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

Steven 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

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Article number21096
JournalJournal of the International AIDS Society
Volume19
Issue number1
DOIs
StatePublished - 2016

Fingerprint

Sexually Transmitted Diseases
HIV
Heterosexuality
Brazil
Incidence
Alcohols
Zambia
Infectious Disease Transmission
Condoms
Thailand
HIV Infections
Cost-Benefit Analysis
Therapeutics
Depression

Keywords

  • Global HIV prevention
  • Global HIV transmission
  • MSM
  • Secondary prevention
  • Treatment as prevention

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents. / Safren, Steven; Hughes, James P.; Mimiaga, Matthew J.; Moore, Ayana T.; Friedman, Ruth Khalili; Srithanaviboonchai, Kriengkrai; Limbada, Mohammed; Williamson, Brian D.; Elharrar, Vanessa; Cummings, Vanessa; Magidson, Jessica F.; Gaydos, Charlotte A.; Celentano, David D.; Mayer, Kenneth H.

In: Journal of the International AIDS Society, Vol. 19, No. 1, 21096, 2016.

Research output: Contribution to journalArticle

Safren, S, Hughes, JP, Mimiaga, MJ, Moore, AT, Friedman, RK, Srithanaviboonchai, K, Limbada, M, Williamson, BD, Elharrar, V, Cummings, V, Magidson, JF, Gaydos, CA, Celentano, DD & Mayer, KH 2016, 'Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents', Journal of the International AIDS Society, vol. 19, no. 1, 21096. https://doi.org/10.7448/IAS.19.1.21096
Safren, Steven ; Hughes, James P. ; Mimiaga, Matthew J. ; Moore, Ayana T. ; Friedman, Ruth Khalili ; Srithanaviboonchai, Kriengkrai ; Limbada, Mohammed ; Williamson, Brian D. ; Elharrar, Vanessa ; Cummings, Vanessa ; Magidson, Jessica F. ; Gaydos, Charlotte A. ; Celentano, David D. ; Mayer, Kenneth H. / Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents. In: Journal of the International AIDS Society. 2016 ; Vol. 19, No. 1.
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abstract = "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.",
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author = "Steven Safren and Hughes, {James P.} and Mimiaga, {Matthew J.} and Moore, {Ayana T.} and Friedman, {Ruth Khalili} and Kriengkrai Srithanaviboonchai and Mohammed Limbada and Williamson, {Brian D.} and Vanessa Elharrar and Vanessa Cummings and Magidson, {Jessica F.} and Gaydos, {Charlotte A.} and Celentano, {David D.} and Mayer, {Kenneth H.}",
year = "2016",
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T1 - Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents

AU - Safren, Steven

AU - Hughes, James P.

AU - Mimiaga, Matthew J.

AU - Moore, Ayana T.

AU - Friedman, Ruth Khalili

AU - Srithanaviboonchai, Kriengkrai

AU - Limbada, Mohammed

AU - Williamson, Brian D.

AU - Elharrar, Vanessa

AU - Cummings, Vanessa

AU - Magidson, Jessica F.

AU - Gaydos, Charlotte A.

AU - Celentano, David D.

AU - Mayer, Kenneth H.

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

KW - Global HIV prevention

KW - Global HIV transmission

KW - MSM

KW - Secondary prevention

KW - Treatment as prevention

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