Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event - Illinois, February 2021.

During February 2021, an opening event was held indoors at a rural Illinois bar that accommodates approximately 100 persons. The Illinois Department of Public Health (IDPH) and local health department staff members investigated a COVID-19 outbreak associated with this opening event. Overall, 46 COVID-19 cases were linked to the event, including cases in 26 patrons and three staff members who attended the opening event and 17 secondary cases. Four persons with cases had COVID-19-like symptoms on the same day they attended the event. Secondary cases included 12 cases in eight households with children, two on a school sports team, and three in a long-term care facility (LTCF). Transmission associated with the opening event resulted in one school closure affecting 650 children (9,100 lost person-days of school) and hospitalization of one LTCF resident with COVID-19. These findings demonstrate that opening up settings such as bars, where mask wearing and physical distancing are challenging, can increase the risk for community transmission of SARS-CoV-2, the virus that causes COVID-19. As community businesses begin to reopen, a multicomponent approach should be emphasized in settings such as bars to prevent transmission* (1). This includes enforcing consistent and correct mask use, maintaining ≥6 ft of physical distance between persons, reducing indoor bar occupancy, prioritizing outdoor seating, improving building ventilation, and promoting behaviors such as staying at home when ill, as well as implementing contact tracing in combination with isolation and quarantine when COVID-19 cases are diagnosed.

Acquired HIV drug resistance and virologic monitoring in a HIV hyper-endemic setting in KwaZulu-Natal Province, South Africa.

BACKGROUND: Introduction of tenofovir (TDF) plus lamivudine (3TC) and dolutegravir (DTG) in first- and second-line HIV treatment regimens in South Africa warrants characterization of acquired HIV-1 drug resistance (ADR) mutations that could impact DTG-based antiretroviral therapy (ART). In this study, we sought to determine prevalence of ADR mutations and their potential impact on susceptibility to drugs used in combination with DTG among HIV-positive adults (≥ 18 years) accessing routine care at a selected ART facility in KwaZulu-Natal, South Africa. METHODS: We enrolled adult participants in a cross-sectional study between May and September 2019. Eligible participants had a most recent documented viral load (VL) ≥ 1000 copies/mL after at least 6 months on ART. We genotyped HIV-1 reverse transcriptase and protease genes by Sanger sequencing and assessed ADR. We characterized the effect of ADR mutations on the predicted susceptibility to drugs used in combination with DTG. RESULTS: From 143 participants enrolled, we obtained sequence data for 115 (80%), and 92.2% (95% CI 85.7-96.4) had ADR. The proportion with ADR was similar for participants on first-line ART (65/70, 92.9%, 95% CI 84.1-97.6) and those on second-line ART (40/44, 90.9%, 95% CI 78.3-97.5), and was present for the single participant on third-line ART. Approximately 89% (62/70) of those on first-line ART had dual class NRTI and NNRTI resistance and only six (13.6%) of those on second-line ART had major PI mutations. Most participants (82%) with first-line viraemia maintained susceptibility to Zidovudine (AZT), and the majority of them had lost susceptibility to TDF (71%) and 3TC (84%). Approximately two in every five TDF-treated individuals had thymidine analogue mutations (TAMs). CONCLUSIONS: Susceptibility to AZT among most participants with first-line viraemia suggests that a new second-line regimen of AZT + 3TC + DTG could be effective. However, atypical occurrence of TAMs in TDF-treated individuals suggests a less effective AZT + 3TC + DTG regimen in a subpopulation of patients. As most patients with first-line viraemia had at least low-level resistance to TDF and 3TC, identifying viraemia before switch to TDF + 3TC + DTG is important to avoid DTG functional monotherapy. These findings highlight a need for close monitoring of outcomes on new standardized treatment regimens.

Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020.

BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS: We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS: By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS: Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission.

Sex Differences in HIV Testing - 20 PEPFAR-Supported Sub-Saharan African Countries, 2019.

Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs.

