JAIDS Journal of Acquired Immune Deficiency Syndromes最新文献

{"title":"Aging with HIV – An Epidemiological Profile of Persons with Diagnosed HIV Aged 50 Years and Older in New York State, 2012-2021","authors":"Zhengyan Wang, Wendy Patterson, Deepa T. Rajulu","doi":"10.1097/qai.0000000000003495","DOIUrl":"https://doi.org/10.1097/qai.0000000000003495","url":null,"abstract":"\u0000 \u0000 Advanced antiretroviral treatment has led to a growing population of older persons with HIV. To understand the characteristics of persons aging with HIV, this analysis examines epidemiological profiles of persons with diagnosed HIV through 2021 aged 50 and older in New York State.\u0000 \u0000 \u0000 \u0000 Persons diagnosed with HIV and reported to the NYS HIV registry by December 31, 2021 were included in the analysis. Characteristics of persons aged 50 years and older were compared to persons aged less than 50 years.\u0000 \u0000 \u0000 \u0000 Persons diagnosed with HIV and aged 50 and older more often reported heterosexual transmission risk and were more often females than individuals diagnosed with HIV under age 50. Among new diagnoses in 2021, persons aged 50 and older were more likely to have a stage 3 HIV diagnosis. By the end of 2021, 57% of persons living with diagnosed HIV were aged 50 and older. There was an upward trend of deaths with cardiovascular disease as an underlying cause of death among persons aged 50 years and older.\u0000 \u0000 \u0000 \u0000 More females diagnosed with HIV and a higher percent of persons who reported heterosexual transmission risk among persons aged 50 and older suggest a need for enhanced clinician education and sexual health discussions with this adult population. A greater rate of stage 3 HIV diagnoses in persons aged 50 and older emphasizes the need for specialized HIV testing and treatment, care for comorbidities, and social supports for this aging population.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141827639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PrEP use in a U.S. national sample of trans men and other trans masculine men who have sex with men: a longitudinal analysis","authors":"Pedro B. Carneiro, Asa E. Radix, Sarit Golub, Nicholas A. Grosskopf, Christian Grov","doi":"10.1097/qai.0000000000003492","DOIUrl":"https://doi.org/10.1097/qai.0000000000003492","url":null,"abstract":"\u0000 \u0000 Efforts to improve PrEP uptake among gay men, transgender women, and Black cisgender women are evident across the US, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other trans masculine people (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning have yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally.\u0000 \u0000 \u0000 \u0000 Using data from a prospective U.S. national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations (GEE) modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time.\u0000 \u0000 \u0000 \u0000 Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24-months, with about one-third of users discontinuing within one-year. Health insurance, having had lower surgery, used PEP or recently having a STI were associated with increased odds of PrEP use.\u0000 \u0000 \u0000 \u0000 We found low uptake of PrEP and high discontinuation rates in a U.S. national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"8 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141646017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV outcomes among women living with HIV who experienced early sexual violence across four sub-Saharan African countries","authors":"Chiara-lyse Lee, Andrea Low, Philip Kreniske, O. Mugurungi, F. Ndagije, L. Tenthani, Elaine J. Abrams, C. Teasdale","doi":"10.1097/qai.0000000000003489","DOIUrl":"https://doi.org/10.1097/qai.0000000000003489","url":null,"abstract":"\u0000 \u0000 Early experiences of sexual violence may influence HIV care and treatment outcomes among women living with HIV (WLHIV). We examined whether self-report by WLHIV of being forced into their first sexual experience was associated with awareness of HIV-positive status, being on antiretroviral therapy (ART) and being virologically suppressed.\u0000 \u0000 \u0000 \u0000 We conducted a secondary analysis using nationally-representative, cross-sectional Population-based HIV Impact Assessment (PHIA) surveys from Lesotho, Malawi, Zambia, and Zimbabwe conducted from 2015 through 2017.