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Internet-recruited gay, bisexual, and other men who have sex with men (MSM) were offered HIV self-tests (HIVSTs) after completing baseline, 3-, 6-, and 9-month follow-up surveys. The surveys asked about the use and distribution of these HIVSTs. Among 995 who reported on their distribution of HIVSTs, 667 (67.0%) distributed HIVSTs to their social network associates (SNAs), which resulted in 34 newly identified HIV infections among 2301 SNAs (1.5%). The main reasons participants reported not distributing HIVSTs included: wanting to use the HIVSTs themselves (74.9%); thinking that their SNAs would get angry or upset if offered HIVSTs (12.5%); or not knowing that they could give the HIVSTs away (11.3%). Self-testing programs can provide multiple HIVSTs and encourage the distribution of HIVST by MSM to their SNAs to increase awareness of HIV status among persons disproportionately affected by HIV., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

South Asian gay, bisexual, and other men who have sex with men (GBMSM) in the United States are subsumed under the broad, heterogeneous category of Asian GBMSM in national surveillance systems. Disaggregated data on their rates of HIV and sexually transmitted infection (STI) testing are not publicly reported. This is problematic as the diversity of ancestries, cultures, and customs across subgroups of Asian GBMSM may contribute to differential HIV and STI testing experiences. To address this deficit in knowledge, 115 South Asian GBMSM recruited through social media advertising and peer referral were surveyed about their patterns of HIV and STI testing. In the past 6 months, almost two-thirds ( n = 72, 62.61%) had two or more male sex partners, and more than a quarter ( n = 33, 28.70%) had condomless anal sex with two or more male partners. In the past year, more than one in four ( n = 32, 27.83%) had not been tested for HIV, and more than two in five ( n = 47, 40.87%) had not been tested for STIs. The prevalence of past-year HIV and STI testing was lower among participants aged ≥35 years and those who had never used pre-exposure prophylaxis. Participants who were partnered were less likely to have been tested for HIV, and those who were born outside the United States were less likely to have been tested for STIs in the past year. Findings highlight gaps in domestic HIV- and STI-prevention efforts with respect to adequately engaging South Asian GBMSM and suggest that some segments of this subgroup may benefit from targeted outreach.

Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one's HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Web-based HIV and sexually transmitted infection (STI) prevention studies are increasingly requesting gay, bisexual, and other men who have sex with men (GBMSM) to return self-collected specimens for laboratory processing. Some studies have solicited self-collected extragenital swabs for gonorrhea and chlamydia testing, but to date, none have solicited self-collected hair samples for pre-exposure prophylaxis (PrEP) adherence testing. Project Caboodle! offered 100 racially/ethnically diverse GBMSM aged 18 to 34 years residing across the United States a choice to self-collect at home and return by mail any of the following: a finger-stick blood sample (for HIV testing), a pharyngeal swab, a rectal swab and a urine specimen (for gonorrhea and chlamydia testing), and a hair sample (to visually assess its adequacy for PrEP drug level testing). Despite not incentivizing specimen return, 51% mailed back at least one type of specimen within 6 weeks (1% returned three specimens, 11% returned four specimens and 39% returned all five specimens). The majority of returned specimens were adequate for laboratory processing. Significantly more participants without a college education ( p = .0003) and those who were working full-time or part-time ( p = .0070) did not return any specimens. In addition, lower levels of HIV-related knowledge ( p = .0390), STI-related knowledge ( p = .0162), concern about contracting HIV ( p = .0484), and concern about contracting STIs ( p = .0108) were observed among participants who did not return any specimens. Self-collection of specimens holds promise as a remote monitoring strategy that could supplement testing in clinical settings, but a better understanding of why some GBMSM may choose to fully, partially, or not engage in this approach is warranted.

