Abstract
HIV Stigma and Testing Behavior at a Minority Serving Institution
Joshua Manlutac, MPHc1 and Bethany Rainisch, Ph.D., M.P.H2
(1)California State University Northridge, Northridge, CA, (2)California State University, Northridge, Northridge, CA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
background: HIV-related stigma and discrimination among collegiate students is presently an emergent public health issue as 44% of college students are living with HIV nationally. Minority groups, especially Blacks or Latinos, aged 18 and over, are at high-risk of acquiring this virus. Stigma is seen to be one of the leading barriers to HIV prevention, treatment and care, making it difficult to reduce the risks of infection among high-risk populations. methodology: A SAMHSA-funded grant, the Services for Telehealth and Rapid Testing (START) program focuses on exploring pre-existing perceptions and stigma against HIV to strategically increase the number of at-risk students who get tested for HIV at a Hispanic serving institution in Los Angeles County. Cross-sectional campus surveys were collected to measure HIV stigma and willingness to get tested for HIV. results: Preliminary analysis reports that 58.7% of college students disagree that getting tested for HIV is normal, 62.7% don’t feel comfortable telling their family about HIV testing, and 59% don’t feel they can speak openly to their friends about HIV testing. These findings suggest that minority students are especially vulnerable to HIV stigma, and may be less likely to get tested for HIV as a result. conclusion: Altering opinions about HIV on college campuses may significantly influence high-risk young adults to get tested for HIV. Such a change in campus climate, as promoted by the START program, is a significant step in reducing discrimination pertaining to HIV and increasing protective behaviors such as HIV testing and risk reduction counseling.
Epidemiology Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related research
Abstract
Impact of Hurricane Sandy on HIV testing rates: An interrupted time series analysis—January 1, 2011- December 31, 2013
Linda Ekperi, DrPH, MPH, Erin Thomas Echols, PhD, Tanya Telfair LeBlanc, PhD, MS, EIS 2000, Erica Elaine Adams, MPH, Grete E. Wilt, MPH, Noelle-Anelique Molinari, PhD and Eric Carbone, PhD
Centers for Disease Control and Prevention, Atlanta, GA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Hurricane Sandy made landfall on the eastern coast of the United States in late October of 2012 resulting in 106 deaths and 71.4 billion dollars in damage. Those with undiagnosed HIV infection may be especially affected by devastating storms and disasters due to potential delays in testing and access to care.
Method: Using MarketScan data from January 2011-December 2013, this study examined weekly HIV testing rates among enrollees not previously diagnosed with HIV. Interrupted time series (ITS) analyses were used to examine whether Hurricane Sandy affected weekly rates of HIV testing in 90 core based statistical areas (CBSAs). Moran’s I and local indicators of spatial association (LISA) analyses were employed to detect spatial clustering among estimated changes in HIV testing rates and storm impact rank.
Results: HIV testing rates declined significantly in storm-affected areas. The mean immediate effect ranged between -7% (95% CI: -13.8, -0.6) in low impact areas and -19% (95% CI: -37.6, -1.2) in very high impact areas. In bivariate Moran’s I and LISA analyses, significant associations between relative changes in HIV testing rates and storm impact were observed (p<0.05).
Conclusion: Hurricane Sandy resulted in an immediate decline in HIV testing rates among storm affected CBSAs, and excessive storm damage was associated with a greater magnitude of testing disruption. Disruption following natural and man-made disasters is concerning and potentially impacts efforts to support the National HIV/AIDS Strategy target of increasing the percentage of people living with HIV who know their serostatus to at least 90 percent.
Administration, management, leadership Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Protection of the public in relation to communicable diseases including prevention or control Public health administration or related administration Public health or related research
Abstract
Trends in HIV Testing: Differences Between Planned and Actual Testing in the United States, 2006-2010
Melanie Gwynn, PhD, MPH, MHA, CHES1, Bankole Olatosi, PhD, MS, MPH, FACHE1, Jan Ostermann, PhD and Khairul Alam Siddiqi, BS, MPS1
(1)University of South Carolina, Columbia, SC
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: Increased human immunodeficiency virus (HIV) testing rates among all risk groups remains a primary strategy in the effort to combat the HIV epidemic. A review of the state of things is necessary to assess progress.
