A Latent Class Analysis of Substance Use and Longitudinal HIV RNA Patterns Among PWH in DC Cohort.

People with HIV (PWH) with substance use disorders (SUD) have worse health outcomes than PWH without SUD. Our objective was to characterize substance use patterns and their impact on longitudinal HIV RNA trajectories among those enrolled in an observational study of PWH in care in Washington, DC. Substance use by type (alcohol, cannabis, opioid, stimulant, hallucinogen, inhalant, sedative) was used to identify shared patterns of substance use using Latent Class Analysis (LCA).

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC.

Background: Since 2000, there have been rising rates of syphilis infections nationally with higher incidence among minorities and persons living with human immunodeficiency virus (HIV) (PLWH). The purpose of this study was to determine syphilis treatment adequacy and factors associated with treatment delay.

Methods: This was a retrospective academic-public health collaboration with the District of Columbia Department of Public Health reviewing surveillance data of all primary, secondary, and early latent syphilis cases diagnosed between January 1, 2015, and December 31, 2019.

Lessons learned from U.S. rapid antiretroviral therapy initiation programs.

Background: Rapid antiretroviral therapy initiation (R-ART) for treatment of HIV has been recommended since 2017, however it has not been adopted widely across the US.

Purpose: The study purpose was to understand facilitators and barriers to R-ART implementation in the U.S.

Risk Factors for Human Papillomavirus-Associated Cancers Among People Living with HIV in Washington, District of Columbia.

District of Columbia (DC) has high rates of HIV infection and human papillomavirus (HPV)-associated cancers. People living with HIV (PLWH) are at risk for developing HPV-associated cancers. Previous studies identified factors that may further increase the risk of HPV-associated cancer among PLWH such as age, race/ethnicity, sex, risk factor for HIV transmission, stage of HIV infection, and age at HIV diagnosis.

Improvements in Virologic Control Among PWH Over Time: Narrowing the Gap Between Those With and Without STIs.

Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012-2016). This was true overall and among those with the greatest number of STIs [age 18-34, men who have sex with men (MSM)].

Identifying Geographic Areas of Washington, DC, With Increased Potential for Sexual HIV Transmission Among People With HIV With STIs and Concurrent Elevated HIV RNA: Data From the DC Cohort.

Background: The Undetectable = Untransmittable (U = U) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from the DC Cohort Longitudinal HIV Study (DC Cohort), a city-wide cohort of persons with HIV (PWH).

Methods: DC Cohort participants aged ≥13 years were included in the study period between April 1, 2016, and March 31, 2018.

Association of Substance Use Disorders with Engagement in Care and Mortality among a Clinical Cohort of People with HIV in Washington, DC.

Substance use disorders (SUDs) are common among people with HIV and can prevent achievement of optimal health outcomes. Using data from a longitudinal HIV cohort study in the District of Columbia (2011-2018), we calculated the prevalence and correlates of SUD (alcohol, stimulant, and/or opioid use disorders) and determined the association of SUD with engagement in HIV care, ART prescription, viral suppression, and mortality. Of 8420 adults, 3168 (37.

Examining Retention in HIV Care and HIV Suppression on Housing Services Intake at a Washington, DC Community Based Organization.

In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing.

Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study.

Background: HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn.

Objective: The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC).

Knowledge, Attitudes, and Behaviors Related to Hepatitis C Screening and Treatment among Health Care Providers in Washington, DC.

Elimination of chronic hepatitis C (HCV) will require scaling up treatment, including possible HCV treatment by primary care providers. The District of Columbia (DC) has a substantial population living with untreated hepatitis C, and treatment expansion would benefit the resident population. The aim of this study was to assess the knowledge, attitudes, and behaviors of primary care providers and specialists related to hepatitis C screening and treatment.

Sexually transmitted infections in persons living with HIV infection and estimated HIV transmission risk: trends over time from the DC Cohort.

Objective: A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs.

Methods: We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidence (syphilis, gonorrhoea and chlamydia) as well as incare viral load (ICVL) and percentage with all viral loads less than the limit of detection (% View Article and Find Full Text PDF

Improving HIV Surveillance Data by Using the ATra Black Box System to Assist Regional Deduplication Activities.

Background: Focused attention on Data to Care underlines the importance of high-quality HIV surveillance data. This study identified the number of total duplicate and exact duplicate HIV case records in 9 separate Enhanced HIV/AIDS Reporting System (eHARS) databases reported by 8 jurisdictions and compared this approach to traditional Routine Interstate Duplicate Review resolution.

