The Implementation of CDC COVID-19 Recommendations for Testing, Isolation, Quarantine and Movement at Emergency Intake Sites of Unaccompanied Children in the United States, April 1-May 31, 2021.

In March 2021, Emergency Intake Sites (EIS) were created to address capacity shortfalls during a surge of Unaccompanied Children at the Mexico-United States land border. The COVID-19 Zone Plan (ZP) was developed to decrease COVID-19 transmission. COVID-19 cumulative percent (%) positivity was analyzed to evaluate the impact of the ZP, venue type and bed capacity across EIS from April 1-May 31, 2021. Results: Of 11 EIS sites analyzed, 54% implemented the recommended ZP. The overall % positivity was 2.47% (95% CI 2.39-2.55). The % positivity at EIS with the ZP, 1.83% (95% CI 1.71-1.95), was lower than that at EIS without the ZP, 2.83%, ( 95% CI 2.72-2.93), and showed a lower 7-day moving average of % positivity. Conclusion: Results showed a possible effect of the ZP on % positivity when controlling for venue type and bed capacity in a specific EIS group comparison, indicating that all three variables could have had effect on % positivity. They also showed that smaller intake facilities may be recommendable during public health emergencies.

Low and Decreasing Prevalence and Rate of False Positive HIV Diagnosis - Chókwè District, Mozambique, 2014-2017.

In 2017, rapid human immunodeficiency virus (HIV) testing services enabled the HIV diagnosis and treatment of approximately 15.3 million persons with HIV infection in sub-Saharan Africa with life-saving antiretroviral therapy (ART) (1). Although suboptimal testing practices and misdiagnoses have been reported in sub-Saharan Africa and elsewhere, trends in population burden and rate of false positive HIV diagnosis (false diagnosis) have not been reported (2,3). Understanding the population prevalence and trends of false diagnosis is fundamental for guiding rapid HIV testing policies and practices. To help address this need, CDC analyzed data from 57,655 residents aged 15-59 years in the Chókwè Health and Demographic Surveillance System (CHDSS) in Mozambique to evaluate trends in the rate (the percentage of false diagnoses among retested persons reporting a prior HIV diagnosis) and population prevalence of false diagnosis. From 2014 to 2017, the observed rate of false diagnosis in CHDSS decreased from 0.66% to 0.00% (p<0.001), and the estimated population prevalence of false diagnosis decreased from 0.08% to 0.01% (p = 0.0016). Although the prevalence and rate of false diagnosis are low and have decreased significantly in CHDSS, observed false diagnoses underscore the importance of routine HIV retesting before ART initiation and implementation of comprehensive rapid HIV test quality management systems (2,4,5).

Respondent driven sampling for HIV biological and behavioral surveillance in Latin America and the Caribbean.

Since 2005, respondent driven sampling (RDS) has been widely used for HIV biological and behavioral surveillance surveys (BBSS) in Latin America and the Caribbean (LAC). In this manuscript, we provide a focused review of RDS among hard-to-reach high-risk populations in LAC and describe their principal operational, design, and analytical considerations. We reviewed published and unpublished reports, protocols, and manuscripts for RDS studies conducted in LAC between January 1, 2005 and December 31, 2011. We abstracted key operational information and generated summary statistics across all studies. Between 2005 and 2011, 87 RDS studies were conducted in 15 countries in LAC (68 % in South America, 18 % in Mexico and Central America, and 14 % in the Caribbean). The target populations were primarily men who have sex with men (43 %), sex workers (29 %), and drug users (26 %). Study considerations included establishing clear eligibility criteria, measuring social network sizes, collecting specimens for biological testing, among others. Most of the reviewed studies are the first in their respective countries to collect data on hard-to-reach populations and the first attempt to use a probability-based sampling method. These RDS studies allowed researchers and public health practitioners in LAC to access hard-to-reach HIV high-risk populations and collect valuable data on the prevalence of HIV and other infections, as well as related risk behaviors.

Short communication: HIV incidence among vulnerable populations in Honduras: results from an integrated behavioral and biological survey among female sex workers, men who have sex with men, and Garifuna in Honduras, 2006.

