Spread Of Human Immunodeficiency Virus Research Articles

Patterns and Determinants of Consistent Condom Use Among Cameroonian Soldiers

Background: Despite numerous health promotion interventions lately conducted, the human immunodeficiency virus (HIV) remains a major cause of morbidity and mortality in sub-Saharan Africa. It is reported that military personnel have a higher prevalence of HIV, compared with the general population. Condom use remains a cheap, easy-to-use, and effective device to prevent the spread of HIV. Growing evidence, however, suggests its underuse among the military personnel. Methods: The current cross sectional study included 325 consenting male and female soldiers from 8 different battalions. Characteristics of the study participants were summarized using frequencies and proportions. Associations between the studied variables were investigated using the Chi-square test of independency; P values < 0.05 were considered statistically significant. Results were presented in the form of tables and graphs. Data analysis was conducted using SPSS version 20.0. Results: Only 28% of the participants used condom during the last unsafe sexual contact. Over 85% of them reported that condoms were always available. Half (50%) of the participants were ashamed to buy condoms. The most commonly reasons for not using condoms were drunkenness (37.5%), trust in the sexual partner (26.5%), tobacco smoking (11.1%), not interested to use a condom (8.9%), and dislike/refusal of condom use by the partner. Main reasons of inconsistent use of condoms included drunkenness, shyness to buy condoms and unavailability in the respective battalions. Trust in sex partners, condom use/sex related stigma, and alcohol abuse were the major determinants of inconsistent condom use during unsafe sexual relations among Cameroonian soldiers. Conclusions: Unprotected sexual practice amongst Cameroonian soldiers was high. Despite the reported high availability of condoms (85%), only 28% of the study respondents used condoms during their last sexual intercourse with different partners. Consistent condom use was sub-optimal among Cameroonian military staff. Keywords: HIV; Soldiers; Condom Use; Cameroon

Comparison of Knowledge, Attitudes, and Practices of Educated and Uneducated Adults Regarding Human Immunodeficiency Virus in Karachi, Pakistan.

BackgroundDespite the high prevalence of human immunodeficiency virus (HIV) in Pakistan, no prior work has been done to specifically highlight the importance of education as a social vaccine against HIV. Therefore, our study focuses on differences in knowledge and practices regarding HIV and acquired immunodeficiency syndrome (AIDS) among educated and uneducated adults.MethodologyA cross-sectional study was carried out in which data was collected from all over Karachi. An individual was designated as educated if he had received education above primary school level. Individuals who had studied till primary school or less were considered uneducated. The questionnaire was split into four sections that assessed respondents' demographics, knowledge, attitudes, and practices regarding HIV/AIDS. Chi square test was used as the primary statistical test.ResultsOut of the 446 adult participants, 235 (52.7%) were educated and 211 (47.3%) were uneducated. Educated participants were significantly more likely to have heard about HIV (183 vs. 39, p < 0.001) and had better knowledge about the symptoms of HIV/AIDS (p < 0.001). Among the participants who knew about AIDS, a greater percentage of uneducated (n = 28, 53%) than educated individuals (n = 68, 37%) believed that people suffering from AIDS should be isolated (p = o.o16) and that HIV can spread through water (40% vs 20% respectively, p < 0.001). Both educated (n = 49, 27%) and uneducated (n = 46, 89%) adults believed that awareness would help prevent the spread of HIV (p = 0.978) and were willing to educate their children about it (p = 0.696).ConclusionOur study revealed a gap in the knowledge about HIV/AIDS between educated and uneducated adults. There is an urgent need for awareness programs that especially reach out to the uneducated masses that are otherwise uninformed about HIV and are under high risk of acquiring HIV.

