Pre-Exposure Prophylaxis Care Cascade Among Men Who Have Sex with Men Engaging in Partner Notification Services at a Sexually Transmitted Infections Clinic.

Partner notification services (PNS) offers opportunities to discuss HIV pre-exposure prophylaxis (PrEP) and provide referrals. We evaluated the PrEP care cascade among men who have sex with men (MSM) engaging in PNS within a sexually transmitted infections clinic. Among 121 MSM eligible for PrEP during PNS, 21% subsequently initiated PrEP.

HIV Linkage to Care and Pre-Exposure Prophylaxis Among Persons in Non-Health Care Sites Who Are Tested for HIV for the First Time, United States, 2019.

CONTEXT: The Centers for Disease Control and Prevention recommends that all persons aged 13 to 64 years are tested for human immunodeficiency virus (HIV). However, results from US surveys show that 50% of persons and less had ever tested for HIV. PROGRAM: The Centers for Disease Control and Prevention annually funds 60 health departments to conduct comprehensive HIV prevention and surveillance activities that include HIV testing. IMPLEMENTATION: We selected the 31 health departments with quality data (ie, ≤20% missing or invalid values for variables to verify linkage to HIV medical care and new HIV diagnoses) in 2019. Main outcomes were new HIV diagnoses, linkage, and pre-exposure prophylaxis (PrEP) awareness and referrals. We used SAS 9.4 to conduct descriptive, chi-square, and multivariate regression analyses. Our objectives were to determine outcomes and characteristics of persons in non-health care settings who tested for HIV for the first time. EVALUATION: Compared with persons who previously tested for HIV, persons who tested for the first time were more likely to be aged 13 to 29 years than aged 30 years and older (62.0% [24 295/39 192] vs 42.1% [61 911/147 087], P < .001) and have a higher percentage of new HIV diagnoses (0.6% [242/39 320] vs 0.5% [667/147 475], P < .001). Among persons who tested for the first time, overall percentages of linkage, PrEP awareness, and PrEP referral were 73.4%, 33.3%, and 30.8%, respectively. Compared with referent groups, persons who tested for the first time in the South and had a new HIV diagnosis were less likely to be linked (adjusted prevalence ratio [aPR] = 0.72, 95% confidence interval [CI]: 0.59-0.89); persons who inject drugs were less likely to be aware of PrEP (aPR = 0.84, 95% CI: 0.77-0.91); and persons in the Northeast were less likely to receive PrEP referrals (aPR = 0.28, 95% CI: 0.26-0.31). DISCUSSION: Non-health care sites should consider increasing HIV testing, PrEP awareness, and prompt referrals to PrEP and HIV treatment services for persons who have never previously tested.

The Louisiana Wellness Centers Program for HIV/STD Prevention Among Gay and Bisexual Men and Transgender Persons.

CONTEXT: During the conduct of the described demonstration project (2012-2015), the Centers for Disease Control and Prevention funding standard for HIV testing was 1.0% newly diagnosed positivity in non-health care settings. For linkage to HIV medical care, the National HIV/AIDS Strategy goal was 85%, and the funding standard was 80% (the Centers for Disease Control and Prevention and National HIV/AIDS Strategy had no other quantified goals/standards relevant to the project). OBJECTIVE: To determine aggregate quantitative results of HIV/STD testing and engagement in HIV care. DESIGN: Information sources used for this case study analysis included the Louisiana Department of Health funding application, progress and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between these agencies. SETTING: Six community-based Wellness Centers throughout Louisiana. PARTICIPANTS: Gay and bisexual men and transgender persons. MAIN OUTCOME MEASURES: New HIV/STD diagnoses from testing, linkage to HIV care, and reengagement in HIV medical care. RESULTS: The percentage of persons who were newly diagnosed with HIV was 1.4% (44/3214). Of the newly diagnosed persons, 91% (40/44) were linked to HIV medical care. Of persons who were identified as out of care, 83% (5/6) were reengaged in HIV medical care. STD testing results showed that 9.0% (294/3251) of the syphilis tests were positive, and 8.3% (803/9719) of the chlamydia/gonorrhea tests were positive. The pharyngeal chlamydia/gonorrhea positivity was 7.6% (256/3375); the rectal chlamydia/gonorrhea positivity was 13% (374/2948); and the urine chlamydia/gonorrhea positivity was 5.1% (173/3396). CONCLUSIONS: The demonstration project was successful. The results were used to discontinue funding for a less effective HIV screening program, continue demonstration project activities with other funds, and make policy changes so that extragenital screening for chlamydia/gonorrhea is now the standard at Louisiana clinics that serve gay and bisexual men and transgender persons.

