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Objectives: High rates of hospitalization and death disproportionately affected Black, Latino, and Asian residents of New York City at the beginning of the COVID-19 pandemic. To suppress COVID-19 transmission, New York City implemented a workforce of community engagement specialists (CESs) to conduct home-based contact tracing when telephone numbers were lacking or telephone-based efforts were unsuccessful and to disseminate COVID-19 information and sanitary supplies. Materials and Methods: We describe the recruitment, training, and deployment of a multilingual CES workforce with diverse sociodemographic backgrounds during July–December 2020 in New York City. We developed standard operating procedures for infection control and safety measures, procured supplies and means of transportation, and developed protocols and algorithms to efficiently distribute workload. Results: From July through December 2020, 519 CESs were trained to conduct in-person contact tracing and activities in community settings, including homes, schools, and businesses, where they disseminated educational materials, face masks, hand sanitizer, and home-based specimen collection kits. During the study period, 94 704 records of people with COVID-19 and 61 246 contacts not reached by telephone-based contact tracers were referred to CESs. CESs attempted home visits or telephone calls with 84 230 people with COVID-19 and 49 303 contacts, reaching approximately 55 592 (66%) and 35 005 (71%), respectively. Other CES activities included monitoring recently arrived travelers under quarantine, eliciting contacts at point-of-care testing sites, and advising schools on school-based COVID-19 mitigation strategies. Practice Implications: This diverse CES workforce allowed for safe, in-person implementation of contact tracing and other prevention services for individuals and communities impacted by COVID-19. This approach prioritized equitable delivery of community-based support services and resources.

Partner services are effective tools to identify new cases among sex or needle-sharing partners of people with a new HIV diagnosis. Little is known about partners previously diagnosed with HIV who are not in care or are in care with unsuppressed HIV viral load. We aimed to quantify the previously diagnosed partners of people with a new HIV infection and examine their HIV care status and viral suppression in the 12 months before elicitation.We did a registry-based study. We used the New York City HIV Surveillance Registry to determine HIV care status and viral load of partners elicited from newly diagnosed people between Jan 1, 2007, and Dec 31, 2018. Previously diagnosed partners with no report of CD4 count or viral load in the preceding 12 months were presumed not to be in care, viral load suppression (200 copies per mL) was based on the last viral load in the year preceding elicitation, and viraemia was defined as a viral load of 200 copies per mL or more. We used multinomial logistic regression to generate covariates of care and viral load status and their marginal effects.11 964 partners were elicited; 2603 (33%) were previously diagnosed and 485 (20%) were not in care. 1153 (49%) of 2343 with a viral load report were in care and viraemic at elicitation. The odds of being not in care were higher in non-Hispanic black than non-Hispanic white or other partners (adjusted odds ratio 1·89, 95% CI 1·09-3·27) and lower in partners with male-to-male sex transmission risk (0·37, 0·26-0·51) and country of birth other than the USA (0·57, 0·39-0·85). The odds of being viraemic were higher in partners younger than 30 years than in those aged 30 years or older (1·68, 1·35-2·09) and lower among people with male-to-male sex transmission risk (0·36, 0·29-0·44) and country of birth other than the USA (0·78, 0·66-0·97).People with HIV should receive ongoing HIV prevention counselling and partner services data should inform engagement in care for previously diagnosed partners.None.

BACKGROUND: To develop a predictive model to prioritize persons with a transmissible HIV viral load for transmission-reduction interventions. METHODS: New York City (NYC) HIV molecular surveillance data from 2010–2013 were used to build a model to predict the probability that the partial pol gene of the virus of a person with a transmissible HIV viral load (>1,500 copies/mL) would be genetically similar to that of a person with a new HIV infection (diagnosis at stage 0 or 1 according to the revised Centers for Disease Control and Prevention classification system). Data from 2013–2016 were then used to validate the model and compare it with five other selection strategies that can be used to prioritize persons for transmission-reduction interventions. RESULTS: A total of 10,609 persons living with HIV (PLWH) were included in the development dataset, and 8,257 were included in the validation dataset. Among the six selection strategies, the predictive model had the highest area under the receiver operating characteristic curve (AUC) (0.86, 95% confidence interval [CI]: 0.84, 0.88), followed by the “Young men who have sex with men (MSM)” (0.79, 95% CI: 0.77, 0.82), “MSM with high viral loads” (0.74, 95% CI: 0.72, 0.76), “Random sample of MSM” (0.73, 95% CI: 0.71, 0.76), “Persons with high viral loads” (0.56, 95% CI: 0.54, 0.59), and “Random sample” (0.50, 95% CI: 0.48, 0.53) strategies. CONCLUSIONS: Jurisdictions should consider applying predictive modeling to prioritize persons with a transmissible viral load for transmission-reduction interventions and to evaluate its feasibility and effectiveness.

The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain.State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative.The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity.Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019.HIV case-finding resulting from APS in the United States is low.

