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BackgroundWidespread viral and serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a unique opportunity to also test for human immunodeficiency virus (HIV) infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on the HIV incidence and the cost-effectiveness of this strategy in 6 US cities.MethodsUsing a previously calibrated dynamic HIV transmission model, we constructed 3 sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviors at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to Scenario 2. We estimated the cumulative number of HIV infections between 2020-2025 and the incremental cost-effectiveness ratios of linked HIV testing over 20 years.ResultsIn the absence of linked, opt-out HIV testing, we estimated a total of a 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviors and no service disruptions), and a 9.0% increase in the worst-case scenario (no behavioral change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health-care costs in each city.ConclusionsA campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce the HIV incidence and reduce direct and indirect health care costs attributable to HIV.

IntroductionPreventing tuberculosis (TB) disease requires treatment of latent TB infection (LTBI) as well as prevention of person-to-person transmission. We estimated the LTBI prevalence for the entire United States and for each state by medical risk factors, age, and race/ethnicity, both in the total population and stratified by nativity.MethodsWe created a mathematical model using all incident TB disease cases during 2013-2017 reported to the National Tuberculosis Surveillance System that were classified using genotype-based methods or imputation as not attributed to recent TB transmission. Using the annual average number of TB cases among US-born and non-US-born persons by medical risk factor, age group, and race/ethnicity, we applied population-specific reactivation rates (and corresponding 95% confidence intervals [CI]) to back-calculate the estimated prevalence of untreated LTBI in each population for the United States and for each of the 50 states and the District of Columbia in 2015.ResultsWe estimated that 2.7% (CI: 2.6%-2.8%) of the U.S. population, or 8.6 (CI: 8.3-8.8) million people, were living with LTBI in 2015. Estimated LTBI prevalence among US-born persons was 1.0% (CI: 1.0%-1.1%) and among non-US-born persons was 13.9% (CI: 13.5%-14.3%). Among US-born persons, the highest LTBI prevalence was in persons aged ≥65 years (2.1%) and in persons of non-Hispanic Black race/ethnicity (3.1%). Among non-US-born persons, the highest LTBI prevalence was estimated in persons aged 45-64 years (16.3%) and persons of Asian and other racial/ethnic groups (19.1%).ConclusionsOur estimations of the prevalence of LTBI by medical risk factors and demographic characteristics for each state could facilitate planning for testing and treatment interventions to eliminate TB in the United States. Our back-calculation method feasibly estimates untreated LTBI prevalence and can be updated using future TB disease case counts at the state or national level.

With the passing of Dawn Kristen Smith, MD, MS, MPH, on 31 October 2022, the HIV world lost a champion for HIV prevention. Dr. Smith was an influential, prolific and [...]

In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals.

Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9-9.1); and (ii) wait for a burial team following a relative's death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2-6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4-4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1-0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2-9.1) than low- transmission (aOR: 2.3; 95% CI: 1.4-3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4-2.5) and aOR: 0.8 (95% CI: 0.6-1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. [phrase omitted] [phrase omitted] Objectif Evaluer l'evolution des connaissances, attitudes et techniques de prevention en matiere d'Ebola durant l'epidemie qui a touche la Sierra Leone entre 2014 et 2015. Methodes Quatre enquetes en grappes ont ete menees: deux avant le pic de l'epidemie (3499 participants) et deux apres (7104 participants). Nous avons mesure l'impact des facteurs geographiques et temporels sur 16 resultats lies aux connaissances, aux attitudes et aux techniques de prevention. Resultats Quatorze des seize resultats lies aux connaissances, aux attitudes et aux techniques de prevention ont progresse dans toutes les regions entre la periode avant le pic et celle apres le pic. La proportion de repondants disposes a: (i) accueillir les survivants a Ebola de retour dans leur communaute est passee de 60,0% a 89,4% (odds ratio ajuste, ORA: 6,0; intervalle de confiance de 95%, IC: 3,9-9,1); et (ii) attendre l'equipe d'inhumation apres la mort d'un proche a egalement augmente, passant de 86,0% a 95,9% (ORA: 4,4; IC de 95%: 3,2-6,0). La proportion de repondants ayant abandonne la pratique risquee des funerailles traditionnelles est passee de 27,3% a 48,2% (ORA: 3,1; IC de 95%: 2,4-4,2), tandis que celle convaincue de l'efficacite des guerisseurs spirituels pour traiter Ebola a diminue, passant de 15,9% a 5,0% (ORA: 0,2; IC de 95%: 0,1-03). La probabilite que les repondants attendent les equipes d'inhumation a augmente dans les regions a haut risque de transmission (ORA: 6,2; IC de 95%: 4,2-9,1), plus que dans les regions a faible risque de transmission (ORA: 2,3; IC de 95%: 1,4-3,8). Les repondants declarent avoir davantage evite tout contact physique avec les corps dans les regions a haut risque de transmission, mais pas dans les regions a faible risque de transmission (ORA: 1,9; IC de 95%: 1,4--2,5 et ORA: 0,8; IC de 95%: 0,6-1,2). Conclusion Les connaissances, attitudes et techniques de prevention en matiere d'Ebola ont evolue durant l'epidemie qui a touche la Sierra Leone, surtout dans les regions a haut risque de transmission. Il faut privilegier l'engagement communautaire axe sur le comportement des les premiers stades de l'epidemie. [phrase omitted] Objetivo Evaluar los cambios en los conocimientos, las actitudes y las practicas de prevencion relacionadas con el ebola durante el brote ocurrido en Sierra Leona entre 2014 y 2015. Metodos Se realizaron cuatro encuestas por conglomerados: dos antes del pico del brote (3499 participantes) y dos despues (7104 participantes). Se evaluo el efecto de los factores temporales y geograficos en 16 resultados de conocimientos, actitudes y practicas de prevencion. Resultados 14 de 16 resultados de conocimientos, actitudes y practicas de prevencion mejoraron en todas las regiones desde antes hasta despues del pico del brote. El porcentaje de los encuestados dispuestos a: (i) acoger a los supervivientes del ebola en la comunidad aumento del 60,0 % al 89,4 % (proporcion de probabilidad ajustada, aOR: 6,0; intervalo de confianza del 95 %, IC: 3,9-9,1); y (ii) esperar al servicio funerario tras la muerte de un familiar aumento del 86,0 % al 95,9 % (aOR: 4,4; IC del 95 %: 3,2-6,0). El porcentaje de personas que evitaron los entierros tradicionales inseguros aumento del 27,3 % al 48,2 % (aOR: 3,1; IC del 95 %: 2,4-4,2) y el porcentaje de personas que creen que los sanadores espirituales pueden tratar el ebola disminuyo del 15,9 % al 5,0 % (aOR: 0,2; IC del 95 %: 0,1-03). La probabilidad de que los encuestados esperan a los servicios funerarios aumento mas en las regiones de alta transmision (aOR: 6,2; IC del 95 %: 4,2-9,1) que en las de baja transmision (aOR: 2,3; IC del 95 %: 1,4-3,8). Segun los reportes de los mismos encuestados, se evito mas el contacto fisico con los cadaveres en las regiones de alta pero no de baja transmision, aOR: 1,9 (IC del 95 %: 1,4-2,5) y aOR: 0,8 (IC del 95 %: 0,6-1,2), respectivamente. Conclusion Los conocimientos, las actitudes y las practicas de prevencion del ebola mejoraron durante el brote en Sierra Leona, en especial en las regiones de alta transmision. Se debe dar prioridad a la participacion de la comunidad orientada al comportamiento en las primeras etapas de los brotes., Introduction The 2013-2016 Ebola virus disease outbreak in West Africa mostly affected Guinea, Liberia and Sierra Leone. In Sierra Leone, over 14 000 cases of Ebola and about 4000 deaths [...]

Introduction: HIV testing is an essential prerequisite for accessing treatment with antiretroviral therapy or prevention using pre-exposure prophylaxis. Internet distribution of HIV self-tests is a novel approach, and data on the programmatic cost of this approach are limited. We analyse the costs and cost-effectiveness of a self-testing programme. Methods: Men who have sex with men (MSM) reporting unknown or negative HIV status were enrolled from March to August 2015 into a 12-month trial of HIV self-testing in the United States. Participants were randomly assigned either to the self-testing arm or the control arm. All participants received information on HIV testing services and locations in their community. Self-testing participants received up to four self-tests each quarter, which they could use themselves or distribute to their social network associates. Quarterly follow-up surveys collected testing outcomes, including number of tests used and new HIV diagnoses. Using trial expenditure data, we estimated the cost of implementing a self-testing programme. Primary outcomes of this analysis included total programme implementation costs, cost per self-test completed, cost per person tested, cost per new HIV diagnosis among those self-tested and cost per quality adjusted life year (QALY) saved. Results: A total of 2665 men were assigned either to the self-testing arm (n = 1325) or the control arm (n = 1340). HIV testing was reported by 971 self-testing participants who completed a total of 5368 tests. In the control arm, 619 participants completed 1463 HIV tests. The self-testing participants additionally distributed 2864 self-tests to 2152 social network associates. Testing during the trial identified 59 participants and social network associates with newly diagnosed HIV infection in the self-testing arm; 11 control participants were newly diagnosed with HIV. The implementation cost of the HIV self-testing programme was $449,510. The cost per self-test completed, cost per person tested at least once, and incremental cost per new HIV diagnosis was $61, $145 and $9365 respectively. We estimated that self-testing programme potentially averted 3.34 transmissions, saved 14.86 QALYs and nearly $1.6 million lifetime HIV treatment costs. Conclusions: The HIV self-testing programme identified persons with newly diagnosed HIV infection at low cost, and the programme is cost saving. Keywords: HIV self-testing; social networks; costs and cost-effectiveness; costing methods; clinical trial expenditures; United States, 1 | INTRODUCTION An estimated 1.1 million people in the United States are living with HIV, and 14% are unaware of their HIV-positive status [1]. Gay, bisexual and other men [...]