Honduras has one of the highest HIV prevalence rates in Central America. Data on HIV incidence are needed to identify groups at greatest need of prevention interventions to inform the national HIV response. We applied a test for recent infection to HIV-positive specimens from a biological and behavioral survey to estimate assay-derived incidence among men who have sex with men (MSM), female sex workers (FSW), and the Garifuna population in Honduras. Assay-derived estimates were compared to the mathematically modeled estimates in the same populations to assess plausibility of the assay-based estimates. Assay-derived incidence was 1.1% (95% CI 0.2-2.0) among MSM, 0.4% (95% CI 0.1-0.8) among the Garifuna, and 0% (95% CI 0-0.01) among FSWs. The modeled incidence estimates were similar at 1.03% among MSM, 0.30% among the Garifuna, and 0.23% among FSWs. HIV incidence based on the assay was highest among MSM in Honduras, lowest among FSWs, and similar to modeled incidence in these groups. Targeted programs on HIV prevention, care, and treatment are urgently needed for the MSM population. Continued support for existing prevention programs for FSWs and Garifuna are recommended.

Correlates of bisexual behaviors among men who have sex with men in El Salvador.

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30-5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01-9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26-0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22-0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.

HIV and STI control in El Salvador: results from an integrated behavioural survey among men who have sex with men.

OBJECTIVE: This cross-sectional study investigates HIV, other sexually transmitted infections (STI), and risk behaviours among men who have sex with men (MSM) in two cities in El Salvador. METHODS: Respondent-driven sampling (RDS) was used to recruit MSM in the cities of San Salvador and San Miguel, El Salvador. Participants responded to questions about HIV risk behaviours; and blood, urine and anal swabs were collected. Blood samples were tested for herpes simplex type 2, syphilis and HIV infection. Urine and anal samples were tested by polymerase chain reaction (PCR) for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. HIV-positive samples were tested with the BED capture enzyme immunoassay to distinguish recent from longstanding HIV infection. We estimated population-adjusted prevalence of behavioural variables, STI and HIV, and identified risk factors for HIV. RESULTS: The final sample included 596 and 195 MSM in San Salvador and San Miguel, respectively. Consistent condom use was low across all partner types as was recent HIV testing. RDS-adjusted HIV prevalence was 10.8% (95% CI 7.4% to 14.7%) in San Salvador, and 8.8% (95% CI 4.2% to 14.5%) in San Miguel. The proportion of recent testing among HIV-positive samples was 20%. Prevalence of any bacterial STI by PRC testing was 12.7% (95% CI 8.2% to 17.5%) in San Salvador, and 9.6% (95% CI 4.9% to 15.4%) in San Miguel. CONCLUSIONS: We found a high prevalence of HIV, high levels of recent infection, and low condom usage. In El Salvador, targeted interventions towards MSM are needed to promote condom use, as well as to diagnose, treat and prevent HIV and other STIs.

Unsafe sexual behaviors among HIV-positive men and women in Honduras: the role of discrimination, condom access, and gender.

BACKGROUND: We conducted a study among HIV-positive men and women in Honduras to describe demographics, HIV risk behaviors and sexually transmitted infection prevalence, and identify correlates of unsafe sex. METHODS: Participants were recruited from HIV clinics and nongovernmental organizations in Tegucigalpa and San Pedro Sula, Honduras in a cross-sectional study in 2006. We used audio-assisted computer interviews on demographics; behaviors in the past 12 months, 6 months, and 30 days; and access to care. Assays performed included herpes (HSV-2 Herpes Select), syphilis (rapid plasma reagin [RPR] and Treponema pallidum particle agglutination assay [TPPA]) serology, and other sexually transmitted infections by polymerase chain reaction (PCR). Bivariate and multivariate analyses were conducted to assess variables associated with unprotected sex across all partner types in the past 12 months. RESULTS: Of 810 participants, 400 were from Tegucigalpa and 410 from San Pedro Sula; 367 (45%) were men. Mean age was 37 years (interquartile range: 31-43). Consistent condom use for men and women was below 60% for all partner types. In multivariate analysis, unprotected sex was more likely among women (odds ratio [OR]: 1.9, 95% confidence interval [CI]: 1.2-3.1, P = 0.007), those with HIV diagnoses within the past year (OR: 2.0, 95% CI: 1.1-3.7, P = 0.016), those reporting difficulty accessing condoms (OR: 2.6, 95% CI: 1.4-4.7, P = 0.003), and those reporting discrimination (OR: 1.8, 95% CI: 1.1-3.0, P = 0.016). CONCLUSIONS: Programs targeting HIV-positive patients need to address gender-based disparities, improve condom access and use, and help establish a protective legal and policy environment free of stigma and discrimination.