Using HIV Surveillance Data to Link People to HIV Medical Care, 5 US States, 2012-2015.

INTRODUCTION: From 2012 through 2015, the Centers for Disease Control and Prevention (CDC) provided funding to 5 health departments for demonstration projects using HIV surveillance data to link people with newly diagnosed HIV to care. We assessed how well these health departments established linkage to care, how the demonstration projects helped them with this work, and if they sustained these activities after CDC funding ended. MATERIALS AND METHODS: We obtained quantitative and qualitative data on linkage-to-care activities from health department communications and progress reports submitted to CDC. We calculated and combined linkage-to-care results for the 5 health departments, and we compared these results with the combined linkage-to-care results for 61 health departments that received CDC funding for routine HIV prevention activities (eg, HIV testing, linkage to and reengagement in HIV care, HIV partner services) and for the same 5 health departments when they used only routine HIV prevention activities for linkage to care. RESULTS: Of 1269 people with a new HIV diagnosis at the 5 health departments, 1124 (89%) were linked to care, a result that exceeded the 2010-2015 National HIV/AIDS Strategy goal (85%), the CDC Funding Opportunity Announcement performance standard (80%), and combined results for the 61 health departments (63%) and the same 5 health departments (66%) using routine HIV prevention activities. Benefits of the projects were improved collaboration and coordination and more accurate, up-to-date surveillance data. All health departments continued linkage-to-care activities after funding ended. PRACTICE IMPLICATIONS: Using HIV surveillance data to link people with HIV to care resulted in substantial clinical and public health benefits. Our observations underscore the importance of collaboration among medical providers, public health staff members, community-based organizations, and people with HIV to ensure the best possible clinical and public health outcomes.

The Usefulness of Individual-Level HIV Surveillance Data to Initiate Statewide HIV Partner Services: Experiences From Hawaii and New Mexico.

CONTEXT: Partner services are a broad array of services that should be offered to persons with human immunodeficiency virus (HIV) and that are based on a process through which HIV-infected persons are interviewed to elicit information about their sex and needle-sharing partners. Human immunodeficiency virus testing of partners can result in a high yield of newly diagnosed HIV positivity, but despite this yield and the benefits of partners knowing their exposures and HIV status, partner services are often not conducted. OBJECTIVE: We sought to determine the newly diagnosed HIV positivity and benefits to 2 health departments that conducted demonstration projects that focused on statewide HIV partner services. DESIGN: The main sources of information used for this case study analysis included the health department funding applications, progress reports and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between Centers for Disease Control and Prevention and the health departments. Required quantitative reporting included the number of partners tested and the number of partners with newly diagnosed confirmed HIV infection. Required qualitative reporting included how health departments benefited from their demonstration project activities. SETTING: Hawaii and New Mexico. PARTICIPANTS: Sex and needle-sharing partners of persons who were newly diagnosed with HIV infection. INTERVENTION: The use of HIV surveillance data to initiate statewide HIV partner services. MAIN OUTCOME MEASURE: Newly diagnosed HIV positivity. RESULTS: During 2012-2015, the newly diagnosed HIV positivity among partners was 18% (78/427): 16% (17/108) in Hawaii and 19% (61/319) in New Mexico. The health departments benefited from improved collaborations among HIV prevention program and surveillance staff and among the health departments, providers, and AIDS service organizations. CONCLUSIONS: Hawaii and New Mexico each achieved a high newly diagnosed HIV positivity and benefited from improved local collaborations. As a result of the success of these projects, both health departments have continued the activities since the end of category C funding by securing alternative funding sources.

Quality of HIV Testing Data Before and After the Implementation of a National Data Quality Assessment and Feedback System.

