EXAMINATION OF UNRECOGNIZED AND MISREPORTED HIV STATUS AMONG MSM AND PWID IN BALTIMORE · 2020. 4....
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EXAMINATION OF UNRECOGNIZED AND MISREPORTED HIV STATUS AMONG MSM AND PWID IN BALTIMORE Poster 904 Danielle German, PhD, MPH Assistant Professor 624 North Broadway, room 753 BalBmore MD, 21205 Phone: 410-502-8936 Email: [email protected] Danielle German 1 , Kate Shearer 2 , Colin Flynn 3 , Carl Latkin 1 , Oliver Laeyendecker 2,4,5 , Thomas C. Quinn 2,4,5 , William Clarke 5 1) Department of Health, Behavior and Society, Johns Hopkins University; 2) Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; 3) Maryland Department of Health and Mental Hygiene; 4) Laboratory of ImmunoregulaBon, Division of Intramural Research, NaBonal InsBtute of Allergy and InfecBous Diseases, NIH, BalBmore, MD; 5) Johns Hopkins University School of Medicine BACKGROUND • IdenBfying individuals with unrecognized HIV infecBon criBcal to deploying HIV tesBng, prevenBon, and surveillance resources. • In our previous study (2008), 33% of men who have sex with men (MSM) in BalBmore classified with unrecognized HIV infecBon had evidence of recent anBretroviral (ARV) medicaBon. • The current study used ARV biomarkers to validate self-reported HIV infecBon in two addiBonal data collecBon waves among MSM (2011 and 2014) and among people who inject drugs (PWID; 2012) to assess changes in misrepresentaBon and obtain a beger assessment of unrecognized HIV infecBon over Bme. ACKNOWLEDGMENTS The authors wish to acknowledge and thank the many parBcipants in NHBS BalBmore (BESURE) as well as the many dedicated BESURE team members for their invaluable contribuBons over Bme. This work was supported by The Johns Hopkins University Center for AIDS Research (1P30AI094189) and the Centers for Disease Control and PrevenBon via a subcontract from the Maryland Department of Health and Mental Hygiene SUMMARY • Approximately half of those originally classified as unrecognized HIV infecBon tested posiBve for non-prophylacBc ARV drugs. Among MSM, misreporBng increased with each Bme interval. Among PWID, misreporBng was comparable to that of MSM. • Compared to MSM who self-reported HIV+ status and ARV use, MSM misreporters in 2011 and 2014 were more commonly non- Hispanic Black, had less educaBon, lowest income, bisexual, and more binge drinking. MSM misreporters in 2014 also were older, more commonly homeless, and reported non-injecBon heroin or cocaine use. • Among PWID, misreporters had lower educaBon and employment and increased binge drinking. • Recalculated prevalence of unrecognized HIV infecBon among HIV+ MSM was 34.3% in 2011 and substanBally reduced to 15.7% in 2014. Recalculated prevalence of unrecognized HIV infecBon among HIV+ PWID was 11.4%. CONCLUSIONS • This bio-behavioral approach across Bme points and populaBons highlights a set of characterisBcs among those more likely to misreport HIV status and suggests hypotheses that may help to improve self-reported data collecBon of HIV status. • There is a criBcal need to enhance assessment of this important metric and to understand the role of economic and social factors such as perceived sBgma, social desirability, and trust on self- report validity related to HIV status in epidemiological research. • Addressing unrecognized HIV infecBon remains an important priority for reducing HIV transmission in BalBmore, parBcularly among younger, African-American, and low SES MSM and African-American low SES PWID. METHODS Data : HIV+ parBcipants in CDC’s NaBonal HIV Behavioral Surveillance System-BalBmore MSM (2011, n=175 and 2014, n=121) and PWID (2012, n=132); Venue-based Bme locaBon sampling (MSM) and respondent driven sampling (PWID). Informed consent for survey and voluntary HIV test; anonymous; interviewer