Rate Of New HIV Diagnoses Research Articles

Impact of a structured HIV testing program in a hospital emergency department and a primary care center.

IntroductionHIV testing guidelines are poorly implemented in most clinical settings. The best screening strategy and healthcare scenario are still unknown. The aim of our study is to evaluate the impact of a structured HIV testing intervention (DRIVE), compared to HIV testing as routinely performed in clinical practice, in two different clinical settings: a primary care center and an emergency department.MethodsProspective evaluation of an HIV testing strategy in two clinical settings from the same healthcare area. The DRIVE program included trained nurse practitioners to perform the screening, a questionnaire to assess the risk of exposure and HIV indicator conditions (RE&IC), and rapid HIV tests. The main variables between the DRIVE program and clinical practice were the absolute number of newly diagnosed HIV infections and testing coverage.ResultsThe DRIVE program included 5,329 participants, of which 51.2% reported at least one positive answer in the questionnaire. The estimated HIV testing coverage was significantly higher in the DRIVE program than in the routine clinical practice (7.17% vs. 0.96%, p < 0.001), and was better in the primary care center than in the emergency department with the two strategies. Twenty-two HIV-positive people were identified, with a rate of 8.6‰ in the emergency department vs. 2.2‰ in the primary care center (p = 0.001). A higher rate of new HIV diagnoses was found in the DRIVE program compared to routine clinical practice (29.6 vs. 3.1 per 100,000 patients attended; p < 0.001).ConclusionsAn easy-to-implement, structured intervention increased the absolute number of new HIV diagnoses and HIV tests, compared to routine clinical practice.

Changes in Characteristics and Behavior Among African American Men Who Have Sex with Men and Women in the Context of Reductions in HIV Diagnoses Among Women.

Men who have sex with men and women (MSMW) connect lower prevalence populations of women to higher prevalence populations of men who have sex with men only. We hypothesize that HIV testing and treatment among MSMW have increased in recent years, and this increase can help explain the declining rates of new HIV diagnoses among African American women. We analyzed data from 2008, 2011, and 2014 of the National HIV Behavioral Surveillance system. African American men who have sex with men (MSM) were surveyed from 19 United States cities using venue-based sampling and tested for HIV infection. We used generalized estimating equations, using year of survey as an independent variable, adjusting for age, to determine differences for selected outcomes regarding healthcare and risk behaviors over time. Among the 1299 African American MSMW interviewed, significant increases were observed in the percent of men who had an HIV test in the previous 12months (2008: 54%, 2011: 69%, and 2014: 68%, p-value < 0.001). Among HIV-positive men, the percentage of men who were aware of their infection at the time of the interview increased significantly over time (26, 35, and 48%, p-value = 0.002). Among those men, the percentage who reported currently being on antiretroviral therapy also increased significantly over time (46, 69, and 72%, p-value = 0.050). The percentage of men reporting high-risk sexual risk behaviors increased or remained stable. Our findings support the hypothesis that HIV testing and treatment has increased among African American MSM from 2008 to 2014. Additional research is needed to fully explore the population-level impact it has on HIV transmission among women.

State minimum wage laws and newly diagnosed cases of HIV among heterosexual black residents of US metropolitan areas

This ecologic cohort study explores the relationship between state minimum wage laws and rates of HIV diagnoses among heterosexual black residents of U.S metropolitan areas over an 8-year span. Specifically, we applied hierarchical linear modeling to investigate whether state-level variations in minimum wage laws, adjusted for cost-of-living and inflation, were associated with rates of new HIV diagnoses among heterosexual black residents of metropolitan statistical areas (MSAs; n=73), between 2008 and 2015. Findings suggest that an inverse relationship exists between baseline state minimum wages and initial rates of newly diagnosed HIV cases among heterosexual black individuals, after adjusting for potential confounders. MSAs with a minimum wage that was $1 higher at baseline had a 27.12% lower rate of newly diagnosed HIV cases. Exploratory analyses suggest that income inequality may mediate this relationship. If subsequent research establishes a causal relationship between minimum wage and this outcome, efforts to increase minimum wages should be incorporated into HIV prevention strategies for this vulnerable population.

