Characteristics of Mpox Vaccine Recipients Among a Sample of Men Who Have Sex With Men With Presumed Exposure to Mpox.

ABSTRACT: Mpox vaccination is recommended for persons exposed to or at risk for mpox. Approximately 25% of an online sample of men who have sex with men (MSM) with presumed mpox exposure were vaccinated (≥1 dose). Vaccination was higher among younger MSM, MSM concerned about mpox, or MSM reporting sexual risk behaviors. Incorporating mpox vaccination into routine sexual health care and increasing 2-dose vaccination uptake is essential to preventing mpox acquisition, improving MSM sexual health, and averting future mpox outbreaks.

Decreases in COVID-19 Cases, Emergency Department Visits, Hospital Admissions, and Deaths Among Older Adults Following the Introduction of COVID-19 Vaccine - United States, September 6, 2020-May 1, 2021.

Throughout the COVID-19 pandemic, older U.S. adults have been at increased risk for severe COVID-19-associated illness and death (1). On December 14, 2020, the United States began a nationwide vaccination campaign after the Food and Drug Administration's Emergency Use Authorization of Pfizer-BioNTech COVID-19 vaccine. The Advisory Committee on Immunization Practices (ACIP) recommended prioritizing health care personnel and residents of long-term care facilities, followed by essential workers and persons at risk for severe illness, including adults aged ≥65 years, in the early phases of the vaccination program (2). By May 1, 2021, 82%, 63%, and 42% of persons aged ≥65, 50-64, and 18-49 years, respectively, had received ≥1 COVID-19 vaccine dose. CDC calculated the rates of COVID-19 cases, emergency department (ED) visits, hospital admissions, and deaths by age group during November 29-December 12, 2020 (prevaccine) and April 18-May 1, 2021. The rate ratios comparing the oldest age groups (≥70 years for hospital admissions; ≥65 years for other measures) with adults aged 18-49 years were 40%, 59%, 65%, and 66% lower, respectively, in the latter period. These differential declines are likely due, in part, to higher COVID-19 vaccination coverage among older adults, highlighting the potential benefits of rapidly increasing vaccination coverage.

Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2017.

CDC's 2006 recommendations for human immunodeficiency virus (HIV) testing state that all persons aged 13-64 years should be screened for HIV at least once, and that persons at higher risk for HIV infection, including sexually active gay, bisexual, and other men who have sex with men (MSM), should be rescreened at least annually (1). Authors of reports published since 2006, including CDC (2), suggested that MSM, a group that is at highest risk for HIV infection, might benefit from being screened more frequently than once each year. In 2013, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to specify an HIV rescreening interval but recommended annual screening for MSM as a reasonable approach (3). However, some HIV providers have begun to offer more frequent screening, such as once every 3 or 6 months, to some MSM. A CDC work group conducted a systematic literature review and held four expert consultations to review programmatic experience to determine whether there was sufficient evidence to change the 2006 CDC recommendation (i.e., at least annual HIV screening of MSM in clinical settings). The CDC work group concluded that the evidence remains insufficient to recommend screening more frequently than at least once each year. CDC continues to recommend that clinicians screen asymptomatic sexually active MSM at least annually. Each clinician can consider the benefits of offering more frequent screening (e.g., once every 3 or 6 months) to individual MSM at increased risk for acquiring HIV infection, weighing their patients' individual risk factors, local HIV epidemiology, and local testing policies.

Population Size Estimates for Men who Have Sex with Men and Persons who Inject Drugs.

Understanding geographic variation in the numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) is critical to targeting and scaling up HIV prevention programs, but population size estimates are not available at generalizable sub-national levels. We analyzed 1999-2010 National Health and Nutrition Examination Survey data on persons aged 18-59 years. We estimated weighted prevalence of recent (past 12 month) male-male sex and injection drug use by urbanicity (the degree to which a geographic area is urban) and US census region and calculated population sizes. Large metro areas (population ≥1,000,000) had higher prevalence of male-male sex (central areas, 4.4% of men; fringe areas, 2.5%) compared with medium/small metro areas (1.4%) and nonmetro areas (1.1%). Injection drug use did not vary by urbanicity and neither varied by census region. Three-quarters of MSM, but only half of PWID, resided in large metro areas. Two-thirds of MSM and two-thirds of PWID resided in the South and West. Efforts to reach MSM would benefit from being focused in large metro areas, while efforts to reach PWID should be delivered more broadly. These data allow for more effective allocation of funds for prevention programs.