administered CAPI survey; remuneraBon for survey and HIV test. Eligibility : 18 or older, live in BalBmore-Towson MSA, parBcipate once per cycle. MSM only: Male, ever sex with a man; analysis limited to MSM in past year. IDU only: IDU in past year. Only those with valid HIV posiBve test results who provided consent for serological storage and future tesBng included in analysis. Serological tesBng : Venipuncture, EIA with WB confirmaBon. Sera tested for ARV presence using liquid chromatography-high resoluBon accurate mass (HRAM) mass spectrometry (Thermo Fisher Q-ExacBve) which detects 20 anBretroviral (ARV) drugs. Same procedures conducted with 10% random sample of HIV- negaBve parBcipants for validaBon. Analysis : Misreported HIV status defined as presence of at least 1 ARV, indicaBng use within at least 24 hours. Analyses compared hypothesized socio-demographic and behavioral characterisBcs of parBcipants with self-reported vs misreported HIV status. Aler removing those with ART evidence, prevalence of unrecognized HIV infecBon was recalculated and analysis examined associated characterisBcs. RESULTS Figure 1. Among parBcipants originally classified with unrecognized HIV infecBon, proporBon tested posiBve and negaBve for non-prophylacBc ARV drugs among NHBS BalBmore MSM in 2011 and 2014 and PWID in 2012 Figure 2. Among parBcipants with HIV posiBve test result, prevalence of self- reported HIV status, misreported HIV status, and recalculated unrecognized HIV infecBon in NHBS BalBmore among MSM in 2011 and 2014 and PWID in 2012 35.4% 66.9% 72.7% 30.3% 17.4% 15.9% 34.3% 15.7% 11.4% 0% 20% 40% 60% 80% 100% MSM3 2011 (n=175) MSM4 2014 (n=121) IDU3 (n=132) Unrecognized HIV infecBon Misreported HIV+ Self-reported HIV+ 47.0% 53.7% 58.3% 53.0% 46.3% 41.7% 0% 20% 40% 60% 80% 100% MSM3 2011 (n=113) MSM4 2014 (n=41) PWID3 2012 (n=36) ARV-negaBve ARV-posiBve Table 1. Demographic and socio-behavioral characterisBcs of NHBS BalBmore parBcipants with self-reported vs misreported HIV infecBon (on ART only), MSM in 2011 and 2014 and PWID in 2012 Table 2. Demographic and social characterisBcs of NHBS BalBmore PWID with unrecognized HIV infecBon, MSM in 2011 and 2014 and PWID in 2012 CharacterisBc MSM 2011 (n=60) MSM 2014 (n=19) PWID 2011 (n=15) Gender: male 100% 100% 67% Age; median (IQR) 28 (22-37) 30 (24-39) 47 (44-54) Race/ethnicity NH White 2% 5% 0% NH Black 93% 84% 93% Hispanic 2% 0% 0% Other 3% 11% 7% Highest educ: HS or less 67% 79% 93% Annual HH income $0-$9,999 42% 47% 60% $10,000-$19,999 13% 32% 27% $20,000+ 40% 16% 13% Current employment Unemployed 42% 42% 40% FT or PT 45% 42% 13% Unable to work 2% 11% 47% Other 12% 5% 0% Homeless in past year 20% 16% 20% Sexual idenBty: Gay 60% 63% 13% Exchange sex past year 23% 26% 13% HIV tesBng Ever 85% 90% 93% Past year 55% 58% 27% CharacterisBc MSM 2011 MSM 2014 PWID 2011 Mis-report (n=53) Self-report (n=43) Mis-report (n=22) Self-report (n=63) Mis-report (n=21) Self-report (n=51) Gender: male 100% 100% 100% 100% 67% 73% Age; median (IQR) 38 (29-49) 41 (29-49) 47 (40-53) 36 (27-52) 51 (46-54) 52 (47-57) Race/ethnicity NH White 4% 12% 0% 13% 5% 2% NH Black 89% 72% 96% 83% 95% 94% Hispanic 2% 2% 0% 2% 0% 0% Other 6% 14% 4% 3% 0% 4% Highest educaBon HS or less 60% 44% 77% 40% 86% 78% College or more 40% 44% 23% 54% 14% 22% Annual HH income $0-$9,999 32% 23% 41% 25% 57% 59% $10,000-$19,999 11% 28% 32% 27% 33% 24% $20,000+ 47% 42% 27% 43% 10% 14% Current employment Unemployed 34% 19% 27% 24% 33% 26% FT or PT 42% 51% 41% 52% 10% 6% Homeless past year 13% 9% 23% 13% 29% 28% Sexual idenBty: Gay 65% 91% 55% 70% 5% 10% Binge drink, past month 32% 37% 46% 19% 33% 10% Non-IDU heroin, cocaine 23% 16% 41% 16% 43% 41%
Transcript of EXAMINATION OF UNRECOGNIZED AND MISREPORTED HIV STATUS AMONG MSM AND PWID IN BALTIMORE · 2020. 4....
