Characteristics and risk of syphilis diagnosis among HIV-infected male cohort: a population-based study in Houston, Texas.

BACKGROUND: This population-based study assessed the characteristics, timing, and risk of syphilis diagnoses among HIV-infected males in Houston, Texas. METHODS: A retrospective cohort of males newly diagnosed as having HIV between January 2000 and December 2002 was constructed using HIV surveillance data. These individuals were cross-referenced to sexually transmitted disease surveillance data to ascertain early syphilis diagnoses for the subsequent 10 years. Multivariable Cox regression was used to identify risk factors for syphilis diagnosis while controlling for the effects of covariates. RESULTS: Approximately 6% of the HIV-infected male cohort received early syphilis diagnoses during a 10-year period. Of these comorbid individuals, 40.8% received an incident syphilis diagnosis 5 years or more after their HIV diagnosis. Men who have sex with men (MSM) transmission risk was associated with significantly increased hazard of having a syphilis diagnosis in multivariable analysis (adjusted hazard ratio [HR] of a syphilis diagnosis, 5.24; 95% confidence interval, 3.41-8.05). Compared with men who were older than 40 years at HIV diagnosis, those 13 to 19 years old were 4.06 (2.18-7.55) times more likely to obtain a syphilis diagnosis. The HRs of having an HIV-syphilis comorbidity decreased as age increased. Compared with whites, non-Hispanic African Americans had 1.59 (1.11-2.26) times increased risk of having a subsequent syphilis diagnosis. Risk-stratified HRs showed that MSM had an increased risk of contracting syphilis in all race/ethnicity and age groups. CONCLUSIONS: This study suggests that HIV-positive African Americans, youth, and MSM had increased risk of having a subsequent syphilis diagnosis. Targeting these groups with STI prevention messaging may be beneficial to reducing comorbidity.

Assessing HIV testing and linkage to care activities and providing academic support to public health authorities in Houston, TX.

BACKGROUND: Health departments often have little knowledge of HIV testing and linkage activities outside of those they directly fund. Many health departments also have limited access to outside academic expertise. METHODS: We conducted a survey of health organizations in the Houston/Harris County region to determine the number of HIV tests completed in 2011, activities that organizations conducted to promote linkage to care for persons newly diagnosed with HIV, and barriers to linkage to care. We also convened a Scientific Advisory Council to advise the local health department on HIV prevention activities. RESULTS: In 2012, 55 of 84 organizations (65.5%) completed the survey and 43 of those 55 organizations reported conducting HIV testing, so were included in this analysis. Organizations reported conducting 210,565 HIV tests in 2011 and 50.9% under health department contract. The median number of tests per organization was 1045 (interquartile ratio: 159-3520). More than 90% of the organizations used active linkage to care methods, but only 46.5% had written linkage to care protocols. Barriers to linkage to care most often reported were client refusal followed by staff capacity and funding limitations. The Scientific Advisory Council provided valuable informal expertise to the local health department. CONCLUSIONS: Half of the HIV testing in the Houston/Harris County region is conducted without local health department funding, and half the organizations conducting HIV testing have linkage to care protocols. The findings of the study and Scientific Advisory Council advice have helped the health department with policy, procedures, evaluation tools, and technical assistance offerings.