Hispanics or Latinos living with diagnosed HIV: progress along the continuum of HIV care - United States, 2010.

The goals of the National HIV/AIDS Strategy are to reduce new human immunodeficiency virus (HIV) infections, increase access to care and improve health outcomes for persons living with HIV, and reduce HIV-related health disparities. In July 2013, by presidential executive order, the HIV Care Continuum Initiative was established, focusing on accelerating federal efforts to increase HIV testing, care, and treatment. Hispanics or Latinos are disproportionately affected by HIV infection; the annual rate of HIV diagnosis among Hispanics or Latinos is approximately three times that of non-Hispanic whites. To achieve the goals of the National HIV/AIDS Strategy, and to be consistent with the HIV Care Continuum Initiative, Hispanics or Latinos living with HIV infection need improved levels of care and viral suppression. Achieving these goals calls for 85% of Hispanics or Latinos with diagnosed HIV to be linked to care, 80% to be retained in care, and the proportion with an undetectable viral load (VL) to increase 20% by 2015. Analysis of data from the National HIV Surveillance System (NHSS) and the Medical Monitoring Project (MMP) regarding progress along the HIV care continuum during 2010 for Hispanics or Latinos with diagnosed HIV infection indicated that 80.3% of HIV-diagnosed Hispanics or Latinos were linked to care, 54.4% were retained in care, 44.4% were prescribed antiretroviral therapy (ART), and 36.9% had achieved viral suppression (VL result of ≤200 copies/mL). Among Hispanic or Latino males and females, the percentages that were linked to care, were prescribed ART, and had achieved viral suppression were similar; however, the percentage retained in care was lower among males compared with females. The levels of linkage to care and viral suppression were lower among Hispanics or Latinos with HIV infection attributed to injection drug use than among those with HIV infection attributed to heterosexual or male-to-male sexual contact. These data demonstrate the need for implementation of interventions and public health strategies that increase linkage to care, retention in care, and consistent ART among Hispanics or Latinos, particularly Hispanics or Latinos who inject drugs.

Men living with diagnosed HIV who have sex with men: progress along the continuum of HIV care--United States, 2010.

Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the risk group most affected by human immunodeficiency virus (HIV). In 2010, among persons newly infected with HIV, 63% were MSM; among persons living with HIV, 52% were MSM. The three goals of the National HIV/AIDS Strategy are to reduce new HIV infections, to increase access to care and improve health outcomes for persons living with HIV, and to reduce HIV-related health disparities. In July 2013, the HIV Care Continuum Initiative was established by executive order to mobilize and accelerate federal efforts to increase HIV testing, services, and treatment along the continuum. To meet the 2015 targets of the National HIV/AIDS Strategy, 85% of MSM diagnosed with HIV should be linked to care, 80% should be retained in care, and the proportion with an undetectable viral load (VL) should be increased by 20%. To assess progress toward meeting these targets, CDC assessed the level at each step of the continuum of care for MSM by age and race/ethnicity. CDC analyzed data from the National HIV Surveillance System (NHSS) and the Medical Monitoring Project (MMP) for MSM with diagnosed HIV infection. The results indicated that 77.5% were linked to care, 50.9% were retained in care, 49.5% were prescribed antiretroviral therapy (ART), and 42.0% had achieved viral suppression. Younger MSM and black/African American MSM had lower levels of care compared with older MSM and those of all other races/ethnicities. Interventions aimed at MSM are needed that increase linkage to care, retention in care, and ART use, particularly among MSM aged <25 years and black/African American MSM.

Progress along the continuum of HIV care among blacks with diagnosed HIV- United States, 2010.