Spatial Epidemiological Pattern of HIV

This paper aims to explain the prevalence rate of Human Immunodeficiency Virus worldwide. The data matrix of CIA World Fact Book (2015) was used through new methodologies enclosed in fractal statistical analysis and data mining. After analyzing the data sets of different countries, a pattern was observed regarding the spatial epidemiological spread of HIV. Fractal statistical analysis revealed that the dynamic expansion of the virus is towards the northeastern hemisphere. Data mining further exposed that the spread of HIV follows the pathway along the coastal areas, specifically, following the trading system of the different countries. Moreover, being situated in the tropical environment can contribute directly and indirectly to the HIV prevalence through climate temperatures and agricultural productivity. Through these findings, it is then posited that the HIV incidence is not merely due to sexual activities rather it is also sensitive to the environmental characteristics of diferent countries.Keywords: Human Immunodeficiency Virus (HIV), spatial epidemiology pattern, Nightingale's environmental theory, fractal statistical analysis, data mining

HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD contacts, and all of these programs linked HIV cases to care. STD programs are providing some HIV services; however, delivery of certain specific services could be improved.

Cell-Mediated Immunity to Target the Persistent Human Immunodeficiency Virus Reservoir.

Effective clearance of virally infected cells requires the sequential activity of innate and adaptive immunity effectors. In human immunodeficiency virus (HIV) infection, naturally induced cell-mediated immune responses rarely eradicate infection. However, optimized immune responses could potentially be leveraged in HIV cure efforts if epitope escape and lack of sustained effector memory responses were to be addressed. Here we review leading HIV cure strategies that harness cell-mediated control against HIV in stably suppressed antiretroviral-treated subjects. We focus on strategies that may maximize target recognition and eradication by the sequential activation of a reconstituted immune system, together with delivery of optimal T-cell responses that can eliminate the reservoir and serve as means to maintain control of HIV spread in the absence of antiretroviral therapy (ART). As evidenced by the evolution of ART, we argue that a combination of immune-based strategies will be a superior path to cell-mediated HIV control and eradication. Available data from several human pilot trials already identify target strategies that may maximize antiviral pressure by joining innate and engineered T cell responses toward testing for sustained HIV remission and/or cure.

Improving the Quality of Diagnostic Studies Evaluating Point of Care Tests for Acute HIV Infections: Problems and Recommendations.

The diagnosis of acute human immunodeficiency virus (HIV) infection (AHI) plays a unique role in preventing the spread of HIV and ending the epidemic. Acutely infected individuals are thought to contribute substantially to forward transmissions of HIV; however, diagnosing AHI in resource-limited settings has proven to be a challenge. While fourth generation antigen-antibody combination assays have been successful in high-resource settings, rapid point of care (POC) versions of these assays have yet to demonstrate high sensitivity to detect AHI. Newer RNA/DNA based POC technologies are being validated, but the challenge to understand the additional value of these devices depends on the quality of study evaluations, in particular choice of study designs and case mix of included populations. In this commentary, we aimed to review the quality of studies evaluating a new fourth generation rapid test for detecting AHI, to identify general methodological limitations and biases in diagnostic accuracy studies, and to recommend strategies for avoiding them in future evaluations. The new studies that were evaluated continued to report the same weaknesses and biases that were seen in previous evaluations of fourth generation rapid tests. We recommend that investigators design future studies carefully, keeping in mind how diagnostic performance may be influenced by prevalence, population, patient case mixes, and reference standards. Care must be taken to avoid biases specific to diagnostic accuracy studies (spectrum, verification, incorporation and reference standard biases). To improve on quality, reporting checklists and guidelines such as Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Standards for Reporting Diagnostic accuracy studies (STARD) should be reviewed prior to conducting studies.

Impact of Antiretroviral Therapy on the Spread of Human Immunodeficiency Virus in Chaoyang District, Beijing, China

Background:Successful antiretroviral therapy (ART) has been demonstrated to be effective in reducing the infectivity of human immunodeficiency virus (HIV). We conducted a study to predict the potential effect of ART on the spread of HIV in Chaoyang District, Beijing, China, using the Asian Epidemic Model (AEM).Methods:The AEM baseline workbook was used to determine the current infection status and to project the future spread of HIV under current conditions. We changed the input on the ART coverage from 2014 to 2025 and also modified the treatment eligibility in the AEM intervention workbook, in order to allow for analysis of the projected downstream impact of ART.Results:By gradually increasing the ART coverage rate from 29.7% (rate of 2013) to 40.0%, 50.0%, 60.0%, 70.0%, 80.0%, and 90.0% (at CD4+ ≤350 cells/μl), and by changing the dates of coverage from 2014 to 2020, the number of new infections showed a cumulative decline of 0.60%, 1.59%, 2.94%, 5.33%, 9.32%, and 14.98%, respectively. After 2020, the projected rates of infection rebounded slightly, so with the exception of the years with very high coverage (90.0%), new infections continued to decrease. When we changed the initial threshold of therapy to CD4+ cell counts ≤500 cells/μl, new infections decreased 6.00%, 11.64%, 15.92%, 21.11%, 26.92%, 33.05%, and 38.75%, respectively, under varying ART coverages.Conclusion:Our study demonstrates that the early initiation of ART for people living with HIV/acquired immune deficiency syndrome (AIDS) has a positive effect in slowing the spread of HIV.

Current HIV Prevention Policies Are Jeopardizing the “End of AIDS” Project: Realities Counteract Liberal Visions

Here I discuss a series of in adequate decisions made by governments of, e.g., the European Union when designing strategies aimed at preventing the spread of human immunodeficiency virus (HIV). Although there have been minor successes in curbing the spread of HIV, here I focus on the multiple failings that have indirectly fostered the spread of HIV. I propose that a novel, programmatic set of strategies are needed to prevent the spread of HIV, which will be necessary to meet aims of the End of AIDS (acquired immunodeficiency syndrome) project. I also discuss barriers to the End of AIDS project, including financial burdens and noncompliance, in particular of the “at-risk” termed population in resource rich countries, with current prevention strategies. The aim is (i) to foster supporting for the UNAIDS project by customized prevention concepts; and (ii) to raise awareness for the challenges yet to come, should the UNAIDS project fail.

Relationship Between Voluntary Medical Male Circumcision and HIV Reduction: A Critical Review

In Kenya, male circumcision among earlier non practicing communities, like the communities from Western Kenya gained popularity in 2008. This is when the voluntary medical male circumcision was introduced as one of the campaigns to reduce the spread of Human Immunodeficiency Virus (HIV). According to [1], as at the end of the year 2013, 792,000 males had been circumcised in the region. The purpose of this study was to investigate the relationship between voluntary medical male circumcision and HIV reduction. The study was based on already done studies and purely depended on findings of past studies. The study revealed that voluntary medical male circumcision can significantly reduce contraction of HIV. It was evident that voluntary medical male circumcision only provides partial protection from HIV infection. While some studies showed that male circumcision is statistically proven to reduce HIV contraction among men than in women. It was also noted that is not properly done, HIV can be transmitted during male circumcision. This review study recommends further study in HIV prone areas like Western Kenya to assess the specific impact of voluntary medical male circumcision commissioned by Kenya government in 2008.

Seroprevalence of HIV Infection and Associated Factors Among Newly Incarcerated Prisoners in Abidjan, Ivory Coast

Poor socio-economic condition of prisoners and practices at risk of getting transmissible diseases in most prisons contribute to the spread of Human Immunodeficiency Virus (HIV) infection. The objectives of this study were to determine HIV seroprevalence among newly incarcerated persons, to describe their risk behaviors, and to identify factors associated with HIV infection. We conducted a cross-sectional study from January 2014 to February 2014 at the biggest prison of Abidjan called “House of Judgement and Correction of Abidjan” (HJCA). Study population included newly incarcerated persons aged more than 18 years. Overall, 370 people were included after an informed consent. Findings showed that 13% of inmates used drug; 8.3% of them using injectable drugs. The vast majority of respondents (97.3%) experienced sexual intercourse and 31.9% had multiple sexual partners. More than half (50.6%) of respondents did not use condom, and among those who use it, 73.6% used it irregularly. During their last sexual intercourse, 71.8% of respondents did not use condom. Overall, 7.9% of respondents were HIV positive. Factors associated with HIV positive status were history of herpes zoster (adj. OR=16.66, 95% CI: 2.66-104.08, p=0.003), history of STIs (adj. OR=8.82, 95% CI: 3.25-23.95, p<0.001), history of tuberculosis (adj. OR=6.49, 95% CI: 1.06-39.79, p=0.043), and having had more than one sexual partner over the last 12 months (adj. OR=8.11, 95% CI: 1.75-37.51, p=0.007). Promoting safer behaviors, routine HIV screening among prisoners, care for HIV-positive people, and improved living conditions in prisons are needed measures to control HIV / AIDS in prison environment in Ivory Coast.