\u0000 \u0000 \u0000 \u0000 Adjusted logistic regression models with survey weights and Taylor series linearization were used to measure the association between forced first sex and three HIV outcomes: (1) knowledge of HIV status among all WLHIV, (2) being on ART among WLHIV with known status, and (3) virologic suppression among WLHIV on ART.\u0000 \u0000 \u0000 \u0000 Among WLHIV, 13.9% reported forced first sex. Odds of knowledge of HIV status were not different for WLHIV with forced first sex compared to those without (adjusted odds ratio (aOR) 1.17; 95% CI: 0.95-1.45). WLHIV with forced first sex had significantly lower odds of being on ART (aOR 0.74, 95% CI: 0.57-0.96) but did not have lower odds of virological suppression (aOR 1.06, 95% CI: 0.80-1.42) compared to WLHIV without forced first sex.\u0000 \u0000 \u0000 \u0000 While high proportions of WLHIV were on ART, report of non-consensual first sex was associated with lower likelihood of being on ART which may suggest that early life trauma could influence long term health outcomes.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"92 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141652806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual factors influencing implementation of HIV treatment support strategies for female sex workers living with HIV in South Africa: A qualitative analysis using the Consolidated Framework for Implementation Research","authors":"Carly A. Comins, M. Mcingana, Becky Genberg, Ntambue Mulumba, Sharmistha Mishra, Rene Phetlhu, Lillian Shipp, J. Steingo, H. Hausler, Stefan Baral, Sheree Schwartz","doi":"10.1097/qai.0000000000003491","DOIUrl":"https://doi.org/10.1097/qai.0000000000003491","url":null,"abstract":"\u0000 \u0000 Female sex workers (FSW) face a confluence of multilevel barriers to HIV care. In South Africa, 63% of FSW are living with HIV and <40% are virally suppressed. The objective of this analysis was to identify implementation determinants of two HIV treatment support strategies.\u0000 \u0000 \u0000 \u0000 The Siyaphambili trial tested a decentralized treatment provision and an individualized case management strategy aimed to support FSW living with unsuppressed HIV viral loads. We identified a nested sample of trial participants using maximum variation sampling (n=36), as well as a purposively selected sample of implementors (n=12). We used semi-structured interview guides, developed using the Consolidated Framework for Implementation Research (CFIR), and deductively coded the transcripts using CFIR, systematically assessing the strength and valence of implementation. We compared construct ratings to determine whether any constructs distinguished implementation across strategies.\u0000 \u0000 \u0000 \u0000 Across three CFIR domains (innovation characteristics, inner setting, and outer setting), 12 constructs emerged as facilitating, hindering, or having mixed effects on strategy implementation. The relative advantage, design, adaptability, and complexity constructs of the innovation characteristics, and the work infrastructure construct of the inner setting were strongly influential (±2 or +2). While the majority of construct valence and strength rating (9-12) were not distinguishing across strategies, we observed 3 weakly distinguishing CFIR constructs (relative advantage, complexity, and available resources).\u0000 \u0000 \u0000 \u0000 Given the potential benefits of differentiated service delivery strategies, identifying the relative importance of implementation determinants facilitates transparency and evaluation, supporting future strategy design and implementation. Optimizing implementation will support addressing inequities in HIV care and treatment services.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"13 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after loss to follow-up for pregnant and postpartum women living with HIV and their children in Kenya: A prospective cohort study","authors":"J. Humphrey, Bett Kipchumba, Marsha Alera, Edwin Sang, Beverly Musick, Lindah Muli, Justin Kipsang, J. Songok, C. Yiannoutsos, Kara Wools-Kaloustian","doi":"10.1097/qai.0000000000003487","DOIUrl":"https://doi.org/10.1097/qai.0000000000003487","url":null,"abstract":"\u0000 \u0000 Many prevention of vertical transmission (PVT) studies assess outcomes within 12 months postpartum and exclude those lost to follow-up (LTFU), potentially biasing outcomes toward those retained in care.\u0000 \u0000 \u0000 \u0000 Five public facilities in western Kenya.\u0000 \u0000 \u0000 \u0000 We recruited women living with HIV (WLH) ≥18 years enrolled in antenatal clinic (ANC). WLH retained in care (RW) were recruited during pregnancy and followed with their children through 6 months postpartum; WLH LTFU (LW, last visit >90 days) after ANC enrollment and ≤6 months postpartum were recruited through community tracing. Re-contact at 3 years was attempted for all participants. Primary outcomes were retention and child HIV-free survival. Generalized linear regression was used to estimated risk ratios (RR) for associations with becoming LTFU by 6 months postpartum, adjusting for age, education, facility, travel time to facility, gravidity, income, and new vs. known HIV positive at ANC enrollment.\u0000 \u0000 \u0000 \u0000 333 WLH (222 RW, 111 LW) were recruited from 2018-2019. More LW versus RW were newly diagnosed with HIV at ANC enrollment (49.6% vs. 23.9%) and not virally suppressed at study enrollment (40.9% vs. 7.7%). 6-month HIV-free survival was lower for children of LW (87.9%) versus RW (98.7%). At 3 years, 230 WLH were retained in care (including 51 previously LTFU before 6 months), 30 transferred, 70 LTFU, and 3 deceased. 3-year child HIV-free survival was 81.9% (92.0% for children of RW, 58.6% for LW), 3.7% were living with HIV, 3.7% deceased, and 10.8% had unknown HIV/vital status. Being newly diagnosed with HIV at ANC enrollment was the only factor associated with becoming LTFU (aRR 1.21, 95% CI 1.11-1.31).\u0000 \u0000 \u0000 \u0000 Outcomes among those LTFU were worse than those retained in care, underscoring the importance of retention in PVT services. Some, but not all, LW re-engaged in care by 3 years, suggesting that PVT services must better address the barriers and transitions women experience during pregnancy and postpartum.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"25 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and correlates of frailty among older adults living with HIV in the CHANGE HIV cohort","authors":"A. Zhabokritsky, Marina Klein, Marianne Harris, Mona Loutfy, S. Guillemi, Darrell H. S. Tan, Julian Falutz, N. Andany, G. Guaraldi, Leif Erik Lovblom, Sharon Walmsley","doi":"10.1097/qai.0000000000003485","DOIUrl":"https://doi.org/10.1097/qai.0000000000003485","url":null,"abstract":"\u0000 \u0000 Advancements in treatment have resulted in improved survival among people living with HIV. However, additional years of life are not necessarily spent in good health, as frailty tends to develop at a younger age among people living with HIV. We set out to examine the prevalence of frailty and its correlates among older adults living with HIV in Canada, with a primary interest in nadir CD4 count.\u0000 \u0000 \u0000 \u0000 We performed a cross-sectional analysis of the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV ≥65 years. Participants were assessed using the Fried Frailty Phenotype at cohort entry and those meeting ≥3 criteria were characterized as frail. We used Poisson regression with robust standard errors to estimate the association between nadir CD4 count and frailty, as well as age, gender, time since HIV diagnosis, comorbidities, marital status and loneliness.\u0000 \u0000 \u0000 \u0000 Among 439 participants included in this analysis (median age 69 years, IQR 67-73), prevalence of frailty was 16.6%. Frailty was not associated with nadir CD4 count. Not being in a relationship (aRR 2.09, 95% CI 1.01-4.30) and greater degree of loneliness (aRR 1.25 per 10 point increase on UCLA loneliness scale, 95% CI 1.09-1.44) were associated with frailty.\u0000 \u0000 \u0000 \u0000 Frailty occurred in 16.6% of older adults living with HIV in this cohort. While nadir CD4 count did not correlate with frailty, being single and lonely did, highlighting the importance of recognizing and addressing these social vulnerabilities among people aging with HIV.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"39 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141663619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons with HIV Engaged in Care in the NA-ACCORD","authors":"Aruna Chandran, Xinyi Feng, Sally B Coburn, P. Kasaie, Jowanna Malone, M. Horberg, B. Hogan, Peter F. Rebeiro, M. J. Gill, Kathleen A. McGinnis, M. Silverberg, M. Karris, S. Napravnik, D. Konkle-Parker, Jennifer Lee, Aimee M. Freeman, Ronel Ghidey, Venezia Garza, V. C. Marconi, Gregory D Kirk, Jennifer E. Thorne, Heidi M Crane, R. Lang, Mari Kitahata, Richard D. Moore, K. Althoff","doi":"10.1097/qai.0000000000003486","DOIUrl":"https://doi.org/10.1097/qai.0000000000003486","url":null,"abstract":"\u0000 \u0000 Socioeconomic status (SES) influences well-being among people living with HIV (PWH); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that: a) select ZIP Code-level SES indicators would be associated with viral suppression, and b) accounting for ZIP Code-level SES would attenuate racial disparities in viral suppression among PWH.