CONTEXT: In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality assessment and feedback system for CDC-funded HIV testing program data. OBJECTIVE: Our objective was to analyze data quality before and after feedback. DESIGN: Coinciding with required quarterly data submissions to CDC, each health department received data quality feedback reports and a call with CDC to discuss the reports. Data from 2008 to 2011 were analyzed. SETTING: Fifty-nine state and local health departments that were funded for comprehensive HIV prevention services. PARTICIPANTS: Data collected by a service provider in conjunction with a client receiving HIV testing. INTERVENTION: National data quality assessment and feedback system. MAIN OUTCOME MEASURES: Before and after intervention implementation, quality was assessed through the number of new test records reported and the percentage of data values that were neither missing nor invalid. Generalized estimating equations were used to assess the effect of feedback in improving the completeness of variables. RESULTS: Data were included from 44 health departments. The average number of new records per submission period increased from 197 907 before feedback implementation to 497 753 afterward. Completeness was high before and after feedback for race/ethnicity (99.3% vs 99.3%), current test results (99.1% vs 99.7%), prior testing and results (97.4% vs 97.7%), and receipt of results (91.4% vs 91.2%). Completeness improved for HIV risk (83.6% vs 89.5%), linkage to HIV care (56.0% vs 64.0%), referral to HIV partner services (58.9% vs 62.8%), and referral to HIV prevention services (55.3% vs 63.9%). Calls as part of feedback were associated with improved completeness for HIV risk (adjusted odds ratio [AOR] = 2.28; 95% confidence interval [CI], 1.75-2.96), linkage to HIV care (AOR = 1.60; 95% CI, 1.31-1.96), referral to HIV partner services (AOR = 1.73; 95% CI, 1.43-2.09), and referral to HIV prevention services (AOR = 1.74; 95% CI, 1.43-2.10). CONCLUSIONS: Feedback contributed to increased data quality. CDC and health departments should continue monitoring the data and implement measures to improve variables of low completeness.

Conflict, Displacement, and IPV: Findings From Two Congolese Refugee Camps in Rwanda.

This study describes the prevalence and correlates of past-year intimate partner violence (IPV) among displaced women. We used bivariate and multivariate analyses to assess the relationships between IPV and select variables of interest. Multivariate logistic regression modeling revealed that women who had experienced outsider violence were 11 times as likely (adjusted odds ratio [AOR] = 11.21; confidence interval, CI [5.25, 23.96]) to have reported IPV than women who had not experienced outsider violence. IPV in conflict-affected settings is a major public health concern that requires effective interventions; our results suggest that women who had experienced outsider violence are at greater risk of IPV.

Newly identified HIV infections in correctional facilities, United States, 2007.

We used Centers for Disease Control and Prevention HIV Counseling and Testing System data from 2007 to determine the percentage and characteristics of persons newly identified as HIV-positive in US correctional facilities. The newly identified HIV positivity was 0.7%, and 30% of detainees newly identified with HIV were categorized as having low-risk heterosexual contact or no acknowledged risk. Correctional facilities should provide detainees with routine opt-out HIV testing, unless the prevalence of previously undiagnosed HIV infection has been documented to be less than 0.1%.

Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 States.

BACKGROUND: Until 2005, national-level data on the sex of sex partners that describe how primary and secondary syphilis affects men who have sex with men (MSM) of different races or ethnicities were not reported. OBJECTIVE: To present data from 27 states comparing trends in primary and secondary syphilis among MSM of different races or ethnicities. DESIGN: Review of case report data and regression analysis. SETTING: Federal database of case reports in the National Electronic Telecommunications System for Surveillance. PARTICIPANTS: Men reported to be MSM. MEASUREMENTS: Cases of primary and secondary syphilis per 100 000 males of matching race or ethnicity ("rates"), determined by using population data from the National Center for Health Statistics as the denominator to compare age and racial and ethnic differences. RESULTS: For each year during 2005 to 2008, 27 states from all U.S. census regions reported data on the sex of sex partners for 70% or more of male cases of primary and secondary syphilis. Regression analysis revealed significantly different trends in rates of primary and secondary syphilis: Absolute increases in rates among black MSM and Hispanic MSM were, respectively, 8.0 times and 2.4 times the absolute increase in rate among white MSM. By region, rates among MSM increased 30% in the Midwest, 48% in the South, 73% in the Northeast, and 77% in the West. By age group, the largest absolute increase in rates occurred among MSM aged 20 to 29 years. LIMITATION: Results from 27 states may not be generalizable to the United States as a whole. CONCLUSION: Rates of primary and secondary syphilis disproportionately increased among black and Hispanic MSM (compared with white MSM) and among young MSM. Care providers should offer counseling about safer sexual practices and screening for syphilis and other sexually transmitted infections when caring for MSM. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

HIV counseling and testing among Hispanics at CDC-funded sites in the United States, 2007.