Objectives. To quantify sociodemographic disparities in prediagnosis preexposure prophylaxis (PrEP) use in persons recently diagnosed with HIV in New York City and assigned for partner services. Methods. We used partner services data from November 2015 to September 2017 from persons diagnosed with HIV in the past 12 months (n = 3739) to compare individuals with self-reported or documented pre–HIV diagnosis PrEP use (“prediagnosis PrEP users”) with those having none (“never users”). We constructed a penalized likelihood regression model generating sociodemographic predictors of prediagnosis PrEP use, employing Firth’s adjustment for the rare outcome. Results. We found report of prediagnosis PrEP use in 95 persons (3%). The adjusted odds ratios (AORs) of prediagnosis PrEP use were lower among non-Hispanic Blacks (AOR = 0.18; 95% confidence interval [CI] = 0.09, 0.32) and Hispanics (AOR = 0.31; 95% CI = 0.17, 0.55) than among non-Hispanic Whites, among persons aged 30 years or older (AOR = 0.45; 95% CI = 0.28, 0.72) than those younger than 30 years, among cis-women (AOR = 0.13; 95% CI = 0.02, 0.48) than cis-men, and among residents of Queens (AOR = 0.25; 95% CI = 0.10, 0.55) than those of Manhattan. Conclusions. Disparities in HIV prevention based on race/ethnicity, gender, age, and local geography may manifest themselves in differential PrEP use.

Background: Assisted partner services (APS) are a longstanding component of public health efforts to control HIV in the United States, but their contemporary effectiveness is uncertain. Methods: The study surveyed U.S. state and local health departments that reported > 300 new HIV diagnoses in 2018 and were participating in phase 1 of the Ending the Epidemic Initiative. The study collected data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined the APS continuum, contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS), and estimated staff case-finding productivity. Findings: Fifteen (79%) of 19 jurisdictions responded to the survey, providing APS outcome data for 13 (68%) areas. Most health departments integrated APS with efforts to link index cases and partners to HIV care (93%) and pre-exposure prophylaxis (86%). A total of 18,833 persons were newly diagnosed with HIV in the 13 areas. Health departments initiated APS investigations on 13,899 (74%) cases and offered and provided APS to 12,338 (66%) and 9,733 (52%) index cases, respectively. Cases named 6,704 partners (contact index=0.69), of whom 2,650 (39%) had previously diagnosed HIV, 2,134 (32%) tested HIV negative, 516 (7.7% of named and 19% of tested partners) were newly diagnosed with HIV, and 2,239 (33%) were not known to have tested. Across all jurisdictions, the case-finding index was 0.053 (median=0.047, range 0.015-0.10). Health departments employed 288 full-time equivalent staff to provide APS. These staff interviewed a mean of 43 index cases annually, identifying a median of 1.8 new HIV infections in partners per staff per year. APS accounted for 2.7% of new diagnoses in 2019. Interpretation: HIV case-finding resulting from APS in the U.S. is low, reflecting low contact elicitation and attrition at each step along the continuum from case initiation to partner testing. Funding Information: Research was supported by NIH award AI027757. Declaration of Interests: None to declare. Ethics Approval Statement: The University of Washington institutional review board (IRB) defined the study as exempt from the need for IRB review.

Social cohesion has varying effects on health. We investigated the association of perceived neighborhood social cohesion with HIV viral suppression using individual-level data from the New York City HIV registry and surveillance-based interviews ( n = 92). Suppression was achieved within 12 months of HIV diagnosis by 60 percent of persons perceiving low cohesion and 71 percent of those perceiving high ( p = 0.31). Controlling for demographic and clinical characteristics and neighborhood poverty, per proportional hazards regression, cohesion was not associated with suppression (adjusted hazards ratio (95% confidence interval) for high versus low cohesion: 0.79 (0.49–1.28)). Cohesion may have heterogeneous effects on HIV medication adherence.

Background Named sex- or needle-sharing partners of HIV-positive individuals are a priority prevention population due to their known HIV exposure. Understanding postexposure and preexposure prophylaxis (PEP and PrEP) awareness and use among them is important for successful interventions. Methods Data from notified partners of HIV-positive individuals (New York City, May 2015-April 2017) were analyzed to describe PEP/PrEP awareness, provider discussion, and use by sociodemographic and risk characteristics. Multivariate logistic regression was used to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of partners' PEP and PrEP awareness. Results Among notified partners (n = 621), PEP and PrEP awareness were 34% and 44%, respectively; provider discussion of PEP was reported by 32% and of PrEP by 42%; PEP use was reported by 2% and PrEP use by 14%. PEP awareness was higher among men who have sex with men sex partners than among heterosexual sex partners (aOR: 4.21; 95% CI: 2.10 to 8.44). Odds of PrEP awareness were lower among black (aOR: 0.34; 95% CI: 0.15 to 0.75) and Hispanic partners (aOR: 0.37; 95% CI: 0.17 to 0.84) than among white partners, and higher among men who have sex with men than heterosexual sex partners (aOR: 4.60; 95% CI: 2.38 to 8.87). Black partners were less likely than whites to report a provider discussion of PrEP. Postnotification HIV-positive test results were significantly lower among partners reporting PEP awareness than among those who had not heard of PEP. Conclusions Low levels of PEP/PrEP awareness and of provider PEP/PrEP discussion among notified partners, particularly blacks, Hispanics, and heterosexual sex partners, indicate the timeliness of tailored prevention messaging, provider training, and sensitization, to avoid disparities in PEP/PrEP use.

