Impact of COVID-19 on People Living With HIV: Data From Five Medical Monitoring Project Sites, 2020-2022.

BACKGROUND: The COVID-19 pandemic disrupted global economic and healthcare systems. People living with HIV (PLWH) represent a marginalized and stigmatized population who may have been particularly impacted. The purpose of this analysis was to describe the impact of the COVID-19 pandemic on PLWH in the United States. SETTING: United States. METHODS: We analyzed surveys of behavioral and clinical characteristics of PLWH residing in 5 states that participated in the Medical Monitoring Project between 2020 and 2022. We described the impact of COVID-19 illness, testing, and diagnoses; receipt of medical care; social service access; employment; and preventive measures by project site and demographic characteristics. RESULTS: Unweighted data from 1715 PLWH were analyzed. A high proportion of PLWH had medical care disrupted by the pandemic; 31% of PLWH missed medical appointments, 26% missed routine laboratory test results, and 7% missed antiretroviral therapy doses. In total, 30% of PLWH reported losing wages and 19% reported difficulty in accessing social services. Overall, 88% reported receiving at least 1 dose of COVID-19 vaccine, but vaccine uptake was low among younger, Black, and Hispanic or Latina/o/x PLWH. CONCLUSIONS: This descriptive analysis reinforces previous findings that show that COVID-19 negatively impacted PLWH and their ability to obtain medical care. Additional efforts will be critical to ameliorating the longer-term impacts of COVID-19 on the health of PLWH and supporting PLWH through future pandemics and healthcare system disruptions.

Pre-exposure prophylaxis (PrEP) use history in people with antiretroviral resistance at HIV diagnosis: Findings from New York City HIV surveillance and partner services, 2015-2022.

BACKGROUND: Drug resistance may be acquired in people starting HIV pre-exposure prophylaxis (PrEP) during undiagnosed infection. Population-based estimates of PrEP-related resistance are lacking. METHODS: We used New York City surveillance and partner services data to measure the effect of PrEP use (tenofovir disoproxil fumarate/tenofivir alafenamide fumarate with emtricitabine) history on baseline prevalence of M184I/V mutations in people diagnosed with HIV, 2015-2022. PrEP use was categorized as "Recent" defined as PrEP stopped ≤ 90 days before diagnosis, "Past" as PrEP stopped >90 days before diagnosis, and "No known use". Resistance associated mutations were determined using the Stanford Algorithm. We used log binomial regression to generate adjusted relative risk (aRR) of M184I/V by PrEP use history in people with and without acute HIV infection (AHI). RESULTS: Of 4,246 newly diagnosed people with a genotype ≤30 days of diagnosis, 560 (13%) had AHI, 136 (3%) reported recent, and 124 (35%) past PrEP use; 98 (2%) harbored M184I/V. In people with AHI, recent PrEP use was associated with 6 times greater risk of M184I/V than no known use (aRR: 5.86; 95% confidence interval [CI]: 2.49-13.77). In people without AHI, risk of M184I/V in recent users was 7 times (aRR:7.26; 95% CI: 3.98-13.24), and in past users, 4 times that of people with no known use (aRR: 4.46; 95% CI: 2.15-9.24). CONCLUSIONS: PrEP use was strongly associated with baseline M184I/V in NYC, regardless of AHI. Ordering a nucleic acid test when indicated after assessment of exposure, antiretroviral history and AHI symptoms can decrease PrEP initiation in people with undetected infection.

Integrating Contact Tracers Into Point-of-Care Testing Workflow to Accelerate the Tracing of People With Exposure to COVID-19, August-December 2020, New York City.

OBJECTIVES: We assessed the timeliness of contact tracing following rapid-positive COVID-19 test result at point-of-care testing (POCT) sites in New York City (NYC). DESIGN: Interviewed case-patients to elicit exposed contacts and conducted COVID-19 exposure notifications. SETTINGS: Twenty-two COVID-19 POCT sites in NYC, the 2 NYC international airports, and 1 ferry terminal. PARTICIPANTS: Case-patients with rapid-positive COVID-19 test results and their named contacts. MAIN OUTCOME MEASURES: We quantified the proportions of interviewed individuals with COVID-19 and notified contacts and assessed the timeliness between the dates of the rapid-positive COVID-19 test results and the interviews or notifications. RESULTS: In total, 11 683 individuals with rapid-positive COVID-19 test results were referred for contact tracing on the day of their diagnosis; 8878 (76) of whom were interviewed within 1 day of diagnosis, of whom 5499 (62%) named 11 486 contacts. A median of 1.24 contacts were identified from each interview. The odds of eliciting contacts were significantly higher among individuals reporting COVID-19 symptoms than among persons with no symptoms (51% vs 36%; adjusted odds ratio [aOR] = 1.37; 95% confidence interval [CI], 1.11-1.70) or living with 1 or more persons than living alone (89% vs 38%; aOR = 12.11; 95% CI, 10.73-13.68). Among the 8878 interviewed case-patients, 8317 (94%) were interviewed within 1 day of their rapid-positive COVID-19 test results and 91% of contact notifications were completed within 1 day of contact identification. The median interval from test result to interview date and from case investigation interview to contact notification were both 0 days (IQR = 0). CONCLUSIONS: The integration of contact tracers into COVID-19 POCT workflow achieved timely case investigation and contact notification. Accelerated contact tracing can be used to curb COVID-19 transmission during local outbreaks.

