Last week in @CDCMMWR: #HIV among PWID in the US and young women in Africa

Monday, January 15, 2018

This week's edition of MMWR features two analyses on HIV. The first is on infection prevalence and risk among persons who inject drugs in 20 U.S. cities. The data comes from the National HIV Behavioral Surveillance system:
In 2015, National HIV Behavioral Surveillance found a 7% prevalence of HIV infection among persons who inject drugs which was lower than in 2012 (11%). Among HIV-negative respondents, 27% reported sharing syringes and 67% reported having vaginal sex without a condom in the previous 12 months; only 52% received syringes from a syringe services program and 34% received all syringes from sterile sources. HIV infection prevalence was higher among blacks (11%) than whites (6%) but more white persons who inject drugs shared syringes (white: 39%; black: 17%) and injection equipment (white: 61%; black: 41%) in the previous 12 months.
What I find interesting is that the prevalence of unsafe injection practices is so much higher among whites than blacks, although this may be related to there being so many new white PWID due to the opioid crisis (i.e., more black PWID have been injecting for longer). What does not surprise me, sadly, is that so few PWID were able to access sterile syringes from a syringe exchange program (SEP). Even after Congress lifted the federal funding ban on SEPs, states and other jurisdictions have been reluctant to operate them.

The second article (which boasts a jaw-dropping 82 co-authors from 22 institutions) reports HIV status and treatment cascade metrics for women aged 15-24 in seven countries in eastern and southern Africa:
Analysis of data from Population-based HIV Impact Assessment surveys conducted during 2015–2017 in seven countries in Eastern and Southern Africa found that the prevalence of HIV infection among adolescent girls and young women was 3.6%. Among those who were HIV-positive, 46.3% reported being aware of their status, and among those aware of their HIV-positive status, 85.5% reported current antiretroviral treatment (ART) use. Overall, viral load suppression among HIV-infected adolescent girls and young women, regardless of status awareness or current use of ART, was 45.0%, well below the UNAIDS target of 73%.
While low levels of awareness of status and viral suppression are pretty depressing, I was encouraged to see that so many who are aware of their infection are on ART. I was also fascinated to learn that the PHIA survey used is funded by PEPFAR:
The PHIA surveys are nationally representative, household-based surveys funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and conducted under the leadership of the respective countries’ ministries of health, CDC, and ICAP at Columbia University). The objectives of the PHIA surveys are to provide national estimates of HIV incidence and subnational estimates of HIV prevalence and viral load suppression to assess the HIV epidemic and the impact of HIV prevention and ART programs in each country. During 2015–2017, PHIA surveys were conducted in Lesotho, Malawi, Swaziland, Uganda, Tanzania Zambia, and Zimbabwe.
Also super cool: the survey takers conduct HIV, CD4, and viral load testing on the spot:
The surveys included home-based HIV counseling and testing conducted in private locations within or around the home, using each country’s national HIV rapid testing algorithm, and employing CD4 testing technology, with results immediately returned to participants. Awareness of HIV status and current ART use (an indicator of ART coverage at the population level) were determined based on responses provided in the survey questionnaire. HIV viral load testing was conducted using plasma specimens or dried blood spots.

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