000000000084] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous antiretroviral therapy (ART) is important for maintaining viral suppression. This analysis estimates prevalence of and reason for ART discontinuation. METHODS Three-stage sampling was used to obtain a nationally representative, cross-sectional sample of HIV-infected adults receiving HIV care. Face-to-face interviews and medical record abstractions were collected from June 2009 to May 2010. Data were weighted based on known probabilities of selection and adjusted for nonresponse. Patient characteristics of ART discontinuation, defined as not currently taking ART, stratified by provider-initiated versus non-provider-initiated discontinuation, were examined. Weighted logistic regression models predicted factors associated with ART discontinuation. RESULTS Of adults receiving HIV care in the United States who reported ever initiating ART, 5.6% discontinued treatment. Half of those who discontinued treatment reported provider-initiated discontinuation. Provider-initiated ART discontinuation patients were more likely to have a nadir CD4 ≥ 200 cells per cubic millimeter. Non-provider-initiated ART discontinuation patients were more likely to have unmet need for supportive services and to have not received HIV care in the past 3 months. Among all patients who discontinued, younger age, female gender, not having continuous health insurance, incarceration, injection drug use, nadir CD4 count ≥ 2 00 cells per cubic millimeter, unmet need for supportive services, no care in the past 3 months and HIV diagnosis ≥ 5 years before interview were independently associated with ART discontinuation. CONCLUSIONS These findings inform development of interventions to increase ART persistence by identifying groups at increased risk of ART discontinuation. Evidence-based interventions targeting vulnerable populations are needed and are increasingly important as recent HIV treatment guidelines have recommended universal ART.
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Affiliation(s)
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
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Bernstein KT, Stephens SC, Moss N, Scheer S, Parisi MK, Philip SS. Partner services as targeted HIV screening--changing the paradigm. Public Health Rep 2014; 129 Suppl 1:50-5. [PMID: 24385649 DOI: 10.1177/00333549141291s108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The San Francisco Department of Public Health (SFDPH) has the goal of offering HIV partner services (PS) to all individuals newly diagnosed with HIV in San Francisco. However, measuring the potential impact of these services is challenging. Building on an existing syphilis partner notification program, we developed a framework for expanding and monitoring HIV PS in San Francisco. METHODS We identified process and outcome measures to evaluate HIV PS in San Francisco, including the number of index patients interviewed, the proportion of named partners who had previously diagnosed HIV infection, the proportion of HIV-uninfected partners who tested through HIV PS, and the positivity rate among the partners tested. Results were recorded in a locally developed electronic surveillance and case-management system at SFDPH. RESULTS We examined HIV PS data from 2005-2011. In 2011, 426 new HIV diagnoses were reported, and 178 were assigned for HIV PS; of these, 124 (69.7%) patients were successfully interviewed, naming a total of 109 sex partners. Of the named partners, 34 (31.2%) had been previously diagnosed with HIV. Among the remaining named partners not known to be HIV infected, 31 (32.3%) were tested, for a positivity of 22.6% (n=7). The proportion of HIV that was newly diagnosed by a provider who participated in the citywide HIV PS program increased from 15.4% in 2005 to 69.5% in 2011. CONCLUSIONS As HIV PS expand, locally relevant outcome measures are increasingly important. Using these criteria, HIV PS as a targeted screening activity resulted in the identification of newly diagnosed HIV cases.
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Affiliation(s)
- Kyle T Bernstein
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA ; University of California at Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA
| | - Sally C Stephens
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA
| | - Nicholas Moss
- San Francisco Department of Public Health, HIV Prevention Section, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Maree Kay Parisi
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Susan S Philip
- San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA
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Chu PL, Nieves-Rivera I, Grinsdale J, Huang S, Philip SS, Pine A, Scheer S, Aragón T. A public health framework for developing local preventive services guidelines. Public Health Rep 2014; 129 Suppl 1:70-8. [PMID: 24385652 DOI: 10.1177/00333549141291s111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this article, we describe the San Francisco Department of Public Health's (SFDPH's) framework for developing evidence-based screening and vaccination recommendations. We first reviewed our local data using surveillance and syndemic data. We then compiled and compared existing federal, state, and local recommendations. Then we identified differences as compared with our local evidence; where more evidence was required to make a recommendation, we culled from additional data sources and conducted additional analyses. Lastly, we developed our guidelines by confirming existing recommendations or making new recommendations based on this process. In the end, we successfully developed evidence-based clinical screening and prevention guidelines that have been adopted by the SFDPH Health Commission. We encourage the use of this framework in other public health settings at the local level.