Abstract Background Delivery of community-based prevention services for HIV, malaria, and diarrhea is a major priority and challenge in rural Africa. Integrated delivery campaigns may offer a mechanism to achieve high coverage and efficiency. Methods We quantified the resources and costs to implement a large-scale integrated prevention campaign in Lurambi Division, Western Province, Kenya that reached 47,133 individuals (and 83% of eligible adults) in 7 days. The campaign provided HIV testing, condoms, and prevention education materials; a long-lasting insecticide-treated bed net; and a water filter. Data were obtained primarily from logistical and expenditure data maintained by implementing partners. We estimated the projected cost of a Scaled-Up Replication (SUR), assuming reliance on local managers, potential efficiencies of scale, and other adjustments. Results The cost per person served was $41.66 for the initial campaign and was projected at $31.98 for the SUR. The SUR cost included 67% for commodities (mainly water filters and bed nets) and 20% for personnel. The SUR projected unit cost per person served, by disease, was $6.27 for malaria (nets and training), $15.80 for diarrhea (filters and training), and $9.91 for HIV (test kits, counseling, condoms, and CD4 testing at each site). Conclusions A large-scale, rapidly implemented, integrated health campaign provided services to 80% of a rural Kenyan population with relatively low cost. Scaling up this design may provide similar services to larger populations at lower cost per person.

BackgroundIntegrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases. A public-private partnership with the Ministry of Health, CDC, Vestergaard Frandsen and CHF International implemented a one-week integrated multi-disease prevention campaign.MethodResidents of Lurambi, Western Kenya were eligible for participation. The aim was to offer services to at least 80% of those aged 15-49. 31 temporary sites in strategically dispersed locations offered: HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment.FindingsOver 7 days, 47,311 people attended the campaign with a 96% uptake of the multi-disease preventive package. Of these, 99.7% were tested for HIV (87% in the target 15-49 age group); 80% had previously never tested. 4% of those tested were positive, 61% were women (5% of women and 3% of men), 6% had median CD4 counts of 541 cell/µL (IQR; 356, 754). 386 certified counselors attended to an average 17 participants per day, consistent with recommended national figures for mass campaigns. Among women, HIV infection varied by age, and was more likely with an ended marriage (e.g. widowed vs. never married, OR.3.91; 95% CI. 2.87-5.34), and lack of occupation. In men, quantitatively stronger relationships were found (e.g. widowed vs. never married, OR.7.0; 95% CI. 3.5-13.9). Always using condoms with a non-steady partner was more common among HIV-infected women participants who knew their status compared to those who did not (OR.5.4 95% CI. 2.3-12.8).ConclusionThrough integrated campaigns it is feasible to efficiently cover large proportions of eligible adults in rural underserved communities with multiple disease preventive services simultaneously achieving various national and international health development goals.

BackgroundAntiretroviral therapy (ART) may influence the biological, social and behavioral determinants of pregnancy in HIV-infected women. However, there are limited longitudinal data on the reproductive intentions and outcomes among women on ART in Africa. METHODOLOGY /PRINCIPAL FINDINGS: Using a prospective cohort design, we analyzed trends in desire for children and predictors of pregnancy among a cohort of 733 HIV-infected women in rural Uganda who initiated ART between May 2003 and May 2004 and were followed up in their homes until June 2006. Women answered in-depth social and behavioral questionnaires administered every quarter in year 1 after initiating ART, and every 6 to 12 months thereafter. Use of family planning methods was assessed at 18 and 24 months after starting ART. We tested for non-constant pregnancy incidence by using a shape parameter test from the Weibull distribution. We modeled repeated measurements of all variables related to the women's desire for children over time using a generalized estimating equation (GEE) extension to the logistic regression model. Risk factors for pregnancy were examined using Cox proportional hazards model. 711 women eligible for the study were followed-up for a median time of 2.4 years after starting ART. During this time, less than 7% of women reported wanting more children at any time point yet 120 (16.9%) women experienced 140 pregnancies and pregnancy incidence increased from 3.46 per 100 women-years (WY) in the first quarter to 9.5 per 100 WY at 24 months (p18.5 (HR = 1.09, CI: 1.01-1.18) and not having used condoms consistently in the last 3 months (HR = 1.79, CI: 1.02-3.13) were independently associated with pregnancy.Conclusion/significanceWomen on ART and their partners should be consistently counseled on the effects of ART in restoring fertility, and offered regularly free and comprehensive family planning services as part of their standard package of care.