Adjusted relative hazards of HIV seroconversion (without accounting for condoms) among North American men who have sex with men from four longitudinal cohort studies, 1995–2007.

*<p>seroconversion.</p>**<p>adjusted for age, race, number of sexual partners, any methamphetamine and popper use in the last six months, and intervention assignment.</p><p>## models 1 and 2 are equivalent apart from using different groups as the reference category.</p

Adjusted relative hazards of HIV seroconversion (with condoms) among North American men who have sex with men from four longitudinal cohort studies, 1995–2007.

*<p>seroconversion.</p>**<p>adjusted for age, race, number of sexual partners, and any methamphetamine and popper use in the last six months, and intervention assignment.</p><p>## models are equivalent except for using different groups as the reference category.</p

Demographic and behavioral characteristics of HPTN 061 participants by seroprotective behavior at baseline.

<p>¹ Participants who are HIV negative, biological male and reported seroprotective behaviors at baseline are included in the table. Data on behavioral characteristics at baseline missing for 34 participants (total cohort N = 1144). CAS—Condomless anal sex</p><p>Demographic and behavioral characteristics of HPTN 061 participants by seroprotective behavior at baseline.</p

Multinomial logistic regression of covariates with sexual behavior (includes all visits)¹.

<p>¹controlled by city; CAS-condomless anal sex</p><p>Multinomial logistic regression of covariates with sexual behavior (includes all visits)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0118281#t002fn001" target="_blank">¹</a>.</p

Characteristics of HIV-positive men who have sex with men (MSM) in San Francisco in the Options cohort at the time of first ACASI, 2009–2010.

<p>Characteristics of HIV-positive men who have sex with men (MSM) in San Francisco in the Options cohort at the time of first ACASI, 2009–2010.</p

Estimated mean number of sexual partners per prior 3-month period and 95% confidence intervals [CI] for each sexual behavior variable of interest among MSM in Options/San Francisco, 2009–2010.

∧<p>Number of participants who contribute to each time point varies because this was not a strictly longitudinal cohort study. All participants started contributing data in 2009, and were at various times since diagnosis when they completed their ACASIs.</p>∧∧<p>PDP = potentially discordant partners (HIV-negative or unknown-status partners).</p>*<p>UAI = unprotected anal intercourse.</p>**<p>uIAI = unprotected insertive anal intercourse.</p>***<p>For participants with plasma viral load <500 copies/ml, number of PDP with whom uIAI occurred was set to 0.</p

Mean number of partners of various types per 3 months since HIV diagnosis among HIV-positive MSM in San Francisco, 2009–2010.

<p>An immediate drop in the total number of male partners in the first year of infection was followed by increases in number of partners over the following 3–4 years. The trend was similar for potentially serodiscordand partners (PDPs) although they comprised only 1/3 to 1/2 of total partnerships. However, unprotected anal intercourse (UAI) with PDPs occurred in far fewer partnerships throughout the follow-up period. Partnerships in which the HIV-positive participant was the insertive partner during unprotected anal intercourse (uIAI) accounted for fewer than 10% of all partnerships and in very few of those partnerships did the participant have sufficient plasma viral load (VL >500 copies/ml) to present a significant transmission risk.</p

Demographic characteristics of the entire cohort and risk factors for HIV infection.

<p>Demographic characteristics of the entire cohort and risk factors for HIV infection.</p

Sexual risk behavior of the 490 participants in serodiscordant partnerships.

<p>Sexual risk behavior of the 490 participants in serodiscordant partnerships.</p

Screening HIV-Infected Patients with Low CD4 Counts for Cryptococcal Antigenemia prior to Initiation of Antiretroviral Therapy: Cost Effectiveness of Alternative Screening Strategies in South Africa

<div><p>Background</p><p>In 2015 South Africa established a national cryptococcal antigenemia (CrAg) screening policy targeted at HIV-infected patients with CD4+ T-lymphocyte (CD4) counts <100 cells/ μl who are not yet on antiretroviral treatment (ART). Two screening strategies are included in national guidelines: reflex screening, where a CrAg test is performed on remnant blood samples from CD4 testing; and provider-initiated screening, where providers order a CrAg test after a patient returns for CD4 test results. The objective of this study was to compare costs and effectiveness of these two screening strategies.</p><p>Methods</p><p>We developed a decision analytic model to compare reflex and provider-initiated screening in terms of programmatic and health outcomes (number screened, number identified for preemptive treatment, lives saved, and discounted years of life saved) and screening and treatment costs (2015 USD). We estimated a base case with prevalence and other parameters based on data collected during CrAg screening pilot projects integrated into routine HIV care in Gauteng, Free State, and Western Cape Provinces. We conducted sensitivity analyses to explore how results change with underlying parameter assumptions.</p><p>Results</p><p>In the base case, for each 100,000 CD4 tests, the reflex strategy compared to the provider-initiated strategy has higher screening costs ($37,536 higher) but lower treatment costs ($55,165 lower), so overall costs of screening and treatment are $17,629 less with the reflex strategy. The reflex strategy saves more lives (30 lives, 647 additional years of life saved). Sensitivity analyses suggest that reflex screening dominates provider-initiated screening (lower total costs and more lives saved) or saves additional lives for small additional costs (<$125 per life year) across a wide range of conditions (CrAg prevalence, patient and provider behavior, patient survival without treatment, and effectiveness of preemptive fluconazole treatment).</p><p>Conclusions</p><p>In countries with substantial numbers of people with untreated, advanced HIV disease such as South Africa, CrAg screening before initiation of ART has the potential to reduce cryptococcal meningitis and save lives. Reflex screening compared to provider-initiated screening saves more lives and is likely to be cost saving or have low additional costs per additional year of life saved.</p></div