Missed Opportunities to Prescribe Preexposure Prophylaxis in South Carolina, 2013-2016.

Background: Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important human immunodeficiency virus (HIV) prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits that occur prior to HIV infection. Methods: This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, healthcare visits and providers, sexually transmitted diseases (STDs), and other diagnoses were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results: Of 885 persons newly diagnosed during the study period, 586 (66%) had 4029 visits to a healthcare facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine-trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted 10% of visits. Also, 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance. In multivariable analyses, being female, black, or aged <30 years were statistically significant predictors of having prior healthcare visits. Among persons with at least 1 healthcare visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusions: Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition.

Rural-urban differences in HIV viral loads and progression to AIDS among new HIV cases.

OBJECTIVE: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the United States has shifted to the South, where an increasing proportion is occurring in rural areas. We sought to gain a better understanding of the affected rural population in this region. METHODS: The statewide HIV/AIDS Electronic Reporting System database was used to examine the epidemiological characteristics of newly diagnosed HIV cases in South Carolina from 2005 to 2011. Rural-urban differences were examined in sociodemographic and clinical characteristics, including progression to AIDS and a decline in HIV viral load (VL) to undetectable levels within 1 year of diagnosis. RESULTS: Of the 5336 individuals newly diagnosed as having HIV, 1433 (26.9%) were from rural areas. Compared with urban residents, a higher proportion of rural residents were black, non-Hispanic (80.1% vs 68.5%; P ≤ 0.0001) and reported heterosexual risk (28.8% vs 22.9%; P = 0.0007). The proportion of female patients was higher in rural areas (29.7% vs 26.4%; P = 0.016). No significant rural-urban differences were found in initial CD4(+) T-cell and VL counts or proportion obtaining an undetectable VL at 1 year. Rural residents were significantly more likely than urban residents to have AIDS at diagnosis or within 1 year of the HIV diagnosis (adjusted odds ratio 1.15; 95% confidence interval 1.007-1.326). CONCLUSIONS: The reasons behind differences in proportions of rural and urban residents who were diagnosed as having AIDS or progressed to AIDS despite similar initial CD4(+) T-cell counts and VL suppression at 1 year are unclear and should be explored in future studies. Future prevention and treatment efforts may need to consider the unique characteristics of rural populations in the South.

Longitudinal association between BMI at diagnosis and HIV disease progression.

Increased body mass index (BMI) has been associated with adverse health outcomes but the effect of BMI on HIV immune markers over time post-HAART is not clearly established. Data were abstracted from 396 medical records at the Ryan White Clinic in South Carolina. All HIV-infected adults who were ≥18 years of age, diagnosed between 1997 and 2010, had weight and height measured within 3 months of diagnosis and had at least one follow-up visit within 6 months of diagnosis, were eligible. The mean CD4 count was calculated for each BMI category and mixed regression analyses was used to determine the association between BMI and CD4 count over time. The overall mean BMI was 27.4 kg/m(2). Longitudinally, the mean CD4 count was 611.2 cells/mm(3) for obese individuals, 598.1 cells/mm(3) for overweight individuals and 550.5 cells/mm(3) for normal weight individuals. When compared to the normal weight category, the obese category had significantly larger increases in CD4 count (5.5 cells/mm(3), P < 0.001) versus the overweight category (-2.1 cells/mm(3), P < 0.001). HIV-infected individuals who were obese at diagnosis had larger increases in CD4 counts over time when compared to overweight individuals at diagnosis. This suggests that providers should pay closer attention to weight at diagnosis to predict the response to treatment and disease trajectory.

Relationship of HIV care engagement to emergency department utilization.

