Behavior change following HIV diagnosis: findings from a Cohort of Los Angeles MSM

Gorbach, Pamina M.; Javanbakht, Marjan; Bolan, Robert

doi:10.1080/09540121.2017.1366415

Cited by 10 publications

(13 citation statements)

References 10 publications

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“…A high rate (6.6 per 100 PYFU) of incident STIs has been found among patients with acute HIV infection7 and patients who continued to practice condomless anal intercourse after being diagnosed as having HIV infection 32. In this study, the incidence of any STI before the achievement of viral suppression was higher in patients without rapid ART initiation than it was in those with rapid ART initiation (28.3 vs 18.8 per 100 PYFU) within a short follow-up duration; this thus raises concerns that STIs may facilitate HIV transmission through genital secretions with relatively high HIV RNA loads 33 34.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

et al. 2019

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ObjectivesRapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings.DesignRetrospective cohort study.SettingA tertiary hospital in metropolitan Taipei, Taiwan.ParticipantsWe included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.Main outcome measuresRapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation.ResultsRapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression.ConclusionsRapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs.Ethics approvalThe study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).

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Section: Discussionmentioning

confidence: 99%

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

et al. 2019

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“…A Mathematical modelling study also reveals substantial risky behaviour reduction among post‐diagnosis MSM in Southern California . However, a recent study in Los Angeles indicates a higher prevalence of condomless anal sex among recently seroconverted MSM compared to that before HIV diagnoses . Per the China CDC guidelines, our study participants received both pre‐test and post‐test counselling in safer sex provided by healthcare staff; participants in the intervention arm received both SOC and peer counselling.…”

Section: Discussionmentioning

confidence: 96%

Peer counselling versus standard‐of‐care on reducing high‐risk behaviours among newly diagnosed HIV‐positive men who have sex with men in Beijing, China: a randomized intervention study

Liu

Vermund

Ruan³

et al. 2018

J Intern AIDS Soc

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IntroductionReducing high‐risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer‐ counselling in reducing high‐risk behaviours among newly diagnosed HIV‐positive Chinese men who have sex with men (MSM).MethodsWe randomized 367 newly diagnosed HIV‐positive men to either standard‐of‐care (SOC; n = 183) or peer‐counselling intervention (n = 184), and followed them for 12 months (visit at 0‐, 3‐, 6‐, 9‐ and 12‐month). SOC participants received counselling on high‐risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre‐post diagnosis high‐risk behaviour change; logistic regression was used to assess the likelihood of practicing high‐risk behaviours between intervention and SOC participants. Both intent‐to‐treat and per‐protocol (full‐dosage) approaches were used for the analyses.ResultsFor pre‐ and post‐diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent‐to‐treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per‐protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98).ConclusionsWe observed a 14 to 43% decrease in the prevalence of selected high‐risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer‐counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM.Clinical Trial Number: NCT01904877

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“…This sample was obtained by recruiting individuals who sought HIV testing and the recent sexual activity they reported on would be expected to include behaviors that influenced their decision to seek testing. Further, the study protocol called for the oversampling of HIV positive individuals and, in particular, recently infected HIV positive individuals . Thus, the generalizability of results presented in this study is limited.…”

Section: Discussionmentioning

confidence: 99%

“…The MetroMates study also selectively enrolled men whose new HIV diagnosis suggested a recent or acute infection. As described by Gorbach et al [32], during the initial phase of enrollment, only men with a recent diagnosis were recruited. To complete enrollment, men with any new diagnosis, including chronically infected men, were recruited.…”

Section: Applicationmentioning

confidence: 99%

Measuring concurrency using a joint multistate and point process model for retrospective sexual history data

Aralis

Gorbach

Brookmeyer

2016

Statistics in Medicine

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Understanding the impact of concurrency, defined as overlapping sexual partnerships, on the spread of HIV within various communities has been complicated by difficulties in measuring concurrency. Retrospective sexual history data consisting of first and last dates of sexual intercourse for each previous and ongoing partnership is often obtained through use of cross-sectional surveys. Previous attempts to empirically estimate the magnitude and extent of concurrency among these surveyed populations have inadequately accounted for the dependence between partnerships and used only a snapshot of the available data. We introduce a joint multistate and point process model in which states are defined as the number of ongoing partnerships an individual is engaged in at a given time. Sexual partnerships starting and ending on the same date are referred to as one-offs and modeled as discrete events. The proposed method treats each individual’s continuation in and transition through various numbers of ongoing partnerships as a separate stochastic process and allows the occurrence of one-offs to impact subsequent rates of partnership formation and dissolution. Estimators for the concurrent partnership distribution and mean sojourn times during which a person has k ongoing partnerships are presented. We demonstrate this modeling approach using epidemiological data collected from a sample of men having sex with men and seeking HIV testing at a Los Angeles clinic. Among this sample, the estimated point prevalence of concurrency was higher among men later diagnosed HIV positive. One-offs were associated with increased rates of subsequent partnership dissolution.

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Behavior change following HIV diagnosis: findings from a Cohort of Los Angeles MSM

Cited by 10 publications

References 10 publications

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Peer counselling versus standard‐of‐care on reducing high‐risk behaviours among newly diagnosed HIV‐positive men who have sex with men in Beijing, China: a randomized intervention study

Measuring concurrency using a joint multistate and point process model for retrospective sexual history data

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