Methods: This study used the ATra Black Box System and 6 eHARS variables for matching case records across jurisdictions: last name, first name, date of birth, sex assigned at birth (birth sex), social security number, and race/ethnicity, plus 4 system-calculated values (first name Soundex, last name Soundex, partial date of birth, and partial social security number).

Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort.

Objective: To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).

Setting: The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC.

Methods: Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders.

Earlier diagnoses and faster treatment of HIV in the District of Columbia: HIV surveillance analysis, 2006-2016.

To address high HIV prevalence, the District of Columbia (DC) Department of Health has implemented multiple strategies to increase routine HIV testing since 2006. Examination of delayed HIV diagnosis over time can demonstrate population-level impact of public health strategies to promote HIV testing. Using HIV surveillance data, we examined delayed HIV diagnosis in DC (stage 3 within 90 days of diagnosis), CD4 count at HIV diagnosis, linkage to HIV care, and time to viral suppression among DC residents age 13 and above who were diagnosed from 2006 to 2016.

Cross-Jurisdictional Data Exchange Impact on the Estimation of the HIV Population Living in the District of Columbia: Evaluation Study.

Background: Accurate HIV surveillance data are essential to monitor trends to help end the HIV epidemic. Owing to strict policies around data security and confidentiality, HIV surveillance data have not been routinely shared across jurisdictions except a biannual case-by-case review process to identify and remove duplicate cases (Routine Interstate Duplicate Review, RIDR). HIV surveillance estimates for the District of Columbia (DC) are complicated by migration and care seeking throughout the metropolitan area, which includes Maryland and Virginia.

For Many Served By The Ryan White HIV/AIDS Program, Disparities In Viral Suppression Decreased, 2010-14.

For twenty-five years, the Ryan White HIV/AIDS Program has supported a comprehensive system of health services for vulnerable and under- or uninsured people living with HIV. Using data from the Health Resources and Services Administration about people living with HIV and served by the Ryan White HIV/AIDS Program, we found reductions in disparities in viral suppression rates between 2010 and 2014-with rates for Blacks/African Americans, adolescents and young adults, and people living in the South becoming more similar to rates for Whites, older adults, and people in other regions of the United States, respectively. Although absolute viral suppression rates for people without stable housing and transgender people improved during the same time period, disparities were not reduced between these groups and those with stable housing and nontransgender people, respectively.

High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011.

Background: In the human immunodeficiency virus (HIV) care continuum, retention in HIV medical care and viral suppression are key goals to improve individual health outcomes and reduce HIV transmission. National data from clinical providers are lacking.

Methods: HIV providers funded by the Ryan White HIV/AIDS Program (RWHAP) annually report demographic, service, and clinical data using encrypted unique client identifiers, and data are processed and de-duplicated to create a single record for each client.

Health care and HIV testing experiences among Black men in the South: implications for "Seek, Test, Treat, and Retain" HIV prevention strategies.

Few studies have explored how overall general health care and HIV/STI testing experiences may influence receipt of "Seek, Test, Treat, and Retain" (STTR) HIV prevention approaches among Black men in the southern United States. Using in-depth qualitative interviews with 78 HIV-negative/unknown Black men in Georgia, we explored factors influencing their general health care and HIV/STI testing experiences. The Andersen behavioral model of health care utilization (Andersen model) offers a useful framework through which to examine the general health care experiences and HIV testing practices of Black men.

Correlates of antiretroviral utilization among hospitalized HIV-infected crack cocaine users.

Despite the availability of antiretroviral therapy (ART), HIV-infected drug users, particularly crack cocaine users, continue to have high HIV-related morbidity and mortality. We conducted a cross-sectional analysis of the baseline data for hospitalized HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit Is an Opportunity for Prevention and Engagement with HIV-Positive Crack Users) in Atlanta and Miami who were eligible for ART (reported any lifetime use of ART or CD4 <350 cells/μl). Among 350 eligible participants, whose mean age was 44.

Acute cholecystitis caused by nontoxigenic Vibrio cholerae O1 Inaba.

A rare case of acute cholecystitis caused by serogroup O1 Vibrio cholerae in an 83-year-old man is presented. His risk factors for cholecystitis included advanced age and previous abdominal surgeries. The patient had consumed raw oysters several days before presentation.

Healthcare-associated Infections: epidemiology, prevention, and therapy.

Reducing nosocomial infection rates is a major component of healthcare improvement. This article reviews the epidemiology, prevention, and therapy for some of the most common healthcare-associated infections, including central line-associated bloodstream infections and catheter-associated urinary tract infections, and 3 common organisms: methicillin-resistant Staphylococcus aureus, multidrug- resistant gram-negative bacteria, and Clostridium difficile.