DRUG PROVISION OF HIV INFECTED CRIMINALS IN INSTITUTIONS OF CRIMINAL-EXECUTIVE SYSTEM OF KRASNODAR REGION

The rapid spread of human immunodeficiency virus (HIV) leads not only to loss of health in persons held in penitentiary institutions, but also to an increase in material costs for drug coverage of the infected, causing the deficit in the budget of the Russian Federation. The aim of the study is the investigation of the problems in drug supply of HIV-infected people and to search for their solutions. Materials and methods . The investigation was conducted on the basis of statistic data, medical statements and accounting to reports of the penitentiary medical organization using methods of analysis, documentary observation, grouping and comparison of data. Results and discussion . It has been established that in institutions of the penal system the number of HIV-infected criminals continues to grow rapidly. It has been determined that currently in the criminal-executive system (CES) of Kuban’ only 5 classes of antiretroviral drugs out of the 10 classes represented on the Russian pharmacy market are used. Hereby the greatest number of drugs used in prison medical organization for conducting antiretroviral therapy (ARVT), are classified as “Nucleoside reverse transcriptase inhibitors” and “Protease Inhibitors”, and other classes of art drugs are represented by only one international nonproprietary name (raltegravir, enfuvirtide, etravirine). Drug treatment of socially significant infectious diseases is supplied centrally and completely satisfies regional needs. The structure of suppliers has been identified and determined. In 2016 the main suppliers were Joint-stock companies (JSC) “National Immunobiological Company” and “R-PHARM”. An acute shortage of drugs for opportunistic infections due to insufficient funding has also been determined. The necessity for urgent replacement of material-technical base in prison pharmacies for compliance with the rules of storage of medicines which can ensure their safety was identified. The imperfection of accounting medicines and urgent necessity of the centralization system of personified registration were revealed. Real needs in funding increasing and the establishment of Central pharmacy were identified. Conclusion. The revealed deficiencies indicate a critical need for opening Central pharmacy in the territorial bodies of the criminal-executive system and establishing a centralized system of personified registration of medical property, as well as improving the process of medical record keeping and the increase in funding.

Knowledge, attitude, and behavioral practices pertaining to human immunodeficiency virus/acquired immune deficiency syndrome among secondary school adolescents in makurdi, Nigeria

Background: Adolescents knowledge with their safe practices pertaining to human immunodeficiency virus (HIV) has a critical impact on the prevention of contracting and spreading HIV. Reports have shown that adolescents in the general setting engage in activities that enhance the spread of the virus. Aim: The study assessed school adolescent's HIV/acquired immune deficiency syndrome (AIDS) knowledge, with its impact on their behaviors and attitudes regarding the infection. Materials and Methods: Two hundred randomly selected adolescent students from 10 different schools in the city metropolis were involved in the cross-sectional study. Primary data were collected using a validated self-administered questionnaire on students HIV/AIDS knowledge, attitude toward people living with HIV/AIDS (PLWHA), and safe practices preventing the spread of HIV/AIDS. Results: The study observed that majority of the students had good knowledge about HIV/AIDS, had good attitude toward PLWHA, and engaged in safe practices that prevent the spread of HIV. The sources of HIV/AIDS information were hospital, school, home, electronic, and print media. The study also found that HIV/AIDS knowledge instilled good attitudes and behavioral practices in the students. Conclusion: The study shows that school sex education, as well as health promotion campaigns through media platforms, could impact positively on the knowledge, attitude, and behavioral practices of adolescents in curbing the spread of HIV/AIDS.