Patterns of Racial/Ethnic Disparities and Prevalence in HIV and Syphilis Diagnoses Among Men Who Have Sex With Men, 2016: A Novel Data Visualization.

To describe disparities in HIV infection and syphilis among gay, bisexual, and other men who have sex with men (MSM) in US states through ratio-based measures and graphical depictions of disparities. We used state-level surveillance data of reported HIV and syphilis cases in 2015 and 2016, and estimates of MSM population sizes to estimate HIV and syphilis prevalence by race/ethnicity and rate ratios (RRs) and to visually display patterns of disparity and prevalence among US states. State-specific rates of new HIV diagnoses were higher for Black than for White MSM (RR range = 2.35 [Rhode Island] to 10.12 [Wisconsin]) and for Hispanic than for White MSM (RR range = 1.50 [Tennessee] to 5.78 [Pennsylvania]). Rates of syphilis diagnoses were higher for Black than for White MSM in 42 of 44 states (state RR range = 0.89 [Hawaii] to 17.11 [Alaska]). Scatterplots of HIV diagnosis rates by race showed heterogeneity in epidemic scenarios, even in states with similar ratio-based disparity measures. There is a widely disparate impact of HIV and syphilis among Black and Hispanic MSM compared with White MSM. Between-state variation suggests that states should tailor and focus their prevention responses to best address state data.

Pretreatment human immunodeficiency virus type 1 (HIV-1) drug resistance in transmission clusters of the Cologne-Bonn region, Germany

ObjectivesIn Germany, previous reports have demonstrated transmitted human immunodeficiency virus type 1 (HIV-1) drug-resistance mutations (DRM) in 11% of newly diagnosed individuals, highlighting the importance of drug-resistance screening before the initiation of antiretroviral therapy (ART). Here, we sought to understand the molecular epidemiology of HIV DRM transmission in the Cologne-Bonn region of Germany, given one of the highest rates of new HIV diagnoses in western Europe (13.7 per 100 000 habitants). MethodsWe analysed 714 HIV-1 ART-naive infected individuals diagnosed at the University Hospitals Cologne and Bonn between 2001 and 2016. Screening for DRM was performed according to the Stanford University Genotypic Resistance Interpretation. Shared DRM were defined as any DRM present in genetically linked individuals (<1.5% genetic distance). Phylogenetic and network analyses were performed to infer putative relationships and shared DRM. ResultsThe prevalence of any DRM at time of diagnosis was 17.2% (123/714 participants). Genetic transmission network analyses showed comparable frequencies of DRM in clustering versus non-clustering individuals (17.1% (85/497) versus 17.5% (38/217)). The observed rate of DRM in the region was higher than previous reports 10.8% (87/809) (p < 0.001), revealing the need to reduce onward transmission in this area. Genetically linked individuals harbouring shared DRM were more likely to live in suburban areas (24/38) than in central Cologne (1/38) (p < 0.001). ConclusionThe rate of DRM was exceptionally high. Network analysis elucidated frequent cases of shared DRM among genetically linked individuals, revealing the potential spread of DRM and the need to prevent onward transmission of DRM in the Cologne-Bonn area.

Relationship of Racial Residential Segregation to Newly Diagnosed Cases of HIV among Black Heterosexuals in US Metropolitan Areas, 2008-2015.

Social science and public health literature has framed residential segregation as a potent structural determinant of the higher HIV burden among black heterosexuals, but empirical evidence has been limited. The purpose of this study is to test, for the first time, the association between racial segregation and newly diagnosed heterosexually acquired HIV cases among black adults and adolescents in 95 large US metropolitan statistical areas (MSAs) in 2008-2015. We operationalized racial segregation (the main exposure) using Massey and Denton's isolation index for black residents; the outcome was the rate of newly diagnosed HIV cases per 10,000 black adult heterosexuals. We tested the relationship of segregation to this outcome using multilevel multivariate models of longitudinal (2008-2015) MSA-level data, controlling for potential confounders and time. All covariates were lagged by 1year and centered on baseline values. We preliminarily explored mediation of the focal relationship by inequalities in education, employment, and poverty rates. Segregation was positively associated with the outcome: a one standard deviation decrease in baseline isolation was associated with a 16.2% reduction in the rate of new HIV diagnoses; one standard deviation reduction in isolation over time was associated with 4.6% decrease in the outcome. Exploratory mediation analyses suggest that black/white socioeconomic inequality may mediate the relationship between segregation and HIV. Our study suggests that residential segregation may be a distal determinant of HIV among black heterosexuals. The findings further emphasize the need to address segregation as part of a comprehensive strategy to reduce racial inequities in HIV.