Outcomes of a Community Engagement and Information Gathering Program to Support Telephone-Based COVID-19 Contact Tracing: Descriptive Analysis.

BACKGROUND: Contact tracing is an important public health tool for curbing the spread of infectious diseases. Effective and efficient contact tracing involves the rapid identification of individuals with infection and their exposed contacts and ensuring their isolation or quarantine, respectively. Manual contact tracing via telephone call and digital proximity app technology have been key strategies in mitigating the spread of COVID-19. However, many people are not reached for COVID-19 contact tracing due to missing telephone numbers or nonresponse to telephone calls. The New York City COVID-19 Trace program augmented the efforts of telephone-based contact tracers with information gatherers (IGs) to search and obtain telephone numbers or residential addresses, and community engagement specialists (CESs) made home visits to individuals that were not contacted via telephone calls. OBJECTIVE: The aim of this study was to assess the contribution of information gathering and home visits to the yields of COVID-19 contact tracing in New York City. METHODS: IGs looked for phone numbers or addresses when records were missing phone numbers to locate case-patients or contacts. CESs made home visits to case-patients and contacts with no phone numbers or those who were not reached by telephone-based tracers. Contact tracing management software was used to triage and queue assignments for the telephone-based tracers, IGs, and CESs. We measured the outcomes of contact tracing-related tasks performed by the IGs and CESs from July 2020 to June 2021. RESULTS: Of 659,484 cases and 861,566 contact records in the Trace system, 28% (185,485) of cases and 35% (303,550) of contacts were referred to IGs. IGs obtained new phone numbers for 33% (61,804) of case-patients and 11% (31,951) of contacts; 50% (31,019) of the case-patients and 46% (14,604) of the contacts with new phone numbers completed interviews; 25% (167,815) of case-patients and 8% (72,437) of contacts were referred to CESs. CESs attempted 80% (132,781) of case and 69% (49,846) of contact investigations, of which 47% (62,733) and 50% (25,015) respectively, completed interviews. An additional 12,192 contacts were identified following IG investigations and 13,507 following CES interventions. CONCLUSIONS: Gathering new or missing locating information and making home visits increased the number of case-patients and contacts interviewed for contact tracing and resulted in additional contacts. When possible, contact tracing programs should add information gathering and home visiting strategies to increase COVID-19 contact tracing coverage and yields as well as promote equity in the delivery of this public health intervention.

Community-Based Workforce for COVID-19 Contact Tracing and Prevention Activities in New York City, July-December 2020.

OBJECTIVES: High rates of hospitalization and death disproportionately affected Black, Latino, and Asian residents of New York City at the beginning of the COVID-19 pandemic. To suppress COVID-19 transmission, New York City implemented a workforce of community engagement specialists (CESs) to conduct home-based contact tracing when telephone numbers were lacking or telephone-based efforts were unsuccessful and to disseminate COVID-19 information and sanitary supplies. MATERIALS AND METHODS: We describe the recruitment, training, and deployment of a multilingual CES workforce with diverse sociodemographic backgrounds during July-December 2020 in New York City. We developed standard operating procedures for infection control and safety measures, procured supplies and means of transportation, and developed protocols and algorithms to efficiently distribute workload. RESULTS: From July through December 2020, 519 CESs were trained to conduct in-person contact tracing and activities in community settings, including homes, schools, and businesses, where they disseminated educational materials, face masks, hand sanitizer, and home-based specimen collection kits. During the study period, 94 704 records of people with COVID-19 and 61 246 contacts not reached by telephone-based contact tracers were referred to CESs. CESs attempted home visits or telephone calls with 84 230 people with COVID-19 and 49 303 contacts, reaching approximately 55 592 (66%) and 35 005 (71%), respectively. Other CES activities included monitoring recently arrived travelers under quarantine, eliciting contacts at point-of-care testing sites, and advising schools on school-based COVID-19 mitigation strategies. PRACTICE IMPLICATIONS: This diverse CES workforce allowed for safe, in-person implementation of contact tracing and other prevention services for individuals and communities impacted by COVID-19. This approach prioritized equitable delivery of community-based support services and resources.