Methods: Pooled cross-sectional analysis of data consisting of participants ages 18-64 years in the 2006-2010 National Health Interview Surveys (NHIS) was used to describe longitudinal trends in HIV testing rates in the US population and differences between planned and actual testing across demographic and risk groups. Correlates of perceived risk for HIV infection and planned and actual HIV testing will be presented. Difference-in-differences models were used to examine differences between planned and actual testing varies based on demographic characteristics, perceived HIV risk, and other healthcare related factors.
Results: Per preliminary data, 93.94% of HIV testing occurred in routine settings. By region, 40.1% of persons living in the South reported ever having an HIV test, followed by 24.3% of persons living in the West. In contrast, 36.9 % of persons living in the West, and 34.1% persons living in the South reported having an HIV test within the past 12 months. For persons with the highest self perceived risk of HIV infection, 7.96% reported ever having an HIV test, .61% reported having an HIV test within the past 12 months, and 35.73% expected to take an HIV test within the next 12 months.
Discussion: Understanding patient preference as related to HIV testing is important for planning and intervention purposes.
Epidemiology Other professions or practice related to public health Planning of health education strategies, interventions, and programs Program planning Public health or related public policy Public health or related research
Abstract
Targeted, Integrated HIV & HCV Screenings in Community Locations
Joseph Olsen, MPH1, Nicole Hubschman, MPH2 and Jean Redmann2
(1)CrescentCare, New Orleans, LA, (2)NO/AIDS Task Force d.b.a CrescentCare, New Orleans, LA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
New Orleans ranks 3rd in the nation for estimated HIV case rates (31.9/100,000). At-risk populations face inequities including poverty, homelessness, and high arrest rates, which relate to both increased HIV risk and presence in the court system. 1.6-1.8% of Louisiana’s population has HCV, with highest prevalence among “baby-boomers” and people who inject drugs.
In 2013 this project began offering rapid HIV testing in a municipal courthouse. As the HIV testing program grew, it sought partnerships to access communities at-risk for HCV. The program expanded to offer HIV/HCV screening at a syringe access program, methadone clinic, center for victims of domestic violence, and two pharmacies; and provides HCV testing alongside existing HIV testing at an STD clinic, center for homeless youth, and National HIV Behavioral Surveillance program.
Since 2013, the program conducted 9,687 HIV tests, and 2,453 HCV tests. 0.6% of HIV tests and 37% of HCV tests were positive. The program used HIV risk-assessment tools to screen for HCV risks. 15% of HIV clients and 57% of HCV clients had never tested before, and many HCV-eligible clients were unaware they were at-risk. Linkage-to-care rates are 85% for HIV and 20% for HCV.
Existing HIV testing programs may already have the foundation to successfully incorporate HCV screening. Programs initiating HCV screening should expect a high volume of HCV+ clients and develop linkage-to-care systems accordingly. The synergy between HIV and HCV screening across environments and risk groups makes adapting HIV testing models for HCV screening worthwhile, but this synergy ends with linkage-to-care.
Administer health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning
Abstract
Acute HIV Discovered During Routine HIV Screening Using 4th Generation Assays in 6 U.S. Emergency Departments
Douglas White, MD1, Priya Mammen, MD, MPH2, Thomas Giordano, MD, MPH3, Siavash Pasalar, PhD4, Kathleen Jacobson, MD5, Nancy Glick, MD6, Beverly Sha, MD7, Daniel Feaster, PhD8, Tamara Todorovic, BS, MPH1, Bijou Hunt, MA6, Vincent Adomolga, MPH9, Ercole Favaloro III, MD10, Lisa Moreno-Walton, MD11 and Bernard Branson, MD12
(1)Alameda Health System - Highland Hospital, Oakland, CA, (2)Sidney Kimmel Medical College/ Thomas Jefferson University Hospital, Philadelphia, PA, (3)Baylor College of Medicine, Houston, TX, (4)Harris Health System, Houston, TX, (5)Keck School of Medicine at USC, Los Angeles, CA, (6)Sinai Health System, Chicago, IL, (7)Rush University Medical Center, Chicago, IL, (8)University of Miami, Miami, FL, (9)Thomas Jefferson University Hospital, Philadelaphia, PA, (10)Louisiana State University Health Science Center, New Orleans, LA, (11)Louisiana State University Health Science Center, New Orleans, LA, New Orleans, LA, (12)Scientific Affairs, LLC, Atlanta, GA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background:
Using 4th generation Ag/Ab assays in ED-based HIV screening programs identifies patients with acute HIV infection (AHI) that would have been missed with Ab-only assays. Identifying AHI is important because immediate initiation of antiretroviral treatment has long-term clinical benefits and limits viral transmission.
Methods:
This retrospective chart review was carried out in 6 U.S. EDs with site-specific HIV screening programs using 4th generation assays. We determined the proportion of AHI among all newly-identified HIV diagnoses and compared the reason for visit between AHI and established HIV (EHI) patients. AHI was defined as a reactive 4th generation test, nonreactive antibody differentiation assay, and reactive RNA test.
Results:
Of the 159,102 tests performed, 605 patients were newly diagnosed with HIV, of which 98 (16.2%) were AHI and 507 (83.8%) were EHI. Patients were primarily male (65.5%) and minority (Black 64.4% and Hispanic 16.8%). Those with AHI tended to be younger and had higher viral load loads and CD4 counts than those with EHI. Patients with AHI were more likely to report viral syndrome and fever and less likely to report trauma, musculoskeletal, psychiatric or pulmonary complaints as their reason for visit than those with EHI.
Conclusion:
When 4th generation HIV assays are used for ED screening, the proportion of newly-diagnosed HIV patients that are AHI is high. The high rate is likely explained by patients seeking care for symptoms attributable to AHI. Patients with AHI also presented with a variety of nonspecific symptoms, justifying non-targeted screening.
Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Correlates of twelve-month HIV testing among U.S. and foreign born high-risk Black heterosexual men in a high risk metropolitan area
Michael A. Joseph, PhD, MPH1, Marilyn Fraser, MD2, Yolene Gousse, DrPH3, Moro Salifu, MD4, Mark Stewart, MD, Ph.D.5 and Tracey E. Wilson, PhD5
(1)School of Public Health at SUNY Downstate Medical Center, Brooklyn, NY, (2)Arthur Ashe Institute for Urban Health, Brooklyn, NY, (3)NY, (4)SUNY Downstate Medical Center, Brooklyn, NY, NY, (5)SUNY Downstate Medical Center, Brooklyn, NY
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background. Despite racial disparities in HIV testing, relatively little is known about risk and protective factors for recent HIV testing among U.S. versus foreign-born Black, heterosexual men.
Methods. We used baseline data from 861 men of the Barbershop Talk With Brothers project—a cluster randomized trial testing the efficacy of a community-based HIV-prevention intervention to reduce HIV risk among Black heterosexual men residing in high-risk areas for HIV infection. Recent testing was defined as having received an HIV test in the past 12 months.
Results. Thirty-three percent were foreign-born. Recent HIV testing was reported by 62%. Among foreign-born men, completed high school (OR = 3.43; 95% CI = 1.74, 6.76), ever spent at least one night in jail or prison (OR = 2.09; 95% CI = 1.09, 4.02) and alcohol use in past 3 months were each associated with increased odds of recent HIV testing. For US-born men, stable housing was associated with a decreased odds (OR = 0.62; 95% CI = 0.38, 0.99), while ever spent at least one night in jail or prison (OR = 1.76; 95% CI = 1.17, 2.66), current health insurance (OR = 1.93; 95% CI = 1.26, 2.96), and HIV transmission knowledge (OR = 1.16; 95% CI = 1.06, 1.26) were each associated with increased odds of recent HIV testing.
