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%
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