To determine if HIV primary care engagement (PCE) is associated with Emergency Department (ED) utilization, a retrospective cohort study using the South Carolina HIV surveillance data from January 1986 to December 2006 linked to the hospital discharge data-set was used to assess utilization at statewide EDs during January 2007-December 2010. Suboptimal PCE was defined as <2 reports of a CD4 + T-cell count or viral load value to surveillance in each calendar year from January 2007 to December 2010. Multivariable logistic regression explored associations of HIV PCE with ED utilization after accounting for sociodemographic characteristics and disease stage. Poisson and negative binominal regression examined PCE, sociodemographic characteristics, and disease stage on the frequency of ED utilization. Suboptimal PCE was associated with increased odds of ED utilization for NIR/NRR (no identified risk/no risk reported; aOR [adjusted odds ratio] = 2.25; CI = 1.69-2.99), self-payers (aOR = 1.81; CI = 1.38-2.39), and those diagnosed with an AIDS-defining illness (ADI; aOR = 1.51; CI = 1.14-2.00), who also had the most median ED visits (six). More ED visits were associated with young age, female (incidence rate ratio [IRR] = 1.16; CI = 1.06-1.27), ADI (IRR = 2.17; CI = 1.93-2.45), Medicaid recipients (IRR = 1.34; CI = 1.21-1.49), indigent/charity recipients (IRR = 1.86; CI = 1.57-2.21), or AIDS > 1 year (IRR = 1.23; CI = 1.13-1.35). Fewer visits to the ED were associated with MSM (males having sex with males IRR = 0.81; CI = 0.72-0.90), NIR/NRR (IRR = 0.86; CI = 0.78-0.95), self-payers (IRR = 0.56; CI = 0.50-0.62), or Medicare recipients (IRR = 0.85; CI = 0.77-0.95). Disease stage and insurance type were differentially associated with primary care and ED utilization. There is a need to evaluate HIV primary care systems to increase access and develop interventions to reduce preventable ED visits.

Disease progression and characteristics of HIV-infected women with and without a history of criminal justice involvement.

Early HIV diagnosis followed by prompt linkage to and consistent retention in HIV-related care is important to decrease morbidity and mortality. Progression to AIDS is of particular interest in HIV-positive women with a history of criminal justice-involvement due to their lack of access to care in the community and poor retention in HIV primary care. In this retrospective cohort study, we characterize the risk of developing AIDS among HIV-infected women with and without a history of criminal justice-involvement. Mean time to AIDS diagnosis was longer [123 ± 3.26 months] for women with no criminal justice-involvement when compared to women who were arrested or who went to prison. Women who were arrested (HR: 1.92, 95% CI: 1.43, 2.58) and women who went to prison (HR: 2.27, 95% CI: 1.52, 3.39) had an increased risk of developing AIDS when compared to women without criminal justice-involvement.

Occurrence of new sexually transmitted diseases in males after HIV diagnosis.

Risk reduction following an HIV diagnosis is important for controlling the epidemic. The objective of this retrospective cohort study of 6,965 HIV-positive males was to evaluate the joint risk of new reportable STDs in males after HIV diagnosis by race/ethnicity and risk behavior. This investigation linked HIV case reports with STD surveillance, clinical care and laboratory datasets to determine new STD acquisition in HIV positive individuals.Compared to White MSM with high care engagement,Black MSM had a significantly higher rate of new reportable STDs for the full time period after HIV diagnosis, B1 year after diagnosis, and[1 year after diagnosis. High HIV care engagement was not as protective against new STD acquisition for Black MSM as it was for White MSM and reasons for this health disparity should be explored.

Perceptions and attitudes about preexposure prophylaxis among seronegative partners and the potential of sexual disinhibition.

OBJECTIVES: Preexposure prophylaxis (PrEP) is a promising strategy to prevent human immunodeficiency virus (HIV) infection, especially among high-risk individuals such as seronegative partners; however, many caveats such as the potential risk of sexual disinhibition and noncompliance need to be considered. We explored the sociodemographic and behavioral factors associated with the adoption of PrEP among HIV seronegative men who have sex with men and heterosexual partners. METHODS: A prepiloted self-administered survey was conducted among seronegative partners in a Ryan White HIV/AIDS Clinic in South Carolina from 2010 to 2011. Bivariate and multivariable analyses were used to explore the data. RESULTS: The survey was completed by 89 seronegative partners. The median age was 42 years (interquartile range 32-50) and a majority was men (56%), black (70%), and heterosexual (74%). A majority (94%) was willing to use PrEP if available; however, 26% of subjects suggested that they would be more likely to have unprotected sex with an HIV-positive partner while using PrEP, and 27% suggested that it would be difficult to take a daily dose of PrEP and consistently use condoms. The multivariable results suggest that the belief that a condom is no longer needed while taking PrEP was more likely among those who did not use a condom during their last sexual intercourse (adjusted odds ratio 7.45; 95% confidence interval 1.57-35.45) and among those with a higher HIV knowledge score (adjusted odds ratio 0.43; 95% confidence interval 0.23-0.78). CONCLUSIONS: Overall, these results suggest high acceptability of PrEP among seronegative partners to lower the risk of HIV transmission; however, there is a substantial risk of sexual disinhibition and noncompliance while using PrEP that may be reduced by ongoing education.

Time to linkage to care and viro-immunologic parameters of individuals diagnosed before and after the 2006 HIV testing recommendations.

OBJECTIVES: To assess the time from linkage to care and viro-immunologic parameters before and after implementation of the Centers for Disease Control and Prevention's 2006 revised human immunodeficiency virus (HIV) testing strategy. METHODS: Case reports from South Carolina's enhanced HIV/AIDS (acquired immunodeficiency syndrome) Reporting System were used to compare time to linkage to care and viro-immunologic indicators at diagnosis and 1 year after diagnosis of HIV in individuals diagnosed between 2004 and 2006 (n = 2456) with those diagnosed between 2008 and 2010 (n = 2118). CD4 T-cell count/percent and viral load tests were used as a proxy for a clinical visit and to determine disease stage. RESULTS: Individuals diagnosed between 2008 and 2010 were less likely than those diagnosed between 2004 and 2006 to be in care after 12 months than within 3 months of HIV diagnosis (adjusted odds ratio [AOR] 0.42, 95% confidence interval [CI] 0.34-0.51). Individuals diagnosed between 2008 and 2010 were more likely than those diagnosed between 2004 and 2006 to have high CD4 T-cell counts (>500 cells per cubic millimeter than ≤200 cells per cubic millimeter; AOR 1.24, 95% CI 1.01-1.51) and have undetectable viral loads 1 year post-HIV diagnosis (AOR 8.42, 95% CI 6.96-10.18). Although period of diagnosis did not predict disease stage 1 year post-HIV diagnosis (AOR 0.99, 95% CI 0.87-1.13), there was a decrease from 13% between 2004 and 2006 to 10% between 2008 and 2010 in the percentage of HIV-only patients at diagnosis who progressed to AIDS 1 year post-HIV diagnosis. CONCLUSIONS: Implementation of routine, opt-out HIV testing resulted in more timely linkage to care and improved viro-immunologic parameters 1 year postdiagnosis when compared with the previous testing recommendations.

Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial.