Optimizing Delivery of HIV Preexposure Prophylaxis for Women in the United States.

Preexposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, it is underutilized among women who are at risk for acquisition of HIV. Women comprise one in five HIV diagnoses in the United States, and significant racial disparities in new HIV diagnoses persist. The rate of new HIV diagnoses among black and African American women in 2015 was 16 times greater than that of white women. These disparities highlight the importance of HIV prevention strategies for women, including the use of PrEP. PrEP is the first highly effective HIV prevention method available to women that is entirely within their control. However, because so few women who may benefit from PrEP are aware of it, few women's healthcare providers offer PrEP to their patients, PrEP has not yet achieved its potential to reduce HIV infections in women. This article describes individual and systemic barriers for women related to the uptake of PrEP services; explains how providers can identify women at risk for HIV; reviews how to provide PrEP to women; and outlines client-centered models for HIV prevention services. Better access to culturally acceptable and affordable medical and social services may offer support to women for consistent and ongoing use of PrEP. This discussion may be used to inform HIV prevention activities for women and guide interventions to decrease racial/ethnic disparities in rates of HIV infection among US women.

HIV: don't be complacent.

British Journal of NursingVol. 26, No. 21 RegularsFree AccessHIV: don't be complacentIan PeateIan PeateSearch for more papers by this authorIan PeatePublished Online:23 Nov 2017https://doi.org/10.12968/bjon.2017.26.21.1149AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail It has been 20 years since the introduction of life-saving, free and effective antiretroviral therapy (ART) in the UK. While there have been many advances in HIV treatments and these advances should be celebrated, caution is needed. HIV infection remains a significant public health concern. Some 30 000 to 33 000 new infections are reported each year in Europe (European Centre for Disease Prevention and Control, 2016). In contrast, the overall number of AIDS cases has continued to steadily decline.In 2016, 5164 people were newly diagnosed with HIV in the UK (3938 men and 1226 women). This represents an 18% decline from the 6286 diagnoses reported in 2015. The decrease was most evident in gay and bisexual men. In this group, the number of HIV diagnoses reported steadily increased from 2850 in 2007 to 3570 in 2015, and then decreased by 21% to 2810 in 2016 (Public Health England, 2017).For the first time, there is a reduction in the rate of new infections among younger people; however, the epidemic may be taking a different path. Newly reported HIV cases in older people (those aged 50 years and over) have increased by 2% in Europe (Tavoschi et al, 2017).The advent of ART has resulted in a considerable reduction in the number of people living with and dying from AIDS in the UK. Those people who are diagnosed early with HIV and who commence ART early can expect a near-normal life expectancy. However, there are challenges that remain, with high rates of late HIV diagnoses, with poorer outcomes, and an ageing population.HIV is associated with significant mortality, serious morbidity and high costs of treatment and care. The infection is still seen as a stigmatising condition—one of the greatest challenges for those who are infected and those at risk (Carabini, 2017). The infection also has a prolonged ‘silent’ period during which it can often remain undiagnosed.There is no cure for HIV. It is still here and we should not be complacent or ignorant of the risks of HIV in the over-50s. The over-50s may have a low awareness of HIV and how it is transmitted and this leads to misconceptions and low perceptions of their own risk. Health professionals should not assume that older people are not running risks through engaging in unsafe sex; making such an assumption is neglect and implicit ageism.The Tavoschi et al (2017) study has demonstrated a steady increase in the rate of new HIV diagnoses among older adults in Europe over a 12-year period. Furthermore, there were stable or increasing trends for transmission modes such as heterosexual contact and injecting drug use among older adults as opposed to a substantial falling trend among younger ones. Tavoschi et al's (2017) work points towards the need to deliver more targeted testing interventions for older adults The perception that older people are not at risk is shared by some healthcare providers; HIV-related services very often focus on a younger population (Tavoschi et al 2017).Nurses are considered to be leaders in public health and, as such, they have a key role to play in increasing awareness among other health workers and expanding opportunities for testing programmes among this population. There is a need for nurses to ensure that all ages are appropriately targeted by sexual health services.As the number of older people living with HIV in the UK rises, and effective HIV treatments are available, nurses can expect to see and be required to offer care to a growing number of older people with HIV-related infection. References Carabini K. Stigma and HIV: the current situation. HIV Nursing. 2017; 17(2): 57–62 Google ScholarEuropean Centre for Disease Prevention and Control. Annual epidemiological report 2016—HIV/AIDS. 2016. http://tinyurl.com/y9fmetgu (accessed 10 November 2017) Google ScholarPublic Health England. HIV in the United Kingdom: decline in new HIV diagnoses in gay and bisexual men in London, 2017 report. Health Protection Report Advanced Access report 11(35). 3 October 2017. http://tinyurl.com/ybovvzj9 (accessed 10 November 2017) Google ScholarTavoschi L, Gomes Dias J, Pharris A. EU/EEA HIV Surveillance Network. New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004-15: an analysis of surveillance data. Lancet HIV. 2017; 4(11):e514–e521. https://doi.org/https://doi.org/10.1016/s2352-3018(17)30155-8 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 23 November 2017Volume 26Issue 21ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 23 November 2017 Published in print 23 November 2017 Information© MA Healthcare LimitedPDF download