The goals of the National HIV/AIDS Strategy are to reduce new human immunodeficiency virus (HIV) infections, increase access to care and improve health outcomes for persons living with HIV, and reduce HIV-related health disparities. Recently, by executive order, the HIV Care Continuum Initiative was established, focusing on accelerating federal efforts to increase HIV testing, care, and treatment. Blacks are the racial group most affected, comprising 44% of new infections and also 44% of all persons living with HIV infection. To achieve the goals of NHAS, and to be consistent with the HIV Care Continuum Initiative, blacks with HIV need high levels of care and viral suppression. Achieving these goals calls for 85% of blacks with diagnosed HIV to be linked to care, 80% to be retained in care, and the proportion with an undetectable viral load (VL) to increase 20% by 2015. Analysis of data from the National HIV Surveillance System (NHSS) and the Medical Monitoring Project (MMP) regarding progress along the HIV care continuum during 2010 for blacks with diagnosed HIV infection indicated that 74.9% of HIV-diagnosed blacks were linked to care, 48.0% were retained in care, 46.2% were prescribed antiretroviral therapy (ART), and 35.2% had achieved viral suppression. Black males had lower levels of care and viral suppression than black females at each step along the HIV care continuum; in addition, levels of care and viral suppression for blacks aged <25 years were lower than those for blacks aged ≥25 years at each step of the continuum. These data demonstrate the need for implementation of interventions and public health strategies that increase linkage to care and consistent ART among blacks, particularly black males and black youths.

Using the National HIV Behavioral Surveillance System to inform HIV prevention efforts in the United States.

The National HIV Behavioral Surveillance system (NHBS) was designed to monitor HIV prevalence and risk factors for infection among higher-risk individuals, i.e., sexually active men who have sex with men who attend venues, injection drug users who injected in the past 12 months, and heterosexuals living in low socioeconomic urban areas. These groups were selected as priorities for behavioral surveillance since they represent the major HIV transmission routes and the populations with the highest HIV burden. NHBS contributes to the nation's program of HIV surveillance by being the only multi-site population-based system that provides estimates on key HIV prevention measures among high-risk HIV-negative individuals, HIV-positive individuals unaware of their infection, and HIV-positive individuals aware of their infection who are in and out of care. Accurate and precise data on the behaviors in these populations are critical for tracking the epidemic, planning effective responses, and monitoring and evaluating those responses. Reports in this supplement illustrate the uses of NHBS data at the national and local level and reflect ongoing efforts to improve the system and remains essential for characterizing and monitoring the burden of HIV infection and sexual and behavioral risks.

Engagement in HIV care among HIV-positive men who have sex with men from 21 cities in the United States.

We assessed factors associated with HIV care among HIV-infected men who have sex with men (MSM). We used 2008 data on MSM from the National HIV Behavioral Surveillance System (NHBS). Venue-based, time-space sampling was used to recruit and interview men in 21 U.S. cities with high AIDS prevalence. Among self-reported HIV-positive MSM, we used generalized estimating equations (clustered on city of interview) to evaluate factors associated with delayed linkage to care (care entry >3 months after diagnosis), not currently receiving care (no visit for HIV care during the 6 months before the study interview), and not being on antiretroviral therapy (ART). Among 8,153 MSM, 882 (11 %) were self-reported HIV-positive. 25 % had delayed linkage, 12 % were not currently receiving care and among those with at least one heath care visit 30 % were not on ART. In multivariate analysis, lower income and testing positive at their first HIV test were associated with delayed linkage. Age 18-29 years, and not having health insurance were associated with not currently receiving care. Among those with at least one health care visit, being age 18-39 years, having private or no health insurance, and stimulant use were associated with not being on ART. These findings can inform efforts to improve engagement in care.

Trends in HIV prevalence and HIV testing among young MSM: five United States cities, 1994-2011.

We examined trends in cross-sectional HIV prevalence (a surrogate for incidence) and past 12 month testing behavior among young men who have sex with men (MSM). The Young Men's Survey and the National HIV Behavioral Surveillance System conducted interviews and HIV testing among MSM recruited by venue-based sampling during 1994-2011. Using data from five cities, we determined whether interview year was associated with HIV prevalence and recent testing for MSM ages 18-22 and 23-29 years, after adjusting for city, race/ethnicity, and education. Multivariable analysis demonstrated an overall increase in prevalence among MSM ages 23-29 years, driven by an increase in Baltimore. There was no change in HIV prevalence among MSM ages 18-22 years overall, although prevalence increased in Baltimore. HIV testing increased significantly for both age groups. Gains in HIV testing are encouraging, but increasing prevalence among young MSM in Baltimore suggests increasing incidence and the need for additional efforts for this population.

Community Guide Methods for Systematic Reviews of Economic Evidence.

