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Achieving the Goals of the National HIV/AIDS Strategy: Declining HIV Diagnoses, Improving Clinical Outcomes, and Diminishing Racial/Ethnic Disparities in King County, WA (2004–2013)

imageBackground: The US National HIV/AIDS Strategy defines national objectives related to HIV prevention and care. The extent to which US cities are meeting those objectives is uncertain. Methods: We analyzed King County, WA, HIV surveillance data collected between 2004 and 2013. The study population included 9539 persons diagnosed as having and living with HIV infection and 3779 persons with newly diagnosed HIV infection. Results: Between 2004 and 2013, the rate of new HIV diagnosis decreased from 18.4 to 13.2 per 100,000 residents (decline of 28%); AIDS diagnosis rates declined 42% from 12 to 7 per 100,000; and age-adjusted death rates decreased from 27 to 15 per 1000 persons living with HIV/AIDS (decline of 42%; P < 0.0001 for all 3 trends). The rate of new HIV diagnosis declined 26% among men who have sex with men (MSM; P = 0.0002), with the largest decline occurring in black MSM (44%). Among 8679 individuals with laboratory results reported to National HIV Surveillance System from 2006 through 2013, viral suppression (viral load <200 copies/mL) increased from 45% to 86% (P < 0.0001), with all racial/ethnic groups achieving greater than 80% viral suppression in 2013. Interpretation: The rates of new HIV diagnosis, AIDS diagnoses, and mortality in persons living with HIV 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. These findings demonstrate substantial local success in achieving the goals of the National HIV/AIDS Strategy. 05/01/2016 01:00 AM
 

Human Immunodeficiency Virus Prevention With Preexposure Prophylaxis in Sexually Transmitted Disease Clinics

imageNo abstract available 05/01/2016 01:00 AM
 

Loss to Follow-Up After Pregnancy Among Sub-Saharan Africa-Born Women Living With Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results From a Large National Cohort

imageBackground: Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. Methods: We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). Results: Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P < 0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50–3.14; P < 0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94–3.23; P < 0.001). Conclusions: One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role. 05/01/2016 01:00 AM
 

A Randomized Controlled Trial Comparing the Treatment of Patients Tested for Chlamydia and Gonorrhea After a Rapid Polymerase Chain Reaction Test Versus Standard of Care Testing

imageBackground: We tested the effect of a rapid molecular test for Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) diagnosis on clinical emergency department decision making compared with standard care. The new test presents an opportunity to improve antibiotic management and patient outcomes. Methods: We conducted a randomized controlled trial of 70 consenting patients 18 years or older presenting to an urban emergency department with sexually transmitted infections complaints (vaginal/penile discharge, dysuria, vaginal/penile itching/pain, dyspareunia). Participants were randomized to rapid testing or standard care if a sexually transmitted infection was suspected. Follow-up phone calls were performed 7 to 10 days postdischarge. The primary outcomes included: antibiotic overtreatment rates, partner notification, and health care utilization. Results: A total of 12.9% tested positive for CT or NG and received antibiotics. Test patients with negative results were less likely to receive empirical antibiotic treatment than control patients, absolute risk difference [RD], 33.4 (95% confidence interval [CI], 7.9%–58.9%), risk ratio [RR], 0.39 (95% CI, 0.19–0.82). Thirty-seven participants (53%) were contacted for follow-up 7 to 10 days postdischarge. Test patients were less likely to report missed antibiotic doses (RD, −51.3%; 95% CI, −84.4% to −18.2%; RR, 0.23; 95% CI, 0.06–0.88). Test patients were more likely to be notified of their results (RD, 50.6%; 95% CI, 22.7%–78.5%; RR, 2.72; 95% CI, 1.26–5.86). There were no significant differences in charges or health care utilization measures. Conclusions: We found a significant reduction in unnecessary antibiotic treatment for CT/NG in subjects receiving the rapid molecular test compared with those receiving nucleic acid amplification test. 05/01/2016 01:00 AM
 

High Rate of Partner Treatment Among Chlamydia trachomatis–Infected Pregnant Women in Lima, Peru

imageAbstract: This was a substudy of 60 Chlamydia trachomatis–infected women from a larger study of pregnant women in Lima, Peru. Participants were encouraged to bring their partners in for concurrent patient-partner treatment. The alternative partner treatment was expedited partner therapy. Partner treatment uptake was 91.7%. Twenty-one partners (38.2%) received treatment through concurrent patient-partner treatment, and 34 (61.8%) through expedited partner therapy. Living with the partner was significantly associated with having the partner treated (P = 0.0028). 05/01/2016 01:00 AM
 