BACKGROUND The rapid human immunodeficiency virus (HIV) self-test in the United States has expanded opportunities for HIV testing in nonclinical settings which may increase early diagnosis of HIV infection. However, broad application may be limited by the cost of the test and concerns that self-testers who test positive will not seek timely HIV care. METHODS We used data from HIV partner services program to compare the sociodemographic characteristics, transmission risk, and clinical stage of persons diagnosed with HIV by report of rapid self-test. Among self-tested persons, we assessed timeliness of seeking definitive testing after self-test and linkage to care. RESULTS From January 2013 to August 2016, 8032 HIV-positive persons were interviewed. Compared with the 7905 persons who did not self-test, self-tested persons were significantly (all P =

The New York City Department of Health Disease Intervention Specialists (DIS) routinely contact newly HIV-diagnosed persons via telephone calls and in-person meetings to conduct partner services (PS) interviews in order to elicit the names and contact information of the HIV-exposed partners for notification and HIV-testing, and to assist clients with linkage to care. From October 2013 to December 2015, we offered PS interviews conducted via video-call alongside voice-call and in-person modes in a selected geographic area of NYC. PS interviews were conducted according to the clients’ preferred mode (in-person, voice- or video-call) and location (health care facility, clients’ residences, or other NYC locations). At the conclusion of the PS interviews, DIS elicited responses from persons interviewed via video-call on their perception, satisfaction and personal experiences using video-call for public health and personal purposes. Acceptance and satisfaction with PS interviews via video-call were high among clients aged

The scale-up of preexposure prophylaxis (PrEP) represents a paradigm shift in HIV prevention that poses unique challenges for public health programs. Monitoring of PrEP implementation at the population level is a national priority, with particular significance in New York City (NYC) given the substantial HIV burden and the prominence of PrEP in state and local Ending the Epidemic program plans. We highlight the importance of local monitoring and evaluation of PrEP implementation outcomes and describe the experience at the NYC Health Department, which includes engaging communities, triangulating a variety of data sources regarding PrEP implementation, and leveraging those data to help guide programming. In NYC, we used data from national surveillance systems and incorporated PrEP-related indicators into existing local data collection systems to help illustrate gaps in PrEP awareness and use. Ultimately, ensuring that PrEP achieves the desired impact at the population level depends on identifying disparities through appropriate and accurate measurement, and addressing them through evidence-based programs.

Late presentation to human immunodeficiency virus (HIV) care is an important concern for clinical outcomes and HIV prevention. Significant proportions of HIV-diagnosed persons are not timely linked to care following HIV diagnosis. We implemented and evaluated an intervention to link to care persons never in HIV care (NIC). Disease intervention specialists (DIS) traced persons presumed to be NIC since HIV diagnosis, offered them assistance with linkage to care, and elicited reasons for NIC. We examined the overall outcomes of the intervention and reasons for NIC. From January 2013 to December 2016, 121 persons were traced; 19% were linked to HIV care. Significantly (all P

We examined care engagement and viral suppression (VS) over a 1- to 5-year period among persons re-engaged in HIV care using retrospective cohort study and longitudinal follow-up. The population comprised five cohorts of persons re-engaged in care from 2009 to 2013. We used surveillance data [CD4 T cell count or HIV viral load (VL) RNA] to measure four outcomes 1-5 years post-care engagement. Engagement-in-care indicated persons with laboratory reports in each follow-up year. Continuous engagement or sustained engagement, respectively, included persons with ≥1 or ≥2 (separated by 90 days) CD4 or VL reports in each follow-up year. VS indicated persons living with HIV (PLWH) re-engaged in care with VL ≤200 copies/mL in any follow-up year, and we measured re-engaged PLWH who subsequently became out of care (OOC) in each follow-up year. Overall, 84-86% PLWH were engaged in care in any follow-up year. The proportions of PLWH cohorts continuously engaged in care [86% (1 year), 77% (2 years), 72% (3 years), 67% (4 years), and 63% (5 years)] declined over time. Thirty-four percent of the PLWH who were re-engaged in care were subsequently OOC in the follow-up years. Most re-engaged PLWH became OOC in their first (40%) and second (30%) follow-up years. In follow-up years (1-5 years), fewer PLWH continuously engaged in care with ≥1 CD4 or VL reports in the registry had VS ≤200 copies/mL: 65%, 58%, 49%, 44%, and 42%, respectively. Encouragingly, higher proportions had VL ≤1500 copies/mL in follow-up years (1-5): (75%, 72%, 73%, 75%, and 70%), likely reflecting levels of HIV treatment. Our results support the use of surveillance data to identify and re-engage OOC PLWH in care. However, structures and programs are needed to support retention in care and reduce repeat OOC.

