A latent class analysis of risk factors for acquiring HIV among men who have sex with men: implications for implementing pre-exposure prophylaxis programs

Current Centers for Disease Control and Prevention (CDC) guidelines for prescribing pre-exposure prophylaxis (PrEP) to prevent HIV transmission are broad. In order to better characterize groups who may benefit most from PrEP, we reviewed demographics, behaviors, and clinical outcomes for individuals presenting to a publicly-funded sexually transmitted diseases (STD) clinic in Providence, Rhode Island, from 2012 to 2014. Latent class analysis (LCA) was used to identify subgroups of men who have sex with men (MSM) at highest risk for contracting HIV. A total of 1723 individuals presented for testing (75% male; 31% MSM). MSM were more likely to test HIV positive than heterosexual men or women. Among 538 MSM, we identified four latent classes. Class 1 had the highest rates of incarceration (33%), forced sex (24%), but had no HIV infections. Class 2 had <5 anal sex partners in the previous 12 months, the lowest rates of drug/alcohol use during sex and lower HIV prevalence (3%). Class 3 had the highest prevalence of HIV (7%) and other STDs (16%), > 10 anal sex partners in the previous 12 months (69%), anonymous partners (100%), drug/alcohol use during sex (76%), and prior STDs (40%). Class 4 had similar characteristics and HIV prevalence as Class 2. In this population, MSM who may benefit most from PrEP include those who have >10 sexual partners per year, anonymous partners, drug/alcohol use during sex and prior STDs. LCA is a useful tool for identifying clusters of characteristics that may place individuals at higher risk for HIV infection and who may benefit most from PrEP in clinical practice

Acute Care Long Acting Reversible Contraceptive Placement: A Compare and Contrast Study

Background: Improving access to effective contraception and reducing rates of unintended pregnancy are national public health objectives. Long Acting Reversible Contraceptives (LARCs) are safe, well tolerated and the most effective means of reversible contraception. Unfortunately, the requisite clinical pathway leading to LARC placement can dissuade women from obtaining care, as this process is often unfamiliar, time-consuming and expensive. LARC counseling and placement in the Acute Care setting is a novel strategy intended to minimize these logistical barriers. In the present study, we hypothesize that women will express interest in an Acute Care based LARC placement program and that an “expedited referral to a Gynecologist” (ERG) will fail to capture a significant proportion of women interested in obtaining a LARC. Methods: This study consists of a 21-question cross-sectional survey, a brief contraceptive counseling video (BCCV) and an optional ERG for contraceptive counseling and placement. A convenience sample of women ages of 18 and 50 were approached at a freestanding urgent care center (UC) (N=146) and an emergency department based urgent care center (ED) (N=144). The study was powered to an N of 288 participants and data analysis completed with chi-squared and t-tests. Results: Of 439 women approached, 290 (66%) met eligibility criteria and enrolled. 152 participants (52%) reported using their preferred method of contraception. This number decreased to 117 (40%) after viewing the BCCV. 154 (53%) of participants expressed interest in returning to an Acute Care setting for LARC placement. Only 28 of the 114 (25%) participants requesting ERG scheduled a visit when contacted by an office manager. There was no statistical difference regarding responses recorded at the ED vs. UC. Conclusion: Nearly half of reproductive age women presenting to the ED and UC are not using their preferred method of contraception. Most women felt comfortable discussing contraception in the Acute Care setting and many expressed interest in an Acute Care based LARC placement program. Moreover, an ERG program failed to link a significant proportion of women interested in obtaining a LARC to care. Acute Care LARC counseling and placement is a novel and potentially viable strategy to supplement existing healthcare infrastructure and improve access to effective contraception

Online Hookup Sites for Meeting Sexual Partners Among Men Who Have Sex with Men in Rhode Island, 2013: A Call for Public Health Action.

Frequent use of websites and mobile telephone applications (apps) by men who have sex with men (MSM) to meet sexual partners, commonly referred to as “hookup” sites, make them ideal platforms for HIV prevention messaging. This Rhode Island case study demonstrated widespread use of hookup sites among MSM recently diagnosed with HIV. We present the advertising prices and corporate social responsibility (CSR) programs of the top five sites used by newly diagnosed HIV-positive MSM to meet sexual partners: Grindr, Adam4Adam, Manhunt, Scruff, and Craigslist. Craigslist offered universal free advertising. Scruff offered free online advertising to selected nonprofit organizations. Grindr and Manhunt offered reduced, but widely varying, pricing for nonprofit advertisers. More than half (60%, 26/43) of newly diagnosed MSM reported meeting sexual partners online in the 12 months prior to their diagnosis. Opportunities for public health agencies to promote HIV-related health messaging on these sites were limited. Partnering with hookup sites to reach high-risk MSM for HIV prevention and treatment messaging is an important public health opportunity for reducing disease transmission risks in Rhode Island and across the United States

How Do Treatment Priorities Differ Between Patients in HIV Care and Their Providers? A Mixed-Methods Study

Evidence suggests priorities differ between patients in HIV care and their providers regarding topics most important to address in care. At five U.S. sites, we asked patients and providers to prioritize 25 potential topic areas to address during routine visits, and invited patients to discuss selection rationale. Patients (n = 206) and providers (n = 17) showed high discordance in rank order priorities (X2 (24, 223) = 71.12; p &lt; 0.0001). Patients ranked social domains such as HIV stigma highly; a higher proportion of providers prioritized substance use domains. HIV stigma was a higher priority for patients in care fewer than 6&nbsp;years (Fisher's exact p = 0.0062), nonwhite patients (Fisher's exact p = 0.0114), and younger patients (Fisher's exact p = 0.0281). Patients' priorities differed between men and women (X2 (24, 188) = 52.89; p &lt; 0.0001), white race vs. other races (X2 (24, 206) = 48.32; p = 0.0023), and Latinos vs. non-Latinos (X2 (24, 206) = 48.65; p = 0.0021). Interviews (n = 79) revealed perceived impact of social context on health and health behaviors