Transmitted drug resistance and type of infection in newly diagnosed HIV-1 individuals in Honduras.

BACKGROUND: Transmitted drug resistance (TDR) reduces the efficacy of antiretroviral treatment and is a public health concern. OBJECTIVES: To gain insight in the epidemiology of TDR in Honduras by evaluating the amount of TDR in a representative sample of newly diagnosed individuals and by determining whether these are recent or established infections. STUDY DESIGN: Two hundred treatment-naïve, newly diagnosed HIV-positive individuals representing different population groups (general population, Garifunas ethnic group, female sex workers and men who have sex with men) and different geographic regions were enrolled during April 2004-April 2007. The HIV-1 pol gene was sequenced to identify drug-resistant mutations and TDR was scored as recommended by the WHO. Specimens were classified as recent or established infections using the BED assay. RESULTS: Among 200 samples analyzed from Honduran patients the prevalence of TDR was 7% (95% CI: 3.9-11.5%), 5% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 3% for nucleoside reverse transcriptase inhibitors (NRTIs) and 0.5% for protease inhibitors (PIs). Testing of these samples with the BED assay revealed that 12% of the specimens were associated with recent infections. TDR was significantly more common in specimens with recent infection (21%) than established infection (5%) (p=0.016). CONCLUSIONS: The prevalence of TDR in Honduras was moderate (7%). The percentage of specimens who were recently infected was low (12%), suggesting that late HIV diagnosis is common. The TDR prevalence was higher in recent than in established infections, which may indicate that TDR is increasing over time. The higher prevalence of NNRTI and NRTI mutations as compared to PI mutations is probably due to a broader and longer use of these drugs in Honduras.

High rates of STD and sexual risk behaviors among Garífunas in Honduras.

BACKGROUND: Honduras has the highest concentration of HIV and AIDS cases in Central America, with an estimated adult HIV prevalence of 1.5%. Prevalence is higher among certain ethnic groups such as the Garífuna with a reported HIV prevalence of 8%. METHODS: A biological and behavioral survey was conducted on a stratified random sample of the Garífuna population in Honduras, using computer-assisted interviews. Blood was tested for HIV, herpes simplex type 2 (HSV-2), and syphilis; urine was tested for Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis, and Mycoplasma genitalum. RESULTS: We enrolled a total of 817 participants, 41% female and 51% male. Estimated prevalences and 95% confidence intervals (CI) were: HIV, 4.5% (95% CI: 3.0 to 6.6), HSV-2, 51.1% (95% CI: 46.7 to 55.6), and syphilis seropositivity, 2.4% (95% CI: 1.4 to 4.0). Sexually transmitted infections in urine were: chlamydia, 6.8% (95% CI: 4.7 to 9.7), gonorrhea, 1.1% (95% CI: 0.4 to 2.9), trichomoniasis, 10.5% (95% CI: 8.1 to 13.6), and Mycoplasma genitalium, 7.1% (95% CI: 5.1 to 9.9). Consistent condom use was low with stable (10.6%) and casual (41.4%) partners. In multivariate analysis, HIV was associated with rural residence. HSV-2 was associated with female sex, older age, and syphilis seropositivity. CONCLUSIONS: We found a moderate prevalence of HIV and a high prevalence of HSV-2 among the Garífunas. HSV-2 may increase the vulnerability of these populations to HIV in the future. Intervention strategies should emphasize sexually transmitted infection control and condom promotion, specifically targeting the Garífuna population.