Introduction: Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. Materials and Methods: The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. Results: Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed Practice Implications: When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection.

ObjectivesCondomless anal intercourse contributes significantly to the spread of HIV among men who have sex with men (MSM). Factors related to condomless anal intercourse with known HIV-positive partners among MSM are not well understood. The authors describe factors associated with inconsistent condom use with known HIV-positive partners prior to participants’ diagnosis with HIV.MethodsNew York City health department disease intervention specialists interviewed newly HIV-diagnosed MSM ages ≥13 years reporting knowingly having anal sex with HIV-positive partners between June 2013 and October 2014. Univariate and bivariate statistics were calculated, in addition to logistic regression analysis.ResultsAmong 95 MSM interviewed, 56% were >30 years and 74% had higher than a high school education. Respondents reported a median of 2 known HIV-positive sex partners. Drug or alcohol use during last sex with their last known HIV-positive partner was reported by 53% of participants. Sixty-five per cent of participants reported inconsistent condom use with last known HIV-positive partner. Inconsistent condom use with all HIV-positive partners was higher among individuals reporting two or more known HIV-positive partners since sexual debut than among those with one (90% vs 59%, pConclusionsSurveyed MSM engaged in high-risk behaviours, including condomless anal sex and drug or alcohol use during sex with persons known to be HIV-positive. These findings can inform interventions with MSM in serodiscordant partnerships.

Background New York City (NYC) health department staff assist people with HIV (PWH) deemed out of care (OOC) per NYC HIV Surveillance Registry to re-engage in HIV care with their last known treating provider/parent clinic or, if preferable/necessary (e.g., moved to a new neighborhood), a new NYC provider. We examined retention in care and viral suppression (VS) of PWH re-engaged in care in a group who agreed to return to care and were cared for by either their previous or a new provider. Methods We analyzed data from 2009 to 2015 on PWH who had ≥2 CD4 count or viral load (VL) test reports in the NYC HIV Registry who fell out of care and then re-engaged in care. We compared characteristics, timeliness and retention in care (≥2 CD4 or VL, ≥90 days apart) and VS (last VL ≤200 copies/mL) of PWH overall and also according to whether they returned to their last known vs. a new provider in year 2 post re-engagement in care. Results From 2009–2015, 882 persons were re-engaged in care by the health department. Most were diagnosed 5–10 (27%) or >10 (67%) years prior, and were OOC for 1–3 years (70%) or >3 years (20%). Most re-engaged PWH were male (63%), black (56%) or Hispanic (34%), US-born (79%), aged 30–49 (48%) or ≥50 (40%) years. Risk factors for HIV included heterosexual transmission (39%), male-sex-with-male (26%) or injection drug use (18%). Twenty-two percent had history of homelessness and 5% incarceration. Fifty-one percent and 49% re-engaged in care with their prior or a new provider, respectively. PWH re-engaged with prior providers vs. new providers had lower rates of prior or current homelessness (17% vs. 28%, P = 0.0001), PWH re-engaged to prior vs. new providers had their first lab reports and achieved VS earlier (1 vs. 2 months, and 4 vs. 5 months, respectively (both P < 0.05). Proportions of PWH re-engaged to prior or new providers and retained in care (92% vs. 91%, respectively) or with VS (73% vs. 75%, respectively) in year 2 did not differ. Conclusion Our results show that health department efforts to re-engage previously OOC-PWH in HIV care resulted in more than 70% achieving VS. Assignment to a new provider resulted in earlier VS but did not affect 2-year VS or care retention. PWH who re-engage in care can safely be given the choice between known or new providers. Disclosures All authors: No reported disclosures.