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Affiliation(s)
- Priscilla Lee Chu
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Israel Nieves-Rivera
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Jennifer Grinsdale
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Sandra Huang
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Susan S Philip
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Amy Pine
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
| | - Tomás Aragón
- San Francisco Department of Public Health, Program Collaboration and Service Integration Work Group, San Francisco, CA
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Sanchez MA, Scheer S, Shallow S, Pipkin S, Huang S. Epidemiology of the viral hepatitis-HIV syndemic in San Francisco: a collaborative surveillance approach. Public Health Rep 2014; 129 Suppl 1:95-101. [PMID: 24385655 DOI: 10.1177/00333549141291s114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To describe the epidemiology of people coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV in San Francisco, the San Francisco Department of Public Health's Communicable Disease Control and Prevention Section and the HIV Epidemiology Section collaborated to link their registries. METHODS In San Francisco, hepatitis reporting is primarily through passive laboratory-based surveillance, and HIV/AIDS reporting is primarily through laboratory-initiated active surveillance. We conducted the registry linkage in 2010 using a sequential algorithm. RESULTS The registry match included 31,997 HBV-infected people who were reported starting in 1984; 10,121 HCV-infected people who were reported starting in 2001; and 34,551 HIV/AIDS cases reported beginning in 1981. Of the HBV and HCV cases, 6.3% and 12.6% were coinfected with HIV, respectively. The majority of cases were white males; however, black people were disproportionately affected. For more than 90% of the HBV/HIV cases, male-to-male sexual contact (men who have sex with men [MSM]) was the risk factor for HIV infection. Injection drug use was the most frequent risk factor for HIV infection among the HCV/HIV cases; however, 35.6% of the HCV/HIV coinfected males were MSM but not injection drug users. CONCLUSIONS By linking the two registries, we found new ways to foster collaborative work and expand our programmatic flexibility. This analysis identified particular populations at risk for coinfection, which can be used by viral hepatitis and HIV screening, prevention, and treatment programs to integrate, enhance, target, and prioritize prevention services and clinical care within the community to maximize health outcomes.
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Affiliation(s)
- Melissa A Sanchez
- San Francisco Department of Public Health, Communicable Disease Control and Prevention Section, Chronic Hepatitis Surveillance, San Francisco, CA
| | - Susan Scheer
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Sue Shallow
- San Francisco Department of Public Health, Communicable Disease Control and Prevention Section, San Francisco, CA
| | - Sharon Pipkin
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA
| | - Sandra Huang
- San Francisco Department of Public Health, Communicable Disease Control and Prevention Section, San Francisco, CA
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Hsu LC, Truong HHM, Vittinghoff E, Zhi Q, Scheer S, Schwarcz S. Trends in early initiation of antiretroviral therapy and characteristics of persons with HIV initiating therapy in San Francisco, 2007-2011. J Infect Dis 2013; 209:1310-4. [PMID: 24218501 DOI: 10.1093/infdis/jit599] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2010, the San Francisco Department of Public Health offered antiretroviral therapy (ART) to all its patients with human immunodeficiency virus (HIV) regardless of CD4 count. We assessed trends in time from diagnosis to ART initiation and factors associated with ART initiation among San Francisco residents living with HIV between 2007 and 2011. Time to ART initiation decreased among those diagnosed with higher CD4 count. ART initiation rate was significantly higher in recent years and lower among African Americans, men who have sex with men who also inject drugs, and persons aged ≥50 years. We found a trend toward early treatment. However, racial and social disparities persist.
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O'Keefe KJ, Scheer S, Chen MJ, Hughes AJ, Pipkin S. People fifty years or older now account for the majority of AIDS cases in San Francisco, California, 2010. AIDS Care 2013; 25:1145-8. [DOI: 10.1080/09540121.2012.752565] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Muthulingam D, Chin J, Hsu L, Scheer S, Schwarcz S. Disparities in engagement in care and viral suppression among persons with HIV. J Acquir Immune Defic Syndr 2013; 63:112-9. [PMID: 23392459 DOI: 10.1097/qai.0b013e3182894555] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Engagement across the spectrum of HIV care can improve health outcomes and prevent HIV transmission. We used HIV surveillance data to examine these outcomes. METHODS San Francisco residents who were diagnosed with HIV between 2009 and 2010 were included. We measured the characteristics and proportion of persons linked to care within 6 months of diagnosis, retained in care for second and third visits, and virally suppressed within 12 months of diagnosis. RESULTS Of 862 persons included, 750 (87%) entered care within 6 months of diagnosis; of these, 72% had a second visit in the following 3-6 months; and of these, 80% had a third visit in the following 3-6 months. Viral suppression was achieved in 50% of the total population and in 76% of those retained for 3 visits. Lack of health insurance and unknown housing status were associated with not entering care (P < 0.01). Persons with unknown insurance status were less likely to be retained for a second visit; those younger than 30 years were less likely to be retained for a third visit. Independent predictors of failed viral suppression included age <40 years, homelessness, unknown housing status, and having a single or 2 medical visits compared with 3 visits. CONCLUSIONS Socioeconomic resources and age, not race or gender, are associated with disparities in engagement in HIV care in San Francisco.