Expanded HIV Testing Strategy Leveraging the Electronic Medical Record Uncovers Undiagnosed Infection Among Hospitalized Patients.

Routine HIV testing of hospitalized patients is recommended, but few strategies to expand testing in the hospital setting have been described. We assessed the impact of an electronic medical record (EMR) prompt on HIV testing for hospitalized patients. We performed a pre-post study at 3 hospitals in the Bronx, NY. We compared the proportion of admissions of patients 21-64 years old with an HIV test performed, characteristics of patients tested, and rate of new HIV diagnoses made by screening while an EMR prompt recommending HIV testing was inactive vs. active. The prompt appeared for patients with no previous HIV test or a high-risk diagnosis after their last HIV test. Among 36,610 admissions while the prompt was inactive, 9.5% had an HIV test performed. Among 18,943 admissions while the prompt was active, 21.8% had an HIV test performed. Admission while the prompt was active was associated with increased HIV testing among total admissions [adjusted odds ratio (aOR) 2.78, 95% confidence interval (CI): 2.62 to 2.96], those without a previous HIV test (aOR 4.03, 95% CI: 3.70 to 4.40), and those with a previous negative test (aOR 1.52, 95% CI: 1.37 to 1.68) (P < 0.0001 for all). Although the prompt was active, testing increased across all patient characteristics. New HIV diagnoses made by screening increased from 8.2/100,000 admissions to 37.0/100,000 admissions while the prompt was inactive and active, respectively (OR 4.51 95% CI: 1.17 to 17.45, P = 0.03). An EMR prompt for hospitalized patients was associated with a large increase in HIV testing, a diversification of patients tested, and an increase in diagnoses made by screening.

Reduced community viral load does not coincide with a reduction in the rate of new HIV diagnoses and recent infections: data from a region of southern Italy.

