Characteristics of Disease Transmission, Geography and Risk in an Urban Population with Endemic HIV

INTRODUCTION : Prior research suggests that sexually transmitted disease is not uniformly distributed throughout populations and geographic areas. Several studies of the geography of STI and HIV revealed a consistent core-like distribution of certain infections, such as gonorrhea, syphilis and HIV/AIDS. These studies further theorized that the conditions that precipitate endemic STI and HIV are not bound to populations, but strongly influenced by network-level features of social groups. METHODS : Two geographic areas in Atlanta, GA were compared – one set of 5 zipcodes in which HIV was highly endemic, and another set of 5 zipcodes in which HIV was only moderately endemic. Two hypotheses were tested in the study area. First, risk variables were selected and composited into a variable representing compound risk, or the presence of multiple risk factors in a single individual, and the distribution of compound risk across the two geographic areas was compared. Second, the correlation between social distance (as geodesic length) and geographic distance (as distance between the centroid of connected individuals) was compared across the two geographic areas. RESULTS : Compound risk was far more prevalent in the high HIV area than in the moderate HIV area (OR: 3.549; 95% CI: 2.438 -- 5.165), even after controlling for potential confounders. A breakdown of the individual risk variables indicates that involvement in sex work (OR: 2.279; 95% CI: 1.549 – 3.354), history of injection drug use (OR: 4.377; 95% CI: 2.35 – 8.152), and having any disease status disparity (OR: 1.511; 95% CI: 1.113 – 2.086) were each significantly more prevalent in the high HIV area than the moderate HIV area, even when stratifying by gender. The examination of the correlation between social distance and geographic distance revealed markedly different correlations in the two geographic areas. For residents of the high HIV area, the Pearson’s correlation score (CC: 0.17175; 95% CI: 0.154887 – 0.188492) was significantly higher than in the moderate HIV area (CC: 0.07021; 95% CI: 0.050822 – 0.08954). CONCLUSION : Areas of high HIV endemicity are associated with at least two of the characteristics described by Rothenberg (2005) : a higher prevalence of individual compound risk than observed in low or moderate HIV areas, and a higher correlation between geodesic and geographic distance than observed in low or moderate HIV areas. If the observed higher correlation is true and can be replicated in other study locations and with other demographic groups, then it may be useful to examine whether areas exhibiting a similar correlation are host to higher than expected rates of HIV. The compound risk finding is in line with the kinds of behavior-oriented HIV/STI risk studies that have been historically emphasized, while the difference correlation between geographic and geodesic distance suggests that behavioral factors do not provide a complete explanation for observed differences in endemicity

HIV Prevention Via Mobile Messaging for Men Who Have Sex With Men (M-Cubed): Protocol for a Randomized Controlled Trial

Background: Men who have sex with men (MSM) continue to be the predominately impacted risk group in the United States HIV epidemic and are a priority group for risk reduction in national strategic goals for HIV prevention. Modeling studies have demonstrated that a comprehensive package of status-tailored HIV prevention and care interventions have the potential to substantially reduce new infections among MSM. However, uptake of basic prevention services, including HIV testing, sexually transmitted infection (STI) testing, condom distribution, condom-compatible lubricant distribution, and preexposure prophylaxis (PrEP), is suboptimal. Further, stronger public health strategies are needed to promote engagement in HIV care and viral load suppression among MSM living with HIV. Mobile health (mHealth) tools can help inform and encourage MSM regarding HIV prevention, care, and treatment, especially among men who lack access to conventional medical services. This protocol details the design and procedures of a randomized controlled trial (RCT) of a novel mHealth intervention that comprises a comprehensive HIV prevention app and brief, tailored text- and video-based messages that are systematically presented to participants based on the participants’ HIV status and level of HIV acquisition risk. Objective: The objective of the RCT was to test the efficacy of the Mobile Messaging for Men (M-Cubed, or M3) app among at least 1200 MSM in Atlanta, Detroit, and New York. The goal was to determine its ability to increase HIV testing (HIV-negative men), STI testing (all men), condom use for anal sex (all men), evaluation for PrEP eligibility, uptake of PrEP (higher risk HIV-negative men), engagement in HIV care (men living with HIV), and uptake of and adherence to antiretroviral medications (men living with HIV). A unique benefit of this approach is the HIV serostatus-inclusiveness of the intervention, which includes both HIV-negative and HIV-positive MSM. Methods: MSM were recruited through online and venue-based approaches in Atlanta, Detroit, and New York City. Men who were eligible and consented were randomized to the intervention (immediate access to the M3 app for a period of three months) or to the waitlist-control (delayed access) group. Outcomes were evaluated immediately post intervention or control period, and again three and six months after the intervention period. Main outcomes will be reported as period prevalence ratios or hazards,depending on the outcome. Where appropriate, serostatus/risk-specific outcomes will be evaluated in relevant subgroups. Men randomized to the control condition were offered the opportunity to use (and evaluate) the M3 app for a three-month period after the final RCT outcome assessment. Results: M3 enrollment began in January 2018 and concluded in November 2018. A total of 1229 MSM were enrolled. Datacollection was completed in September 2019.Conclusions: This RCT of the M3 mobile app seeks to determine the effects of an HIV serostatus–inclusive intervention on the use of multiple HIV prevention and care-related outcomes among MSM. A strength of the design is that it incorporates a large sample and broad range of MSM with differing prevention needs in three cities with high prevalence of HIV among MSM