Background Retention of people with HIV (PWH) in HIV care is essential for optimal health outcomes. Unmet needs for ancillary services, such as housing, food, transportation, or mental health services may pose barriers to sustained retention in HIV care. Methods A representative sample of people with HIV (PWH) aged ≥18 years and receiving HIV care in NYC between 2015 and 2016 was interviewed for the Medical Monitoring Project (MMP). Questions attempted to identify needs for ancillary services among participants. We explored correlates of expressed needs for ancillary services in the 12 months prior to the interview date. Results Of 654 PWH interviewed, 650 (99%) were current with HIV care. Of these, 323 (50%) expressed a need for ancillary services. Among the 323 PWH expressing needs, 209 (65%) were males, 163 (50%) were non-Hispanic blacks, 118 (37%) were Hispanic, and 111 (35%) were individuals identifying as gay (26%) or lesbian (9%).The median age was 50 [interquartile range (IQR) 40–58 years]. In the multivariate model, non-Hispanic blacks (OR: 2.5; 95% CI: 1.4, 4.6) and Hispanics (OR: 2.5; 95% CI: 1.4, 4.7) had higher odds than whites of expressing current needs for ancillary services. A higher need for ancillary services was expressed by PWH that were virally suppressed vs. not suppressed (OR: 1.7; 95% CI: 1.0, 3.0) and those with a history of injection drug use vs. those without (OR 2.2; 95% CI: 1.3, 3.7). Conclusion Half of the PWH in our sample expressed a current need for ancillary services despite being actively engaged in HIV. Providers should routinely screen their patients, especially non-Hispanic black and Hispanic patients and persons with substance use history, for unmet needs and proactively link them to social service providers in order to promote overall well-being and retention in HIV care. Disclosures All authors: No reported disclosures.

BACKGROUND Identification and characterization of patients in HIV-serodiscordant partnerships can inform strategies to improve HIV prevention efforts for this group. METHODS We conducted a case-control analysis using New York City Department of Health and Mental Hygiene HIV surveillance and partner services (PS) data from July 2006 to July 2010. HIV-infected index patients reported and interviewed for PS who named 1 or more sex and/or syringe-sharing partner (n = 1309) and their sex partners notified by New York City Department of Health and Mental Hygiene with confirmed HIV serostatus (n = 1564) were selected for analysis. Index patients were classified into either serodiscordant or seroconcordant-positive partnerships based on the HIV serostatus of their partner(s). Multivariable regression analysis was conducted to examine the likelihood of membership in a serodiscordant partnership by a range of individual- and partnership-level variables. RESULTS Of the 1309 index patients, 624 (48%) were in HIV-serodiscordant partnerships. In multivariable analysis, the likelihood of serodiscordant partnership membership was slightly higher among women, individuals with unknown HIV transmission risk, and those with 2 to 3 named partners versus 1. Index patients claimed more partners than they named; for example, index patients who named 1 partner claimed an average of 2.3 partners in the past 12 months. CONCLUSIONS Many HIV-infected patients who received PS were in HIV-serodiscordant partnerships, with characteristics indicating potential for HIV transmission. Our findings suggest several potential programmatic and policy needs, including enhanced linkage-to-care efforts for this population, especially HIV-infected individuals with uncontrolled viremia; ongoing PS for individuals with evidence of continuing exposure of others; and participation by patients and their serodiscordant, steady partners in local prevention interventions.

Objective Locate persons living with HIV (PLWH) presumed lost to follow-up (LTFU), and assist them with partner services and linkage to HIV-related care. Design Locate and facilitate re-engagement in care for PLWH-LTFU in New York City (NYC), with longitudinal follow-up using HIV surveillance registry. Settings HIV care facilities and communities in NYC. Patients PLWH, reported in the NYC HIV surveillance registry, who had a NYC care provider and residential address at last report in the registry. Presumed-LTFU was defined as having no CD4+ or viral load during the most recent 9 months during the study period July 2008-December 2010. Intervention Case-workers conducted public health investigation to locate PLWH presumed-LTFU and offered them assistance with partner and linkage-to-care services. Main outcome measures Results of partner and linkage-to-care services, and reasons for LTFU. Results From July 2008 to December 2010, 797 PLWH presumed-LTFU were prioritized for investigation; 14% were never located. Of the 689 located, 33% were current to care, 5% had moved or were incarcerated, 2% had died, and 59% (409) were verified to be LTFU. Once located, 77% (315/409) accepted clinic appointments, and 57% (232/409) returned to care. Among the 161 who provided reasons for LTFU, the most commonly reported was 'felt well' (41%). Conclusions Health department case-workers helped more than half PLWH-LTFU re-engage in HIV medical care. HIV prevention strategies must include efforts to re-engage PLWH-LTFU in care, for treatment consideration under current treatment guidelines to improve their clinical status and decrease transmission risk.

Purpose To determine if sexually active heterosexual HIV-infected 15– to 24–year-old youth have different sexual or other risk behaviors depending on whether they were infected perinatally or heterosexually. Methods We compared youth aged 15 to 24 years who acquired HIV perinatally or sexually and were interviewed in-person or by phone for partner services by the New York City Department of Health and Mental Hygiene. We included heterosexually active youth with at least one sexual partner of the opposite sex in the past 12 months, and excluded men who have sex with men and injection drug users. We used χ 2 tests and t tests to compare demographics, sexual risk behaviors, partner services outcomes, and viral loads. Results Both groups reported few partners (median 1, mean 2), and only 12% of partners of perinatally infected youth were previously diagnosed (18% of sexually infected youths' partners). A minority reported always using condoms. Both groups had similar rates of sexually transmitted infections and median HIV plasma RNA (perinatally infected: 5,140 copies/mL; sexually infected: 6,835 copies/mL). Despite these similarities, among tested partners not previously HIV diagnosed, none of 17 named by perinatally infected youth was newly HIV diagnosed, whereas 21% (8/39, p = .09) of those named by sexually infected youth were newly diagnosed. Conclusions Though perinatally infected youth did not transmit HIV infection to previously undiagnosed partners, they had similar HIV-related risk behaviors to youth infected sexually who reported on risks that led to their infection. HIV prevention among HIV-infected youth remains a critical challenge.

HIV disproportionately affects blacks more than other groups in New York City (NYC) as well as nationally. Partner Services (PS) are a proven way to interrupt HIV transmission. In NYC, PS outcomes are worse among blacks compared to other race/ethnic groups. We compared PS outcomes by country of birth to identify opportunities for improved PS effectiveness. We assessed number of sex and needle-sharing partners elicited, notified, and HIV tested, as well as number of newly identified HIV cases and number of interviews needed to identify a new HIV case. Between July 2006 and December 2008, 1049 African Americans, 285 Caribbean-born blacks, and 168 African-born blacks were interviewed for HIV Partner Services. African Americans, Caribbean-born blacks, and African-born blacks had average age of 38, 37, and 43 years and 10.0%, 0.4%, and 0.6% reported intravenous drug use, respectively. All groups had a high proportion of cases with an AIDS-defining CD4 count at HIV diagnosis (30.8%, 34.5%, and 47.9% for African Americans, Africans, and Caribbeans, respectively). The number needed to interview to find one newly diagnosed HIV case was high for all groups (66, 57, and 56 among African Americans, Africans, and Caribbeans, respectively), indicating all had similarly low rates of new HIV case identification. NYC blacks and their partners are benefiting from current Partner Services outreach as PS did identify new HIV cases among partners from all 3 groups. However, further work is needed to improve HIV case finding from Partner Services in these groups, and additional measures to promote early diagnosis are needed.

BACKGROUND Men who have sex with men (MSM) account for a higher proportion of HIV diagnoses than any other risk group in the United States. Given that in NYC MSM younger than 30 years represent a growing proportion of new diagnoses among MSM, we examined differences between MSM by age. METHODS We analyzed NYC surveillance and partner services (PS) data for MSM newly diagnosed with HIV from January 2007 to December 2008. We compared demographics, HIV-related risk behaviors, and sexual partner characteristics between younger MSM (

HIV partner services can effectively reach populations with high HIV prevalence. However, located and notified sex and needle-sharing partners of persons infected with HIV often fail to test. Field testing may increase the proportion of notified partners who test for HIV. In 2008, New York City's health department incorporated field testing into partner services. After the introduction of field testing, the proportion of notified partners who tested for HIV rose from 52% to 76% (P

Public health usually notifies partners of STD exposure in-person despite availability of other options. We examined trends in in-person versus telephone notification for HIV 3 years after the introduction of a telephone option. Most notifications were made by telephone. Partners notified doubled; however, the proportion HIV testing declined slightly.

Between July 2006 and November 2007, a total of 894 blacks and 491 Hispanics were interviewed to assess partner notification services. Fewer Hispanics needed to be interviewed to identify 1 newly diagnosed partner as compared with blacks (24 vs. 60, P < 0.01), but number needed to be interviewed was similar for identifying partners with any HIV infection.

Objective:We describe an effort to reduce transmission of a multidrug-resistantStreptococcus pneumoniae(MDRSP) in a long-term-care facility (LTCF).Design:Longitudinal cross-sectional study.Setting:An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones.Participants:Residents and staff members of the LTCF during 1999 through 2001.Intervention:Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission.Results:Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred.Conclusions:Infection control contributed to less transmission of MDRSP in the LTCF. Additional strategies are needed to reduce transmission and carriage among certain resident populations.

Strains of newly emerging Salmonella enterica subsp. enterica (subspecies I) serotype 4,5,12:i:− causing food-borne infections, including a large food poisoning outbreak ( n = 86) characterized by persistent diarrhea (14% bloody), abdominal pain, fever, and headache, were examined. The organisms were found in the stool samples from the patients. The biochemical profile of the organisms is consistent with that of S. enterica subsp. I serotypes, except for decreased dulcitol (13%) and increased inositol (96%) utilization. Twenty-eight percent of the strains showed resistance to streptomycin, sulfonamides, or tetracycline only; all three antimicrobial agents; or these agents either alone or in combination with ampicillin, trimethoprim, and trimethoprim-sulfamethoxazole. None of the serotype 4,5,12:i:− strains showed resistance or decreased susceptibility to chloramphenicol or ciprofloxacin. On pulsed-field gel electrophoresis (PFGE), the strains showed 11 or 12 resolvable genomic fragments with 18 banding patterns and three PFGE profile (PFP) clusters (i.e., PFP/A, PFP/B, and PFP/C). Seventy-five percent of the isolates fingerprinted were closely related (zero to three band differences; similarity [Dice] coefficient, 86 to 100%); 63% of these were indistinguishable from each other (PFP/A 1 ). PFP/A 1 was common to all strains from the outbreak and 11 hospital sources. Strains from six other hospitals shared clusters PFP/B and PFP/C. PFP/C 4 , of the environmental isolate, was unrelated to PFP/A and PFP/B. Nine band differences (similarity coefficient, 61%) were noted between PFP/A 1 and PFP/E of the multidrug-resistant S. enterica subsp. enterica serotype Typhimurium definitive type 104 strains. Whether these emerging Salmonella strains represent a monophasic, Dul − variant of serotype Typhimurium or S. enterica subsp. enterica serotype Lagos or a distinct serotype of S. enterica subsp. I is not yet known. Some of the phenotypic and genotypic properties of the serotype 4,5,12:i:− strains are described here.