We assessed whether changes in community viral load (CVL) over time were associated with the rate of new HIV diagnoses (NDs). HIV-1-positive individuals referred to our institute and permanently residing in our province were considered for inclusion in the study. A total of 861 HIV-infected adults with at least one HIV RNA measurement (12 530 measurements in total) between 2008 and 2014 were included. Viraemia copy-years were calculated from all HIV RNA values for each patient using the trapezoidal rule; multiple CVL indicators were considered. Total NDs and recent infections (< 1 year) were analysed separately. The association between NDs and CVL was tested by means of mixed Poisson models, with CVL as a fixed effect and year as a random effect. The incidence of NDs was 2.28 per 100 000 residents in 2008 and 2.52 per 100 000 residents in 2014. Total numbers of NDs and recent infections did not vary significantly over time (P for trend 0.879 and 0.39, respectively). Mean HIV RNA decreased from 31 095.8 HIV-1 RNA copies/mL in 2008 to 21 231.5 copies/mL in 2014 (P < 0.001); a downward trend was always observed regardless of the CVL indicator considered. Depending on the indicator, there were some differences in CVL by patient characteristics. The most substantial contributors to CVL appeared to be male individuals, men who have sex with men (MSM), non-Italians, and untreated subjects (all P < 0.05). The relative risk of ND increased among Italians and MSM with an increasing proportion of subjects having an undetectable HIV RNA, and decreased in the same population with increasing levels of CVL. In our setting, CVL represented a good marker of access to care and treatment; however, reduced CVL did not coincide with a reduction in the rate of NDs.

High Rate of Hepatitis B and C Coinfections Among People Living with HIV-1 in Bulgaria: 2010-2014.

In a representative nationwide study, we have determined the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections among HIV-positive patients diagnosed during the period 2010-2014 in Bulgaria. Despite a relatively low rate of new HIV diagnoses, the rates of hepatitis B and C coinfections among these patients fell within the upper range reported in Europe. HBsAg and HCV antibodies (Ab) were found in 10.4% and 25.6% of the tested individuals, respectively. Importantly, high rates of active hepatitis infections were confirmed by detection of HBV DNA in 51.1% and HCV RNA in 78.1% of the tested individuals. Hepatitis coinfections affected mostly high risk groups and persons with multiple risk behavior, including people who inject drugs, men who have sex with men, prisoners, and Roma people.

Surveillance of HIV assisted partner services using routine health information systems in Kenya.

BackgroundThe utilization of routine health information systems (HIS) for surveillance of assisted partner services (aPS) for HIV in sub-Saharan is sub-optimal, in part due to poor data quality and limited use of information technology. Consequently, little is known about coverage, scope and quality of HIV aPS. Yet, affordable electronic data tools, software and data transmission infrastructure are now widely accessible in sub-Saharan Africa.MethodsWe designed and implemented a cased-based surveillance system using the HIV testing platform in 18 health facilities in Kenya. The components of this system included an electronic HIV Testing and Counseling (HTC) intake form, data transmission on the Global Systems for Mobile Communication (GSM), and data collection using the Open Data Kit (ODK) platform. We defined rates of new HIV diagnoses, and characterized HIV-infected cases. We also determined the proportion of clients who reported testing for HIV because a) they were notified by a sexual partner b) they were notified by a health provider, or c) they were informed of exposure by another other source. Data collection times were evaluated.ResultsAmong 4351 clients, HIV prevalence was 14.2 %, ranging from 4.4–25.4 % across facilities. Regardless of other reasons for testing, only 107 (2.5 %) of all participants reported testing after being notified by a health provider or sexual partner. A similar proportion, 1.8 % (79 of 4351), reported partner notification as the only reason for seeking an HIV test. Among 79 clients who reported HIV partner services as the reason for testing, the majority (78.5 %), were notified by their sexual partners. The majority (52.8 %) of HIV-infected patients initiated their HIV testing, and 57.2 % tested in a Voluntary Counseling and Testing (VCT) site co-located in a health facility. Median time for data capture was 4 min (IQR: 3–15), with a longer duration for HIV-infected participants, and there was no reported data loss.ConclusionaPS surveillance using new technologies is feasible, and could be readily expanded into HIV registries in Kenya and other sub-Saharan countries. Partner services are under-utilized in Kenya but further documentation of coverage and implementation gaps for HIV and aPS services is required.

