[Show abstract][Hide abstract] ABSTRACT: New York City (NYC) remains an epicenter of the HIV epidemic in the United States. Given the variety of evidence-based HIV prevention strategies available and the significant resources required to implement each of them, comparative studies are needed to identify how to maximize the number of HIV cases prevented most economically.
A new model of HIV disease transmission was developed integrating information from a previously validated micro-simulation HIV disease progression model. Specification and parameterization of the model and its inputs, including the intervention portfolio, intervention effects and costs were conducted through a collaborative process between the academic modeling team and the NYC Department of Health and Mental Hygiene. The model projects the impact of different prevention strategies, or portfolios of prevention strategies, on the HIV epidemic in NYC.
Ten unique interventions were able to provide a prevention benefit at an annual program cost of less than $360,000, the threshold for consideration as a cost-saving intervention (because of offsets by future HIV treatment costs averted). An optimized portfolio of these specific interventions could result in up to a 34% reduction in new HIV infections over the next 20 years. The cost-per-infection averted of the portfolio was estimated to be $106,378; the total cost was in excess of $2 billion (over the 20 year period, or approximately $100 million per year, on average). The cost-savings of prevented infections was estimated at more than $5 billion (or approximately $250 million per year, on average).
Optimal implementation of a portfolio of evidence-based interventions can have a substantial, favorable impact on the ongoing HIV epidemic in NYC and provide future cost-saving despite significant initial costs.
PLoS ONE 09/2013; 8(9):e73269. DOI:10.1371/journal.pone.0073269 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Bronx, one of 5 boroughs in New York City (NYC), bears a high burden of HIV. We evaluated the impact of HIV testing initiatives in the Bronx, including the 2008 The Bronx Knows campaign.
We used data from an annual telephone survey representative of NYC adults to compare 2005 and 2009 estimates of HIV testing prevalence among Bronx residents and to identify correlates of testing. We used NYC HIV surveillance data to evaluate changes in the percentage of persons concurrently being diagnosed with HIV and AIDS, an indicator of delayed HIV diagnosis.
Between 2005 and 2009, relative increases of 14% and 32% were found in the proportion of Bronx adults who have ever been HIV tested and who have been tested in the past year, respectively (P < 0.001). The largest increases were among those aged 24-44 years, men, non-Hispanic blacks and Hispanics, and those with low income or education, nonheterosexual identity, a personal doctor/provider, or health insurance. Factors independently associated with being recently tested included black or other race, Hispanic ethnicity, and bisexual identity. The proportion concurrently diagnosed with HIV and AIDS fell 22% from 2005 to 2009, and decreases generally occurred among subgroups experiencing increases in testing.
Community-wide testing in the Bronx increased the proportion of people with known HIV status and reduced the proportion with delayed diagnoses.
[Show abstract][Hide abstract] ABSTRACT: To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM.
Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005-2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries.
We calculated overall, age-specific and race/ethnicity-specific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity.
The average prevalence of male same-sex behavior during 2005-2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM.
The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
[Show abstract][Hide abstract] ABSTRACT: In 2007, via a high-profile media campaign, the New York City Department of Health and Mental Hygiene (NYC DOHMH) introduced the "NYC Condom," the first specially packaged condom unique to a municipality. We conducted a survey to measure NYC Condom awareness of and experience with NYC Condoms and demand for alternative male condoms to be distributed by the DOHMH. Trained interviewers administered short, in-person surveys at five DOHMH-operated sexually transmitted disease (STD) clinics in Spring 2008. We systematically sampled eligible patients: NYC residents aged ≥18 years waiting to see a physician. We approached 539; 532 agreed to be screened (98.7% response rate); 462 completed the survey and provided NYC zip codes. Most respondents were male (56%), non-Hispanic black (64%), aged 18-24 years (43%) or 25-44 years (45%), employed (65%), and had a high school degree/general equivalency diploma or less (53%). Of those surveyed, 86% were aware of the NYC Condom, and 81% of those who obtained the condoms used them. NYC Condom users were more likely to have four or more sexual partners in the past 12 months (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.0-3.8), use condoms frequently (AOR = 2.1, 95% CI = 1.3-3.6), and name an alternative condom for distribution (AOR = 2.2, 95% CI = 1.3-3.9). The most frequently requested condom types respondents wanted DOHMH to provide were larger size (28%), ultra thin/extra sensitive (21%), and extra strength (16%). We found high rates of NYC Condom use. NYC Condom users reported more sexual partners than others, suggesting the condom initiative successfully reached higher-risk persons within the STD clinic population. Study results document the condom social marketing campaign's success.
Journal of Urban Health 08/2011; 88(4):749-58. DOI:10.1007/s11524-011-9597-y · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background While men who have sex with men (MSM) comprise the majority of new HIV and new syphilis cases in the U.S., understanding the full burden of disease among them has been challenging as direct estimates of Men who Have Sex with Men (MSM) numbers in the general population have been largely unavailable. We describe the population of Men who Have Sex with Men (MSM) in New York City, compare their demographics, risk behaviours, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in disease rates among Men who Have Sex with Men (MSM).