IMPORTANCE: To increase human immunodeficiency virus (HIV) testing rates, many institutions and jurisdictions have revised policies to make the testing process rapid, simple, and routine. A major issue for testing scale-up efforts is the effectiveness of HIV risk-reduction counseling, which has historically been an integral part of the HIV testing process. OBJECTIVE: To assess the effect of brief patient-centered risk-reduction counseling at the time of a rapid HIV test on the subsequent acquisition of sexually transmitted infections (STIs). DESIGN, SETTING, AND PARTICIPANTS: From April to December 2010, Project AWARE randomized 5012 patients from 9 sexually transmitted disease (STD) clinics in the United States to receive either brief patient-centered HIV risk-reduction counseling with a rapid HIV test or the rapid HIV test with information only. Participants were assessed for multiple STIs at both baseline and 6-month follow-up. INTERVENTIONS: Participants randomized to counseling received individual patient-centered risk-reduction counseling based on an evidence-based model. The core elements included a focus on the patient's specific HIV/STI risk behavior and negotiation of realistic and achievable risk-reduction steps. All participants received a rapid HIV test. MAIN OUTCOMES AND MEASURES: The prespecified outcome was a composite end point of cumulative incidence of any of the measured STIs over 6 months. All participants were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum (syphilis), herpes simplex virus 2, and HIV. Women were also tested for Trichomonas vaginalis. RESULTS: There was no significant difference in 6-month composite STI incidence by study group (adjusted risk ratio, 1.12; 95% CI, 0.94-1.33). There were 250 of 2039 incident cases (12.3%) in the counseling group and 226 of 2032 (11.1%) in the information-only group. CONCLUSION AND RELEVANCE: Risk-reduction counseling in conjunction with a rapid HIV test did not significantly affect STI acquisition among STD clinic patients, suggesting no added benefit from brief patient-centered risk-reduction counseling. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01154296.

Mixtures of sediment chemical contaminants at freshwater sampling sites across Europe with different contaminant burdens.

Extended chemical analyses of fluvial sediments were undertaken to establish the key pollutant pressures and mixtures present across nine European Union inland waterways. A wide range of chemical components and physical parameters were investigated including substances from the EU Priority List and Watch List. The data set was examined for key indicator compounds, however it was found that a wide range of pollution pressures were present in the different sediments including organic hydrocarbons, metal(loid)s, nutrients, polycyclic aromatic hydrocarbon (PAH), polychlorinated biphenyl (PCB) compounds, perfluoroalkyl and polyfluoroalkyl substances and pesticides, some of which exceeded regulatory guidance at different sampling points. The presence of such a wide range of compounds underpins the complex chemical composition of sediments that have acted as sinks for many decades absorbing contaminants from urban, industrial and agricultural sources. This dataset has been used to describe average overall toxicity of the sediments sampled, a calculation which was based on key components identified by Principal Component Analysis (PCA) and for those that had existing freshwater sediment regulatory values. A total of 33 components were used including PCBs, PAHs, metal(iod)s and pesticides. This analysis reflected the contamination of each site, with most indicating some level of toxicity during the sampling period. Watch List chemicals triclosan (TCS) and diclofenac (DIC) were also investigated; levels were relatively low, typically 10-100's ng L-1, however they were present at all sampling sites. The dataset is available as a resource for future chemical, and toxicological, sediment analysis comparisons.

HIV testing among Deep South residents with serious psychological distress.

OBJECTIVE: To describe the prevalence of serious psychological distress among Deep South residents and human immunodeficiency virus (HIV) testing among Deep South residents with serious psychological distress. METHODS: Data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey from Georgia, Louisiana, Mississippi, and South Carolina were used for this study. Andersen's behavioral model of health care use provided the conceptual framework for the study. The Kessler 6 was used to dichotomize the sample as having or not having serious psychological distress. chi2 Test and multivariate logistic regression analyses were performed on the weighted data. RESULTS: Only 5.7% of our sample had experienced serious psychological distress in the past 30 days. A majority proportion of persons with serious psychological distress (54.9%) had been tested for HIV. HIV testing was slightly more prevalent among males with serious psychological distress (63%) than females with serious psychological distress (60%). Predisposing factors (age, race/ethnicity, and urbanization) were confounders of HIV testing among both males and females with serious psychological distress. Enabling factors (income, health care access) were only confounders of HIV testing among males with serious psychological distress. CONCLUSION: Future HIV prevention and management efforts should consider the potential role of concurrent serious psychological distress in impacting an individual's daily life and health activities such as self-care, caring for family, and maintaining employment.

Preexposure prophylaxis for HIV infection: healthcare providers' knowledge, perception, and willingness to adopt future implementation in the southern US.

BACKGROUND: Understanding providers' perspective on preexposure prophylaxis (PrEP) would facilitate planning for future implementation. METHODS: A survey of care providers from sexually transmitted disease and family planning clinics in South Carolina and Mississippi was conducted to assess their knowledge, perception, and willingness to adopt PrEP. Multivariable logistic and general linear regression with inverse propensity score treatment weights were used for analyses. RESULTS: Survey response rate was 360/480 (75%). Median age was 46.9 years and a majority were women (279 [78%]), non-Hispanic white (277 [78%]), nonphysicians (254 [71%]), and public health care providers (223 [62%]). Knowledge about PrEP was higher among physicians compared with nonphysicians (P = 0.001); nonpublic health care providers compared with public health care providers (P = 0.023), and non-Hispanic whites compared with non-Hispanic blacks (P = 0.034). The majority of the providers were concerned about the safety, efficacy, and cost of PrEP. Providers' perceptions about PrEP were significantly associated with their sociodemographic and occupational characteristics. The willingness to prescribe PrEP was more likely with higher PrEP knowledge scores (adjusted odds ratio [aOR] 14.94; 95% confidence interval [CI] 3.21-69.61), older age (aOR 1.14; 95% CI 1.01-1.29), and in those who agreed that "PrEP would empower women" (aOR 2.90; 95% CI 1.28-6.61); and was less likely for "other" race/ethnicity versus white (aOR 0.23; 95% CI 0.07-0.76) and in those who agreed that "PrEP, if not effective, could lead to higher HIV transmission" (aOR 0.45; 95% CI 0.27-0.75). CONCLUSIONS: To improve the acceptance of PrEP among providers, there is a need to develop tailored education/training programs to alleviate their concerns about the safety and efficacy of PrEP.

Delivering laboratory results by text message and e-mail: a survey of factors associated with conceptual acceptability among STD clinic attendees.

OBJECTIVE: This study examines factors associated with the acceptability of receiving sexually transmitted disease (STD) laboratory results by text message and e-mail among clinic attendees. SUBJECTS AND METHODS: An anonymous self-administered survey was conducted with a convenience sample of STD clinic attendees in South Carolina and Mississippi in 2009-2010. In total, 2,719 individuals with a median age of 26 years (interquartile range, 21-32 years) completed the survey. RESULTS: More than 70% had Internet access at home, and 80% reported using text messaging daily. Participants preferred receiving laboratory results by text message compared with e-mail (50.2% versus 42.3%; p<0.001). Acceptability of receiving laboratory results by text message was higher with younger age (adjusted odds ratio [aOR] 1.13; 95% confidence interval [CI] 1.10-1.26), daily use of text messaging (aOR 1.30; 95% CI 1.14-1.49), and reporting cell phone and text message as the preferred choice of regular communication with the clinic (aOR 2.31; 95% CI 1.50-3.58) and was significantly lower in female subjects (aOR 0.89; 95% CI 0.81-0.98) and those with college-level education (aOR 0.88; 95% CI 0.77-0.99). CONCLUSIONS: A majority of STD clinic attendees have access to cell phones and Internet. The acceptability of receiving STD laboratory results electronically may facilitate test result delivery to patients and expedite treatment of infected individuals.

SARS-CoV-2 Infection Among Pregnant People at Labor and Delivery and Changes in Infection Rates in the General Population: Lessons Learned From Illinois.