Human immunodeficiency virus infection among male prison inmates in Birnin Kebbi, Nigeria

Background and Objective: Prisons are penal institutions, where most often human immunodeficiency virus (HIV) testing of inmates is neglected. The prison could serve as a source of HIV spread during reintegration of the inmates back into the society upon release. The study is designed to determine the seroprevalence of HIV infection among male inmates in Birnin Kebbi prison, Nigeria. Materials and Methods: A total of 290 counseled and consenting inmates aged 15–55 years were enrolled in a “cross-sectional” study. Serum samples prepared from venous whole blood obtained from inmates were screened for HIV infection by a parallel testing algorithm using two commercial HIV-1 and 2 antigen testing kits. Results and Analyses: The results from the study showed that 8 (2.76%) out of the 290 inmates enrolled in the study had detectable HIV antibodies. The prevalence rate among the age groups was as follows; 15–24 years (2.78%), 25–34 years (2.74%), 35–44 years (5%), and 4–55 years (0.00%). Among the ethnic groups, the prevalence rates recorded were Tiv (14.29%), Nigeriens (7.69%), Igbo (4.55%), Yoruba (2.7%), and Hausa/Fulani (1.92%). Conclusion: Our study observes a high prevalence rate of HIV, across age grades, and ethnicities among inmates. Considering the non-HIV testing of inmates in prisons, we recommend the establishment of preventive and management measures of HIV in penal institutions throughout the country.

Needle exchange for controlling HIV spread under endogenous infectivity

Losses due to Human immunodeficiency virus (HIV) infections among injection drug users are substantial. Among HIV prevention programmes targeting injection drug users (IDUs), needle and syringe programmes are relatively easy to administrate and are cost-effective. We study the problem of optimally allocating prevention effort over a finite time horizon in a needle and syringe programme by balancing the benefit of infections averted with prevention costs. To maximize the system value, one needs to consider the timing and amount of prevention effort carefully. A key finding of our work is that extreme treatment policies from previous literature are not optimal. Instead, a period of moderate prevention effort is crucial in an optimal policy. We also find that as the time horizon increases, a policy of initial extreme treatment becomes more attractive and such treatment duration grows. Another interesting finding is the nonlinear impact of control effectiveness on the amount of prevention effort: when prevention effort is highly effective, the amount of effort decreases with the effectiveness, contrary to what one might expect. Through policy comparison, optimal policies are found to be most beneficial when the budget is less constrained.

Inside Insite

The debate around supervised injection facilities (SIF) rages on more than a decade after the opening of Insite, Canada’s first supervised injection site in Vancouver. Recently, an article published in the journal Addiction reignited the discussion when it made a financial case for introducing facilities in Ottawa and Toronto. The model predicts that the introduction of two SIFs in Ottawa and three in Toronto would be a cost-savings measure to prevent the spread of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among intravenous drug users (IVDUs). Over 600 total cases of HIV or HCV are projected to be averted in a 20-year period, saving over $40 million in healthcare costs in Toronto and over $30 million in Ottawa. Opponents deny the benefits of safe injection sites despite research conducted on Insite, which suggest that these facilities have tremendous utility and are economically viable. Insite targets and attracts high-risk IVDUs, fosters safer injection habits and prevents transmission of needle-sharing diseases. Insite’s facilities also offer complementary detoxification and rehabilitation services and encourage users to register for these programs. In contrast to arguments made by opponents, Insite has not been found to increase incidental overdoses, neighbourhood crime rates, or public disposal of needles. Given the outcomes of research conducted on Insite, the viability of similar facilities in Ontario should be further explored.