The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States.

BACKGROUND: The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain. SETTING: State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative. METHODS: The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity. RESULTS: Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019. CONCLUSIONS: HIV case-finding resulting from APS in the United States is low.

The usefulness of HIV partner services in the age of treatment as prevention: a registry-based study.

BACKGROUND: Partner services are effective tools to identify new cases among sex or needle-sharing partners of people with a new HIV diagnosis. Little is known about partners previously diagnosed with HIV who are not in care or are in care with unsuppressed HIV viral load. We aimed to quantify the previously diagnosed partners of people with a new HIV infection and examine their HIV care status and viral suppression in the 12 months before elicitation. METHODS: We did a registry-based study. We used the New York City HIV Surveillance Registry to determine HIV care status and viral load of partners elicited from newly diagnosed people between Jan 1, 2007, and Dec 31, 2018. Previously diagnosed partners with no report of CD4 count or viral load in the preceding 12 months were presumed not to be in care, viral load suppression (<200 copies per mL) was based on the last viral load in the year preceding elicitation, and viraemia was defined as a viral load of 200 copies per mL or more. We used multinomial logistic regression to generate covariates of care and viral load status and their marginal effects. FINDINGS: 11 964 partners were elicited; 2603 (33%) were previously diagnosed and 485 (20%) were not in care. 1153 (49%) of 2343 with a viral load report were in care and viraemic at elicitation. The odds of being not in care were higher in non-Hispanic black than non-Hispanic white or other partners (adjusted odds ratio 1·89, 95% CI 1·09-3·27) and lower in partners with male-to-male sex transmission risk (0·37, 0·26-0·51) and country of birth other than the USA (0·57, 0·39-0·85). The odds of being viraemic were higher in partners younger than 30 years than in those aged 30 years or older (1·68, 1·35-2·09) and lower among people with male-to-male sex transmission risk (0·36, 0·29-0·44) and country of birth other than the USA (0·78, 0·66-0·97). INTERPRETATION: People with HIV should receive ongoing HIV prevention counselling and partner services data should inform engagement in care for previously diagnosed partners. FUNDING: None.

Ongoing Disparities in Prediagnosis Preexposure Prophylaxis Use Among Persons Recently Diagnosed With HIV in New York City, 2015-2017.

Objectives. To quantify sociodemographic disparities in prediagnosis preexposure prophylaxis (PrEP) use in persons recently diagnosed with HIV in New York City and assigned for partner services.Methods. We used partner services data from November 2015 to September 2017 from persons diagnosed with HIV in the past 12 months (n = 3739) to compare individuals with self-reported or documented pre-HIV diagnosis PrEP use ("prediagnosis PrEP users") with those having none ("never users"). We constructed a penalized likelihood regression model generating sociodemographic predictors of prediagnosis PrEP use, employing Firth's adjustment for the rare outcome.Results. We found report of prediagnosis PrEP use in 95 persons (3%). The adjusted odds ratios (AORs) of prediagnosis PrEP use were lower among non-Hispanic Blacks (AOR = 0.18; 95% confidence interval [CI] = 0.09, 0.32) and Hispanics (AOR = 0.31; 95% CI = 0.17, 0.55) than among non-Hispanic Whites, among persons aged 30 years or older (AOR = 0.45; 95% CI = 0.28, 0.72) than those younger than 30 years, among cis-women (AOR = 0.13; 95% CI = 0.02, 0.48) than cis-men, and among residents of Queens (AOR = 0.25; 95% CI = 0.10, 0.55) than those of Manhattan.Conclusions. Disparities in HIV prevention based on race/ethnicity, gender, age, and local geography may manifest themselves in differential PrEP use.

Duration Since Never in HIV Care and Immediate Blood-Draw After HIV Diagnosis are Associated with Willingness to Link to Care Following Health Department Outreach, New York City.

Late presentation to human immunodeficiency virus (HIV) care is an important concern for clinical outcomes and HIV prevention. Significant proportions of HIV-diagnosed persons are not timely linked to care following HIV diagnosis. We implemented and evaluated an intervention to link to care persons never in HIV care (NIC). Disease intervention specialists (DIS) traced persons presumed to be NIC since HIV diagnosis, offered them assistance with linkage to care, and elicited reasons for NIC. We examined the overall outcomes of the intervention and reasons for NIC. From January 2013 to December 2016, 121 persons were traced; 19% were linked to HIV care. Significantly (all P < 0.001) higher proportions of persons linked versus not linked to care were diagnosed < 1 year prior to being contacted by DIS (48% vs. 13%) or had a HIV-related laboratory test performed within 0-7 days of their diagnosis (87% vs. 33%). Among the 105 who provided reasons for NIC, most commonly reported were not believing one's HIV diagnosis (30%) and lacking medical insurance (18%). Approximately 10% had been to a hospital emergency room and 20% to a primary care physician in the past year. Health department efforts to link persons NIC for HIV care were effective with a minority of eligible persons. Persons diagnosed within 1 year or who underwent HIV-related testing within 0-7 days of diagnosis were more likely to link to care. Newly HIV-diagnosed persons should be promptly referred to undergo all diagnostic testing and assessments on the same day or within 1 week of diagnosis.

Where Are They Now? Assessing if Persons Returned to HIV Care Following Loss to Follow-Up by Public Health Case Workers Were Engaged in Care in Follow-Up Years.

We examined care engagement and viral suppression (VS) over a 1- to 5-year period among persons re-engaged in HIV care using retrospective cohort study and longitudinal follow-up. The population comprised five cohorts of persons re-engaged in care from 2009 to 2013. We used surveillance data [CD4 T cell count or HIV viral load (VL) RNA] to measure four outcomes 1-5 years post-care engagement. Engagement-in-care indicated persons with laboratory reports in each follow-up year. Continuous engagement or sustained engagement, respectively, included persons with ≥1 or ≥2 (separated by 90 days) CD4 or VL reports in each follow-up year. VS indicated persons living with HIV (PLWH) re-engaged in care with VL ≤200 copies/mL in any follow-up year, and we measured re-engaged PLWH who subsequently became out of care (OOC) in each follow-up year. Overall, 84-86% PLWH were engaged in care in any follow-up year. The proportions of PLWH cohorts continuously engaged in care [86% (1 year), 77% (2 years), 72% (3 years), 67% (4 years), and 63% (5 years)] declined over time. Thirty-four percent of the PLWH who were re-engaged in care were subsequently OOC in the follow-up years. Most re-engaged PLWH became OOC in their first (40%) and second (30%) follow-up years. In follow-up years (1-5 years), fewer PLWH continuously engaged in care with ≥1 CD4 or VL reports in the registry had VS ≤200 copies/mL: 65%, 58%, 49%, 44%, and 42%, respectively. Encouragingly, higher proportions had VL ≤1500 copies/mL in follow-up years (1-5): (75%, 72%, 73%, 75%, and 70%), likely reflecting levels of HIV treatment. Our results support the use of surveillance data to identify and re-engage OOC PLWH in care. However, structures and programs are needed to support retention in care and reduce repeat OOC.

Locating People Diagnosed With HIV for Public Health Action: Utility of HIV Case Surveillance and Other Data Sources.

INTRODUCTION: Human immunodeficiency virus (HIV) case surveillance and other health care databases are increasingly being used for public health action, which has the potential to optimize the health outcomes of people living with HIV (PLWH). However, often PLWH cannot be located based on the contact information available in these data sources. We assessed the accuracy of contact information for PLWH in HIV case surveillance and additional data sources and whether time since diagnosis was associated with accurate contact information in HIV case surveillance and successful contact. MATERIALS AND METHODS: The Case Surveillance-Based Sampling (CSBS) project was a pilot HIV surveillance system that selected a random population-based sample of people diagnosed with HIV from HIV case surveillance registries in 5 state and metropolitan areas. From November 2012 through June 2014, CSBS staff members attempted to locate and interview 1800 sampled people and used 22 data sources to search for contact information. RESULTS: Among 1063 contacted PLWH, HIV case surveillance data provided accurate telephone number, address, or HIV care facility information for 239 (22%), 412 (39%), and 827 (78%) sampled people, respectively. CSBS staff members used additional data sources, such as support services and commercial people-search databases, to locate and contact PLWH with insufficient contact information in HIV case surveillance. PLWH diagnosed <1 year ago were more likely to have accurate contact information in HIV case surveillance than were PLWH diagnosed ≥1 year ago ( P = .002), and the benefit from using additional data sources was greater for PLWH with more longstanding HIV infection ( P < .001). PRACTICE IMPLICATIONS: When HIV case surveillance cannot provide accurate contact information, health departments can prioritize searching additional data sources, especially for people with more longstanding HIV infection.

Men Who Have Sex With Men Seek Timely Human Immunodeficiency Virus Confirmation and Care After Rapid Human Immunodeficiency Virus Self-Test: Data From Partner Services Program, New York City.

BACKGROUND: The rapid human immunodeficiency virus (HIV) self-test in the United States has expanded opportunities for HIV testing in nonclinical settings which may increase early diagnosis of HIV infection. However, broad application may be limited by the cost of the test and concerns that self-testers who test positive will not seek timely HIV care. METHODS: We used data from HIV partner services program to compare the sociodemographic characteristics, transmission risk, and clinical stage of persons diagnosed with HIV by report of rapid self-test. Among self-tested persons, we assessed timeliness of seeking definitive testing after self-test and linkage to care. RESULTS: From January 2013 to August 2016, 8032 HIV-positive persons were interviewed. Compared with the 7905 persons who did not self-test, self-tested persons were significantly (all P = <0.0001) male (96% vs 78%), white/non-Hispanic (46% vs 16%), men who have sex with men (92% vs 58%), college educated (67% vs 35%), and residing in medium-high income NYC neighborhoods (51% vs 44%). Higher proportions of self-tested (91%) than non-self-tested persons (81%) linked to care within three months of diagnosis. Significantly (P = <0.0001) more persons that self-tested positive (39/44, 89%) than persons that self-tested negative (14/36, 39%) sought laboratory-based HIV test within 1 month of last self-testing; and negative than positive self-tested persons were diagnosed with acute HIV infection (44% vs. 9%, P = <0.0001). CONCLUSIONS: Our findings suggest that men who have sex with men sought timely HIV confirmatory testing and linkage to care after self-test. However, the cost of self-test kit may be an important barrier to its wide adoption across sociodemographic groups.

Sociodemographic Differences in Clients Preferring Video-Call Over In-person Interview: A Pilot Study of HIV Tele-partner Services.

The New York City Department of Health Disease Intervention Specialists (DIS) routinely contact newly HIV-diagnosed persons via telephone calls and in-person meetings to conduct partner services (PS) interviews in order to elicit the names and contact information of the HIV-exposed partners for notification and HIV-testing, and to assist clients with linkage to care. From October 2013 to December 2015, we offered PS interviews conducted via video-call alongside voice-call and in-person modes in a selected geographic area of NYC. PS interviews were conducted according to the clients' preferred mode (in-person, voice- or video-call) and location (health care facility, clients' residences, or other NYC locations). At the conclusion of the PS interviews, DIS elicited responses from persons interviewed via video-call on their perception, satisfaction and personal experiences using video-call for public health and personal purposes. Acceptance and satisfaction with PS interviews via video-call were high among clients aged <30 years, men who have sex with men, or with education above high school; while PS yields were similar across modes. These results provide evidence of the potential effectiveness of video-call interviews for specific populations.

For partner services, do we need "face-time," or FaceTime?: Trends in relative proportion of in-person notifications and HIV testing after introduction of a telephone option for HIV exposure notification by public health.

Public health usually notifies partners of STD exposure in-person despite availability of other options. We examined trends in in-person versus telephone notification for HIV 3 years after the introduction of a telephone option. Most notifications were made by telephone. Partners notified doubled; however, the proportion HIV testing declined slightly.

Bringing HIV partner services into the age of social media and mobile connectivity.

