NHPC Studies of Interest

2015 National HIV Prevention Conference (NHPC) Studies of Interest

The 2015 NHPC takes place during a time of major advancements and exciting breakthroughs in HIV prevention. The 760 abstracts being presented this year showcase research on some of the most promising advances in the field. The selected studies below highlight some of this important work, including:

• New data on knowledge and awareness of pre-exposure prophylaxis (PrEP) among providers as well as those who may benefit most from PrEP use, including gay and bisexual men of color
• Targeted research exploring what more needs to be done to ensure that transgender individuals are able to access quality HIV prevention and care services
• Real-world examples of the success of CDC’s High-Impact Prevention approach, which is transforming the HIV prevention landscape by focusing resources on the most effective combinations of scientifically proven, cost-effective, targeted, and scalable interventions.

PrEP

Pre-exposure prophylaxis (PrEP) is a powerful HIV prevention tool that has the potential to dramatically reduce the risk of HIV infection. The following selected studies highlight progress and challenges in getting PrEP into the hands of people most at risk of HIV infection.

PrEP Awareness and Attitudes in a Nationally Representative Survey of Primary Care Clinicians in the United States, 2009-2013 
(Oral Presentation, Session B-01, Abstract ID 1686)

Overview: Like most Americans, uninfected people at high risk for HIV often seek medical care from primary care providers. This analysis examines trends in awareness of PrEP and willingness to prescribe it among more than 1,500 clinicians, including family/general practitioners, internists, nurse practitioners and obstetrician/gynecologists (OB/GYNs), finding that:

• Awareness of PrEP was low among clinicians (2009: 24%, 2010: 29%) at the start of the study period but increased after trials reported effectiveness (2012: 49%, 2013: 51%, 2014: 61%, 2015: 64%);
• Clinicians surveyed over the six year period were most willing to provide PrEP for the uninfected partner in an HIV discordant couple (79%), followed by MSM (65%) and people who inject drugs (62%);
• OB/GYNs were slightly more willing than family physicians to prescribe PrEP, as were clinicians in a group practice, compared to a solo practice; and
• Once clinicians were given accurate information about PrEP and indications for use, they demonstrated greater willingness to prescribe.

While many more primary care providers need to know about PrEP, these findings show promising improvements in awareness of and attitudes toward a relatively new prevention tool.

Contact: Dawn Smith, CDC
Location: Embassy C (Hyatt Regency Atlanta)
Date/Time: Monday, December 7, 10:30 AM -12:00 PM EST

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Knowledge, Information-Seeking, Communication, and Use of PrEP and PEP among Gay and Bisexual men
(Oral Presentation, Session B-01, Abstract ID 1420)

Overview: To maximize the potential public health benefit of PrEP, it is important to ensure that those who might benefit most from PrEP are aware of it. This analysis assesses factors associated with current levels of knowledge, information-seeking, partner communication, and use of PrEP and post-exposure prophylaxis (PEP) among a key target population: men who have sex with men (MSM).

Using a web-based survey conducted between December 2014 and March 2015 of more than 3,000 MSM aged 18-64, including an oversampling of high-risk subgroups [young (18-39), black, and Latino MSM] with the majority living in high HIV prevalence cities, the authors found that:

• Overall, knowledge of PrEP and PEP was high (71% and 58%, respectively);
• MSM aged 18-24 were the least likely to know about PrEP, while MSM aged 25-44 were most likely to know about it;
• Men who thought they were at risk for HIV were 57% more likely to use PrEP than those who did not perceive such a risk; and
• Men who engaged in high-risk behaviors, such as recent anal sex without a condom or being in a sexual relationship with an HIV-positive partner, were 82% more likely to use PrEP than those who did not.

While the study sample is not nationally representative, the findings provide an important window into PrEP awareness and use among some of those at greatest risk for HIV.

Contact: Jo Stryker, CDC
Location: Embassy C (Hyatt Regency Atlanta)
Date/Time: Monday, December 7, 10:30 AM -12:00 PM EST

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Transgender Individuals and HIV

Transgender individuals in the United States are at particularly high risk for HIV infection. However, because data for this population are not uniformly collected, information is lacking on the full impact of HIV and prevention efforts in this population.

These selected studies explore the effectiveness of new approaches to identify transgender individuals at risk for HIV in the United States and best practices in providing HIV testing, prevention services, and linkage to care for specific transgender subgroups.

HIV Testing, Seropositivity and Linkage to Care among Transgender Persons in CDC-Funded Testing Sites in the United States, 2012-2013
(Oral Presentation, Session C-04, Abstract ID 1559)

Overview: Identifying transgender people within current data systems is often challenging, due to a reliance on reporting systems that ask only about current gender, without a secondary question on a person’s sex at birth. This study uses HIV testing data collected using a two-step approach, with sex at birth asked in addition to current gender, to better understand access to HIV testing services among this population. Findings show that:

• Two-step gender identification yielded 70% more testing events among transgender (TG) groups than a one-step approach;
• Combining sex at birth and current gender, six TG subgroups were identified: male at birth and identifying as a transgender woman (M-MTF), male at birth and identifying as a woman (M-F), male at birth and identifying as other/unspecified (M-OTH), female at birth and identifying as a transgender man (F-FTM), female at birth and identifying as a man (F-M), female at birth and identifying as other/unspecified (F-OTH);
• Among the subgroups, M-MTF showed the highest rate of HIV prevalence (4.3%), followed by M-OTH (1.6%) and M-F (1.4%); and
• Levels of injection drug use and unprotect sexual behaviors varied among TG groups.

The study shows that using two-step gender identification, which CDC encourages state and local health departments to incorporate in monitoring and surveillance systems, helps prevent misclassification of transgender persons. The study also reveals important differences in demographic characteristics, risk behaviors, and HIV status among TG subgroups that could influence HIV prevention strategies.

Contact: Mesfin Mulatu, CDC
Location: A706 (Atlanta Marriott Marquis)
Date/Time: Monday, December 7, 1:30-3:00 PM EST

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Assessment of Six Community-Based Organizations’ Efforts in Preventing HIV among Young Transgender Communities of Color
(Oral Presentation, Session C-04, Abstract ID 1422)

Overview: Transgender women of color are at particularly high risk for HIV. This study describes successful efforts to provide HIV prevention services to young transgender (YTG) persons of color and their partners, implemented at CDC-funded community-based organizations (CBOs) in six cities across the U.S.

Together, over the first three years of the five year program, the six CBOs:

• Increased the number of YTG tested from 530 in year one to 748 in year three;
• Linked 100% of newly diagnosed YTG to care in year three, up from 89% in year one;
• However, the number of HIV-positive diagnoses declined from year one to year three, highlighting the need to focus more intensively on identification of positives in future efforts.

The study authors identify key factors for success and best practices among the CBOs, such as making sure staff are well-trained and culturally aware, offering YTG testing alongside other prevention and support services, and strengthening relationships between health departments and CBOs to improve linkage to care.

Contact: Ekaterine Shapatava, CDC
Location: A706 (Atlanta Marriott Marquis)
Date/Time: Monday, December 7, 1:30-3:00 PM EST

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What Works: High-Impact Prevention in Action

High-Impact Prevention (HIP) means targeting the right combinations of scientifically proven, cost-effective, and scalable interventions to the right people, at the right time, and in the right geographic areas. This approach maximizes HIV prevention resources, increasing the number of new infections averted for every prevention dollar spent. This will be essential for achieving the goals of the National HIV/AIDS Strategy.

These selected studies highlight key elements of High-Impact Prevention at work: scaling up HIV testing, increasing access to condoms and sterile syringes, and ensuring that everyone living with HIV is linked to appropriate care and treatment.

HIV Risk Behaviors and Prevention Services among Persons who Inject Drugs in 20 Cities with and without Large-Scale Syringe Exchange Programs in the United States
(Oral Presentation, Session A-09, Abstract ID 1675) (Embargoed until 8:00AM EST on Tuesday, December 8)

Overview: This is the largest multi-site dataset ever analyzed to assess the association of access to large-scale syringe exchange programs (SEPs) on reducing high-risk injection behaviors in the United States. Using data from the 2012 National HIV Behavioral Surveillance system, the authors examined self-reported HIV risk behaviors among more than 10,000 people who inject drugs (PWID) in 20 cities with and without large-scale SEPs.

The authors found that PWID living in cities with large-scale SEPs were less likely to engage in high-risk injection behaviors. Compared to PWID in cities with no large-scale SEPs, they were:

• Less likely to inject with used syringes and to share syringes with more than two people;
• More likely to obtain sterile syringes; and
• More likely to accept free condoms.

This large multi-site data analysis further supports previous studies conducted over the past 25 years that have demonstrated the importance of SEPs in reducing HIV risk behaviors among PWID in large urban centers in the United States.

Contact: Dita Broz, CDC
Location: Courtland (Hyatt Regency Atlanta)
Date/Time: Tuesday, December 8, 1:30-3:00 PM EST

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I Can’t Breathe: The Intersection of Barriers to Linkage to Care in the Deep South
(Oral Presentation, Session C-19, Abstract ID 1149) (Embargoed until 8:00AM EST on Tuesday, December 8)

Overview: In Louisiana, African-Americans comprise 32% of the overall population, yet account for 70% of new HIV diagnoses, 69% of people living with HIV (PLWH) not engaged in HIV medical care, and 72% of PLWH who were not virally suppressed in 2012.

This study details Louisiana Links, a demonstration project funded by CDC with project participation from other agencies, to improve linkage to care and treatment in the state. The program employed five Linkage to Care Coordinators to personally follow up with individuals who were either a) identified using surveillance data as diagnosed with HIV in the past six months but not yet linked to care, b) previously diagnosed but not in care in the previous 12-36 months, or c) in care but not virally suppressed. In doing so, the Louisiana Office of Public Health:

• Enrolled 300 PLWH (90% black and 31% MSM) into the program during the first year of implementation (September 2013 – September 2014);
• Provided hands-on support to meet the unique needs of each enrollee, including finding employment opportunities, locating housing and child care, and helping cover transportation costs for medical visits;
• Linked 84% of all enrollees and 86% of black enrollees to care; and
• Helped 49% of all enrollees and 48% of black enrollees achieve viral suppression by the end of the first year

The success of Louisiana Links’ personalized, comprehensive approach can serve as a best practice model for other states in the Deep South where structural barriers such as poverty, racism and homophobia may prevent PLWH from accessing quality health care.

Contact: Jacquelyn Bickham, Louisiana Office of Public Health
Location: A704 (Atlanta Marriott Marquis)
Date/Time: Tuesday, December 8, 10:30 AM - 12:00 PM EST

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES