Using laboratory surveillance data to estimate engagement in care among persons living with HIV in Los Angeles County, 2009.

Poor engagement in HIV care has been associated with delayed access to antiretroviral treatment and increased HIV transmission. Using viral load (VL) results from HIV laboratory surveillance data to conduct longitudinal and cross-sectional analyses, we examined linkage to care, retention in care, and their associated factors in 37,325 persons living with HIV (PLWH) in Los Angeles County (LAC). Linkage to care was considered timely if a VL test result was present ≤3 months of diagnosis. Successful retention in care was defined as having two or more VL test results ≥90 days apart during 2009. Of 6841 persons newly diagnosed with HIV in 2007-2009, 67% were linked to care within 3 months of diagnosis. Factors associated with delayed linkage to care included being African American, Latino, and Asian/Pacific Islander (adjusted hazard ratio [AHR]=0.81; 95% CI=0.75-0.87, AHR=0.83; 95% CI=0.77-0.89, AHR=0.82; 95% CI=0.71-0.94, respectively). Of the 37,325 PLWH, 52% were retained in care during 2009. Factors associated with lack of retention in care included injection drug use (adjusted prevalence ratio [APR]=0.88; 95% CI=0.84-0.93), incarceration at diagnosis (APR=0.56; 95% CI=0.51-0.61), being diagnosed in pre-highly active antiretroviral therapy (HAART) era (APR=0.94; 95% CI=0.92-0.96) or at a public facility (APR=0.97; 95% CI=0.95-1.00), age <45 years (APR=0.87; 95% CI=0.86-0.89), and having concurrent HIV/AIDS diagnoses (APR=0.94; 95% CI=0.92-0.96). This study demonstrates the value of using VL surveillance data to monitor engagement in care among PLWH, and its potential to improve linkage and retention efforts where disparities in care are observed.

Factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles.

Latinos are more likely to test late for HIV infection compared to other racial/ethnic groups in the United States. A population-based interview study was used to examine factors associated with late HIV testing for Latinos diagnosed with AIDS in Los Angeles County (LAC) to develop more effective HIV testing outreach strategies. Latinos testing for HIV within one year of an AIDS diagnosis were considered as late testers, while those diagnosed with AIDS more than one year after an HIV diagnosis were defined as non-late testers. After adjusting for age, education, country of birth, and injection drug use in a logistic regression analysis, completion of the interview in Spanish was the main factor associated with late testing (adjusted Odds Ratio (AOR) = 2.9, 95% Confidence Intervals (CIs): 1.4, 6.0). Latinos testing late for HIV were also more likely to test due to illness (p<0.0001) and less likely to test as part of a clinical screening (p<0.0001). Late testers were more likely to receive their first positive HIV test as a hospital inpatient (p<0.0001) and less likely to test positive at a community health center or public clinic (p=0.05). To accomplish widespread and timely HIV testing for Latinos in LAC, Spanish-language social marketing campaigns are needed and Spanish-speaking patients should be offered HIV testing in all clinical settings.

Demographic characteristics and sexual behaviors associated with methamphetamine use among MSM and non-MSM diagnosed with AIDS in Los Angeles County.

Demographic and behavioral factors associated with methamphetamine use are presented for 455 men who have sex with men (MSM) and 228 non-MSM diagnosed with AIDS in Los Angeles County (LAC) from 2000 to 2004, as there are limited population-based data for these subgroups. Lifetime methamphetamine use was 35% for MSM, 14% for non-MSM, 50% for white MSM, and 35% for black MSM. Methamphetamine use in the previous 12 months among MSM (11%) and non-MSM (0.4%) was less than lifetime use. Compared to MSM with no history of methamphetamine use in a multivariate analysis, MSM methamphetamine users were more likely to be non-Latino (white or black) (OR = 2.8, 95% CI: 1.6, 4.9) compared to Latino and reported > or = 10 sexual partners in the previous 12 months (OR = 3.1, 95% CI: 1.7, 5.6). These data indicate that methamphetamine has been widely used by both MSM and non-MSM with AIDS in LAC and that lifetime use is associated with sexual risk behaviors among MSM.