\u0000 \u0000 \u0000 \u0000 The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH.\u0000 \u0000 \u0000 \u0000 Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP Code(s) between 2010-2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators as well as sex, Hepatitis C status, and age.\u0000 \u0000 \u0000 \u0000 We observed a dose response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5 to 0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of ∼40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White individuals. The disparity persisted but narrowed by 3-4% when including SES in the models.\u0000 \u0000 \u0000 \u0000 ZIP Code-based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP Code-level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141673773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause and estrogen associations with gut barrier, microbial translocation, and immune activation biomarkers in women with and without HIV","authors":"B. Peters, David B. Hanna, Xiaonan Xue, Kathleen Weber, Allison A. Appleton, Seble G. Kassaye, Elizabeth Topper, Russell P. Tracy, Chantal Guillemette, Patrick Caron, Phyllis C. Tien, Q. Qi, Robert D. Burk, Anjali Sharma, Kathryn Anastos, Robert C. Kaplan","doi":"10.1097/qai.0000000000003419","DOIUrl":"https://doi.org/10.1097/qai.0000000000003419","url":null,"abstract":"\u0000 \u0000 Estrogens may protect the gut barrier and reduce microbial translocation and immune activation, which are prevalent in HIV infection. We investigated relationships of the menopausal transition and estrogens with gut barrier, microbial translocation, and immune activation biomarkers in women with and without HIV.\u0000 \u0000 \u0000 \u0000 Longitudinal and cross-sectional studies nested in the Women’s Interagency HIV Study.\u0000 \u0000 \u0000 \u0000 Intestinal fatty acid binding protein (IFAB), lipopolysaccharide binding protein (LBP), and soluble CD14 (sCD14) levels were measured in serum from 77 women (43 with HIV) before, during, and after the menopausal transition (∼6 measures per woman over ∼13 years). A separate cross-sectional analysis was conducted among 72 post-menopausal women with HIV with these biomarkers and serum estrogens.\u0000 \u0000 \u0000 \u0000 Women in the longitudinal analysis were a median age of 43 years at baseline. In piece-wise linear mixed-effects models with cut-points 2 years before and after the final menstrual period to delineate the menopausal transition, sCD14 levels increased over time during the menopausal transition (Beta [95% CI]=38 [12, 64] ng/mL/year, p=0.004), followed by a decrease post-transition (-46 [-75, -18], p=0.001), with the piece-wise model providing a better fit than a linear model (p=0.0006). In stratified analyses, these results were only apparent in women with HIV. In cross-sectional analyses among women with HIV, free estradiol was inversely correlated with sCD14 levels (r=-0.26, p=0.03). LBP and IFAB levels did not appear related to the menopausal transition and estrogen levels.\u0000 \u0000 \u0000 \u0000 Women with HIV may experience heightened innate immune activation during menopause, possibly related to depletion of estrogens.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"44 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141345190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating HIV Cluster Analysis in Everyday Public Health Practice: Lessons Learned from a Public Health – Academic Partnership","authors":"John Fulton, Vladimir Novitsky, F. Gillani, August Guang, Jon Steingrimsson, Aditya Khanna, Joel Hague, Casey Dunn, Joseph Hogan, Katharine Howe, Meghan MacAskill, L. Bhattarai, Thomas Bertrand, U. Bandy, Rami Kantor","doi":"10.1097/qai.0000000000003469","DOIUrl":"https://doi.org/10.1097/qai.0000000000003469","url":null,"abstract":"\u0000 \u0000 The use of molecular HIV cluster analysis to supplement public health contact tracing has shown promise in addressing HIV outbreaks. However, the potential of HIV cluster analysis as an adjunct to daily, person-by-person HIV prevention efforts remains unknown. We documented lessons learned within a unique public-health–academic partnership, while guiding workaday HIV prevention efforts with near-real-time molecular cluster analysis.