EXAMINATIONOFUNRECOGNIZEDANDMISREPORTEDHIVSTATUSAMONGMSMANDPWIDINBALTIMORE
Poster904DanielleGerman,PhD,MPHAssistantProfessor624NorthBroadway,room753BalBmoreMD,21205Phone:410-502-8936Email:[email protected]
DanielleGerman1,KateShearer2,ColinFlynn3,CarlLatkin1,OliverLaeyendecker2,4,5,ThomasC.Quinn2,4,5,WilliamClarke5
1)DepartmentofHealth,BehaviorandSociety,JohnsHopkinsUniversity;2)DepartmentofEpidemiology,BloombergSchoolofPublicHealth,JohnsHopkinsUniversity;3)MarylandDepartmentofHealthandMentalHygiene;4)LaboratoryofImmunoregulaBon,DivisionofIntramuralResearch,NaBonalInsBtuteofAllergyandInfecBousDiseases,NIH,BalBmore,MD;5)JohnsHopkinsUniversitySchoolofMedicine
BACKGROUND
• IdenBfyingindividualswithunrecognizedHIVinfecBoncriBcaltodeployingHIVtesBng,prevenBon,andsurveillanceresources.
• Inourpreviousstudy(2008),33%ofmenwhohavesexwithmen(MSM)inBalBmoreclassifiedwithunrecognizedHIVinfecBonhadevidenceofrecentanBretroviral(ARV)medicaBon.
• ThecurrentstudyusedARVbiomarkerstovalidateself-reportedHIVinfecBonintwoaddiBonaldatacollecBonwavesamongMSM(2011and2014)andamongpeoplewhoinjectdrugs(PWID;2012)toassesschangesinmisrepresentaBonandobtainabegerassessmentofunrecognizedHIVinfecBonoverBme.
ACKNOWLEDGMENTS
TheauthorswishtoacknowledgeandthankthemanyparBcipantsinNHBSBalBmore(BESURE)aswellasthemanydedicatedBESUREteammembersfortheirinvaluablecontribuBonsoverBme.ThisworkwassupportedbyTheJohnsHopkinsUniversityCenterforAIDSResearch(1P30AI094189)andtheCentersforDiseaseControlandPrevenBonviaasubcontractfromtheMarylandDepartmentofHealthandMentalHygiene
SUMMARY
• ApproximatelyhalfofthoseoriginallyclassifiedasunrecognizedHIVinfecBontestedposiBvefornon-prophylacBcARVdrugs.AmongMSM,misreporBngincreasedwitheachBmeinterval.AmongPWID,misreporBngwascomparabletothatofMSM.
• ComparedtoMSMwhoself-reportedHIV+statusandARVuse,MSMmisreportersin2011and2014weremorecommonlynon-HispanicBlack,hadlesseducaBon,lowestincome,bisexual,andmorebingedrinking.MSMmisreportersin2014alsowereolder,morecommonlyhomeless,andreportednon-injecBonheroinorcocaineuse.
• AmongPWID,misreportershadlowereducaBonandemploymentandincreasedbingedrinking.
• RecalculatedprevalenceofunrecognizedHIVinfecBonamongHIV+MSMwas34.3%in2011andsubstanBallyreducedto15.7%in2014.RecalculatedprevalenceofunrecognizedHIVinfecBonamongHIV+PWIDwas11.4%.
CONCLUSIONS• Thisbio-behavioralapproachacrossBmepointsandpopulaBons
highlightsasetofcharacterisBcsamongthosemorelikelytomisreportHIVstatusandsuggestshypothesesthatmayhelptoimproveself-reporteddatacollecBonofHIVstatus.
• ThereisacriBcalneedtoenhanceassessmentofthisimportantmetricandtounderstandtheroleofeconomicandsocialfactorssuchasperceivedsBgma,socialdesirability,andtrustonself-reportvalidityrelatedtoHIVstatusinepidemiologicalresearch.
• AddressingunrecognizedHIVinfecBonremainsanimportantpriorityforreducingHIVtransmissioninBalBmore,parBcularlyamongyounger,African-American,andlowSESMSMandAfrican-AmericanlowSESPWID.
METHODS
Data:HIV+parBcipantsinCDC’sNaBonalHIVBehavioralSurveillanceSystem-BalBmoreMSM(2011,n=175and2014,n=121)andPWID(2012,n=132);Venue-basedBmelocaBonsampling(MSM)andrespondentdrivensampling(PWID).InformedconsentforsurveyandvoluntaryHIVtest;anonymous;intervieweradministeredCAPIsurvey;remuneraBonforsurveyandHIVtest.
Eligibility:18orolder,liveinBalBmore-TowsonMSA,parBcipateoncepercycle.MSMonly:Male,eversexwithaman;analysislimitedtoMSMinpastyear.IDUonly:IDUinpastyear.OnlythosewithvalidHIVposiBvetestresultswhoprovidedconsentforserologicalstorageandfuturetesBngincludedinanalysis.