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Scheer S, Nakelsky S, Bingham T, Damesyn M, Sun D, Chin CS, Buckman A, Mark KE. Estimated HIV Incidence in California, 2006-2009. PLoS One 2013; 8:e55002. [PMID: 23405106 PMCID: PMC3566146 DOI: 10.1371/journal.pone.0055002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 10/09/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction Accurate estimates of HIV incidence are crucial for prioritizing, targeting, and evaluating HIV prevention efforts. Using the methodology the CDC used to estimate national HIV incidence, we estimated HIV incidence in Los Angeles County (LAC), San Francisco (SF), and California’s remaining counties. Methods We estimated new HIV infections in 2006–2009 among adults and adolescents in LAC, SF and the remaining California counties using the Serologic Testing Algorithm for Recent Seroconversion (STARHS). STARHS methodology uses the BED HIV-1 capture enzyme immunoassay to determine recent HIV infections by testing remnant serum from persons newly diagnosed with HIV. A population-based incidence estimate is calculated using HIV testing data from newly diagnosed cases and imputing for persons unaware of their HIV infection. Results For years 2007–2009, respectively, we estimated new infections in LAC to be 2426 (95% CI 1871–2982), 1669 (CI 1309–2029) and 1898 (CI 1452–2344) (p<0.01); in SF for 2006–2009, 492 (CI 327–657), 490 (CI 335–646), 458 (CI 342–574) and 367 (CI 261–473) (p = 0.14); and in the remaining California counties in 2008–2009, 2526 (CI 1688–3364) and 2993 (CI 2141–3846) respectively. HIV infection rates among men who have sex with men (MSM) in LAC were 100 times higher than other risk populations; the SF MSM rate was 3 to 18 times higher than other demographic groups. In LAC, incidence rates among African-Americans were twice those of whites and Latinos; persons 40 years or older had lower rates of infection than younger persons. Discussion We report the first HIV incidence estimates for California, highlighting geographic disparities in HIV incidence and confirming national findings that MSM and African-Americans are disproportionately impacted by HIV. HIV incidence estimates can and should be used to target prevention efforts towards populations at highest risk of acquiring new HIV infections, focusing on geographic, racial and risk group disparities.
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Affiliation(s)
- Susan Scheer
- San Francisco Department of Public Health, HIV Epidemiology Section, San Francisco, CA, USA.
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Scheer S, Hughes AJ, Tejero J, Damesyn MA, Mark KE, Arguello TM, Wohl AR. Regional differences among HIV patients in care: California medical monitoring project sites, 2007-2008. Open AIDS J 2012; 6:188-95. [PMID: 23049669 PMCID: PMC3462328 DOI: 10.2174/1874613601206010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 10/28/2011] [Accepted: 11/23/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Medical Monitoring Project (MMP) is a national, multi-site population-based supplemental HIV/AIDS surveillance project of persons receiving HIV/AIDS care. We compared California MMP data by region. Demographic characteristics, medical care experiences, HIV treatment, clinical care outcomes, and need for support services are described. METHODS HIV-infected patients 18 years or older were randomly selected from medical care facilities. In person structured interviews from 2007 - 2008 were used to assess sociodemographic characteristics, self-reported clinical outcomes, and need for supportive services. Pearson chi-squared, Fisher's exact and Kruskal-Wallis p-values were calculated to compare regional differences. RESULTS Between 2007 and 2008, 899 people were interviewed: 329 (37%) in San Francisco (SF), 333 (37%) in Los Angeles (LA) and 237 (26%) in other California counties. Significant regional sociodemographic differences were found. Care received and clinical outcomes for patients in MMP were positive and few regional differences were identified. HIV case management (36%), mental health counseling (35%), and dental services (29%) were the supportive services patients most frequently needed. Unmet needs for supportive services were low overall. Significant differences by region in needed and unmet need services were identified. DISCUSSION The majority of MMP respondents reported standard of care CD4 and viral load monitoring, high treatment use, undetectable HIV viral loads and CD4 counts indicative of good immune function and treatment efficacy. Information from MMP can be used by planning councils, policymakers, and HIV care providers to improve access to care and prevention. Identifying regional differences can facilitate sharing of best practices among health jurisdictions.
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Affiliation(s)
- Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Alison J Hughes
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Judith Tejero
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Mark A Damesyn
- California Department of Public Health, Sacramento, CA, USA
| | - Karen E Mark
- California Department of Public Health, Sacramento, CA, USA
| | | | - Amy R Wohl
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
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