Background: Methamphetamine use is associated with increased risk of HIV transmission, increased ... more Background: Methamphetamine use is associated with increased risk of HIV transmission, increased rate of sero-conversion among those who are HIV positive and MRSA-related infections among intravenous drug users. Data collected through the National HIV Behavioral Surveillance (NHBS) allow description of methamphetamine use and HIV status among three populations at increased risk for HIV in Denver, CO: men who have sex with men (MSM), intravenous drug users (IDU) and heterosexuals at risk (HET). Methods: Data were collected in three cycles between 2006 and 2009: HET, identified by residence or recreation in census tracts with high poverty and incident HIV rates (n=891) MSM (n=543) and IDU (n=422). Eligible participants were identified through respondent-driven sampling (HET and IDU) or at randomly sampled venues (MSM). Consenting participants completed an in-depth behavioral questionnaire and most agreed to HIV testing. Presented estimates are unweighted. Results: Among HET, 94 (10.5%...
Objectives: To describe the challenges, mechanisms, and solutions to integrating rapid and standa... more Objectives: To describe the challenges, mechanisms, and solutions to integrating rapid and standard HCV testing into the established protocol of the National HIV Behavioral Surveillance (NHBS) system at two sites, Denver and Dallas. Methods: Between August and December 2009, injection drug users (IDU) were recruited using respondent-driven sampling as part of NHBS. In Denver, consenting participants provided a serum sample for standard HCV testing (ORTHO HCV Version 3.0 ELISA), an oral specimen for rapid HIV testing (OraQuick ADVANCE Rapid HIV-1/2 Antibody Test), and a finger stick and second oral specimen to evaluate a rapid HCV test (Chembio DPP HCV Rapid Test). In Dallas, sample specimens and tests were similar for standard HCV and rapid HIV testing. The MedMira Rapid Test using whole blood from a fingerstick was evaluated. Results: The most significant challenge to the integration was drawing blood from overly scarred veins, a common problem with the IDU population. In Denver, w...
Prevention science : the official journal of the Society for Prevention Research, 2015
Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic... more Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic in the USA. PWID are also disproportionately affected by limited access to health care and preventative services. We sought to compare current health care coverage, HCV, and HIV testing history, hepatitis A and B vaccination coverage, and co-occurring substance use among PWID in two US cities with similar estimated numbers of PWID. Using data from the 2009 National HIV Behavioral Surveillance system in Denver (n = 428) and Seattle (n = 507), we compared HCV seroprevalence and health care needs among PWID. Overall, 73 % of participants who tested for HCV antibody were positive. Among those who were HCV antibody-positive, vaccination coverage for hepatitis A and B was low (43 % in Denver and 34 % in Seattle) and did not differ significantly from those who were antibody-negative. Similarly, participation in alcohol or drug treatment programs during the preceding 12 months was not significa...
We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early... more We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early HIV included both acute (infected past 30 days) and recent (estimated recency past 240 days). Acute infections were defined as screen immunoassay (IA) negative/NAAT-positive or IA-positive/Multispot-negative/NAAT-positive. Recent infections were defined as avidity index cutoff <30 % on an avidity-based IA and, (1) not reporting antiretroviral therapy use or, (2) HIV RNA >150 copies/mL. Of 937 samples, 26 % (244) were HIV-infected and of these 5 % (12) were early. Of early infections, 2 were acute and 10 recent; most (8/12) were among black MSM. Early infection was associated with last partner of black race [adjusted relative risk (ARR) = 4.6, confidence intervals (CI) 1.2-17.3], receptive anal sex at last sex (ARR = 4.3, CI 1.2-15.0), and daily Internet use to meet partners/friends (ARR = 3.3, CI 1.1-9.7). Expanding prevention and treatment for black MSM will be necessary for reducing incidence in the United States.
