Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents

© 2016 Safren SA et al. Introduction: Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmission...

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Main Authors: Steven A. Safren, James P. Hughes, Matthew J. Mimiaga, Ayana T. Moore, Ruth Khalili Friedman, Kriengkrai Srithanaviboonchai, Mohammed Limbada, Brian D. Williamson, Vanessa Elharrar, Vanessa Cummings, Jessica F. Magidson, Charlotte A. Gaydos, David D. Celentano, Kenneth H. Mayer
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Published: 2018
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spelling th-cmuir.6653943832-562462018-09-05T03:11:24Z Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents Steven A. Safren James P. Hughes Matthew J. Mimiaga Ayana T. Moore Ruth Khalili Friedman Kriengkrai Srithanaviboonchai Mohammed Limbada Brian D. Williamson Vanessa Elharrar Vanessa Cummings Jessica F. Magidson Charlotte A. Gaydos David D. Celentano Kenneth H. Mayer Medicine © 2016 Safren SA et al. Introduction: Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings. Methods: HIV-positive individuals (n = 749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use. Results: An estimated 3.81 (standard error, (SE) = 0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE = 1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI = 1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI = 2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI = 18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI = 4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR = 1.04, 95% CI = 1.01, 1.08) was also significantly associated with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors. Conclusions: These data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts. 2018-09-05T03:11:24Z 2018-09-05T03:11:24Z 2016-01-01 Journal 17582652 2-s2.0-85015624101 10.7448/IAS.19.1.21096 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85015624101&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/56246
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Steven A. Safren
James P. Hughes
Matthew J. Mimiaga
Ayana T. Moore
Ruth Khalili Friedman
Kriengkrai Srithanaviboonchai
Mohammed Limbada
Brian D. Williamson
Vanessa Elharrar
Vanessa Cummings
Jessica F. Magidson
Charlotte A. Gaydos
David D. Celentano
Kenneth H. Mayer
Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
description © 2016 Safren SA et al. Introduction: Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings. Methods: HIV-positive individuals (n = 749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use. Results: An estimated 3.81 (standard error, (SE) = 0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE = 1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI = 1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI = 2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI = 18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI = 4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR = 1.04, 95% CI = 1.01, 1.08) was also significantly associated with increased STI incidence. In bivariate models for both HIV transmissions and STI incidence, higher depressive symptoms were significant predictors. Conclusions: These data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts.
format Journal
author Steven A. Safren
James P. Hughes
Matthew J. Mimiaga
Ayana T. Moore
Ruth Khalili Friedman
Kriengkrai Srithanaviboonchai
Mohammed Limbada
Brian D. Williamson
Vanessa Elharrar
Vanessa Cummings
Jessica F. Magidson
Charlotte A. Gaydos
David D. Celentano
Kenneth H. Mayer
author_facet Steven A. Safren
James P. Hughes
Matthew J. Mimiaga
Ayana T. Moore
Ruth Khalili Friedman
Kriengkrai Srithanaviboonchai
Mohammed Limbada
Brian D. Williamson
Vanessa Elharrar
Vanessa Cummings
Jessica F. Magidson
Charlotte A. Gaydos
David D. Celentano
Kenneth H. Mayer
author_sort Steven A. Safren
title Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
title_short Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
title_full Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
title_fullStr Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
title_full_unstemmed Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents
title_sort frequency and predictors of estimated hiv transmissions and bacterial sti acquisition among hiv-positive patients in hiv care across three continents
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85015624101&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/56246
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