BACKGROUND: A substantial proportion of recent sex partners named by persons with sexually transmitted infections are not notified about their exposure despite attempts by public health officials. Although text messaging (texting) and Internet-based communications (dating Web sites, e-mail, etc) are used by a large segment of the public for regular communications, these tools have been underused for partner services (PS). METHODS: We augmented PS for HIV in New York City using texting and Internet-based means to contact persons for whom traditional information (landline telephone number, postal address) was unavailable. We compared traditional PS (traditionalPS), Internet-based PS (IPS) in January 2011 to October 2012, and texting PS (txtPS) from January 2012 (when txtPS was initiated) through October 2012 on outcomes of contact attempts, notification, and HIV testing. RESULTS: From January 2011 to October 2012, of 3319 partners elicited, 2604 and 275 partners had traditional and only Internet-based contact information and were selected for traditionalPS and IPS, respectively. From January to October 2012, 368 of 1569 partners had only texting-enabled cellphone numbers and were selected for txtPS. The contact rate for txtPS (285/368 [77%]) was significantly higher (P < 0.0001) than the contact rates for traditionalPS (1803/2604 [69%]) and IPS (112/275 [41%]). There was a higher likelihood of notifying contacted IPS (odds ratio, 2.1; 1.2-3.4) and txtPS (odds ratio, 2.4; 1.7-3.2) than traditionalPS partners (P ≤ 0.0001). However, among the notified partners, traditionalPS partners were significantly (P < 0.0001) more likely than txtPS or IPS partners to test for HIV after partner notification (69% vs 45% and 34%, respectively). CONCLUSIONS: Augmenting traditionalPS with txtPS and IPS enabled notification of hundreds of previously untraceable partners and several new HIV diagnoses.

HIV partner services are associated with timely linkage to HIV medical care.

The Centers for Disease Control and Prevention (CDC) recommends that persons diagnosed with HIV receive partner services with health department involvement. CDC describes partner services as not only including partner notification, but also linkage to medical care for HIV-infected persons. The New York City Health Department formed a unit in 2006 to expedite partner services. We examined the contribution of our HIV partner services program in improving timely linkage and retention in HIV medical care.

Do sexual risk behaviors differ between heterosexual youth infected with HIV perinatally versus sexually?

PURPOSE: To determine if sexually active heterosexual HIV-infected 15- to 24-year-old youth have different sexual or other risk behaviors depending on whether they were infected perinatally or heterosexually. METHODS: We compared youth aged 15 to 24 years who acquired HIV perinatally or sexually and were interviewed in-person or by phone for partner services by the New York City Department of Health and Mental Hygiene. We included heterosexually active youth with at least one sexual partner of the opposite sex in the past 12 months, and excluded men who have sex with men and injection drug users. We used χ(2) tests and t tests to compare demographics, sexual risk behaviors, partner services outcomes, and viral loads. RESULTS: Both groups reported few partners (median 1, mean 2), and only 12% of partners of perinatally infected youth were previously diagnosed (18% of sexually infected youths' partners). A minority reported always using condoms. Both groups had similar rates of sexually transmitted infections and median HIV plasma RNA (perinatally infected: 5,140 copies/mL; sexually infected: 6,835 copies/mL). Despite these similarities, among tested partners not previously HIV diagnosed, none of 17 named by perinatally infected youth was newly HIV diagnosed, whereas 21% (8/39, p = .09) of those named by sexually infected youth were newly diagnosed. CONCLUSIONS: Though perinatally infected youth did not transmit HIV infection to previously undiagnosed partners, they had similar HIV-related risk behaviors to youth infected sexually who reported on risks that led to their infection. HIV prevention among HIV-infected youth remains a critical challenge.

Lost or just not following up: public health effort to re-engage HIV-infected persons lost to follow-up into HIV medical care.

OBJECTIVE: Locate persons living with HIV (PLWH) presumed lost to follow-up (LTFU), and assist them with partner services and linkage to HIV-related care. DESIGN: Locate and facilitate re-engagement in care for PLWH-LTFU in New York City (NYC), with longitudinal follow-up using HIV surveillance registry. SETTINGS: HIV care facilities and communities in NYC. PATIENTS: PLWH, reported in the NYC HIV surveillance registry, who had a NYC care provider and residential address at last report in the registry. Presumed-LTFU was defined as having no CD4+ or viral load during the most recent 9 months during the study period July 2008-December 2010. INTERVENTION: Case-workers conducted public health investigation to locate PLWH presumed-LTFU and offered them assistance with partner and linkage-to-care services. MAIN OUTCOME MEASURES: Results of partner and linkage-to-care services, and reasons for LTFU. RESULTS: From July 2008 to December 2010, 797 PLWH presumed-LTFU were prioritized for investigation; 14% were never located. Of the 689 located, 33% were current to care, 5% had moved or were incarcerated, 2% had died, and 59% (409) were verified to be LTFU. Once located, 77% (315/409) accepted clinic appointments, and 57% (232/409) returned to care. Among the 161 who provided reasons for LTFU, the most commonly reported was 'felt well' (41%). CONCLUSIONS: Health department case-workers helped more than half PLWH-LTFU re-engage in HIV medical care. HIV prevention strategies must include efforts to re-engage PLWH-LTFU in care, for treatment consideration under current treatment guidelines to improve their clinical status and decrease transmission risk.