Estimating the epidemiological impact of reaching the objectives of the Florida integrated HIV prevention and care plan in Miami-Dade County

Background

The US Ending the HIV Epidemic (EHE) initiative aims to reduce national HIV incidence 90% by 2030 and to address the disproportionate burden of HIV among different racial/ethnic populations. Florida's state-wide 2022-2026 Integrated HIV Prevention and Care Plan outlines objectives for reaching EHE goals. In Miami-Dade County, we determined the epidemiological impact of achieving the integrated plan's objectives individually and jointly.

Methods

We adapted an HIV transmission model calibrated to Miami-Dade County adjusting access to HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral treatment to model the effects of each objective between 2022 and 2030. We compared two service scale-up approaches: (a) scale-up proportionally to existing racial/ethnic group access levels, and (b) scale-up according to new diagnoses across racial/ethnic groups (equity-oriented). We estimated reductions in new HIV infections by each objective and approach, compared to the EHE's incidence reduction target.

Findings

The single most influential strategy was reducing new HIV diagnoses in Hispanic/Latinx men who have sex with men through increased PrEP uptake, resulting in 907/2444 (37.1%) fewer annual new HIV infections in 2030. Achieving all objectives jointly would result in 1537/2444 (62.9%) and 1553/2444 (63.5%) fewer annual new HIV infections with the proportional and equity-oriented approaches, respectively.

Interpretation

Achieving the goals of Florida's integrated care plan would significantly reduce HIV incidence in Miami-Dade County; however, further efforts are required to achieve EHE targets. Structural changes in service delivery and a focus on effective implementation of available interventions to address racial/ethnic disparities will be crucial to ending the HIV epidemic.

Funding

This work was supported by the National Institutes of Health/National Institute on Drug Abuse grant no. R01-DA041747.

Geographic disparities in violent crime during the COVID-19 lockdown in Miami-Dade County, Florida, 2018-2020

OBJECTIVES

This study uses two cluster detection techniques to identify clusters of violent crime during the 3 months of the 2020 COVID-19 lockdown in Miami-Dade County compared to that during an equivalent period in 2018 and 2019.

METHODS

Violent crime data from the Miami-Dade Central Records Bureau were analyzed. The Local Indicators of Spatial Association statistics and a space-time permutation statistic were used to identify clusters of violent crimes and outliers, and Global Moran's I tool was used to assess spatial patterning in violent crime. Neighborhood disadvantage data were obtained from the American Community Survey 5-year estimates linked with arrest locations.

RESULTS

Violent crime arrests fell by 7.1% in 2020. Arrests were concentrated in predominantly Black disadvantaged neighborhoods in the northern part, and similar results were produced for core clusters by the two cluster techniques with positive global Moran's I for all study years. Although accounting for only 17% of the county population, nearly half of violent crime arrests were for Black or African American. Males comprised most violent crime arrests.

CONCLUSIONS

Crime prevention and intervention efforts should be focused on both high-risk places and offenders.

Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016

In 2016, four clusters of local mosquitoborne Zika virus transmission were identified in Miami-Dade County, Florida, USA, generating "red zones" (areas into which pregnant women were advised against traveling). The Miami-Dade County Mosquito Control Division initiated intensive control activities, including property inspections, community education, and handheld sprayer applications of larvicides and adulticides. For the first time, the Mosquito Control Division used a combination of areawide ultralow-volume adulticide and low-volume larvicide spraying to effectively control Aedes aegypti mosquitoes, the primary Zika virus vector within the county. The number of mosquitoes rapidly decreased, and Zika virus transmission was interrupted within the red zones immediately after the combination of adulticide and larvicide spraying.

Zika Virus IgM 25 Months after Symptom Onset, Miami-Dade County, Florida, USA

We assessed IgM detection in Zika patients from the 2016 outbreak in Miami-Dade County, Florida, USA. Of those with positive or equivocal IgM after 12-19 months, 87% (26/30) had IgM 6 months later. In a survival analysis, ≈76% had IgM at 25 months. Zika virus IgM persists for years, complicating serologic diagnosis.

Perceptions of Zika Virus Risk during 2016 Outbreak, Miami-Dade County, Florida, USA

We conducted a survey on Zika virus perceptions and behaviors during the 2016 outbreak in Miami-Dade County, Florida, USA. Among women, Zika knowledge was associated with having a bachelor’s degree. Among men, knowledge was associated with knowing someone at risk. Interventions during future outbreaks could be targeted by sex and education level.

The donation and sale of blood by intravenous drug users

In spite of efforts to dissuade intravenous drug users (IVDUs) from donating or selling blood, some continue to do so. As part of a longitudinal study, 915 IVDUs in South Florida were interviewed concerning their history of donation or sale of blood and tested for antibodies to HIV-1 and HTLV-I/II. Approximately 17 percent had either donated or sold blood during 1985 through 1988; most contributors (80.4 percent) sold to commercial blood services. IVDUs who had donated/sold blood were more likely to be male and not in drug treatment than were those who had not contributed blood. IVDUs not in treatment at the time of interview were more likely than IVDUs in treatment to have sold blood. Of those who had donated/sold blood since 1985, 19.6 percent subsequently tested positive for antibodies to HIV-1 and 5.7 percent were positive for antibodies to HTLV-I/II. Increased effort is required to screen prospective donors and sellers, particularly at commercial blood banks.