OBJECTIVES: We sought to determine whether Hispanic-White HIV testing disparities exist and to identify characteristics associated with newly diagnosed HIV among Hispanics. METHODS: We used 2007 HIV Counseling and Testing System data to compare test-level records of Hispanics and non-Hispanic Whites, and we conducted a multivariate logistic regression analysis to identify characteristics associated with newly diagnosed HIV. RESULTS: Relative to Whites, Hispanics were more likely to have had a positive HIV test result (1.2% versus 0.8%), to have newly diagnosed HIV (0.8% versus 0.6%), and to have test results returned and receive posttest counseling more than 2 weeks after testing (24.3% versus 21.5%). Newly diagnosed HIV among Hispanics was most strongly associated with being a man who has sex with men (MSM; adjusted odds ratio [AOR] = 6.8; 95% confidence interval [CI] = 6.1, 7.6), being both an MSM and an injection drug user (AOR = 3.7; 95% CI = 2.6, 5.3), and being aged 40 to 49 years (AOR = 6.4; 95% CI = 4.9, 8.2). CONCLUSIONS: Hispanic-White disparities exist with respect to rates of positive HIV test results and late return of results. HIV prevention strategies such as rapid testing should focus on Hispanic MSM.

Prevalence of syphilis seroreactivity in the United States: data from the National Health and Nutrition Examination Surveys (NHANES) 2001-2004.

BACKGROUND: There have been no recent US population-based estimates of syphilis seroprevalence. We determined the prevalence of syphilis seroreactivity among a representative sample of the US population. METHODS: Sera from 18- to 49-year-old participants in the National Health and Nutrition Examination Surveys 2001-2004 were tested for syphilis IgG antibody using an enzyme immunoassay (EIA). Specimens with positive or indeterminate EIAs underwent rapid plasma reagin (RPR) testing; RPR titers > or =1:8 were considered positive. Specimens with RPR titers <1:8 underwent confirmatory testing with Treponema pallidum particle agglutination (TP-PA). RESULTS: Sera were available for 5767 participants. EIA testing was positive or indeterminate for 126, of which 10 had RPR titers > or =1:8. Of the remaining 116 specimens, 60 had positive TP-PA tests, including all 19 with RPR titers >1:1. Overall weighted syphilis seroprevalence was 0.71% (95% CI: 0.51-0.96). Prevalence was similar among males (0.76%) and females (0.67%) and increased with age, less education, and lower income (P <0.001 for each). Non-Hispanic blacks had the highest prevalence (4.3%), followed by Mexican-Americans (0.98%) and non-Hispanic whites (0.07%; P <0.001). CONCLUSIONS: The prevalence of syphilis seroreactivity was low (0.71%) in the general US population of 18- to 49-year-olds. However, consistent with surveillance data, this nationally representative survey showed substantial disparities in syphilis by race/ethnicity.

Trends in infectious diseases and the male to female ratio: possible clues to changes in behavior among men who have sex with men.

Men who have sex with men (MSM) are a priority population for HIV care and prevention programs. This report describes HIV and other sexually transmitted disease (STD) trends among MSM in metropolitan Atlanta by analyzing nine databases. We describe the use of the male-to-female (M:F) ratio, a surrogate marker for MSM in databases without standardized MSM variables that is recommended as an indirect measure of HIV risk behavior in the CDC/HRSA Integrated Guidelines for Developing Epidemiologic Profiles. During 1997 to 2001, there were increases among MSM for reported syphilis (from 9% to 17%), anti-biotic-resistant gonorrhea (from 4.8% to 8.6%), and HIV seroprevalence (from 33% to 43%). During 1998 to 2001, the M:F ratio for cases peaked at 12:1 during a hepatitis A outbreak among MSM, increased for shigellosis (from 1:0 to 18:1) and giardiasis (from 1.7 to 2.1), and did not appreciably change for hepatitis B, salmonellosis, or chlamydia. HIV and several other STDs appear to have increased among MSM in metropolitan Atlanta. When standardized MSM variables are not available, an M:F ratio is useful.