P164 Management of primary and secondary syphilis in a large London teaching hospital

Background/introduction Acute syphilis is on the increase and prompt treatment is vitally important to prevent onward transmission. Aim(s)/objectives To ensure compliance with BASHH audit outcomes for the management of acute syphilis. Methods We collected all patients who had been coded as primary or secondary syphilis (A1 or A2) for 12 months from May 2014. Demographics, symptoms at presentation and subsequent management were collected. Results 132 records were returned with 89% (117/131) identifying as men who have sex with men (MSM). 55% (72/132) were HIV positive, with 3 new HIV diagnoses. 70% (89/128) had symptoms of acute syphilis; with an ulcer, 87% (41/47) had herpes simplex virus (HSV) PCR which was positive in 7% of cases. Dark ground microscopy was performed in 38% (20/52) with one third being positive. 42% (56/131) were treated for syphilis on their initial visit (14% if seen by a technician, 31% if seen by a nurse and 51% if seen by a medic, p = 0.006). 90% had been treated by 2 weeks. Discussion/conclusion MSM comprised the majority of acute syphilis with high rates of new HIV diagnoses, reinforcing the importance of routine HIV testing. There was a high co-infection prevalence of HSV. Dark ground microscopy was positive in a third of samples, perhaps due to technical difficulties in the clinic. Only 4 in 10 patients were treated at the first visit indicating a lack of awareness of symptoms of acute syphilis. More education on recognising and treating acute syphilis, especially in high risk groups, is needed.

O23.2 Achieving the goals of the us national hiv/aids strategy: declining hiv diagnoses, improving clinical outcomes, and diminishing racial/ethnic disparities in king county, wa., usa

Background US national data suggest that new HIV diagnoses are now declining. However, that decline has been uneven, and has not clearly included men who have sex with men (MSM), the group most affected by HIV in the US. Methods We used data from the US Census, American Community Survey, and the King County, WA HIV/AIDS Reporting System (NHSS) 2004–2013 to assess trends in the rates of new HIV diagnoses, AIDS diagnoses and age- and reporting lag-adjusted HIV-associated mortality rates among King County residents. Trends in viral suppression, defined as the proportion of individuals with a last reported plasma viral load (VL) result of Results Between 2004 and 2013, the rate of new HIV diagnoses decreased from 18.4 to 13.2 per 100,000 residents (decline of 28%); AIDS diagnosis rates declined 42% from 12.3 to 7.2 per 100,000; and death rates decreased from 27 to 15 per 1,000 persons living with HIV/AIDS (PLWHA) (decline of 44%; p Conclusions The rates of new HIV diagnosis, AIDS diagnoses and mortality in PLWHA in King County, WA have significantly declined over the last decade. These changes have occurred concurrent with a dramatic increase in HIV viral suppression, and have affected diverse populations, including MSM and African American MSM.

O20.1 The challenges of diversity: hiv-1 subtype distribution and transmission networks within the australian molecular epidemiology network-hiv 2005–2012

Introduction Rates of new HIV diagnoses are increasing in Australia, with evidence of an increasing proportion of non-B subtypes reflecting a growing impact of sexual networks, migration and travel. This present study aims to further define HIV-1 subtype diversity and investigate HIV-1 transmission networks within Australia. Methods The Australian Molecular Epidemiology Network (AMEN) HIV collaborating sites in Western Australia, South Australia, Victoria, Queensland and Western Sydney, provided baseline HIV-1 partial pol sequence, age and gender information for a total of 4929 patients during 2005–2012. HIV-1 phylogenetic analyses utilised MEGA V6, with a stringent classification of transmission clusters (bootstrap ≥98%, genetic distance ≤1.5%). Results HIV-1 B subtype represented 74.9% of 4929 sequences (WA 59.3%, SA 68.6%, W Syd 75.2%, Vic 75.7%, Qld 82.3%), with a greater proportion of clusters compared to non-B subtypes (27.6% vs 22.4% of sequences, p = 0.003), larger cluster size (36.0% with >2 sequences vs 24.8% of non-B clusters, p = 0.03) and more male-only groups (90%). The largest cluster comprised 29 B subtype sequences from Vic + WA (age range 23–70 years). HIV-1 subtype C networks (38 groups) included more female/male groups (73.6%) and a smaller proportion of groups >2 (16%), while CRF01_AE networks (44 groups) included 59.1% male-only groups, with groups >2 accounting for 22.7%. Conclusion This nationwide study of HIV-1 sequences involving 4929 patients’ highlights the increasing diversity of HIV-1 subtypes within the Australian epidemic, as well as differences in transmission networks within Australia that are associated with these HIV-1 subtypes. These findings provide epidemiological insights not readily available using standard surveillance methods and can inform the development of effective strategies for prevention of new HIV-1 diagnoses across Australian state boundaries. Disclosure of interest statement None declared.