HIV prevention research among men who have sex with men (MSM) has traditionally focused on individual risk reduction strategies. Our study evaluated awareness, utilization, and preferences for 10 complementary HIV prevention strategies among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019, 79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074, 83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the least familiar option, and engaging in sexual activities other than anal sex was the most utilized option. Progressively older and bisexual-identifying MSM were less likely, but those with higher educational levels and easy access to local HIV resources were more likely to be aware of and to be utilizing a greater number of strategies. Additionally, Hispanic MSM were less likely to be aware of, and those in a "closed" relationship were less likely to be utilizing a greater number of strategies. In a subset of 775 multiple strategy users, pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of sex partners emerged as the most preferred options. Combination intervention packages for MSM should be tailored to personal circumstances, including sexual orientation, relationship characteristics and access to local HIV resources.

Background: The Centers for Disease Control and Prevention estimates that 1.1 million people in the United States are living with HIV and 1 in 8 are estimated to be unaware of their serostatus. Little is known about whether individuals would consider being tested for HIV in nontraditional health care settings such as a dentist's office. Studies in selected US cities have indicated high acceptability of receiving an HIV test among people attending dental clinics. However, we are not aware of studies that have assessed willingness to receive HIV testing in dental care settings at a national level., Objective: Using a web-based sample of adult residents of the United States, we sought to assess the self-reported willingness to receive any type of HIV testing (ie, oral fluid rapid testing, finger-stick blood rapid testing, or venipuncture blood testing) in a dental care setting and evaluate independent associations of willingness with the extent to which dental care providers were perceived as knowledgeable about HIV and how comfortable participants felt discussing HIV with their dental care providers., Methods: Participants were recruited using banner advertisements featured on social networking platforms (Facebook and Instagram) from December 2018 to February 2019. Demographic and behavioral data including information on sexual behaviors in the past 6 months, HIV testing history, and dental/health care-seeking history were collected using an anonymous web-based survey. Willingness to receive any type of HIV testing in a dental care setting was assessed on 4-point scale from very willing to very unwilling. Factors independently associated with participants' willingness were identified using a multivariable logistic regression model., Results: Of the 421 participants in our study aged 18 to 73 years, 271 (64.4%) reported having oral sex, 197 (46.8%) reported having vaginal sex, and 136 (32.3%) reported having anal sex in the past 6 months. Approximately one-third had never been tested for HIV (137/421, 32.5%), and the same proportion had not been tested in the past year (137/421, 32.5%). Most participants had dental insurance coverage (356/421, 84.6%), and more than three-fourths reported being very or somewhat willing (326/421, 77.4%) to receive any type of HIV testing in a dental care setting. Higher levels of willingness were associated with being 18 to 24 years versus ≥35 years (aOR 3.22, 95% CI 1.48-6.98), 25 to 34 years versus ≥35 years (aOR 5.26, 95% CI 2.52-10.98), believing that one's dental care provider is knowledgeable about HIV (aOR 2.04, 95% CI 1.06-3.92), and feeling comfortable discussing HIV with one's dental care provider (aOR 9.84, 95% CI 3.99-24.27)., Conclusions: Our data indicate high acceptability of receiving HIV testing in a dental care setting, especially among those who report having a positive patient-provider relationship. Future research should focus on assessing dental care providers' attitudes, self-efficacy, and beliefs about whether HIV testing fits into the scope of dentistry., (©Matthew T Rosso, Akshay Sharma. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 21.07.2020.)

Use of Pre-exposure prophylaxis (PrEP) for HIV prevention by men who have sex with men (MSM) may be impacted by relationship dynamics. We assessed perceived partner support of PrEP use and benefit of PrEP by relationship characteristics among male couples. Baseline data from a randomized control trial of video-based HIV counseling and testing among male couples in the U.S. were used in adjusted multilevel regression models to assess individual and dyadic characteristics. Among 659 participants, 73.3% thought their partner would be supportive of their PrEP use; 26.7% reported their partner would not support PrEP use, which was significantly associated with intimate partner violence (IPV) (p = 0.008). Most (57.7%) did not believe PrEP would be beneficial to them or their partner. Couples with a sexual agreement allowing outside partners were significantly associated with higher perceived support of partners for PrEP (p < 0.001) and benefit of PrEP use (p < 0.001). Perceived partner support of PrEP was high but perceived benefit of PrEP was low, both shaped by relationship dynamics that highlight the need for tailored dyadic interventions. The association between perceived PrEP support and IPV points to the need to integrate relationship contexts in HIV prevention programs.