Persons who inject drugs (PWIDs) have limited access to health care services yet are at very high... more Persons who inject drugs (PWIDs) have limited access to health care services yet are at very high risk for blood borne infections such as HCV and HIV. CDC estimates that injection drug use (IDU) accounted for 48% of acute hepatitis C cases in the United States in 2007 (MMWR, 2009), and previous studies have found prevalence of HCV infection up to 70-80% among persons who inject drugs (PWIDs). There are currently no rapid HCV tests available on the US market, but several are in various stages of development, testing, and clinical trials and one is currently under review at FDA. To evaluate the performance of these rapid tests in field settings, CDC collaborated with four 2009 National HIV Behavioral Surveillance System (NHBS) sites (Dallas, Denver, Seattle, New York City) that conducted HCV testing among persons who injected drugs at least once in the previous 12 months. The four sites integrated both rapid and standard HCV tests (Enzyme Immunoassay and Recombinant Immunoblot Assay: ...
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 19, 2014
At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosi... more At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosis of human immunodeficiency virus (HIV) infection. Approximately one in four of the estimated HIV infections diagnosed in 2011 were attributed to heterosexual contact. Heterosexuals with a low socioeconomic status (SES) are disproportionately likely to be infected with HIV. June-December 2010. The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, injecting drug users, and heterosexuals at increased risk for HIV infection. Data for NHBS are collected in rotating cycles in these three different populations. For the 2010 NHBS cycle among heterosexuals, men and women were eligible to participate if they were aged 18-60 years, lived in a participating MSA, were able to complete a behavioral survey in English or Span...
Men who have sex with men (MSM) are at high risk for disease associated with human papillomavirus... more Men who have sex with men (MSM) are at high risk for disease associated with human papillomavirus (HPV). In late 2011, HPV vaccine was recommended for males through age 21 and MSM through age 26. Using data from the 2011 National HIV Behavioral Surveillance System, we assessed self-reported HPV vaccine uptake among MSM, using multivariate analysis to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Among 3221 MSM aged 18-26, 157 (4.9%) reported ≥1 vaccine dose. Uptake was higher among men who visited a healthcare provider (aPR 2.3, CI: 1.2-4.2), disclosed same-sex sexual attraction/behavior to a provider (aPR 2.1, CI: 1.3-3.3), reported a positive HIV test (aPR 2.2, CI: 1.5-3.2), or received hepatitis vaccine (aPR 3.9, CI: 2.4-6.4). Of 3064 unvaccinated MSM, 2326 (75.9%) had visited a healthcare provider within 1 year. These national data on HPV vaccine uptake among MSM provide a baseline as vaccination recommendations are implemented.
Denver Public Health implements the National HIV Behavioral Surveillance System (NHBS), a cyclica... more Denver Public Health implements the National HIV Behavioral Surveillance System (NHBS), a cyclical survey of populations at increased risk for HIV. We evaluated the implementation of NHBS among Denver men who have sex with men (MSM), considering the system's simplicity, data quality, representativeness, and sensitivity to trends. We found that the time required for implementation and the complexity of data management and analysis are barriers to disseminating local findings. Data quality has improved in each cycle of the study but must be protected by continually checking for errors and training field staff to be attentive to detail. Compared with the US census and other convenience samples of Denver MSM, the overall demographic representativeness of NHBS has improved over time. However, there is concern that the underlying population included in the study may be changing. NHBS survey data show evidence of two suspected trends in the local MSM population at risk for HIV: increasing sexual risk-taking and the transition away from bars as a dominant partner-finding location. It is unclear whether the increasing reports of sexual risk-taking reflect a real trend or simply a change in the population sampled, since most NHBS participants are recruited at gay bars and other venues. To ensure that the sample continues to represent the underlying population at risk and accurately identify trends, it is necessary to closely monitor MSM sample characteristics during implementation and incorporate weighted data provided by the Centers for Disease Control and Prevention into analyses.
