The burgeoning HIV/HCV syndemic in the urban Northeast: HCV, HIV, and HIV/HCV coinfection in an urban setting.

Despite recommendations for generation-based HCV and once lifetime HIV screening, thousands of individuals in the U.S. still remain untested and undiagnosed. This cross-sectional study examines the correlates of HCV and HIV monoinfection and HIV/HCV coinfection in an urban Northeast setting.Utilizing an electronic database from a mobile medical clinic in New Haven, CT from January 2003 to July 2011, 8,311 individuals underwent structured health assessment and screening for HIV and HCV.HIV [N = 601 (8.0%)] and HCV [N = 753 (10.1%)] infection were identified, and 197 (26.1%) of the 753 with HCV were coinfected with HIV. Both monoinfection and coinfection status were independently correlated with crack cocaine use and increasing age. HIV/HCV coinfection was correlated with men having sex with men (MSM) (AOR = 38.53, p<0.0080), shooting gallery use (AOR = 3.06, p<0.0070), and not completing high school (AOR = 2.51, p<0.0370). HCV monoinfection correlated with health insurance (AOR = 2.16, p<0.0020), domestic violence (AOR = 1.99, p<0.0070), and being Hispanic (AOR = 2.63, p<0.0001), while HIV monoinfection correlated with having had syphilis (AOR = 2.66, p<0.0001) and being Black (AOR = 1.73, p = 0.0010).Though HIV and HCV share common transmission risk behaviors, independent correlates with viral infection status in an urban Northeast setting are distinct and have important implications for surveillance, healthcare delivery, disease prevention, and clinical care

HIV-related stigma among people living with HIV/AIDS in rural Central China

Abstract Background HIV-related stigma among people living with HIV/AIDS (PLWHA) has been associated with many negative consequences, including poor adherence to therapy and undue psychological stress. However, the relative influence of specific demographic and situational factors contributing to HIV-related stigma among rural PLWHA in central China remains unknown. The aim of this study was to explore the level of HIV-related stigma among rural PLWHA across specific demographic and situational factors in central China. Methods A cross-sectional study was conducted among PLWHA receiving care through the Chinese Centers for Disease Control of Zhenping county in Henan Province, China. Participants completed a 55-item questionnaire which included demographic and disease-related factors, HIV-related stigma was measured utilizing the validated Berger HIV Stigma Scale which has good psychometric characteristics in Chinese PLWHA. Results A total of 239 PLWHA completed the survey. The mean total HIV-related stigma score was 105.92 (SD = 12.35, 95% CI: 104.34, 107.49). Multivariable linear regression analysis revealed a higher level of HIV-related stigma in younger PLWHA (β = − 0.57, 95% CI = − 0.78,-0.35, p<0.001) and those who self-reported opportunistic infections (β = 6.26, 95% CI = 1.26, 11.26, p < 0.05). Conclusions The findings in the current study suggest that rural PLWHA in central China suffer from the burden of HIV-related stigma at a moderate to high level. Younger PLWHA and PLWHA that have opportunistic infections tend to perceive a higher level of HIV stigma

Bivariate logistic regression comparisons of HIV/HCV coinfection, HCV monoinfection, and HIV monoinfection compared to patients without infection.

<p>HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; PWID  =  Person Who Injects Drugs; “Speedball”  =  Injected Mixture of Cocaine and Heroin.</p

Geospatial density of HIV/HCV Coinfection, HCV Monoinfection, and HIV Monoinfection, respectively, in CHCV population by Census Block Group, 2003-2011.

<p>(N = 7,720).</p

Graphical Representation of Overlapping Relationships Between HIV/HCV Coinfection, HCV Monoinfection and HIV Monoinfection, 2003-2011.

<p>(N = 7473) MSM  =  Men-Who-Have-Sex-with-Men; STI  =  Sexually Transmitted Infection.</p

Characteristics among patients with completed surveys with HIV/HCV coinfection as compared to patients with HIV monoinfection, HCV monoinfection, and those neither infected with HIV nor HCV.

<p>(N = 7473).</p>a<p>P-value reported using the Kruskal-Wallis test; ^b P-value not significant using Dunn's multiple corrections test.</p>*<p>p<0.05 comparing the non-infected group with each of the other groups using Dunn's multiple corrections test.</p><p>Legend: HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; PWID  =  Person Who Injects Drugs; “Speedball”  =  Injected Mixture of Cocaine and Heroin.</p

Multivariate analysis with best fit models for HIV/HCV coinfection using both forwards and backwards regression modeling with AIC and Pearson's correlation for bivariate correlations with p<.05.

<p>Hepatitis C and HIV monoinfected groups are included for comparison.</p><p>HIV  =  Human Immunodeficiency Virus; HCV  =  Hepatitis C Virus; MSM  =  Men-Who-Have-Sex-with-Men; WSW  =  Women-Who-Have-Sex-with-Women; STI  =  Sexually Transmitted Infection; AIC  =  Akaike Information Criteria; BIC =  Bayesian Information Criterion.</p

Impact of Availability of Telehealth Programs on Documented HIV Viral Suppression: A Cluster-Randomized Program Evaluation in the Veterans Health Administration

Background: Telehealth may improve care for people with HIV who live far from HIV specialty clinics. We conducted a cluster-randomized evaluation to determine the impact of availability of HIV telehealth programs on documented viral suppression in Veterans Administration clinics. Methods: In 2015–2016, people who previously traveled to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. Patients were cluster-randomized to immediate telehealth availability (n = 925 patients in service areas of 13 primary care clinics offering telehealth) or availability 1 year later (n = 745 patients in 12 clinics). Measures during the evaluation year included telehealth use among patients in areas where telehealth was available and documented HIV viral suppression (viral load performed and /mL). Impact of telehealth availability was determined using intention-to-treat (ITT) analyses that compared outcomes for patients in areas where telehealth was available with outcomes for patients where telehealth was not available, regardless of telehealth use. Complier average causal effects (CACEs) compared outcomes for telehealth users with outcomes for control patients with equal propensity to use telehealth, when available. Results: Overall, 120 (13.0%) patients utilized telehealth when it was available. Availability of telehealth programs led to small improvements in viral suppression in ITT analyses (78.3% vs 74.1%; relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.11) and large improvements among telehealth users in CACE analyses (91.5% vs 80.0%; RR, 1.14; 95% CI, 1.01 to 1.30). Conclusions: Availability of telehealth programs improved documented viral suppression. HIV clinics should offer telehealth visits for patients facing travel burdens