Transgender youth have low rates of engagement in HIV prevention, shaped in part by experiences of transphobia and lack of access to culturally competent care. Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing coupled with video-chat counseling. A diverse sample of 202 binary and nonbinary transgender youth (TY) were recruited online, and randomized 2:1 to receive the intervention or a control condition of only home-based HIV self-testing. TY were willing to order HIV self-testing kits and report their results. Half of those in the intervention arm opted to use the video-chat counseling and, among those who did, levels of satisfaction were high. Project Moxie demonstrates the ability to recruit TY online and provide them with access to home HIV testing. Further work is required to develop online interventions for youth who do not wish to receive counseling through video-chat formats.

Gay, bisexual and other men who have sex with men (GBMSM) experience greater health disparities, and concern about other health conditions may decrease engagement in HIV prevention. This study assessed perceived threat and impact of HIV relative to other health concerns among GBMSM. Data were from a national online survey of GBMSM conducted between August and September 2015. Participants ranked concern about contracting HIV and impact of HIV on their health compared with other health conditions. The association of HIV threat and impact with recent condomless anal sex (CAS) and HIV testing were assessed using regression models. Among 466 participants, threat and impact of HIV were ranked lower compared to cancer, Alzheimer's and heart disease. Concern about getting HIV was associated with greater odds of recent HIV testing (adjOR 1.1, 95%CI 1.02-1.18) and lower CAS (adjOR 0.86, 95%CI 0.78-0.94). Among GBMSM, other health conditions may be perceived as a greater threat and higher impact on health compared with HIV. Integrating complex health care concerns with HIV prevention strategies may increase engagement in prevention.

There is growing evidence that sexual behaviors among male couples are strongly shaped by emotional and quality characteristics of the relationship, and that the labels that men attach to their relationships may indicate how men perceive and engage in risk taking. There has been a lack of attention to how male couples label their relationships, and how discordant understandings of relationship labels may shape HIV risk behavior. Using data from a sample of 804 partnered men who have sex with men, this analysis examines associations between discordant relationship labeling and participation in HIV testing and sexual behavior. Men who labeled their relationship differently from their partners were less likely to have been recently tested for HIV and more likely to engage in sexual risk. The results underscore the need to develop interventions that provide spaces and skills for men to learn how to effectively navigate HIV risks in their relationships.

Partnered men who have sex with men are not immune to the risk of HIV. Analyzing dyadic data from 360 male couples recruited from April 2016 to June 2017, we examined how relationship characteristics might influence HIV testing behavior and perceptions of partners' HIV testing. Increasing levels of mutual trust were associated with lower odds of both partners (versus neither) having been tested in the past year (aOR = 0.91, 95% CI 0.83-0.99), but increasing levels of communal coping were associated with higher odds (aOR = 1.06, 95% CI 1.02-1.10). Only one partner was more likely to be correct about whether or not his partner had been tested in the past year (versus both) if someone had broken their sexual agreement (aOR = 2.60, 95% CI 1.17-5.76). Increasing differences in trust (aOR = 1.10, 95% CI 1.01-1.20) were also associated with higher odds of only one partner being correct. Dyadic HIV prevention efforts should incorporate skills building around negotiating sexual agreements and constructive communication.

HIV-positive men who have sex with men (MSM) were recruited on www.Facebook.com and www.Poz.com to give HIV self-tests to their contacts. Study participants completed a baseline survey, were given two self-tests, and completed a survey 2 months later. Of 133 eligible men, 40 (30%) completed both surveys. Most participants were 30-54 years old and non-Hispanic white. Some had a detectable viral load (n = 4), had condomless anal sex with male partners of negative or unknown status (n = 17), and had met anal sex partners at gay dating websites (n = 23). Of 80 self-tests given to participants, 59 (74%) were distributed, primarily to non-Hispanic white MSM, 30-54 years old who were friends. Participants reported results from 31 distributed tests; 2 sex partners of participants had positive results. Participants indicated these two persons were unaware of their infections. Expanding recruitment websites might reach non-white MSM. Unrecognized infections were identified through online recruitment and self-test distribution via HIV-positive persons.

Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain heavily impacted by HIV. The purpose of this study was to describe intergenerational differences in functional knowledge of HIV prevention strategies, perceived risk, recent condomless anal sex (CAS), and HIV testing behavior. Eight hundred sexually active GBMSM were recruited via Facebook from August to September 2015, and administered a Web-based survey which included 12 multiple-choice questions to elicit data regarding functional knowledge of different HIV prevention approaches (e.g., condom use, pre-exposure prophylaxis post-exposure prophylaxis, treatment as prevention, circumcision). Cumulative logit and multivariable logistic models were formulated to examine birth cohort variations across four analytic outcomes. Younger generations were significantly more knowledgeable, as were GBMSM with higher education. Non-Hispanic non-White GBMSM and those reporting a bisexual/other sexual orientation had lower functional knowledge. Younger generations were equally concerned about contracting HIV as their older counterparts. Perceived risk was significantly higher among non-Hispanic non-White and Hispanic GBMSM, but lower among those with higher education and those in a relationship. Finally, birth cohort variations with respect to engaging in CAS with ≥2 men in the past 3 months and testing for HIV in the past year were not markedly pronounced. Younger GBMSM might be more knowledgeable about HIV prevention strategies compared to their predecessors, but are equally concerned about contracting HIV. Researchers and practitioners should consider intergenerational and other demographic differences while designing multifaceted HIV prevention programs for GBMSM.

Men who have sex with men (MSM) may prioritize interpersonal and structural factors, such as LGBTQ-related inequalities, housing instability, financial insecurity, and relationship seeking, over HIV prevention. The aim of this study was to assess how MSM prioritize HIV relative to other factors and the association between HIV prioritization, HIV testing and sexual risk behavior, and perceived risk. Data were collected from a national online survey of MSM in the United States assessing HIV knowledge and prioritization. Participants ranked HIV prevention relative to LGBTQ-related concerns and life issues (e.g., housing, job, relationship). Adjusted regression models were conducted to assess the association of HIV prioritization with HIV testing and condomless anal sex (CAS) and to evaluate associations between perceived risk and HIV risk behavior. Among 516 participants, HIV prevention was ranked significantly higher among MSM reporting recent CAS ( p = .04) and HIV testing within the past ( p = .02); HIV prevention was prioritized higher relative to life issues among MSM reporting last HIV test more than 1 year ago ( p = .02). Perceived HIV risk was significantly associated with higher HIV prioritization relative to LGBTQ concerns ( p = .001) and life issues ( p = .001). Higher HIV perceived risk was associated with lower odds of any CAS ( p < .001) and higher odds of having an HIV test in the past year ( p < .001). In this online study, HIV prioritization was identified as differentially associated with HIV testing, sexual risk behavior, and perceived HIV risk. HIV prevention programs should integrate strategies to address social and structural inequalities based on priority needs of MSM.

HIV testing is the gateway into both prevention and treatment services. It is important to understand how men who have sex with men (MSM) perceive HIV self-tests. We conducted focus groups and individual interviews to collect feedback on two HIV self-tests, and on a dried blood spot (DBS) specimen collection kit. Perceptions and attitudes around HIV self-testing (HIVST), and willingness to distribute HIV self-tests to others were assessed. MSM reported HIVST to be complementary to facility-based testing, and liked this approach because it offers privacy and convenience, does not require counseling, and could lead to linkage to care. However, they also had concerns around the accuracy of HIV self-tests, their cost, and receiving a positive test result without immediate access to follow-up services. Despite these issues, they perceived HIVST as a positive addition to their HIV prevention toolbox.

