HIV

In Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance. Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3. Injection of illicitly consumed opioids is associated with an increased risk of infectious diseases, including HIV infection. An investigation of an HIV outbreak among persons reporting IDU identified homelessness as a social determinant for increased risk for HIV infection.

Objective: We sought to measure the burden of emergency department (ED) visits associated with injection drug use (IDU), HIV infection, and homelessness; and the intersection of homelessness with IDU and HIV infection in Massachusetts via syndromic surveillance data.

The prevalence of persons living and diagnosed with HIV infection in the United States in 2010 to 2014 increased in number and rate (Center for Disease Control & Prevention (CDC), 2016). In 2015, persons aged 25-29 years had the highest rate (33.4), followed by persons aged 20-24 years (31.2) (CDC, 2016). Consistent reduced viral load is associated with reduced morbidity and mortality and a lower likelihood of transmitting HIV to sex partners (CDC, 2011). Retention into HIV care promotes life and decreases the risk for HIV transmission (Yehia et. al. 2015). Preventing HIV transmission, prevention intervention strategy is critical and should be ongoing to all HIV patients consistently. New cases of HIV in the United States are increasing by approximately 30, 000 per year and with this increase, more providers are needed (Weiser et al.2016).

Objective: To povide knowledge on the factors that predict retention in care and health outmomes among HIV patients and be able to understand viral load and its relation to retention in care.

In 2015, ISDH responded to an HIV outbreak among persons using injection drugs in Scott County [1]. Information to manage the public health response to this event and aftermath included data from multiple sources (e.g., HIV testing, surveillance, contact tracing, medical care, and HIV prevention activities). During the outbreak, access to timely and accurate data for program monitoring and reporting was difficult for health department staff. Each dataset was managed separately and tailored to the relevant HIV program area’s needs. Our challenge was to create a platform that allowed separate systems to communicate with each other and design a DP that offered a consolidated view of data. ISDH initiated efforts to integrate these HIV data sources to better track HIV prevention, diagnosis, and care metrics statewide, support decision-making and policies, and facilitate a more rapid response to future HIV-related investigations. The Centers for Disease Control and Prevention (CDC) through its Info-Aid program provided technical assistance to support ISDH’s data integration process and develop a DP that could aggregate these data and improve reporting of crucial statewide metrics. After an initial assessment phase, an in-depth analysis of requirements resulted in several design principles and lessons learned that later translated into standardization of data formats and design of the data integration process.

Objective: The objective was to design and develop a dashboard prototype (DP) that integrates HIV data from disparate sources to improve monitoring and reporting of HIV care continuum metrics in Indiana. The tool aimed to support Indiana State Department of Health (ISDH) to monitor key HIV performance indicators, more fully understand populations served, more quickly identify and respond to crucial needs, and assist in planning and decision-making.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED may lead to earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3,4,5) High risk patients should recieve screening for HIV and those patients who have a lab test for GC/chlamydia represent a high risk patient popualtion.(4) While the ED is a frequent health care access point for patients seeking evaluation for sexually transmitted diseases, ED providers may not be following guidlines for HIV testing in high risk patients.

Objective

To assess compliance with CDC and USPSTF guidelines for HIV testing in a regional cohort of emergency departments.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED will lead earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3) The analysis was focused on ED providersÕ knowledge and attitudes towards routine HIV testing, perceived barriers to HIV testing.

Objective:

To evaluate ED staff attitudes and potential barriers towards ED based POC HIV testing in an urban academic ED prior to implementing an ED based POC HIV test.

Detection of the signs of HIV epidemic transition from concentrated to generalized stage is an important issue for many countries including Ukraine. Objective and timely detection of the generalization of HIV epidemic is a significant factor for the development and implementation of appropriate preventive programs. As an additional method for estimating HIV epidemic stage, the spatial analysis of the reported new HIV cases among injection drug use (IDU) and other populations (due to sexual way of transmission) has been recommended. For studying new HIV cases in small societies, Relative Risk (RR) rates are preferred over incidence indicators. Spatial clustering based on the calculation of RR rates allows us to locate the high risk areas of HIV infection with greater accuracy. In our opinion, in the process of epidemic generalization the spatial divergence of epidemic will be observed as well. In particular, clusters with high RR of sexual HIV transmission independent from the clusters with high RR of injection HIV transmission may appear.

Objective

To investigate the utility of spatial analysis in the tracking of the stages of the HIV epidemic at an administrative territory level, using the Odessa region, Ukraine as an example.

Local data focused on the injection drug using (IDU) population was analyzed using representative samples from three years, 2005, 2009, and 2012, to garner an understanding of high-risk behavior associated with disease transmission.

Objective

The objective of this study is to present findings from the National HIV Behavioral Surveillance (NHBS) in New Orleans.

In 2007, the United Nations recommended provision of VMMC in settings with high HIV prevalence and low rates of male circumcision (MC). This recommendation was based on randomized studies in Africa, which demonstrated that MMC reduces HIV acquisition by 38%_66% [1]. Tanzania was among 13 countries selected for early implementation. In response, IntraHealth International, through the US PresidentÍs Emergency Plan for AIDS Relief (PEPFAR) and Centers for Disease Control and Prevention (CDC) supported the Ministry of Health and Social Welfare (MOHSW) to launch a VMMC program in Shinyanga and Simiyu regions where HIV prevalence is high (7.4%) and VMMC is low (30-32%). Older men age 30-49 have the highest risk of contracting HIV and, thus, are in greater need of the protective effects of VMMC; however, significant cultural and attitudinal barriers hinder MC acceptance and uptake in this population. For example, from Oct 2010-Sep 2012, 65,812 males in Tanzania were circumcised, yet only 7.1% were men over 20 years. To maximize impact, the project implemented an intensive social mobilization initiative using mobile text messaging (SMS) and community sensitization activities targeting men over 20 years.

Objective

To describe the success of mobile text messaging and community sensitization activities to increase the number of men 20 years and above accessing VMMC services in Tanzania.

Although U.S. Mother to Child transmission (MCT) rates of HIV have been reduced from approximately 25% to less than 2%, transmissions continue to occur.1 This reduction comes in a large part from treating pregnant mothers with antiretroviral medications.2 Despite these efforts, Louisiana has one of the highest rates of MCT of HIV in the U.S.3 Real-time identification of pregnancy status would allow high risk HIV-infected pregnant women to be targeted for follow-up. In Louisiana, laboratories are required to report positive HIV tests to SHP, most of which are received in electronic lab reporting (ELR) format. Although pregnancy status is not a variable provided on lab reports, some reports do contain information that is useful in identifying pregnancy status.

Objective

To identify, in real-time, pregnancy status of HIV-infected women through information found in laboratory reports received by the STD/HIV Program (SHP) at the Louisiana Office of Public Health. This identification will be used for targeted follow-up.

To apply syndromic techniques in assessing whether the false-positive rate (FP rate) of a rapid oral HIV test, routinely used for screening in New York Cityís STD clinics, deviated from the manufacturerís claim; results of which have important implications for assessing clinical test performance.