High incidence of HIV-associated mortality among black and Hispanic infants and women of childbearing age in the United States 1990-2001.

This study examined HIV-associated mortality in infants and in women of childbearing age (15-44 years) in the United States from 1990-2001. HIV-associated deaths were identified from national vital records using multiple cause-of-death data. HIV-associated mortality was higher in black and Hispanic women than in white women (rate ratio(black) = 13.5, 95% CI = 13.2-13.8; rate ratio(Hispanic) = 2.4, 95% CI = 1.9-3.2). Racial/ethnic trends in infant mortality rates from HIV reflected trends observed in women (rate ratio(black) = 16.3, 95% CI = 13.5-19.7; rate ratio(Hispanic) = 3.4, 95% CI = 3.3-3.5). HIV-associated mortality decreased in infants and in women of childbearing age following the availability of highly active antiretroviral therapy, but the decrease was considerably less marked in black women than in women of other racial/ethnic groups. Our findings indicate the need for increased emphasis on prevention of HIV mortality in black and Hispanic women and infants. Reduction of HIV prevalence in young women may also prevent infant mortality from HIV by reducing mother-to-child transmission.

Multistate outbreak of Listeria monocytogenes infection linked to delicatessen turkey meat.

BACKGROUND: Despite a decreasing incidence of listeriosis in the United States, molecular subtyping has increased the number of recognized outbreaks. In September 2000, the New York City Department of Health identified a cluster of infections caused by Listeria monocytogenes isolates with identical molecular subtypes by pulsed-field gel electrophoresis (PFGE) and ribotyping. METHODS: To determine the magnitude of the outbreak and identify risk factors for infection, we notified state health departments and conducted a case-control study. A case was defined as a patient or mother-infant pair infected with Listeria monocytogenes whose isolate yielded the outbreak PFGE pattern. Controls were patients infected with Listeria monocytogenes whose isolate yielded a different PFGE pattern. Patients were asked about food and drink consumed during the 30 days before the onset of illness. RESULTS: Between May and December 2000, there were 30 clinical isolates of Listeria monocytogenes with identical PFGE patterns identified in 11 US states. Cases of infection caused by these isolates were associated with 4 deaths and 3 miscarriages. A case-control study implicated sliced processed turkey from a delicatessen (Mantel-Haenszel odds ratio, 8.0; 95% confidence interval, 1.2-43.3). A traceback investigation identified a single processing plant as the likely source of the outbreak, and the company voluntarily recalled 16 million pounds of processed meat. The same plant had been identified in a Listeria contamination event that had occurred more than a decade previously. CONCLUSIONS: Prevention of persistent L. monocytogenes contamination in food processing plants presents a critical challenge to food safety professionals.

An outbreak of febrile gastroenteritis associated with delicatessen meat contaminated with Listeria monocytogenes.

In June 2001, the Los Angeles County Department of Health Services/Public Health conducted a cohort study of an outbreak of acute febrile gastroenteritis among 16 of 44 healthy attendees of a catered party. The median age of the attendees who became ill was 15.5 years. Symptoms included body aches (in 88% of attendees), fever (81%), headache (81%), diarrhea (63%), and vomiting (56%). Illness was associated with ingestion of precooked, sliced turkey (P=.000004). Six stool specimens yielded Listeria monocytogenes. Leftover turkey yielded L. monocytogenes, 1.6x10(9) cfu/g. All isolates were serotype 1/2a and had matching molecular fingerprints. Clusters of suspect cases were identified among attendees at 2 other catered events, but no additional cases were confirmed. This is only the third reported outbreak of L. monocytogenes-associated gastroenteritis in the United States. In cases of febrile gastroenteritis for which routine cultures for enteric pathogens are negative, clinicians should suspect listeriosis and should consider asking laboratories to retain stool specimens to expedite testing for Listeria organisms.