Impact of Male Circumcision among heterosexual HIV cases: comparisons between three low HIV prevalence countries.

BackgroundStudies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries.MethodsCross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where <10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004–2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined.ResultsAnnual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26–0.70, 1.91–2.28, and 2.69–3.47, respectively; for women: 0.10–0.34, 1.10–2.10 and 2.41–3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries.ConclusionsThe lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.

Rates and Predictors of Newly Diagnosed HIV Infection Among Veterans Receiving Routine Once-Per-Lifetime HIV Testing in the Veterans Health Administration.

To determine predictors and variations in the rate of newly diagnosed HIV infection among persons who underwent routine (ie, non-risk based) rather than risk-based HIV testing in Veterans Health Administration (VHA) facilities. Retrospective observational study of the HIV infection new rates during the period when VHA policy called for routine (2009-2012) versus risk-based (2006-2009) HIV testing. Source data for testing results at 18 VHA facilities were obtained from the VHA National Corporate Data Warehouse. New HIV diagnoses were established in 0.14% (95% confidence interval (CI): 0.12 to 0.46) of the 210,957 patients tested in the routine testing period versus 0.46% (95% CI: 0.42 to 1.29) of the 89,652 patients tested in the risk-based testing period. Among persons aged 65-74 years and 75 years or older, the new diagnosis rates were 0.07% (95% CI: 0.04 to 0.09) and 0.02% (95% CI: 0.00 to 0.03), respectively, and thus less than the generally accepted cost-effective threshold of 0.10%. Among African Americans, the upper bound of the 95% CI of the crude rate of new diagnoses during the routine-testing period was greater than 0.1% across all age strata. When assessed by year of testing, the adjusted rates of new diagnoses fell from 0.20% in 2010 to 0.10% in 2012. Routine HIV testing is cost-effective among persons younger than 65 years. Among older patients, risk-based testing may be a more efficient and cost-effective approach. This will be increasingly relevant if rates of new HIV diagnoses in persons undergoing routine testing continue to decrease.

Transmission clustering among newly diagnosed HIV patients in Chicago, 2008 to 2011: using phylogenetics to expand knowledge of regional HIV transmission patterns.

HIV transmission cluster analyses can inform HIV prevention efforts. We describe the first such assessment for transmission clustering among HIV patients in Chicago. We performed transmission cluster analyses using HIV pol sequences from newly diagnosed patients presenting to Chicago's largest HIV clinic between 2008 and 2011. We compared sequences through progressive pairwise alignment, using neighbor joining to construct an unrooted phylogenetic tree. We defined clusters as >2 sequences among which each sequence had at least 1 partner within a genetic distance of ≤1.5%. We used multivariable regression to examine factors associated with clustering and used geospatial analysis to assess geographic proximity of phylogenetically clustered patients. We compared sequences from 920 patients, median age of 35 years, 75% male, 67% black, 23% Hispanic, and 8% had a rapid plasma reagin titer ≥1:16 concurrent with their HIV diagnosis. We had HIV transmission risk data for 54%; 43% identified as men who have sex with men (MSM). Phylogenetic analysis demonstrated 123 patients (13%) grouped into 26 clusters, the largest having 20 members. In multivariable regression, age <25, black race, MSM status, male gender, higher HIV viral load, and rapid plasma reagin ≥1:16 associated with clustering. We did not observe geographic grouping of genetically clustered patients. Our results demonstrate high rates of HIV transmission clustering, without local geographic foci, among young black MSM in Chicago. Applied prospectively, phylogenetic analyses could guide prevention efforts and help break the cycle of transmission.

Rate of new HIV diagnoses among Latinos living in Florida: disparities by country/region of birth

HIV incidence in the USA is three times higher for Latinos than for non-Latino whites. Latinos differ in educational attainment, poverty, insurance coverage, and health-care access, factors that affect HIV knowledge, risk behaviors, and testing. The purpose of this study was to identify differences in demographics, risk factors, and rate of new HIV diagnoses by birth country/region among Latinos in Florida to guide the targeting of primary and secondary prevention programs. Using Florida HIV/AIDS surveillance data from 2007 to 2011 and the American Community Survey, we compared demographic and risk factors, and calculated annual and five-year age-adjusted rates of new HIV diagnoses for 5801 Latinos by birth country/region. Compared to US-born Latinos, those born in Cuba and South America were significantly more likely to report the HIV transmission mode of MSM; those born in the Dominican Republic (DR) heterosexual transmission; and those born in Puerto Rico injection drug use. Mexican- and Central American-born Latinos were more likely to be diagnosed with AIDS within a month of HIV diagnosis. The rate of new HIV diagnoses among Latinos declined 33% from 2007 to 2011. HIV diagnoses over time decreased significantly for Latinos born in Mexico and increased nonsignificantly for those born in the DR. Although this study was limited to Latinos living in Florida, results suggest that tailoring HIV primary prevention and testing initiatives to specific Latino groups may be warranted.

How treatment as prevention is understood and perceived by vertically infected HIV-positive young people in the UK: results of a small cross-sectional study

BackgroundTreatment as Prevention (TasP) is an effective intervention to prevent the onward transmission of HIV by lowering viral loads in HIV seropositive patients. In view of the high rates of new HIV diagnoses globally in young people, the benefits of TasP as a HIV prevention strategy could be immense. However, the intervention is not a straighforward HIV prevention strategy; there are many practical and ethical implications to be considered before it should be universally recommended. We know that HIV-positive young people (aged 16–29 years) have poor condom use, low rates of disclosure, and chaotic drug adherence patterns. How will TasP affect these other HIV prevention behaviours? Such young people who are already on treatment can give an invaluable insight into many elements of TasP that need to be considered before it is universally adopted as a HIV prevention strategy. The purpose of this survey is to determine understanding and perception of TasP by vertically infected HIV-positive young people. Methods16 young people with HIV infection answered the survey, which was delivered in person or by telephone. Participation was voluntary, and information gained from this survey would affect health education programming at a UK non-governmental organisation working with such youngsters. The survey contained a mixture of multiple-choice and short-answer questions, and was prefaced by a simple definition of TasP. FindingsAll 16 respondents were HIV positive and aged 18–29 years, 15 (94%) self-identified as black African, 12 (75%) were women, and 12 (75%) were taking antiretroviral drugs. When asked how likely hypothetically they were to choose to take TasP, six (38%) responded very likely, four (25%) likely, one (6%) unlikely, two (13%) very unlikely, and three (19%) unsure. Eight (50%) respondents identified reduction in transmission as the primary benefit of TasP, with five (31%) citing potential for personal health improvements as a benefit. When asked what they perceived to be negative aspects of TasP, six (38%) reported concerns about the daily hassle of taking antiretroviral drugs (such as routine, lifestyle, burden), five (31%) about unnecessary drug side-effects, and four (25%) about the financial value of TasP. Key learning priorities for respondents were basics of TasP, positive and negative aspects of TasP, and health implications of TasP (12 [75%] respondents each). InterpretationThis survey highlights HIV-positive young people's need for information about TasP. We need to assess the acceptability of TasP among such youngsters. The survey was done with a small group who were vertically infected with HIV and living in the UK. This subgroup was selected because it is the demographic that makes up most people of this age group at the third sector (charity) organisation undertaking the survey, and the results were intended to guide future programming of the organisation. The survey was done with a small convenience sample selected at random from people in the target age group. The results provide an insight into the range of understanding and opinions of TasP and are to be used as a guide for further investigation and provision of information, not necessarily as representation of the thoughts or opinions of the whole population. FundingNone.