\u0000 \u0000 \u0000 \u0000 An academic-public health partnership in the State of Rhode Island, USA.\u0000 \u0000 \u0000 \u0000 We recorded perceptions of our team of academicians and public-health staff that were encountered in an 18-month study evaluating integration of molecular cluster analysis with HIV contact-tracing for public-health benefit. Focus was on monthly conferences where molecular clustering of each new statewide diagnosis was discussed to facilitate targeted interventions, and on attempted re-interviews of all newly HIV-diagnosed persons statewide whose HIV sequences clustered, to increase partner naming.\u0000 \u0000 \u0000 \u0000 Three main themes emerged: First, multidisciplinary conferences are substantially beneficial for gleaning actionable inferences from integrating molecular cluster analysis and public-health data. Second, universal re-interviews were perceived to potentially have negative consequences but may be selectively beneficial. Third, translation of cluster analysis into public-health action is hampered by jurisdictional surveillance boundaries and within-jurisdictional data silos, across which data sharing is problematic.\u0000 \u0000 \u0000 \u0000 Insights from a statewide public-health–academic partnership support integration of molecular HIV cluster analyses with public-health efforts, which can guide public-health activities to prevent transmission, while identifying substantial barriers to integration, informing continued research.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141354006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the HIV cascade of care using routinely collected clinical data to guide programmatic interventions and policy decisions","authors":"G. Bakoyannis, B. Elul, Kara K. Wools-Kaloustian, Steven Brown, A. Semeere, Barbara Castelnuovo, L. Diero, G. Nakigozi, R. Lyamuya, C. Yiannoutsos","doi":"10.1097/qai.0000000000003413","DOIUrl":"https://doi.org/10.1097/qai.0000000000003413","url":null,"abstract":"\u0000 \u0000 The HIV care cascade is a framework to examine effectiveness of HIV programs and progress toward global targets to end the epidemic but has been conceptualized as a unidirectional process that ignores cyclical care patterns. We present a dynamic cascade that accounts for patient “churn,” and apply novel analytic techniques to readily available clinical data to robustly estimate program outcomes and efficiently assess progress towards global targets.\u0000 \u0000 \u0000 \u0000 Data were assessed for 35,649 people living with HIV and receiving care at 78 clinics in East Africa between 2014-2020. Patients were aged >15 years and had >1 viral load measurements. We used multi-state models to estimate the probability of being in 1 of 5 states of a dynamic HIV cascade: (1) in HIV care but not on antiretroviral therapy (ART); (2) on ART; (3) virally suppressed; (4) in a gap-in-care; and (5) deceased; and compared these among subgroups. To assess progress towards global targets, we summed those probabilities across patients and generated population-level proportions of patients on ART and virally suppressed in mid-2020.\u0000 \u0000 \u0000 \u0000 One year following enrollment, 2.8% of patients had not initiated ART, 86.7% were receiving ART, 57.4% were virally suppressed,10.2% were disengaged from care, and 0.3% had died. At 5 years, the proportion on ART remained steady but viral suppression increased to 77.2%. Of those aged 15-25, >20% had disengaged from care and <60% were virally suppressed. In mid-2020, 90.1% of the cohort was on ART, 90.7% of whom had suppressed virus.\u0000 \u0000 \u0000 \u0000 Novel analytic approaches can characterize patient movement through a dynamic HIV cascade and, importantly, by capitalizing on readily available data from clinical cohorts, offer an efficient approach to estimate population-level proportions of patients on ART and virally suppressed. Significant progress towards global targets was observed in our cohort but challenges remain among younger patients.\u0000","PeriodicalId":508427,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":"119 46","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}