Partner notification of exposure to gonorrhea or chlamydia is traditionally conducted by the inde... more Partner notification of exposure to gonorrhea or chlamydia is traditionally conducted by the index case or a disease intervention specialist. However, a significant proportion of partners remain untreated and thus are at risk for continued transmission. Expedited partner therapy (EPT) obviates the requirement for a health care visit by the partner: the index case delivers medications to the partner. Although shown to be efficacious in randomized control trials, effectiveness studies of delivering EPT in real-world situations are needed. We describe the implementation, patient characteristics, and clinical impact of an EPT program at the Denver Metro Health Clinic (DMHC). We identified 2578 patient visits eligible for EPT (heterosexual men or women diagnosed as having chlamydia or gonorrhea) from November, 2006, to April, 2011. We examined EPT acceptance rates over clinical process improvements. To measure clinical impact, we assessed the association between initial acceptance of EPT and infection status among 351 patients who returned for retesting. Requiring complete documentation of EPT in the clinic electronic medical record increased EPT acceptance from 20% to 48%. Expedited partner therapy acceptance was associated with a reduced risk of chlamydial reinfection (odds ratio, 0.7; 95% confidence interval, 0.3-1.6) and a reduced risk of gonorrheal reinfection (odds ratio, 0.5; 95% confidence interval, 0.2-1.4); however, these changes were not statistically significant. Expedited partner therapy at the DMHC was substantially enhanced by process changes in the clinic and may be associated with a decreased risk of reinfection.
Journal of acquired immune deficiency syndromes (1999), Jan 12, 2015
Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our go... more Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our goal was to validate the Denver HIV Risk Score (DHRS) using a national cohort from the CDC. Patients ≥13 years of age were included, 4,830,941 HIV tests were performed, and 0.6% newly-diagnosed infections were identified. Of all visits, 9% were very low risk (HIV prevalence = 0.20%); 27% low risk (HIV prevalence = 0.17%); 41% moderate risk (HIV prevalence = 0.39%); 17% high risk (HIV prevalence = 1.19%); and 6% very high risk (HIV prevalence = 3.57%). The DHRS accurately categorized patients into different HIV risk groups.
Background: Methamphetamine use is associated with increased risk of HIV transmission, increased ... more Background: Methamphetamine use is associated with increased risk of HIV transmission, increased rate of sero-conversion among those who are HIV positive and MRSA-related infections among intravenous drug users. Data collected through the National HIV Behavioral Surveillance (NHBS) allow description of methamphetamine use and HIV status among three populations at increased risk for HIV in Denver, CO: men who have sex with men (MSM), intravenous drug users (IDU) and heterosexuals at risk (HET). Methods: Data were collected in three cycles between 2006 and 2009: HET, identified by residence or recreation in census tracts with high poverty and incident HIV rates (n=891) MSM (n=543) and IDU (n=422). Eligible participants were identified through respondent-driven sampling (HET and IDU) or at randomly sampled venues (MSM). Consenting participants completed an in-depth behavioral questionnaire and most agreed to HIV testing. Presented estimates are unweighted. Results: Among HET, 94 (10.5%...
Objectives: To describe the challenges, mechanisms, and solutions to integrating rapid and standa... more Objectives: To describe the challenges, mechanisms, and solutions to integrating rapid and standard HCV testing into the established protocol of the National HIV Behavioral Surveillance (NHBS) system at two sites, Denver and Dallas. Methods: Between August and December 2009, injection drug users (IDU) were recruited using respondent-driven sampling as part of NHBS. In Denver, consenting participants provided a serum sample for standard HCV testing (ORTHO HCV Version 3.0 ELISA), an oral specimen for rapid HIV testing (OraQuick ADVANCE Rapid HIV-1/2 Antibody Test), and a finger stick and second oral specimen to evaluate a rapid HCV test (Chembio DPP HCV Rapid Test). In Dallas, sample specimens and tests were similar for standard HCV and rapid HIV testing. The MedMira Rapid Test using whole blood from a fingerstick was evaluated. Results: The most significant challenge to the integration was drawing blood from overly scarred veins, a common problem with the IDU population. In Denver, w...
