ABSTRACT
BACKGROUND: Successful partner notification can improve community-level outcomes by increasing the proportion of persons living with human immunodeficiency virus (HIV) who are linked to HIV care and virally suppressed, but it is resource intensive. Understanding where HIV transmission pathways may be undetected by routine partner notification may help improve case finding strategies. METHODS: We combined partner notification interview and HIV sequence data for persons diagnosed with HIV in Wake County, NC in 2012 to 2013 to evaluate partner contact networks among persons with HIV pol gene sequences 2% or less pairwise genetic distance. We applied a set of multivariable generalized estimating equations to identify correlates of disparate membership in genetic versus partner contact networks. RESULTS: In the multivariable model, being in a male-male pair (adjusted odds ratio [AOR], 16.7; P = 0.01), chronic HIV infection status (AOR, 4.5; P < 0.01), and increasing percent genetic distance between each dyad member's HIV pol gene sequence (AOR, 8.3 per each 1% increase, P < 0.01) were all associated with persons with HIV clustering but not being identified in the partner notification network component. Having anonymous partners or other factors typically associated with risk behavior were not associated. CONCLUSIONS: Based on genetic networks, partnerships which may be stigmatized, may have occurred farther back in time or may have an intervening partner were more likely to be unobserved in the partner contact network. The HIV genetic cluster information contributes to public health understanding of HIV transmission networks in these settings where partner identifying information is not available.
Subject(s)
Contact Tracing , HIV Infections/diagnosis , HIV/genetics , pol Gene Products, Human Immunodeficiency Virus/genetics , Adult , Cluster Analysis , Female , HIV Infections/epidemiology , Humans , Male , Middle Aged , Models, Statistical , North Carolina/epidemiology , Transgender Persons/statistics & numerical dataABSTRACT
BACKGROUND: Hospitals and other health care agencies are required to conduct a community health needs assessment (CHNA) every 3 years to obtain information about the health needs and concerns of the population. In 2013, to avoid duplication of efforts and to achieve a more comprehensive CHNA, Wake County Human Services, WakeMed Health and Hospitals, Duke Raleigh Hospital, Rex Healthcare, Wake Health Services, United Way of the Greater Triangle, and the North Carolina Institute for Public Health partnered to conduct a joint assessment for Wake County. METHODS: Information was collected from the community through opinion surveys and focus groups. To understand the social, economic, and health status of Wake County residents, statistics were also collected from state, county, and local sources. Analysis of all data sources allowed 9 areas of community concern to be identified. Five community forums were held simultaneously at locations in east, south, west, north, and central Wake County to inform residents about the main findings of the assessment and to prioritize the 9 areas of concern. RESULTS: The top 3 priority areas identified were poverty and unemployment, health care access and utilization, and mental health and substance use. LIMITATIONS: Results may not be generalizable to counties in North Carolina that are more rural or to counties outside North Carolina. CONCLUSIONS: The success of this unique collaborative process provides further opportunity for the project partners and other organizations to coordinate action plans, pool resources, and jointly address the priorities of this assessment over the next 3 years.