Extragenital Screening in Men Who Have Sex With Men Diagnoses More Chlamydia and Gonorrhea Cases Than Urine Testing Alone

imageAbstract: Data were evaluated to determine the benefit of extragenital screening among men who have sex with men in detecting chlamydia/gonorrhea infections. More than seventy percent of chlamydia infections and >80% of gonorrhea infections would have been missed with urine testing alone in the course of a year. Extragenital testing is critical for identifying sexually transmitted diseases among men who have sex with men. 05/01/2016 01:00 AM
 

Examining the Correlates of Sexually Transmitted Infection Testing Among Men Who Have Sex With Men in Ouagadougou and Bobo-Dioulasso, Burkina Faso

imageBackground: Men who have sex with men (MSM) are a population at risk for HIV acquisition and transmission and other sexually transmitted infections (STIs). In Burkina Faso, the prevalence of HIV among MSM is higher than that of other reproductive-aged adults. Early and frequent STI testing and treatment can help prevent HIV acquisition and transmission and may improve linkage to care. Methods: A cross-sectional study used respondent-driven sampling of MSM in the urban centers of Ouagadougou and Bobo-Dioulasso, Burkina Faso, to complete a questionnaire and HIV and syphilis testing. The binary-dependent variable in these analyses was self-reported prior STI testing in the past 12 months. Independent variables included sociodemographic characteristics, sexual behaviors, and psychosocial factors, selected according to the modified social ecological model. Bivariate associations at the P < 0.05 level were used to create a manual forward stepwise multivariable logistic regression. Results: Seventy-six percent of participants (511/672) did not test for STIs in the last 12 months. Testing for STIs was associated with STI symptoms (odds ratio [OR], 2.56; 95% confidence interval [95% CI], 1.39–4.76) and independently associated with depressive symptoms (adjusted OR, 1.49; 95% CI, 1.01–2.20) and discussing HIV and STIs with main male partners (adjusted OR, 1.73; 95% CI, 1.23–1.76). Conclusions: These data suggest that periodic targeted STI screening for MSM in Burkina Faso may represent an important component of comprehensive HIV prevention programming. The relationship between depression and STI risks is well established, and these data further indicate that screening for depression may be warranted during these clinical encounters. 05/01/2016 01:00 AM
 

Molecular Subtyping and Surveillance of Resistance Genes In Treponema pallidum DNA From Patients With Secondary and Latent Syphilis in Hunan, China

imageBackground: Over the past decade, the incidence of syphilis and widespread macrolide resistance in its etiological agent, Treponema pallidum subsp. pallidum, have become a major health concern across countries, including China. Regional trends in subtypes and antibiotic resistance can be monitored effectively by molecular surveillance programs. In this study, whole blood samples were used to assess circulating T. pallidum strains collected from various regions of Hunan, China, between 2013 and 2015. Methods: Traditional polymerase chain reaction, targeting polA, tpp47, bmp, and tp0319 genes, was used as preliminary screening assay. About 455 polymerase chain reaction-positive specimens were obtained from 2253 whole blood samples of patients with secondary or latent syphilis. Molecular subtyping was performed using a Centers for Disease Control and Prevention–based typing method combined with an analysis of the variable region of tp0548 gene. Resistance to macrolides was analyzed by examining point mutations in 23S rRNA, and the presence of the G1058C point mutation within 16S rRNA associated with decreased susceptibility to doxycycline was assessed. Results: Circulating T. pallidum strains were resolved into 32 subtypes, among which subtype 14d/f was predominant. A2059G mutation in 23S rRNA, and the G1058C mutation in 16S rRNA was absent, but the prevalence of A2058G mutation in 23S rRNA was 97.5%. Conclusions: We found that it is possible to use whole blood to evaluate molecular subtypes and monitor antibiotic resistance in circulating T. pallidum strains, especially when chancres are absent. High frequency of macrolide-resistant T. pallidum indicates that macrolide antibiotics, such as azithromycin, should be avoided as a treatment option for syphilis in Hunan, China. 05/01/2016 01:00 AM