Prevention science : the official journal of the Society for Prevention Research, 2015
Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic... more Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic in the USA. PWID are also disproportionately affected by limited access to health care and preventative services. We sought to compare current health care coverage, HCV, and HIV testing history, hepatitis A and B vaccination coverage, and co-occurring substance use among PWID in two US cities with similar estimated numbers of PWID. Using data from the 2009 National HIV Behavioral Surveillance system in Denver (n = 428) and Seattle (n = 507), we compared HCV seroprevalence and health care needs among PWID. Overall, 73 % of participants who tested for HCV antibody were positive. Among those who were HCV antibody-positive, vaccination coverage for hepatitis A and B was low (43 % in Denver and 34 % in Seattle) and did not differ significantly from those who were antibody-negative. Similarly, participation in alcohol or drug treatment programs during the preceding 12 months was not significa...
We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early... more We tested blood samples from men who have sex with men (MSM) to detect early HIV infection. Early HIV included both acute (infected past 30 days) and recent (estimated recency past 240 days). Acute infections were defined as screen immunoassay (IA) negative/NAAT-positive or IA-positive/Multispot-negative/NAAT-positive. Recent infections were defined as avidity index cutoff <30 % on an avidity-based IA and, (1) not reporting antiretroviral therapy use or, (2) HIV RNA >150 copies/mL. Of 937 samples, 26 % (244) were HIV-infected and of these 5 % (12) were early. Of early infections, 2 were acute and 10 recent; most (8/12) were among black MSM. Early infection was associated with last partner of black race [adjusted relative risk (ARR) = 4.6, confidence intervals (CI) 1.2-17.3], receptive anal sex at last sex (ARR = 4.3, CI 1.2-15.0), and daily Internet use to meet partners/friends (ARR = 3.3, CI 1.1-9.7). Expanding prevention and treatment for black MSM will be necessary for reducing incidence in the United States.
Persons who inject drugs (PWIDs) have limited access to health care services yet are at very high... more Persons who inject drugs (PWIDs) have limited access to health care services yet are at very high risk for blood borne infections such as HCV and HIV. CDC estimates that injection drug use (IDU) accounted for 48% of acute hepatitis C cases in the United States in 2007 (MMWR, 2009), and previous studies have found prevalence of HCV infection up to 70-80% among persons who inject drugs (PWIDs). There are currently no rapid HCV tests available on the US market, but several are in various stages of development, testing, and clinical trials and one is currently under review at FDA. To evaluate the performance of these rapid tests in field settings, CDC collaborated with four 2009 National HIV Behavioral Surveillance System (NHBS) sites (Dallas, Denver, Seattle, New York City) that conducted HCV testing among persons who injected drugs at least once in the previous 12 months. The four sites integrated both rapid and standard HCV tests (Enzyme Immunoassay and Recombinant Immunoblot Assay: ...
Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), Jan 19, 2014
At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosi... more At the end of 2010, an estimated 872,990 persons in the United States were living with a diagnosis of human immunodeficiency virus (HIV) infection. Approximately one in four of the estimated HIV infections diagnosed in 2011 were attributed to heterosexual contact. Heterosexuals with a low socioeconomic status (SES) are disproportionately likely to be infected with HIV. June-December 2010. The National HIV Behavioral Surveillance System (NHBS) collects HIV prevalence and risk behavior data in selected metropolitan statistical areas (MSAs) from three populations at high risk for HIV infection: men who have sex with men, injecting drug users, and heterosexuals at increased risk for HIV infection. Data for NHBS are collected in rotating cycles in these three different populations. For the 2010 NHBS cycle among heterosexuals, men and women were eligible to participate if they were aged 18-60 years, lived in a participating MSA, were able to complete a behavioral survey in English or Span...
Men who have sex with men (MSM) are at high risk for disease associated with human papillomavirus... more Men who have sex with men (MSM) are at high risk for disease associated with human papillomavirus (HPV). In late 2011, HPV vaccine was recommended for males through age 21 and MSM through age 26. Using data from the 2011 National HIV Behavioral Surveillance System, we assessed self-reported HPV vaccine uptake among MSM, using multivariate analysis to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Among 3221 MSM aged 18-26, 157 (4.9%) reported ≥1 vaccine dose. Uptake was higher among men who visited a healthcare provider (aPR 2.3, CI: 1.2-4.2), disclosed same-sex sexual attraction/behavior to a provider (aPR 2.1, CI: 1.3-3.3), reported a positive HIV test (aPR 2.2, CI: 1.5-3.2), or received hepatitis vaccine (aPR 3.9, CI: 2.4-6.4). Of 3064 unvaccinated MSM, 2326 (75.9%) had visited a healthcare provider within 1 year. These national data on HPV vaccine uptake among MSM provide a baseline as vaccination recommendations are implemented.
Denver Public Health implements the National HIV Behavioral Surveillance System (NHBS), a cyclica... more Denver Public Health implements the National HIV Behavioral Surveillance System (NHBS), a cyclical survey of populations at increased risk for HIV. We evaluated the implementation of NHBS among Denver men who have sex with men (MSM), considering the system's simplicity, data quality, representativeness, and sensitivity to trends. We found that the time required for implementation and the complexity of data management and analysis are barriers to disseminating local findings. Data quality has improved in each cycle of the study but must be protected by continually checking for errors and training field staff to be attentive to detail. Compared with the US census and other convenience samples of Denver MSM, the overall demographic representativeness of NHBS has improved over time. However, there is concern that the underlying population included in the study may be changing. NHBS survey data show evidence of two suspected trends in the local MSM population at risk for HIV: increasing sexual risk-taking and the transition away from bars as a dominant partner-finding location. It is unclear whether the increasing reports of sexual risk-taking reflect a real trend or simply a change in the population sampled, since most NHBS participants are recruited at gay bars and other venues. To ensure that the sample continues to represent the underlying population at risk and accurately identify trends, it is necessary to closely monitor MSM sample characteristics during implementation and incorporate weighted data provided by the Centers for Disease Control and Prevention into analyses.
Partner notification of exposure to gonorrhea or chlamydia is traditionally conducted by the inde... more Partner notification of exposure to gonorrhea or chlamydia is traditionally conducted by the index case or a disease intervention specialist. However, a significant proportion of partners remain untreated and thus are at risk for continued transmission. Expedited partner therapy (EPT) obviates the requirement for a health care visit by the partner: the index case delivers medications to the partner. Although shown to be efficacious in randomized control trials, effectiveness studies of delivering EPT in real-world situations are needed. We describe the implementation, patient characteristics, and clinical impact of an EPT program at the Denver Metro Health Clinic (DMHC). We identified 2578 patient visits eligible for EPT (heterosexual men or women diagnosed as having chlamydia or gonorrhea) from November, 2006, to April, 2011. We examined EPT acceptance rates over clinical process improvements. To measure clinical impact, we assessed the association between initial acceptance of EPT and infection status among 351 patients who returned for retesting. Requiring complete documentation of EPT in the clinic electronic medical record increased EPT acceptance from 20% to 48%. Expedited partner therapy acceptance was associated with a reduced risk of chlamydial reinfection (odds ratio, 0.7; 95% confidence interval, 0.3-1.6) and a reduced risk of gonorrheal reinfection (odds ratio, 0.5; 95% confidence interval, 0.2-1.4); however, these changes were not statistically significant. Expedited partner therapy at the DMHC was substantially enhanced by process changes in the clinic and may be associated with a decreased risk of reinfection.
Journal of acquired immune deficiency syndromes (1999), Jan 12, 2015
Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our go... more Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our goal was to validate the Denver HIV Risk Score (DHRS) using a national cohort from the CDC. Patients ≥13 years of age were included, 4,830,941 HIV tests were performed, and 0.6% newly-diagnosed infections were identified. Of all visits, 9% were very low risk (HIV prevalence = 0.20%); 27% low risk (HIV prevalence = 0.17%); 41% moderate risk (HIV prevalence = 0.39%); 17% high risk (HIV prevalence = 1.19%); and 6% very high risk (HIV prevalence = 3.57%). The DHRS accurately categorized patients into different HIV risk groups.
Uploads
Papers by A. al-Tayyib