Xiao Zang1, Cassandra Mah2, Amanda My Linh Quan2,3, Jeong Eun Min4, Wendy S Armstrong5, Czarina N Behrends6, Carlos Del Rio5, Julia C Dombrowski7, Daniel J Feaster8, Gregory D Kirk9, Brandon D L Marshall1, Shruti H Mehta9, Lisa R Metsch10, Ankur Pandya11, Bruce R Schackman6, Steven Shoptaw12, Steffanie A Strathdee13, Emanuel Krebs2,4, Bohdan Nosyk2,4. 1. Department of Epidemiology, School of Public Health, Brown University, Providence, RI. 2. Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada. 3. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 4. Center for Health Evaluation and Outcome Sciences; Vancouver, British Columbia, Canada. 5. Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA. 6. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, NY. 7. Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA. 8. Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. 9. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 10. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY. 11. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA. 12. School of Medicine, University of California Los Angeles, Los Angeles, CA; and. 13. School of Medicine, University of California San Diego, La Jolla, CA.
Abstract
BACKGROUND: Understanding the sources of HIV transmission provides a basis for prioritizing HIV prevention resources in specific geographic regions and populations. This study estimated the number, proportion, and rate of HIV transmissions attributable to individuals along the HIV care continuum within different HIV transmission risk groups in 6 US cities. METHODS: We used a dynamic, compartmental HIV transmission model that draws on racial behavior-specific or ethnic behavior-specific and risk behavior-specific linkage to HIV care and use of HIV prevention services from local, state, and national surveillance sources. We estimated the rate and number of HIV transmissions attributable to individuals in the stage of acute undiagnosed HIV, nonacute undiagnosed HIV, HIV diagnosed but antiretroviral therapy (ART) naïve, off ART, and on ART, stratified by HIV transmission group for the 2019 calendar year. RESULTS: Individuals with undiagnosed nonacute HIV infection accounted for the highest proportion of total transmissions in every city, ranging from 36.8% (26.7%-44.9%) in New York City to 64.9% (47.0%-71.6%) in Baltimore. Individuals who had discontinued ART contributed to the second highest percentage of total infections in 4 of 6 cities. Individuals with acute HIV had the highest transmission rate per 100 person-years, ranging from 76.4 (58.9-135.9) in Miami to 160.2 (85.7-302.8) in Baltimore. CONCLUSION: These findings underline the importance of both early diagnosis and improved ART retention for ending the HIV epidemic in the United States. Differences in the sources of transmission across cities indicate that localized priority setting to effectively address diverse microepidemics at different stages of epidemic control is necessary.
BACKGROUND: Understanding the sources of HIV transmission provides a basis for prioritizing HIV prevention resources in specific geographic regions and populations. This study estimated the number, proportion, and rate of HIV transmissions attributable to individuals along the HIV care continuum within different HIV transmission risk groups in 6 US cities. METHODS: We used a dynamic, compartmental HIV transmission model that draws on racial behavior-specific or ethnic behavior-specific and risk behavior-specific linkage to HIV care and use of HIV prevention services from local, state, and national surveillance sources. We estimated the rate and number of HIV transmissions attributable to individuals in the stage of acute undiagnosed HIV, nonacute undiagnosed HIV, HIV diagnosed but antiretroviral therapy (ART) naïve, off ART, and on ART, stratified by HIV transmission group for the 2019 calendar year. RESULTS: Individuals with undiagnosed nonacute HIV infection accounted for the highest proportion of total transmissions in every city, ranging from 36.8% (26.7%-44.9%) in New York City to 64.9% (47.0%-71.6%) in Baltimore. Individuals who had discontinued ART contributed to the second highest percentage of total infections in 4 of 6 cities. Individuals with acute HIV had the highest transmission rate per 100 person-years, ranging from 76.4 (58.9-135.9) in Miami to 160.2 (85.7-302.8) in Baltimore. CONCLUSION: These findings underline the importance of both early diagnosis and improved ART retention for ending the HIV epidemic in the United States. Differences in the sources of transmission across cities indicate that localized priority setting to effectively address diverse microepidemics at different stages of epidemic control is necessary.
Authors: D Panagiotoglou; M Olding; B Enns; D J Feaster; C Del Rio; L R Metsch; R M Granich; S A Strathdee; B D L Marshall; M R Golden; S Shoptaw; B R Schackman; B Nosyk Journal: AIDS Behav Date: 2018-09
Authors: Bohdan Nosyk; Xiao Zang; Emanuel Krebs; Jeong Eun Min; Czarina N Behrends; Carlos Del Rio; Julia C Dombrowski; Daniel J Feaster; Matthew Golden; Brandon D L Marshall; Shruti H Mehta; Lisa R Metsch; Bruce R Schackman; Steven Shoptaw; Steffanie A Strathdee Journal: Clin Infect Dis Date: 2019-11-27 Impact factor: 9.079
Authors: Xiao Zang; Emanuel Krebs; Siyuan Chen; Micah Piske; Wendy S Armstrong; Czarina N Behrends; Carlos Del Rio; Daniel J Feaster; Brandon D L Marshall; Shruti H Mehta; Jonathan Mermin; Lisa R Metsch; Bruce R Schackman; Steffanie A Strathdee; Bohdan Nosyk Journal: Clin Infect Dis Date: 2021-06-01 Impact factor: 9.079
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Authors: Janet M Blair; Jennifer L Fagan; Emma L Frazier; Ann Do; Heather Bradley; Eduardo E Valverde; Ad McNaghten; Linda Beer; Shuyan Zhang; Ping Huang; Christine L Mattson; Mark S Freedman; Christopher H Johnson; Catherine C Sanders; Kathryn E Spruit-McGoff; James D Heffelfinger; Jacek Skarbinski Journal: MMWR Suppl Date: 2014-06-20
Authors: Xiao Zang; Emanuel Krebs; Jeong E Min; Ankur Pandya; Brandon D L Marshall; Bruce R Schackman; Czarina N Behrends; Daniel J Feaster; Bohdan Nosyk Journal: Med Decis Making Date: 2019-12-22 Impact factor: 2.583
Authors: Douglas K Owens; Karina W Davidson; Alex H Krist; Michael J Barry; Michael Cabana; Aaron B Caughey; Susan J Curry; Chyke A Doubeni; John W Epling; Martha Kubik; C Seth Landefeld; Carol M Mangione; Lori Pbert; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2019-06-18 Impact factor: 56.272
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