In the United States, an estimated 67% of new HIV diagnoses are among men who have sex with men (MSM), however 25% of HIV-positive MSM in the 2014 National HIV Behavioral Surveillance Survey were unaware of their infection. HIV self-testing (HIVST) with rapid diagnostic tests (RDTs) may facilitate access to HIV testing. We evaluated the ability of 22 MSM to conduct two HIV RDTs (OraQuick ® In-Home HIV Test and a home-use prototype of Sure Check ® HIV 1/2 Assay), interpret sample images of test results, and collect a dried blood spot (DBS) specimen. While some participants did not follow every direction, most participants were able to conduct HIVST and correctly interpret their results. Interpretation of panels of RDT images was especially difficult when the "control" line was missing, and 27% of DBS cards produced were rated as of bad quality. Modifications to the DBS instructions were necessary prior to evaluating the performance of these tests in real-world settings.

Peer-driven HIV prevention strategies can be effective in identifying high-risk persons with undiagnosed infections. Besides individual self-testing, other potential uses of rapid home HIV test kits include distributing them, and testing with others within one's social or sexual networks. We sought to identify factors associated with the willingness to engage in these alternative activities among men who have sex with men (MSM) in the United States. From May to October 2014, we surveyed 828 HIV-negative or unknown status MSM about multiple aspects of rapid home HIV testing. A greater proportion indicated being likely to distribute free oral fluid (OF) tests compared to free finger-stick blood (FSB) tests (91% versus 79%), and almost three-fourths (72%) reported being likely to test with their friends or sex partners in the future. MSM not identifying as homosexual/gay were less willing to distribute OF tests, and those with lower educational attainment were more willing to distribute FSB tests. MSM unaware of their HIV status were less likely to report potentially testing with others using free rapid home HIV tests compared to those who were HIV-negative. Finally, MSM willing to self-test were more likely to report future test kit distribution, and those willing to distribute kits were more likely to report potentially testing with others. Engaging individuals with positive attitudes towards these strategies in prevention efforts could help increase HIV testing levels among MSM. A greater understanding of the potential public health impact of rapid home HIV test kits is necessary.

Background: Tenofovir disoproxil fumarate (TDF) is an antiretroviral agent frequently used to treat human immunodeficiency virus (HIV). There are concerns regarding its potential to cause acute kidney injury, chronic kidney disease, and proximal tubulopathy. Although TDF can effectively suppress HIV after kidney transplantation, it is unknown whether use of TDF-based antiretroviral therapy (ART) after kidney transplantation adversely affects allograft survival., Methods: We examined 104 HIV+ kidney transplant (KT) recipients at our center between 2001 and 2014. We generated a propensity score for TDF treatment using recipient and donor characteristics. We then fit Cox proportional hazards models to investigate the association between TDF treatment and 3-year, death-censored primary allograft failure, adjusting for the propensity score and delayed graft function (DGF)., Results: Of the 104 HIV+ KT candidates who underwent transplantation during the study period, 23 (22%) were maintained on TDF-based ART at the time of transplantation, and 81 (78%) were on non-TDF-based ART. Median age of the cohort was 48 years; 87% were male; 88% were black; and median CD4 count at transplantation was 450 cells/mm 3 . Median kidney donor risk index was 1.2. At 3 years post transplantation, primary allograft failure occurred in 26% of patients on TDF-based ART and in 28% of patients on non-TDF-based ART (P=.5). TDF treatment was not associated with primary allograft failure at 3 years post transplant after adjusting for DGF and a propensity score for TDF use (hazard ratio 2.12, 95% confidence interval 0.41-10.9)., Conclusions: In a large single-center experience of HIV+ kidney transplantation, TDF use following kidney transplantation was not significantly associated with primary allograft failure. These results may help inform management for HIV+ KT recipients in need of TDF therapy for adequate viral suppression., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV transmission at the population and individual levels., Methods: Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk., Results: When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence., Conclusions: RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms., Competing Interests: The authors have declared that no competing interests exist.

Men who have sex with men (MSM) represent a disproportionately impacted risk group for HIV incidence among at-risk U.S., Populations: Few studies have identified risk factors associated with HIV testing frequency both within and outside of traditional health care settings. MSM enrolled in a prospective cohort were mailed at-home specimen collection kits and followed for a year. Incidence density rate ratios (IDRR) of testing were calculated, and generalized estimating equations were used to analyze the association between HIV testing and behavioral factors. The incidence rate of testing was higher among Black MSM than White MSM (IDRR: 1.3, 95% confidence interval CI [1.1, 1.5]) and higher among MSM who reported 3+ condomless anal intercourse partners (CAI) than MSM who reported no CAI (IDRR: 1.6, 95% CI [1.3, 2.0]). Increasing availability of HIV testing outside traditional health care settings, including at-home testing kits, in conjunction with targeted behavioral interventions and biomedical treatment preventions is needed.