Assessing and monitoring vaccination coverage levels: lessons from the Americas

Según lo establecido por la Organización Panamericana de la Salud (OPS), conseguir una alta cobertura de vacunación es una meta esencial para la Región de las Américas. Es indispensable lograr niveles de cobertura de 95 por ciento o mayores para poder alcanzar los objetivos de la OPS de eliminar el sarampión y la rubéola, controlar las enfermedades prevenibles mediante la vacunación, y hacer perdurar la eliminación de la poliomielitis en territorio americano. Para poder alcanzar esos niveles, es imprescindible que las estadísticas de vacunación sean fiables y que las autoridades sanita- rias midan y monitoreen los niveles de cobertura a lo largo del tiempo. Los métodos elegidos por los directores de los programas de vacunación para calcular la cobertura dependerán de la información que haga falta. En general, los directores del Programa Ampliado de Inmunización (PAI) necesitarán información acerca de la cobertura para poder: 1) determinar la verdadera cobertura en los niveles nacional y local, 2) determinar cuán adecuada es la cobertura en una zona determinada, 3) monitorear las tendencias a lo largo del tiempo, y 4) monitorear las actividades de vacunación mientras se están llevando a cabo. Para lograr lo primero -determinar cuáles son los niveles verdaderos de cobertura-, los administradores tienen dos opciones: a) valerse de los datos acerca de las dosis administradas (es decir, el número de dosis de la vacuna que se ha administrado, dividido por la población que debió recibir una dosis) o b) llevar a cabo una encuesta para determinar la cobertura. Para lograr lo segundo -saber si la cobertura en una zona determinada es adecuada (por ej., mayor de 90 por ciento)-, se puede realizar un muestreo por lotes para garantizar la calidad (MLGC). El MLGC es una metodología de encuesta basada en el uso de muestras pequeñas que permite determinar si la cobertura en una zona determinada es adecuada o no, pero no sirve para estimar el nivel de cobertura. Para el tercer propósito -monitorear las tendencias a lo largo del tiempo-, se pueden usar los datos correspondientes al número de dosis administradas. Para lograr el cuarto propósito -determinar si procede vacunar o llevar a cabo una campaña de vacunación u otra actividad afín-, la "herramienta de monitoreo rápido" creada por la OPS es una magnífica solución. Cada uno de estos métodos posee ventajas y desventajas. Los datos sobre el número de dosis...

Comparison of HIV infection risk behaviors among injection drug users from East and West Coast US cities.

This study assessed whether behavioral differences explained higher human immunodeficiency virus (HIV) seroprevalence among injection drug users (IDUs) in three East Coast versus two West Coast cities in the United States. Sociodemographic, sexual, and injecting information were collected during semiannual face-to-face interviews. Baseline data from New York City; Baltimore, Maryland; and New Haven, Connecticut, were compared with data from Los Angeles, California, and San Jose, California. Among 1,528 East Coast and 1,149 West Coast participants, HIV sero-prevalence was 21.5% and 2.3%, respectively (odds ratio [OR] 11.9; 95% confidence interval [CI] 7.9-17.8). HIV risk behaviors were common among IDUs on both coasts, and several were more common among West Coast participants. Adjusting for potential risk factors, East (vs. West) Coast of residence remained highly associated with HIV status (adjusted OR 12.14; 95% CI 7.36-20.00). Differences in HIV sero-prevalence between East and West Coast cities did not reflect self-reported injection or sexual risk behavior differences. This suggests that other factors must be considered, such as the probability of having HIV-infected injection or sexual partners. Prevention efforts are needed on the West Coast to decrease HIV-associated risk behaviors among IDUs, and further efforts are also needed to reduce HIV incidence on the East Coast.

Variability in the incidence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among young injecting drug users in New York City.

Cohort studies of young (aged 18-30 years) injecting drug users recruited in 1997-1999 in the Harlem and Lower East Side areas of New York City, New York, were used to assess the incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The authors found that HIV incidence was low at both sites: 0.8/100 person-years at the Harlem site and 0/100 person-years at the Lower East Side site. In contrast, HBV incidence was moderate (12.2/100 person-years) at the Harlem site and high (30.7/100 person-years) at the Lower East Side site. Similarly, HCV incidence was moderate (9.3/100 person-years) at the Harlem site and high (34.0/100 person-years) at the Lower East Side site. Results show that high rates of HBV and HCV transmission do not imply high rates of HIV transmission, even within an area of high HIV seroprevalence.

Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment.

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.

El predominio heterosexual del SIDA en la República Dominicana / AIDS heterosexual predominance in the Dominican Republic

Se exponen los datos de evolución del SIDA en la República Dominicana durante el período comprendido entre 1983 y 1989. La definición del SIDA se basó en una prueba serológica positiva para el virus de la inmunodeficiencia humana (VIH) y los criterios clínicos estándares. Se notificaron al Ministerio de Salud 1 202 casos de SIDA (820 varones, 372 mujeres y 10 de sexo no verificado), con una tasa global de 17 casos por 100 000 personas. Se apreció una evolución rápida de la epidemia, habiéndose notificado 43 por ciento del total de casos en 1989. La exposición heterosexual dio cuenta de 53 por ciento (593) de los casos, con una razón varones/mujeres de 2,2:1, lo cual sugiere un país con patrón I/II según los criterios de la OMS. La prevalencia fue máxima en las zonas turísticas urbanas de Santo Domingo y Puerto Plata y sus alrededores y en los distritos de alta concentración de barracas de plantaciones de azúcar, en donde trabajan y viven trabajadores de Haití y de la República Dominicana. Se describe la distribución de casos de SIDA según las categorías de transmisión-exposición, edad, sexo, año del diagnóstico y distrito. El Programa Nacional de Vigilancia del SIDA podría mejorarse si se validaran las categorías de exposición-transmisión investigando determinados casos y se mejorara la notificación mediante la capacitación del personal de salud asistencial. Los datos de vigilancia epidemiológica contribuirán a que las actividades de salud pública futuras se dirijan a las regiones y personas expuestas a mayor riesgo

El predominio heterosexual del SIDA en la República Dominicana / AIDS heterosexual predominance in the Dominican Republic

Se exponen los datos de evolución del SIDA en la República Dominicana durante el período comprendido entre 1983 y 1989. La definición del SIDA se basó en una prueba serológica positiva para el virus de la inmunodeficiencia humana (VIH) y los criterios clínicos estándares. Se notificaron al Ministerio de Salud 1 202 casos de SIDA (820 varones, 372 mujeres y 10 de sexo no verificado), con una tasa global de 17 casos por 100 000 personas. Se apreció una evolución rápida de la epidemia, habiéndose notificado 43 por ciento del total de casos en 1989. La exposición heterosexual dio cuenta de 53 por ciento (593) de los casos, con una razón varones/mujeres de 2,2:1, lo cual sugiere un país con patrón I/II según los criterios de la OMS. La prevalencia fue máxima en las zonas turísticas urbanas de Santo Domingo y Puerto Plata y sus alrededores y en los distritos de alta concentración de barracas de plantaciones de azúcar, en donde trabajan y viven trabajadores de Haití y de la República Dominicana. Se describe la distribución de casos de SIDA según las categorías de transmisión-exposición, edad, sexo, año del diagnóstico y distrito. El Programa Nacional de Vigilancia del SIDA podría mejorarse si se validaran las categorías de exposición-transmisión investigando determinados casos y se mejorara la notificación mediante la capacitación del personal de salud asistencial. Los datos de vigilancia epidemiológica contribuirán a que las actividades de salud pública futuras se dirijan a las regiones y personas expuestas a mayor riesgo

El predominio heterosexual del SIDA en la Republica Dominicana

Se exponen los datos de evolucion del SIDA en la Republica Dominicana durante el periodo comprendido entre 1983 y 1989. La definicion del SIDA se baso en una prueba serologica positiva para el virus de la inmunodeficiencia humana (VIH) y los criterios clinicos estandares. Se notificaron al Ministerio de Salud 1202 casos de SIDA (820 varones, 372 mujeres y 10 de sexo no verificado), con una tasa global de 17 casos por 100.000 personas. Se aprecio una evolucion rapida de la epidemia, habiendose notificado 43 por ciento del total de casos en 1989. Se describe la destribuicion de casos de SIDA segun las categorias de transmision - exposicion, edad, sexo, ano del diagnostico y distrito.(AU)