SerologicaltesBng:Venipuncture,EIAwithWBconfirmaBon.SeratestedforARVpresenceusingliquidchromatography-highresoluBonaccuratemass(HRAM)massspectrometry(ThermoFisherQ-ExacBve)whichdetects20anBretroviral(ARV)drugs.Sameproceduresconductedwith10%randomsampleofHIV-negaBveparBcipantsforvalidaBon.
Analysis:MisreportedHIVstatusdefinedaspresenceofatleast1ARV,indicaBngusewithinatleast24hours.Analysescomparedhypothesizedsocio-demographicandbehavioralcharacterisBcsofparBcipantswithself-reportedvsmisreportedHIVstatus.AlerremovingthosewithARTevidence,prevalenceofunrecognizedHIVinfecBonwasrecalculatedandanalysisexaminedassociatedcharacterisBcs.
RESULTSFigure1.AmongparBcipantsoriginallyclassifiedwithunrecognizedHIVinfecBon,proporBontestedposiBveandnegaBvefornon-prophylacBcARVdrugsamongNHBSBalBmoreMSMin2011and2014andPWIDin2012
Figure2.AmongparBcipantswithHIVposiBvetestresult,prevalenceofself-reportedHIVstatus,misreportedHIVstatus,andrecalculatedunrecognizedHIVinfecBoninNHBSBalBmoreamongMSMin2011and2014andPWIDin2012
35.4%66.9% 72.7%
30.3%
17.4% 15.9%34.3%15.7% 11.4%
0%
20%
40%
60%
80%
100%
MSM32011(n=175) MSM42014(n=121) IDU3(n=132)
UnrecognizedHIVinfecBon
MisreportedHIV+
Self-reportedHIV+47.0% 53.7% 58.3%
53.0% 46.3% 41.7%
0%
20%
40%
60%
80%
100%
MSM32011(n=113) MSM42014(n=41) PWID32012(n=36)
ARV-negaBve
ARV-posiBve
Table1.Demographicandsocio-behavioralcharacterisBcsofNHBSBalBmoreparBcipantswithself-reportedvsmisreportedHIVinfecBon(onARTonly),MSMin2011and2014andPWIDin2012
Table2.DemographicandsocialcharacterisBcsofNHBSBalBmorePWIDwithunrecognizedHIVinfecBon,MSMin2011and2014andPWIDin2012
CharacterisBc MSM2011(n=60) MSM2014(n=19) PWID2011(n=15)
Gender:male 100% 100% 67%Age;median(IQR) 28(22-37) 30(24-39) 47(44-54)Race/ethnicityNHWhite 2% 5% 0%NHBlack 93% 84% 93%Hispanic 2% 0% 0%Other 3% 11% 7%Highesteduc:HSorless 67% 79% 93%AnnualHHincome$0-$9,999 42% 47% 60%
$10,000-$19,999 13% 32% 27%
$20,000+ 40% 16% 13%CurrentemploymentUnemployed 42% 42% 40%FTorPT 45% 42% 13%Unabletowork 2% 11% 47%Other 12% 5% 0%Homelessinpastyear 20% 16% 20%SexualidenBty:Gay 60% 63% 13%Exchangesexpastyear 23% 26% 13%
HIVtesBngEver 85% 90% 93%Pastyear 55% 58% 27%
CharacterisBc MSM2011 MSM2014 PWID2011
Mis-report(n=53)
Self-report(n=43)
Mis-report(n=22)
Self-report(n=63)
Mis-report(n=21)
Self-report(n=51)
Gender:male 100% 100% 100% 100% 67% 73%Age;median(IQR) 38(29-49) 41(29-49) 47(40-53) 36(27-52) 51(46-54) 52(47-57)
Race/ethnicity
NHWhite 4% 12% 0% 13% 5% 2%NHBlack 89% 72% 96% 83% 95% 94%Hispanic 2% 2% 0% 2% 0% 0%Other 6% 14% 4% 3% 0% 4%HighesteducaBon
HSorless 60% 44% 77% 40% 86% 78%
Collegeormore 40% 44% 23% 54% 14% 22%
AnnualHHincome
$0-$9,999 32% 23% 41% 25% 57% 59%
$10,000-$19,999 11% 28% 32% 27% 33% 24%
$20,000+ 47% 42% 27% 43% 10% 14%Currentemployment
Unemployed 34% 19% 27% 24% 33% 26%FTorPT 42% 51% 41% 52% 10% 6%
Homelesspastyear 13% 9% 23% 13% 29% 28%
SexualidenBty:Gay 65% 91% 55% 70% 5% 10%
Bingedrink,pastmonth 32% 37% 46% 19% 33% 10%
Non-IDUheroin,cocaine 23% 16% 41% 16% 43% 41%