BACKGROUND A substantial proportion of recent sex partners named by persons with sexually transmitted infections are not notified about their exposure despite attempts by public health officials. Although text messaging (texting) and Internet-based communications (dating Web sites, e-mail, etc) are used by a large segment of the public for regular communications, these tools have been underused for partner services (PS). METHODS We augmented PS for HIV in New York City using texting and Internet-based means to contact persons for whom traditional information (landline telephone number, postal address) was unavailable. We compared traditional PS (traditionalPS), Internet-based PS (IPS) in January 2011 to October 2012, and texting PS (txtPS) from January 2012 (when txtPS was initiated) through October 2012 on outcomes of contact attempts, notification, and HIV testing. RESULTS From January 2011 to October 2012, of 3319 partners elicited, 2604 and 275 partners had traditional and only Internet-based contact information and were selected for traditionalPS and IPS, respectively. From January to October 2012, 368 of 1569 partners had only texting-enabled cellphone numbers and were selected for txtPS. The contact rate for txtPS (285/368 [77%]) was significantly higher (P < 0.0001) than the contact rates for traditionalPS (1803/2604 [69%]) and IPS (112/275 [41%]). There was a higher likelihood of notifying contacted IPS (odds ratio, 2.1; 1.2-3.4) and txtPS (odds ratio, 2.4; 1.7-3.2) than traditionalPS partners (P ≤ 0.0001). However, among the notified partners, traditionalPS partners were significantly (P < 0.0001) more likely than txtPS or IPS partners to test for HIV after partner notification (69% vs 45% and 34%, respectively). CONCLUSIONS Augmenting traditionalPS with txtPS and IPS enabled notification of hundreds of previously untraceable partners and several new HIV diagnoses.

The Centers for Disease Control and Prevention (CDC) recommends that persons diagnosed with HIV receive partner services with health department involvement. CDC describes partner services as not only including partner notification, but also linkage to medical care for HIV-infected persons. The New York City Health Department formed a unit in 2006 to expedite partner services. We examined the contribution of our HIV partner services program in improving timely linkage and retention in HIV medical care.

In their recently published study, Halkitis et al. [1] compare three HIV testing strategies—alternative venue, partner services, and social network—and conclude that the social network strategy is the most effective in identifying previously undiagnosed HIV-positive African–American men who have sex with men. Though we commend Halkitis and colleagues’ effort to compare testing strategies, we caution readers about their conclusion. Data presented for the three strategies are not comparable because, for two of the strategies, program staff members were unable to check if testers were already known to the health department to be HIV infected. This is because of the legal restrictions in the New York State that protect the confidentiality of persons living with HIV. As staff members within the HIV partner services program within the New York City (NYC) Department of Health and Mental Hygiene, we are, unlike Halkitis et al., able to check if clients have been reported to the NYC HIV Surveillance Registry. When we submitted data to Halkitis et al., we excluded all testers who were previously diagnosed with HIV, regardless of whether they had disclosed their status. Had we included nondisclosers in the numerator, the detection rate for partner services would be 22%, far higher than the 14.3% detection rate reported in the study and also higher than that reported for social networks (19.3%). From our experience, persons living with HIVoften do not disclose their HIV status when testing because of denial, embarrassment, desire for incentives, or other reasons. As noted by Halkitis et al., incentives significantly increased enrollment. Incentives, therefore, may have increased the proportion of known positives who accepted testing. We agree with Halkitis and colleagues’ call for a “rigorous experimental study design to identify the most effective HIV testing strategies” and recommend that such a study include collaboration with local health departments to verify self-reported HIV status with the local HIV surveillance registry. Previously diagnosed repeat testers should be excluded from such analyses.

OBJECTIVES: To assess barriers to human immunodeficiency virus (HIV) testing, health care contacts history, and HIV testing history among patients diagnosed concurrently with HIV and acquired immunodeficiency syndrome (AIDS). METHODS: We surveyed patients concurrently diagnosed with HIV/AIDS who had participated in the partner notification program of the New York City Department of Health and Mental Hygiene, between January 2008 and December 2008. RESULTS: The most common reason interviewees volunteered for delaying testing (64%) was that they did not believe they were at risk for HIV. When read a list of potential barriers, 69% of interviewees replied affirmatively that they did not test for HIV because they did not believe they were at risk, and 52% replied affirmatively that they did not test because they thought their behaviors kept them safe from getting HIV. Half of all interviewees reported having insurance during part or all of the year before they were diagnosed with HIV/AIDS, and 70% had at least 1 health care visit in the year before they were diagnosed with HIV/AIDS. CONCLUSIONS: A lack of perception of risk was the most common reason for not testing for HIV sooner among these concurrently diagnosed patients. The majority of these patients were accessing medical care, indicating that this population could have benefited from routine HIV testing.

Objective To assess provider and client acceptance of health department-delivered HIV partner services (PS) delivered in clinical and community settings. Methods In 2006, New York city (NYC) formed the HIV field services unit (FSU), staffed with experienced sexually transmitted disease intervention specialists (DIS). DIS were stationed at 8 large hospitals to assist clinical providers and their HIV-positive patients with PS in areas with high rates of delayed HIV diagnoses and HIV-related mortality. We surveyed providers (self-administered questionnaire) and clients (staff-administered) to examine provider and patients as well as patients' HIV-exposed partners' acceptance of and concerns regarding PS. Results Response rates were as follows: 63% (132/211) providers; 90% (492/544) patients who accepted PS; 73% (16/22) patients who declined PS; 83% (139/168) partners who received notification; and 81% (25/31) partners who declined notification. Most providers felt the DIS focus and expert skills in PS was beneficial to providers (87%) and clients (89%). Most patients (91%) had a positive or neutral attitude about the health department-delivered PS. Most providers reported no disadvantage to DIS providing PS (69%); their most commonly cited (24%) concern was potential patient confusion about the roles of providers versus DIS. Patients' most common concerns were the intrusive nature of the interviews and the length of the interview (50/492, 20%). The partners wanted to know who named them (32/139, 23%). Conclusions Health department-delivered PS by DIS in clinical and community settings was acceptable to providers, HIV-infected patients, and HIV-exposed partners. Overall, our survey showed strong provider and client support for this approach.

Injection drug users (IDUs) account for more than 60% of all new hepatitis C virus (HCV) infections in the United States.1,2 Fifty to eighty percent of new IDUs are infected within 6 to 12 months of initial injection.3 Current treatment regimens are not highly effective, and no vaccine against HCV is available.1,4–7 Studies suggest that drug treatment and syringe exchange programs may play a role in reducing HCV infection among participants by promoting drug abstinence or safer injection practices among those who continue to use drugs.3,8–12 The New York City Department of Health conducted a survey of local drug treatment and syringe exchange programs to determine whether their HCV screening and counseling practices were carried out, as recommended in recent federal guidelines.1

Linley et al.1 report that late diagnoses are more common among older persons newly diagnosed with HIV than among younger persons nationwide and conclude by emphasizing the need for full implementation of the Centers for Disease Control and Prevention’s 2006 recommendation for routine HIV screening for persons aged 13 to 64 years.2 In New York City, we also noted a higher proportion of concurrent (within 31 days) HIV/AIDS diagnoses among older persons (37% among persons aged ≥ 50 years vs 22% overall in 2010).3,4 While we agree that routine HIV screening is key to making diagnoses of HIV among older persons earlier in the course of their infection, partner services (PS)5 for all persons newly diagnosed with HIV, including those aged 50 years or older, are also important. Challenging the perception of an “asexual” older age, we have found that persons aged 50 years or older are well represented both among the 4678 persons interviewed for PS from 2007 to 2011 (890 or 19% were ≥ 50 years old at interview) and among those persons named as recent sex partners by all PS clients during the same time period (8% of 6371 named were aged ≥ 50 years). Of the 890 newly diagnosed persons aged 50 years or older we interviewed for PS, 89% reported sexual activity before their HIV diagnosis, and more than half (52%) reported having had at least one sex partner in the year before diagnosis. There were 410 named partners who were 50 years old or older located for HIV exposure notification. Of those located, 183 (45%) were previously diagnosed with HIV infection, and 227 (55%) had negative or unknown HIV status at notification. Of the notified partners aged 50 years or older with negative or unknown HIV serostatus, 81% (183/227) were tested for HIV, and among them 20 (11%) were newly diagnosed with HIV infection as a result of PS. Of these 20 newly diagnosed persons aged 50 years or older, 4 (20%) were concurrently diagnosed with HIV/AIDS. Late diagnoses were averted in 16 (80%) of 20 older persons diagnosed following PS, and they were linked to care at an earlier stage of disease. While routine HIV screening in clinical settings can accelerate time to diagnosis in persons aged 50 years or older, PS complement this approach, enabling HIV testing of older adults with recent HIV exposure and HIV diagnoses early in the course of infection.