Background: The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators to improve the HIV care continuum in the USA, but the economic and epidemiological effect of achieving those indicators remains unclear. We aimed to project the impact of achieving NHAS goals on HIV incidence, prevalence, mortality, and costs among adults in the USA over 10 years., Methods: We constructed a dynamic transmission model of HIV progression and care engagement based on literature sources and the most recent published US Centers for Disease Control and Prevention data. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within 1 month), and indicator 5 (90% of diagnosed individuals in care)., Findings: At current rates of engagement in the HIV care continuum, we project 524,000 (95% uncertainty range 442,000-712,000) new HIV infections and 375,000 deaths (364,000-578,000) between 2016 and 2025. Achievement of NHAS progress indicators 1 and 4 has modest epidemiological effect (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (NHAS indicator 5) averts 52% (95% UR 47-56) of new infections. Achievement of all NHAS targets resulted in a 58% reduction (95% UR 52-61) in new infections and 128 000 lives saved (106,000-223,000) at an incremental health system cost of US$105 billion., Interpretation: Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the USA, but continued and increased financial investment will be required., Funding: The National Institutes of Health, the B Frank and Kathleen Polk Assistant Professorship in Epidemiology, Emory University CFAR, Johns Hopkins University CFAR, and CDC/NCHHSTP Epidemiological and Economic Modeling Agreement (5U38PS004646)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: We investigated whether eventual causes of death among a cohort of inmates imprisoned in the southeastern United States differed from those in previous prisoner studies., Methods: We matched 23 510 prisoners in Georgia, a state with historically low levels of heroin consumption but moderate amounts of injection drug use, who were incarcerated on June 30, 1991, to death registries through 2010. Main exposure was 4-year time intervals over 2 decades of observation; main outcome was mortality from liver disease, HIV, and overdose., Results: Although the HIV-related mortality rate exceeded that from liver-related conditions before 2003, liver disease subsequently surpassed HIV as a cause of death. Among 3863 deaths, 22 (0.6%) occurred within 2 weeks after release from prison. Of these, only 2 were caused by accidental poisoning (likely drug overdose). Cardiovascular disease and cancer were the most frequent causes of death in this aging cohort., Conclusions: Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast.

Background: Often in public health, we are interested in promoting routine preventive screenings (e.g., blood glucose monitoring, hypertension screening, or mammography). Evaluating novel interventions to encourage frequent screenings using randomized controlled trials can help inform evidence-based health promotion programs. When the desired behavior change is a recurrent event, specifying the most meaningful study outcomes may prove challenging., Methods: To understand the efficiency of multiple approaches for evaluating an intervention seeking to increase regular health screenings we (a) simulated several replications of a trial with a positive intervention effect under various censoring scenarios, (b) formulated three different analytical outcome definitions (screening a certain number of times during the entire study period versus not, screening at least once within a clinically meaningful time period versus not, "hazard" or instantaneous rate of screening), and (c) compared them with regard to interpreting results and estimating power at different sample sizes., Results: Approaches which better utilize detailed prospective data, while also accounting for within-participant correlations, are less likely to miss the actual underlying benefits conferred by a new prevention strategy compared to relying on a dichotomous measure derived from aggregating events over the study duration. Such approaches are also more powerful in realistic scenarios wherein some participants are lost to follow-up over time., Conclusions: Researchers should carefully consider the choice of analytical outcomes and strive to employ more efficient approaches that model comprehensive event-specific information, rather than summarizing repeated measures into less-informative dichotomous responses, while designing and conducting trials with recurrent preventive screenings., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: Online HIV prevention studies have been limited in their ability to obtain biological specimens to measure study outcomes. We describe factors associated with willingness of men who have sex with men (MSM) to take a free home HIV test as part of an online HIV prevention study., Methods: Between March and April 2009, we interviewed 6163 HIV-negative MSM and assessed the willingness to test for HIV infection using a home collection kit., Results: Men reported being very likely (3833; 62%) or likely (1236; 20%) to accept a home HIV test as part of an online HIV prevention study. The odds of being willing to home test were higher for men who were offered incentives of $10 or $25, were black, had unprotected anal intercourse in the past 12 months, and were unaware of their HIV status., Conclusions: Home testing offered as part of online HIV prevention research is acceptable overall and in important subgroups of high-risk MSM.

