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Background Despite rising rates of syphilis among people with HIV (PWH) in the United States, there is no optimal syphilis screening frequency or prioritization. Methods We reviewed records of all PWH in care between January 1, 2014 and November 16, 2018 from four sites in the CFAR Network of Integrated Clinical Systems Cohort (CNICS; N=8455). We calculated rates of syphilis testing and incident syphilis and used Cox proportional hazards models modified for recurrent events to examine demographic and clinical predictors of testing and diagnosis. Results Participants contributed 29568 person-years of follow-up. The rate of syphilis testing was 118 tests per 100 person-years (95%CI: 117-119). The rate of incident syphilis was 4.7 cases per 100 person-years (95%CI: 4.5-5.0). Syphilis diagnosis rates were highest among younger cisgender MSM and transgender women, Hispanic individuals, people who inject drugs, and those with detectable HIV RNA, rectal infections, and hepatitis C. Conclusion We identified PWH who may benefit from more frequent syphilis testing and interventions for syphilis prevention.

Early antiretroviral therapy (ART) initiation reduces the risk of disease progression and HIV transmission, but data on time from HIV care entry to ART initiation are lacking. Using data from the Medical Monitoring Project (MMP), a population-based probability sample of HIV-infected adults receiving medical care in the United States, we assessed time from care entry to ART initiation among persons diagnosed , and persons without AIDS at care entry (HR 0.37; CI 0.31-0.43) had significantly longer times to ART initiation. Overall, time to ART initiation was suboptimal by current standards and significant disparities were noted among certain subgroups. Efforts to encourage prompt ART initiation should address delays among those without health insurance and among certain sociodemographic subgroups.

Increasing attention is being paid to best practice in mental health sciences. One crucial aspect of this is the extent to which the mental health workforce has the knowledge and skills to implement state-of-the-art interventions. Recently, evidence has indicated that sexual offending often begins in adolescence, can be a persistent disorder when left untreated, and is associated with a range of other mental health problems in the perpetrator and subsequently in victims. A small number of evaluations of treatment programs are appearing but little work has appeared addressing the issue of how the workforce is equipped, or can be trained, to work with this challenging population. In this paper we present data on the effects of training on knowledge, skills, confidence, and willingness, to work with this client group. Trainees were 107 mental health workers who attended training workshops provided throughout Queensland, Australia by the Griffith Adolescent Forensic Assessment and Treatment Centre. Results showed that the measures developed for assessing training effects were change sensitive and valid. Training was associated with increases in self-rated skills, confidence, knowledge, and willingness to work with this population, and these changes were maintained for the follow-up sample.