Ward Cates: A Life Well Lived

After a long illness Willard (Ward) Cates, Jr. passed away on March 17, 2016. Ward was our friend, our colleague, and a giant force in public health. Ward was born in Cleveland, OH, on November 16, 1942, and he grew up in Rye, NY. He graduated from Rye High School in 1960 and Yale University in 1964 with a Bachelor's degree in history. Ward completed combined MD and MPH degrees at Yale in 1971. Ward's love affair with Yale University and his classmates was sustained over a lifetime. After a stint in the United States Army, Ward joined the Epidemic Intelligence Service of the U.S. Centers for Disease Control and Prevention (CDC) in 1974, the pivotal event in his professional life. Ward began training at the CDC at a time when abortion rights were a critical national topic. Ward and his colleagues demonstrated the profoundly positive effects of legal abortion services on women's health. Ward spent the rest of his life as a world-wide leader in family planning policy and research, and he wrote more than 100 articles on this topic. From 1982 to 1992, Ward served as the director of the Division of Sexually Transmitted Diseases at the CDC, and to this position he brought his vast knowledge of women's health. Ward revolutionized the division of sexually transmitted diseases and worked to integrate the division into the rest of the CDC; he introduced epidemiology as the “basic science” of public health and insisted on bringing scientific rigor to sexually transmitted disease (STD) prevention programs. Using his vast knowledge of women's reproductive health, Ward expanded the work of the division to include STD sequelae, such as infertility and ectopic pregnancy. Ward took over the STD division at the beginning of the human immunodeficiency virus (HIV) pandemic; he played a critical role in defining the contribution of STDs to the spread of HIV, the phenomenon ultimately identified as “epidemiologic synergy.” From 1992 to 1995, Ward returned to the Epidemic Intelligence Service as director, allowing him to focus on the discipline of epidemiology that was so central to his thinking. Ward was recruited to Family Health International (now FHI 360), in 1995, and was appointed as president and CEO in 1998. Ward spent the rest of his career at FHI. Working at FHI, Ward became a leader in the prevention of HIV. He launched the NIH Prevention Trials Network in (HPTN) 1999, and until his death, he played key roles in virtually every project related to HIV prevention whether behavioral or biological. In his last year, Ward worked tirelessly to promote a randomized controlled trial to better understand the role of hormonal contraception in the acquisition of HIV. A brief summary of a lifetime of exceptional professional accomplishments cannot do justice to Ward Cates, the man. Ward was a positive force. He had terrific intellect, rare knowledge across several fields of biology and medicine, exceptional leadership skills, humility, equanimity, and humanity; he had a generosity of spirit that he shared with everyone he met. Ward was passionate in his research efforts, and his passion led to inception and completion of projects that improved health worldwide. Ward was a happy man. He was happy with his beloved family; he was happy with his friends (and nearly everyone who knew him announced themselves as his best friend); he was happy in his professional life; and he was happy with the contributions he made as a scientist and as a mentor. And in turn, his presence brought happiness to everyone who knew him and loved him.

Mechanisms of HIV Transcriptional Regulation by Drugs of Abuse.

There is a strong correlation between the use and abuse of illicit drugs and the spread of Human Immunodeficiency Virus (HIV). It is well established that illicit drugs users are a high risk population for infection with HIV with an increased rate of HIV transmission and replication. Cocaine, amphetamine, methamphetamine, heroin and morphine stand out as the most frequently abused illicit drugs and their use correlates well with HIV infection and AIDS progression. Notably, the high incidence of HIV infection in illicit drug abusers is primarily due to high risk activities such as needle sharing and unprotected sex. Several studies have also demonstrated that drugs of abuse increase viral RNA concentrations by enhancing HIV replication, in particular in the central nervous system (CNS). The CNS is a common target for both drugs of abuse and HIV, and their synergistic action accelerates neuronal injury and cognitive impairment. In order to generate complete genomic transcripts, HIV gene expression has to progress through both the initiation and elongation phases of transcription, which requires coordinated action of different transcription factors. In this review, we will provide the latest updates of the molecular mechanisms that regulate HIV transcription and discuss how drugs of abuse, such as cocaine, amphetamine, methamphetamine, heroin and morphine, modulate those mechanisms to upregulate HIV transcription and eventually HIV replication.

Using HIV Sequence and Epidemiologic Data to Assess the Effect of Self-referral Testing for Acute HIV Infection on Incident Diagnoses in San Diego, California.

Because recently infected individuals disproportionately contribute to the spread of human immunodeficiency virus (HIV), we evaluated the impact of a primary HIV screening program (the Early Test) implemented in San Diego. The Early Test program used combined nucleic acid and serology testing to screen for primary infection targeting local high-risk individuals. Epidemiologic, HIV sequence, and geographic data were obtained from the San Diego County Department of Public Health and the Early Test program. Poisson regression analysis was performed to determine whether the Early Test program was temporally and geographically associated with changes in incident HIV diagnoses. Transmission chains were inferred by phylogenetic analysis of sequence data. Over time, a decrease in incident HIV diagnoses was observed proportional to the number primary HIV infections diagnosed in each San Diego region (P < .001). Molecular network analyses also showed that transmission chains were more likely to terminate in regions where the program was marketed (P = .002). Although, individuals in these zip codes had infection diagnosed earlier (P = .08), they were not treated earlier (P = .83). These findings suggests that early HIV diagnoses by this primary infection screening program probably contributed to the observed decrease in new HIV diagnoses in San Diego, and they support the expansion and evaluation of similar programs.