OBJECTIVES: The Illinois Department of Public Health (IDPH) assessed whether increases in the SARS-CoV-2 test positivity rate among pregnant people at labor and delivery (L&D) could signal increases in SARS-CoV-2 prevalence in the general Illinois population earlier than current state metrics. MATERIALS AND METHODS: Twenty-six birthing hospitals universally testing for SARS-CoV-2 at L&D voluntarily submitted data from June 21, 2020 through January 23, 2021, to IDPH. Hospitals reported the daily number of people who delivered, SARS-CoV-2 tests, and test results as well as symptom status. We compared the test positivity rate at L&D with the test positivity rate of the general population and the number of hospital admissions for COVID-19-like illness by quantifying correlations in trends and identifying a lead time. RESULTS: Of 26 633 reported pregnant people who delivered, 96.8% (n = 25 772) were tested for SARS-CoV-2. The overall test positivity rate was 2.4% (n = 615); 77.7% (n = 478) were asymptomatic. In Chicago, the only region with a sufficient sample size for analysis, the test positivity rate at L&D (peak of 5% on December 7, 2020) was lower and more stable than the test positivity rate of the general population (peak of 14% on November 13, 2020) and lagged hospital admissions for COVID-19-like illness (peak of 118 on November 15, 2020) and the test positivity rate of the general population by about 10 days (Pearson correlation = 0.73 and 0.75, respectively). PRACTICE IMPLICATIONS: Trends in the test positivity rate at L&D did not provide an earlier signal of increases in Illinois's SARS-CoV-2 prevalence than current state metrics did. Nonetheless, the role of universal testing protocols in identifying asymptomatic infection is important for clinical decision making and patient education about infection prevention and control.

Predictors of time to enter medical care after a new HIV diagnosis: a statewide population-based study.

Public health benefits of expanded HIV screening will be adequately realized only if an early diagnosis is followed by prompt linkage to care. We characterized rates and factors associated with failure to enter into medical care within three months of HIV diagnosis and assessed the predictors of time to enter care over a follow-up period of up to 60 months. The study cohort included 3697 South Carolina (SC) residents' ≥13 years who were newly HIV-diagnosed in 2004-2008. Date of first laboratory report of CD4(+) T-cell count or viral load (VL) test after 30 days of confirmatory HIV diagnosis was used to define time to linkage to care. Results showed that of the total 3697 persons, 1768 (48%) entered care within three months, 1115 (30%) in four-12 months after diagnosis, and 814 (22%) failed to initiate care within 12 months of HIV diagnosis. At the end of study follow-up period of up to 60 months from the date of HIV diagnosis, 472/3697 (13%) individuals remained out of care. Multivariable Cox proportional hazards analysis showed that compared with hospitals, time to enter care was shorter in those diagnosed at state mental health/correctional facilities (adjusted hazards ratio [aHR] 1.16; 95% confidence interval [CI] 1.02-1.34) and longer in those diagnosed at county health departments (aHR 0.87; 95% CI 0.80-0.96) and at "Other/unknown" facilities (aHR 0.79; 95% CI 0.70-0.89). Time to entry into care was longer for men (aHR 0.82; 95% CI 0.75-0.89) compared with women, blacks (aHR 0.91; 95% CI 0.83-0.98) compared with whites, and males who have sex with males (MSM) (aHR 0.89; 95% CI 0.80-0.98) compared with heterosexual exposure. Delayed entry into HIV care remains a challenge in controlling HIV transmission in SC. Better integration of testing and care facilities could improve the proportion of newly HIV-diagnosed persons who enter care in a timely manner.

Demographic characteristics and behavioral risk factors of HIV infection and association with survival among individuals 50 years or older.

OBJECTIVES: To investigate the association of socio-behavioral characteristics and viro-immunological status with survival in a cohort of HIV-infected individuals by age in South Carolina (SC). METHODS: Logistic regression was used to compare the characteristics of individuals' ≥50 years old to individuals 20-49 years old at HIV diagnosis who were reported to SC enhanced HIV/AIDS Reporting System (eHARS) from January 1998 to December 2009. Cox proportional hazards analysis was used to examine the time to death after HIV diagnosis over the study period. RESULTS: Of the 7531 participants, 1204 (16%) were ≥50 years old. Multivariable analyses suggested that individuals ≥50 years old were more likely to have simultaneous AIDS (aOR 1.80, 95% CI 1.54-2.10). For individuals ≥50 years old, the risk of death was more than three times when compared to the younger age group (HR: 3.46, 95% CI 2.27, 5.30). CONCLUSION: Routine HIV screening may decrease late-stage diagnosis and improved linkage to care may decrease mortality in older adults.