Background Persons living with Human Immunodeficiency Virus (PLWH) are disproportionately burdened with methicillin resistant Staphylococcus aureus (MRSA). Our objective was to evaluate prevalence and risks for MRSA colonization in PLWH. Methods Adults were recruited from Johns Hopkins University AIDS Service in Baltimore, MD, USA. A risk questionnaire and specimen collection from anatomical sites with culture susceptibility and genotyping were completed. Generalized estimating equation modeling identified MRSA colonization risk factors. Results Of 500 participants, most were black (69%), on antiretroviral therapy (ART) (87%), with undetectable viral loads (73.4%). Median CD4 count was 487 cells/mm3 (IQR: 316 – 676.5 cells/mm3). MRSA prevalence was 15.4%, predominantly from the nares (59.7%). Forty percent were nares negative yet colonized elsewhere. Lower odds for colonization were associated with recent sexual activity (AOR: 0.84, P<0.001) and ART (AOR: 0.85, P=0.011). Increased odds were associated with lower income (<$25,000 vs. >$75,000 AOR: 2.68, P<0.001), recent hospitalization (AOR: 1.54, P<0.001), incarceration (AOR: 1.55, P<0.001), use of street drugs or (AOR: 1.43, P<0.001 and skin abscess (AOR: 1.19, P<0.001). Conclusions Even with high MRSA prevalence, the proportion identified through nares surveillance alone was low, indicating the importance of screening multiple anatomical sites. Associations were not found with same-sex coupling or black race. MRSA prevention might be a benefit of ART in PLWH.

Purpose Pre‐exposure prophylaxis (PrEP) prevents HIV yet uptake remains suboptimal across the United States. This paper evaluates the impact of outreach activities led by nurse supervised community healthcare workers (CHWs) on the PrEP care cascade. Methods This is an observational programmatic evaluation of LGBTQ + community outreach between March 1, 2016, to March 31, 2020, as part of a public health initiative. Descriptive statistics are used to characterize the data by outreach type. Results 2,465 participants were reached. Overall, a PrEP appointment was scheduled for 94 (3.8%) with 70 (2.8%) confirmed to have completed a PrEP visit. Success for each type of community outreach activity was evaluated with virtual models outperforming face‐to‐face. Face‐to‐face outreach identified nine persons among 2,188 contacts (0.41%) completing an initial PrEP visit. The website prepmaryland.org identified 4 among 24 contacts (16.7%) and the PrEP telephone/text warm‐line identified 18 among 60 contacts (30%). The PrEPme smartphone application identified 39 among 168 contacts (23.2%). Conclusions Face‐to‐face community outreach efforts reached a large number of participants, yet had a lower yield in follow‐up and confirmed PrEP visits. All virtual platforms reached lower total numbers, but had greater success in attendance at PrEP visits, suggesting enhanced linkage to care.

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The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy.