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The Challenges of Translating PrEP Interest into Uptake among Young Black MSM in Atlanta, GA
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Reported by Jules Levin
CROI 2017 Feb 14-16 Seattle, WA
Charlotte-Paige Rolle MD MPH, Eli S. Rosenberg PhD, Aaron J. Siegler PhD, Travis Sanchez MPH, Nicole Luisi MS MPH, Scott Cutro MD, Carlos del Rio MD, Patrick S. Sullivan DVM PhD, Colleen F. Kelley MD MPH
WEBCAST:http://www.croiwebcasts.org/console/player/33463?mediaType=slideVideo&
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HIV in Georgia/Atlanta: "75% of HIV infections diagnosed among males in Georgia in 2014 were attributed to the MSM transmission category......Black/non-Hispanics accounted for the majority of the diagnoses (65% of new HIV infectionsand 67% of Stage 3 (AIDS)).......Among males living with HIV infection in Georgia, 77% of cases were attributed to the MSM transmission category.......Among females living with HIV infection in Georgia, 80% of cases were attributed to the heterosexual contact transmission category......Among males living with Stage 3 (AIDS), 75% of cases were attributed to the MSM transmission category......To highlight the aging problem - In Table 5 Persons living with diagnosed HIV infection and Stage 3 (AIDS) by sex, age and race/ethnicity, Georgia through December 31, 2014 -37% over 50,66% are over the age of 40: 29% 40-49, 27% 50-59 and 10% 60+ / 66% are Black/Non-Hispanic, 20% White/Non-Hispanic, 6% Hispanic/Latino
https://dph.georgia.gov/sites/dph.georgia.gov/files/HIV_EPI_2014_Surveillance_ Summary_corrected_6_5_16.pdf
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FEASIBILITY OF A PHARMACIST-RUN HIV PREP CLINIC IN A COMMUNITY PHARMACY SETTING
Elyse Tung
Kelley-Ross Pharmacy, Seattle, WA, USA
http://www.croiwebcasts.org/console/player/33408?mediaType=audio&
TEXT MESSAGING IS ASSOCIATED WITH IMPROVED RETENTION IN A CLINIC-BASED PREP PROGRAM
Christine M Khosropour
University of Washington, Seattle, WA, USA
http://www.croiwebcasts.org/console/player/33411?mediaType=slideVideo&
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"In conclusion, I hope to hav convinced you that implementation of prep into observational studies is feasible with limited resources however additional delivery efforts may be required and importantly there is an ethical obligation for prevention studies especially those targeting YBMSM to offer prep as an hiv prevention option. Prep uptake among YBMSM in our sample was suboptiomal (despite ameloiortaion of key obstacles given info and access to providers) and there seems to be this critical barrer between interest and uptake which suggested that we needed to focus efforts on developing interventions to improve progression from willingness to PrEP uptake."
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There were 2,640 persons with a new diagnoses of HIV infection in Georgia during 2014
Persons aged 20-29 years at the time of diagnosis represented the largest age group (37%) for new diagnoses of HIV infection in Georgia during 2014.
Persons aged 20-29 years at the time of diagnosis represented the largest age group (37%) for new diagnoses of HIV infection in Georgia during 2014.
⋅ Black/Non-Hispanics accounted for 65% of new HIV infection diagnoses and comprised 31% of Georgia's population.
⋅ White/Non-Hispanics accounted for 13% of new HIV infection diagnoses and comprised 54% of Georgia's population.
⋅ Hispanics/Latinos of all races accounted for 5% of new diagnoses of HIV infection and comprised 9% of Georgia's population.
⋅Using multiple imputation, 75% of HIV infections diagnosed among males in Georgia in 2014 were attributed to the MSM transmission category.
⋅Among women, 81% of HIV infections diagnosed in 2014 were attributed to heterosexual contact.
Georgia DPH 2014
Report https://dph.georgia.gov/enhanced-perinatal-hivaids-surveillance-eps
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Current risk assessment tools do not accurately identify black MSM who may need PrEP, -Current risk assessment tools do not accurately identify black MSM who may need PrEP
Kaplan-Meier analyses were used to demonstrate cumulative probability estimates for PrEP interest (blue), initiation visit (green) and medication start (red) (Figure 3a and b). Panel A shows these findings for the entire cohort and reveals immediate PrEP interest with over 50% of the cohort reporting interest at the baseline study visit however what is striking is the marked drop-off from interest to inititation visit and from initiation to medication start.
However lets now look at the same findings on a conditional plot with shows time to prep interest for the general cohort, time to prep initiation visit for those interested and time to medication start for those who initiated . What we now see is a median time to prep initiation of 16 weeks among those interested and median time to prep medication start of 4 weeks.
These findings again demonstrate that there seems to be some critical barrier beween prep interest and initiation for YBMSM
.....the point was to provide a standard of care that you might find for somebody visiting a provider in the real world and that we actually didn't a priori have evidence that men would have so much delay and difficulty once informed about and offered PrEP.....
HIV in Georgia/Atlanta:
"75% of HIV infections diagnosed among males in Georgia in 2014 were attributed to the MSM transmission category......Black/non-Hispanics accounted for the majority of the diagnoses (65% of new HIV infectionsand 67% of Stage 3 (AIDS)).......Among males living with HIV infection in Georgia, 77% of cases were attributed to the MSM transmission category.....Black/Non-Hispanics accounted for 68% of persons living with Stage 3 (AIDS) and comprised 31% of Georgia's population.....Among females living with HIV infection in Georgia, 80% of cases were attributed to the heterosexual contact transmission category......Among males living with Stage 3 (AIDS), 75% of cases were attributed to the MSM transmission category......The majority (77%) of cumulative HIV cases were male.......There were racial/ethnic disparities among cumulative HIV infections in Georgia in 2014.o Black/Non-Hispanics accounted for 66% of cumulative HIV infections....Among male adults/adolescents, 73% of cumulative cases were attributed to the MSM transmission category.......The highest cumulative number of diagnoses of HIV infection in Georgia were in the Fulton (22,723) and DeKalb (11,876) Public Health Districts." To highlight the aging problem - In Table 5 Persons living with diagnosed HIV infection and Stage 3 (AIDS) by sex, age and race/ethnicity, Georgia through December 31, 2014 -37% over 50,66% are over the age of 40: 29% 40-49, 27% 50-59 and 10% 60+ / 66% are Black/Non-Hispanic, 20% White/Non-Hispanic, 6% Hispanic/Latino
The overall state prevalence rate for HIV infection in 2014 was 527 cases per 100,000 population. Three Public Health Districts had HIV prevalence rates that exceeded the overall state rate in 2014: Fulton (1602 per 100,000), DeKalb (1252 per 100,000) and Clayton (824 per 100,000).
In 2014, Georgia was ranked fifth highest in the nation for the total number of new diagnoses of HIV infection among adults and adolescents after Florida, California, Texas, and New York1. There were2,640 new diagnoses of HIV infectionduring 2014 in Georgia.The majority of these new
1 Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol.26.
http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Published November 2015. Accessed February 2016
diagnoses were among males (80%).The highest percentage of new HIV diagnoses was seen among those aged 30 to 39 years (24%), and the highest percentage of Stage 3 (AIDS) was also seen among those aged 20-29 years (37%).Among all races/ethnicities, Black/non-Hispanics accounted for the majority of the diagnoses (65% of new HIV infectionsand 67% of Stage 3 (AIDS)).
The majority of persons living with HIV infection were male (75%)......Black/Non-Hispanics accounted for 66% of persons living with HIV infection and comprised 31% of Georgia's population......White/Non-Hispanics accounted for 20% of persons living with HIV infection and comprised 54% of Georgia's population......Hispanic/Latinos of all races accounted for 6% of persons living with HIV infection and comprised 9% of Georgia's population.
Seventy five percent (1586) of new HIV infections among Georgia males in 2014 were attributed to male to male sexual (MSM) contact. Among women, 81% (407) of new HIV infections were attributed to heterosexual contact (HET).Similar to the new diagnoses of HIV infection, themajority of prevalent cases are among Black/Non-Hispanic persons (68%) and males
(78%). Seventy-seven percent (30,845) of prevalent HIV cases among males were attributed to the MSM transmission categoryand 80% (10,352) of cases among females were attributed to heterosexual contact.
New Diagnoses
Tables 2 to 4: New diagnoses of HIV infection, Georgia, January 01, 2014 to December 31, 2014
- There were 2,640 persons with a new diagnoses of HIV infection in Georgia during 2014.
- The majority of the new HIV diagnoses were among males (80%).
- Persons aged 20-29 years at the time of diagnosis represented the largest age group (37%) for new diagnoses of HIV infection in Georgia during 2014.
- There were racial/ethnic disparities among persons with new diagnoses of HIV infection in Georgia in 2014.
⋅Black/Non-Hispanics accounted for 65% of new HIV infection diagnoses and comprised 31% of Georgia's population.
⋅White/Non-Hispanics accounted for 13% of new HIV infection diagnoses and comprised 54% of Georgia's population.
⋅Hispanics/Latinos of all races accounted for 5% of new diagnoses of HIV infection and comprised 9% of Georgia's population.
⋅The overall state rate for new diagnoses of HIV infectionin 2014 was 26 cases per 100,000 population. In 2014, several Public Health Districts had newly diagnosed HIV infection rates that exceeded the overall state rate:Fulton(77 per 100,000),DeKalb(61 per 100,000) and Clayton (44 per 100,000).
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