Conclusions. We observed significant disparities in recent HIV testing between U.S. and foreign born men. Strategies to increase rates of HIV testing among high risk heterosexual Black men should take into account nativity status.
Implementation of health education strategies, interventions and programs
Abstract
Role of rapid point of care HIV testing in an Emergency Department screening program
Priya Mammen, MD, MPH1, Joseph Hardardt, BS2, Frances Nelson, MA3 and Vincent Adomolga, MPH4
(1)Sidney Kimmel Medical College/ Thomas Jefferson University Hospital, Philadelphia, PA, (2)Sidney Kimmel Medical College, Philadelphia, PA, (3)Thomas Jefferson University Hospital, Philadelphia, PA, (4)Thomas Jefferson University Hospital, Philadelaphia, PA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
The CDC recommends HIV testing for all patients ages 13-64 in multiple settings including Emergency Departments (EDs). EDs often utilize both POC testing and laboratory based testing. Increased focus and stress on lab based 4th generation testing has limited funding and support for rapid point of care (POC) testing.
We evaluated the role and impact of rapid POC testing as part of an ED based opt-out HIV screening program.
This was a retrospective chart review of all patients newly diagnosed with HIV through an ED based screening program. Patients were tested on an opt-out basis using a testing algorithm that utilizes both laboratory based testing and POC testing. Data was reviewed to determine how positive diagnoses had been tested.
From June 2014 through January 2017, 21,233 total HIV were performed- 63%(13447) lab tests and 37%(7821) POC. 80 patients were newly diagnosed with HIV; of these 35(44%) had reactive POC testing which led to positive confirmatory testing. POC tests were used when no other laboratory tests were done, reflecting lower acuity of presentation. POC was 1.3 times (95% CI: 0.9-2.1) more likely to identify a positive result compared to lab test.
Rapid POC testing has an important role in HIV screening in the ED and is ideal for those patients who do not need invasive testing, including IV access. Decreased POC testing could result in missed opportunities to successfully screen and diagnose HIV in those presenting to the ED for unrelated medical issues.
Administer health education strategies, interventions and programs Clinical medicine applied in public health Planning of health education strategies, interventions, and programs Provision of health care to the public Public health or related nursing
Abstract
Voluntary HIV Test Choice and Reasons for Accepting or Declining Testing among Young African American Women Living in Disadvantaged Southern Urban Communities
JeeWon Cheong, Ph.D., Jalie Tucker, Ph.D., M.P.H. and Susan Chandler, M.P.H, M.A.
University of Florida, Gainesville, FL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: The Southern U.S. carries a greater burden of HIV than other U.S. regions, having 44% of all HIV cases, higher incidence, and lower rates of treatment referral, retention in care, and viral suppression. African American women in particular are disproportionately affected by HIV and accounted for 69% of HIV-diagnosed Southern women in 2014. To understand barriers to and incentives for HIV testing — the initial step in the HIV care continuum — this study investigated reasons for accepting or declining a free, immediately available HIV test.
Methods: African American women (N=207; Mean age=20.5) living in disadvantaged neighborhoods in a southern U.S. city were recruited using a peer-driven method suitable for recruiting hard-to-reach samples and offered free voluntary HIV testing after completing a structured interview. After making their decision, participants rated the importance of various reasons for accepting or declining testing. Exploratory factor analysis investigated the underlying structures of those reasons.
Results: About 70% accepted testing. Factor analysis indicated that HIV test acceptance was associated with (1) awareness of HIV medical treatment benefits, (2) concerns about current sexual relationships and HIV risks, and (3) health protection and test convenience. Test refusal was associated with (1) anticipated negative consequences of a positive test and privacy concerns, and (2) low perception of HIV risk.