Hidden and Mobile: A Web-based Study of Migration Patterns of Men Who Have Sex With Men in China.

Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and more likely to migrate due to widespread stigma and discrimination in China. Their mobility complicates estimation of local MSM population sizes and the provision of HIV services, and may also contribute to the spread of HIV. Between 1 January 2008 and 31 December 2012, the visits of all individuals to the largest Chinese MSM dating website were recorded. After a predesigned de-identification procedure by the website, we analyzed Internet Protocol addresses for migration patterns. Migrants were defined as individuals who were away from their registered residence for >6 months in the last 12 months. The website contained data on 794 912 MSM eligible for the study, of which 34.5% were migrants. The median age was 26 years (range, 18-61 years), and 85.5% were unmarried. Compared with nonmigrant MSM, migrants were less likely to be married to a woman (8.6% vs 13.5%; P < .001). The 5 provinces with the highest migrant inflow ratios were Guangdong, Shanghai, Beijing, Tianjin, and Zhejiang. Eastern coastal cities were the primary destination of MSM from southwestern China. Preferential MSM migration may influence MSM population sizes in both originating and destination provinces, particularly for provinces with uneven inflow and outflow. MSM migration from southwestern China, which has the highest HIV prevalence in this population, to coastal cities with lower prevalence may have implications for the spread of the HIV epidemic as well as HIV care services.

Tuberculosis Epidemiology at the Country Scale: Self-Limiting Process and the HIV Effects.

BackgroundThe global spread of the human immunodeficiency virus (HIV) is the main hypothesis behind tuberculosis (TB) positive trends in the last decades, according to modeling studies and World Health Organization Reports (WHO). On one hand, TB (WHO) reports do not explicitly consider a modeling approach, but cover country and global TB trends. On the other hand, modeling studies usually do not cover the scale of WHO reports, because of the amount of parameters estimated to describe TB natural history. Here we combined these two principal sources of TB studies covering TB High Burden Countries (HBCs) dynamics. Our main goals were: (i) to detect the endogenous component of TB dynamics since 1974 for TB HBCs; and (ii) to explore the HIV exogenous effects on TB models`parameters.Methods and FindingsWe explored the relationship between the TB per capita population rate of change (RI) and the infectious class size following an endogenous/exogenous framework. RI can be affected by intra-population processes (i.e. competition, predation) and exogenous variables like HIV. We found that TB dynamics had always a strong endogenous component, represented by a negative correlation between TB population size and RI, which was captured by the discrete logistic model. Moreover, we explored the HIV exogenous effects on TB models`parameters. We found that overall the TB+HIV logistic model was more parsimonious than TB model alone, principally in the African region. Our results showed that HIV affected principally TB carrying capacity, as expected by the known HIV effects on TB natural-history. We also tested if DOTS (Directly Observed Treatment Short-Course Strategy), poverty levels and BCG (Bacillus Calmette-Guérin) coverage explained the models´ residuals variances, but they did not.ConclusionsSince 1974, TB dynamics were categorized in distinct chronological domains, with different dynamics but nearly the same underlying mechanism: a negative relationship between RI and infected class size (i.e. self-limiting). In the last decades, not only HIV spread represented a new TB chronological domain, but it also has been pushing TB carrying capacity (K) to higher levels. TB has a complex natural-history and imposes real challenges to model its dynamics. Yet, we were able to explore and reveal the main drivers of TB dynamics for HBCs since 1974, through a simple approach. Based on our results, we suggest that the endogenous view should be considered as a plausible hypothesis to model and explain TB dynamics and that future World Health Organization reports could include the endogenous/exogenous framework as a supplement to help to decipher the main drivers of TB dynamics and other diseases.