Methods Population denominators and demographic and behavioural data were obtained from population-based behavioural surveys during 2005–2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from citywide disease surveillance registries. We calculated overall, age- and race/ethnicity-specific case rates and rate ratios for Men who Have Sex with Men (MSM) and MSW, and analysed trends in Men who Have Sex with Men (MSM) rates by age and race/ethnicity.
Results The average prevalence of same-sex behaviour among sexually active men during 2005–2008 (5.0%; 95% CI 4.5 to 5.6) differed by age (peaking at 8% among 40–49-year-old men) and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared to MSW, Men who Have Sex with Men (MSM) differed significantly on all demographics and reported a higher prevalence of condom use at last sex and of HIV testing, but also more sex partners; 38.4% of Men who Have Sex with Men (MSM) and 13.6% of MSW reported =3 partners in the last year (p<0.001). Men who Have Sex with Men (MSM) HIV and P&S syphilis rates were 2526.9/100 000 and 707.0/100 000, each of which was over 140 times MSW rates. Rates were highest among young and black Men who Have Sex with Men (MSM) (See Abstract LBO-1.5 table 1). Over 4 years, HIV rates more than doubled and P&S syphilis rates increased sixfold among 18–29-year-old Men who Have Sex with Men (MSM) to reach 8870.0/100 000 and 2900.4/100 000 in 2008, respectively.
Conclusions The substantial population of Men who Have Sex with Men (MSM) in NYC is at high risk for transmission of sexually transmitted infections given high disease rates and ongoing risk behaviours. There is significant overlap between HIV and P&S syphilis epidemics in NYC with the relatively small subgroups of young and non-Hispanic black Men who Have Sex with Men (MSM) disproportionately affected. Integration of HIV and STD case data would allow for better identification and characterisation of the population affected by these synergistic epidemics. Intensified and innovative efforts to implement and evaluate prevention programs are required.
[Show abstract][Hide abstract] ABSTRACT: Background Nucleic acid amplification testing (NAAT) is an important tool for identifying acute HIV infection (AHI), a period of high infectivity when antibody is undetectable. NAAT pooling methods (pNAAT) help contain the costs of screening for AHI. In 2008 NYC STD clinics began routine pNAAT screening for all rapid antibody negative specimens; it was standard of care in all nine clinics by 2009. A pattern of risk factors among AHI cases detected during universal screening suggested the feasibility of using targeted screening to maximise the yield of AHI cases detected while minimising costs of screening.
Methods Using medical record data, we reviewed cases of AHI diagnosed in nine NYC STD clinics for 2008–2009. From these we developed targeting criteria for AHI screening, and compared yields and costs before and after targeting.was implemented.
Results Targeted screening began in May 2010 and included the following risk criteria: MSM, females who have had sex with MSM, sex with an injection drug user, exchange sex for money or drugs, shared injection drug works, or recent victim of sexual assault. Prior, 42 696 specimens were screened by pNAAT from June through December 2009, yielding 23 AHI cases (5.4 cases/10 000 specimens). Of these cases, there were 21 males, including 15 who have sex with men (MSM) (71%, 15/21), 1 female, and 1 transgender. The mean age for patients was 30 years; racial/ethnic breakdown was: 57% Black, 39% Hispanic, 13% white, 4% other. Subsequently, 5280 specimens were screened by pNAAT from June through December 2010, representing an 88% decrease in testing compared to the same period during the previous year. A total of 18 AHI cases (34.1/10 000 specimens) were detected; all were MSM. The mean age was 29 years and racial/ethnic breakdown was: 44% Black, 28% Hispanic, 28% white, 5% Asian. Cost data are provided in Abstract O1-S11.04 table 1.
Conclusion AHI screening increases case detection compared to using antibody tests alone. After initial investment in the effort, we were able to cut the cost per case identified by over sevenfold. This approach may make AHI screening more feasible/affordable in settings with patients at very high risk of newly-acquiring HIV.
[Show abstract][Hide abstract] ABSTRACT: We assessed awareness and experience with the NYC Condom via surveys at 7 public events targeting priority condom distribution populations during 2007. Most respondents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alternative condoms offered for free: 22% wanted ultra-thin, 18% extra-strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives.
American Journal of Public Health 12/2009; 99(12):2178-80. DOI:10.2105/AJPH.2008.152298 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed awareness and ex- perience with the NYC Condom via surveys at 7 public events targeting priority condom distribution popu- lations during 2007. Most respon- dents (76%) were aware of NYC Condoms. Of those that had obtained them, 69% had used them. Most (80%) wanted alterna- tive condoms offered for free: 22% wanted ultra-thin, 18% extra- strength, and 14% larger-size. Six months after the NYC Condom launch, we found high levels of awareness and use. Because many wanted alternative condoms, the Department of Health and Mental Hygiene began distributing the 3 most-requested alternatives. (Am J Public Health. 2009;99:1-3. doi: