Regression to the mean and changes in risk behavior following study enrollment in a cohort of U.S. women at risk for HIV

Haley, Danielle F.; Frew, Paula M.; Golin, Carol E.; Adimora, Adaora A.; Kuo, Irene; Justman, Jessica; Soto-Torres, Lydia; Wang, Jing; Hodder, Sally

doi:10.1016/j.annepidem.2015.03.013

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…This is consistent with data from other HIV prevention studies showing declines in risk behaviours following enrolment due to either regression to the mean [21] or study participation [22–26]. Repeated inquiry via these assessments could also result in additional self-monitoring, leading, in turn, to a decrease in risk behaviour over time.…”

Section: Discussionsupporting

confidence: 88%

Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV‐positive patients in HIV care across three continents

Safren

Mimiaga

Moore

et al. 2016

Journal of the International AIDS Society

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IntroductionSuccessful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings.MethodsHIV-positive individuals (n=749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use.ResultsAn estimated 3.81 (standard error, (SE)=0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI=2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI=18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI=4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR=1.04, 95% CI=1.01, 1.08) was also significantly associated with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors.ConclusionsThese data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts.

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Section: Discussionsupporting

confidence: 88%

Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV‐positive patients in HIV care across three continents

Safren

Mimiaga

Moore

et al. 2016

Journal of the International AIDS Society

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“…Simulated PWH in the No MCC strategy were assumed to have characteristics similar to MCC patients before they entered the program. However, outcomes from the year before MCC may have been uncharacteristically poor, so that some of the projected benefits of MCC may be related to “regression to the mean” [57]. However, we found that even a small benefit attributable to MCC, such as increased viral suppression of 1%, would lead to a cost-effective program at current programmatic costs.…”

Section: Discussionmentioning

confidence: 86%

Cost-effectiveness of a Medical Care Coordination Program for People With HIV in Los Angeles County

Mje

et al. 2019

Open Forum Infectious Diseases

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Background The Los Angeles County (LAC) Division of HIV and STD Programs implemented a medical care coordination (MCC) program to address the medical and psychosocial service needs of people with HIV (PWH) at risk for poor health outcomes. Methods Our objective was to evaluate the impact and cost-effectiveness of the MCC program. Using the CEPAC-US model populated with clinical characteristics and costs observed from the MCC program, we projected lifetime clinical and economic outcomes for a cohort of high-risk PWH under 2 strategies: (1) No MCC and (2) a 2-year MCC program. The cohort was stratified by acuity using social and clinical characteristics. Baseline viral suppression was 33% in both strategies; 2-year suppression was 33% with No MCC and 57% with MCC. The program cost $2700/person/year. Model outcomes included quality-adjusted life expectancy, lifetime medical costs, and cost-effectiveness. The cost-effectiveness threshold for the incremental cost-effectiveness ratio (ICER) was $100 000/quality-adjusted life-year (QALY). Results With MCC, life expectancy increased from 10.07 to 10.94 QALYs, and costs increased from $311 300 to $335 100 compared with No MCC (ICER, $27 400/QALY). ICERs for high/severe, moderate, and low acuity were $30 500/QALY, $25 200/QALY, and $77 400/QALY. In sensitivity analysis, MCC remained cost-effective if 2-year viral suppression was ≥39% even if MCC costs increased 3-fold. Conclusions The LAC MCC program improved survival and was cost-effective. Similar programs should be considered in other settings to improve outcomes for high-risk PWH.

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“…Alternatively, awareness of one's HIV positivity status may raise psychological distress and reduce motivation for sex . It is challenging to disaggregate whether high‐risk behaviours were reduced among HIV‐positive MSM as a result of the HIV diagnosis itself or due to the impact of pre‐ and post‐test counselling; or the dramatic decrease was simply a phenomenon of “regression to the mean” in a prospective intervention study. Future trial with minimum yet ethical pre‐ and post‐test safer sex counselling may help better elucidate the influence of HIV diagnosis on modifying high‐risk behaviours.…”

Section: Discussionmentioning

confidence: 99%

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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Regression to the mean and changes in risk behavior following study enrollment in a cohort of U.S. women at risk for HIV

Cited by 6 publications

References 16 publications

Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV‐positive patients in HIV care across three continents

Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV‐positive patients in HIV care across three continents

Cost-effectiveness of a Medical Care Coordination Program for People With HIV in Los Angeles County

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

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