Objectives. We investigated whether eventual causes of death among a cohort of inmates imprisoned in the southeastern United States differed from those in previous prisoner studies. Methods. We matched 23 510 prisoners in Georgia, a state with historically low levels of heroin consumption but moderate amounts of injection drug use, who were incarcerated on June 30, 1991, to death registries through 2010. Main exposure was 4-year time intervals over 2 decades of observation; main outcome was mortality from liver disease, HIV, and overdose. Results. Although the HIV-related mortality rate exceeded that from liver-related conditions before 2003, liver disease subsequently surpassed HIV as a cause of death. Among 3863 deaths, 22 (0.6%) occurred within 2 weeks after release from prison. Of these, only 2 were caused by accidental poisoning (likely drug overdose). Cardiovascular disease and cancer were the most frequent causes of death in this aging cohort. Conclusions. Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast. (Am J Public Health. 2015;105:e51–e57. doi:10.2105/AJPH.2014.302546) [ABSTRACT FROM AUTHOR]

Background: Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain disproportionately affected by human immunodeficiency virus (HIV). Yet their testing frequency is suboptimal and condomless anal sex (CAS) is increasing. Behavioral theories posit that information about HIV is a pivotal construct in individual risk reduction. However, measurements of knowledge have traditionally focused on ever hearing about HIV and being aware of the most common routes of spread. Objective: Using a national Web-based sample of sexually active GBMSM, we sought to (1) quantify levels of detailed knowledge about HIV epidemiology and transmission dynamics, (2) describe variations in detailed knowledge levels across demographic strata, and (3) evaluate potential associations of increasing levels of detailed knowledge with HIV testing in the past year and engaging in CAS with a male partner in the past 3 months. Methods: GBMSM were recruited through a social networking website (Facebook) from August to September 2015 and asked 17 knowledge-based questions pertaining to the following 2 domains using a Web-based survey: HIV epidemiology (9 questions including statistics on incidence, prevalence, and distribution) and HIV transmission dynamics (8 questions including modes of spread and per-act transmission probabilities). Ordinal domain-specific indices of detailed knowledge were created for each respondent by summing their number of correct responses. Separate cumulative logit models were used to identify factors independently associated with each index, and multivariable logistic regression models were used to characterize associations with HIV testing history and recently engaging in CAS. Results: Of the 1064 participants in our study, only half (49.62%, 528/1064) had been tested for HIV in the past year, and almost half (47.84%, 509/1064) had engaged in CAS with a male partner in the past 3 months. Majority scored 3 of 9 epidemiology questions correct (26.88%, 286/1064) and 5 of 8 transmission dynamics questions correct (25.00%, 266/1064). Participants younger than 35 years, of non-Hispanic non-white or Hispanic race and ethnicity, with lower educational levels, and who reported a sexual orientation other than homosexual or gay were significantly less knowledgeable about HIV transmission dynamics. Increasing levels of knowledge about this domain were independently associated with testing in the past year (adjusted odds ratio for each additional correct response: 1.10, 95% CI 1.01-1.20) but not with recent CAS. Increasing knowledge about HIV epidemiology was not associated with either outcome. Conclusions: Increasing detailed knowledge about HIV epidemiology might not be as important as educating sexually active GBMSM regarding transmission dynamics. Researchers and practitioners designing prevention messages targeting GBMSM should bear in mind that not all knowledge is equal and that some aspects might have a greater positive impact than others. Future research to identify influential content and contemporary modes of delivery is needed. [ABSTRACT FROM AUTHOR]