Conclusions: Findings suggest that HIV testing can be promoted by education about HIV medical treatment advances; messages emphasizing sexual relationships and risks; offering free, convenient testing as a health check; and continued efforts to reduce HIV stigma.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Prevalence of HIV Testing Among Adults with a Hepatitis C Diagnosis: Findings from the National Health and Nutrition Examination Survey 2009 - 2014
Bankole Olatosi, PhD, MS, MPH, FACHE and Chamberline Ozigbu, MD, MPH
University of South Carolina, Columbia, SC
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background
Hepatitis C virus (HCV) is responsible for about 75%-85% of chronic liver diseases and the primary cause of hepatocellular carcinoma in the United States. People living with HCV have severe health outcomes when co-infected with Human Immunodeficiency Virus (HIV). Interestingly, the use of antiretroviral therapy in HIV positive patient with Hep C co-infection markedly improves the health outcomes. Since HCV and HIV share similar transmission risks, guidance to test HCV-infected persons for HIV is imperative. In this study, we quantified the prevalence of HIV testing among HCV-positive adults.
Methods
We analyzed weighted pooled data from the National Health and Nutrition Examination Survey (NHANES), 2009-2014 limiting analysis to participants aged 18 – 64 years (N= 14,425). NHANES participants were tested for HCV RNA and stratified by test results as (“Positive/Negative”). HIV testing prevalence was characterized by demographic and behavioral factors such as gender, age, race/ethnicity, education, poverty status, injection drug user (IDU), sexual orientation, and number of opposite/same (men only) sex partners in the past 12 months. All statistical analyses were conducted using SAS statistical software 9.4
Results:
We estimated that about 1.1% of respondents (n = 163) tested positive for HCV infection. Among these, 52.2% had never tested for HIV. Compared with HCV-negative adults, a significantly higher percentage of HCV-positive adults were less educated, non-Hispanic black, male, older, living below poverty and IDU.
Conclusions:
A new approach to increase HIV testing among persons infected with HCV is needed in order to reduce morbidity and mortality rates.
Public health or related public policy Public health or related research
Abstract
Increasing Colorectal Cancer Screenings amongst People Living with HIV/AIDS through Self-Administered Tests
Joanne Tillman, MPH, CHES and Julie Booth, MS, CPHQ, RHIA, CDIP
AIDS Healthcare Foundation, Los Angeles, CA
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: People living with HIV and/or AIDS (PLWHA) have a higher risk for cancer. Colorectal cancer (CRC) is the third leading cause of cancer death and occurs at a comparatively higher rate amongst PLWHA. CRC screenings are recommended for people aged >50; which PLWHA are more frequently reaching with the advancements in HIV/AIDS treatment. CRC can be detected by the self-screening stool sample examination, fecal occult blood test (FOBT).
Methods: Positive Healthcare (PHP/PHC) developed a FOBT screening incentive program to remove barriers and increase compliance rates of CRC screenings amongst their high-risk PLWHA population. Noncompliant individuals were enrolled in the program, and mailed a FOBT kit with the self-administered test, instructions, CRC health education, and a prepaid envelope to return the completed test. All participants were offered a $15 incentive for completing the test.
Results: A total of 415 patients received the FOBT kits by mail. The program was implemented for 2 months and yielded a 24% completion rate. 2% tested positive for abnormal results and received follow-up testing and interventions from their primary care provider. PHP/PHC’s overall 2016 member CRC screening rates increased from 23% to 30% with the implementation of this program.
Conclusions: The data indicated that PLWHA are more likely to complete a CRC screening when provided a FOBT than those who did not. Results revealed the $15 incentive positively affected the members’ satisfaction and likelihood of completion. The FOBT screening incentive program contributed to detecting more possible CRC in PLWHA and linking patients to appropriate care.
Administer health education strategies, interventions and programs Chronic disease management and prevention Provision of health care to the public Public health or related education