INTRODUCTION: Community Guide systematic economic reviews provide information on the cost, economic benefit, cost-benefit, and cost-effectiveness of public health interventions recommended by the Community Preventive Services Task Force on the basis of evidence of effectiveness. The number and variety of economic evaluation studies in public health have grown substantially over time, contributing to methodologic challenges that required updates to the methods for Community Guide systematic economic reviews. This paper describes these updated methods. METHODS: The 9-step Community Guide economic review process includes prioritization of topic, creation of a coordination team, conceptualization of review, literature search, screening studies for inclusion, abstraction of studies, analysis of results, translation of evidence to Community Preventive Services Task Force economic findings, and dissemination of findings and evidence gaps. The methods applied in each of these steps are reported in this paper. RESULTS: Two published Community Guide reviews, tailored pharmacy-based interventions to improve adherence to medications for cardiovascular disease and permanent supportive housing with housing first to prevent homelessness, are used to illustrate the application of the updated methods. The Community Preventive Services Task Force reached a finding of cost-effectiveness for the first intervention and a finding of favorable cost-benefit for the second on the basis of results from the economic reviews. CONCLUSIONS: The updated Community Guide economic systematic review methods provide transparency and improve the reliability of estimates that are used to derive a Community Preventive Services Task Force economic finding. This may in turn augment the utility of Community Guide economic reviews for communities making decisions about allocating limited resources to effective programs.

Comparison of demographic and behavioral characteristics of men who have sex with men by enrollment venue type in the National HIV Behavioral Surveillance System.

BACKGROUND: During 2003-2005, the National HIV Behavioral Surveillance System (NHBS) enrolled men who have sex with men (MSM) from 12 different venue types in 15 metropolitan areas in the United States. Our goal was to examine whether limiting NHBS enrollment venues to gay bars and dance clubs could increase efficiency without changing the overall results and conclusions. METHODS: We used logistic regression analysis to compare the demographic characteristics and reported HIV risk behaviors among MSM enrolled in gay bars and dance clubs with those enrolled in sex venues and those enrolled in other venues. RESULTS: Of the 11,471 eligible men included in the analysis, 6419 (56%) were enrolled at bars and clubs, 481 (4%) at sex venues, and 4571 (40%) at other venues. Compared with men enrolled at bars and clubs, men enrolled at sex venues were more likely to be older, of nonwhite race/ethnicity, bisexual, infrequent gay venue attendees, and to have 10 or more male sex partners in the past 12 months. Men enrolled at other venues were more likely to be older and less likely to use noninjecting drugs in the past 12 months. The absolute differences in these characteristics between men enrolled in bars and clubs and those enrolled in comparison venue categories were small in most instances. CONCLUSIONS: Although the differences in characteristics by venue category were not large in magnitude, there was evidence that restricting NHBS enrollment to bars and clubs would affect national estimates of behavioral risk factors among MSM.

Priority Topics for the Community Preventive Services Task Force, 2020-2025: A Data-Driven, Partner-Informed Approach.

INTRODUCTION: The Community Preventive Services Task Force periodically engages in a process to identify priority topics to guide their work. This article described the process and results for selecting priority topics to guide the work of the Community Preventive Services Task Force for the period 2020-2025. METHODS: The Community Preventive Services Task Force started with Healthy People 2020 topics. They solicited input on topics from partner organizations and the public. The Community Preventive Services Task Force considered information on 8 criteria for each topic. They conducted preliminary voting and applied a priori decision rules regarding the voting results. The Community Preventive Services Task Force then engaged in facilitated deliberations and took a final vote. This process occurred October 2019-June 2020. RESULTS: From Healthy People 2020, a total of 37 topics were selected as the starting point. The initial voting and decision rules resulted in 3 topics being determined as priorities. Community Preventive Services Task Force members considered data and information on the criteria to inform their deliberations on an additional 7 topics. A total of 9 topics were selected as the set of priorities for 2020-2025. CONCLUSIONS: Having a process that is routine and data-driven ensures that the selection of priorities is sound. By reviewing priority topics every 5 years, the Community Preventive Services Task Force will continue to provide relevant recommendations on community preventive services to improve the nation's health.

Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV.

BACKGROUND: Correlates of main reasons for not HIV testing, HIV testing intentions, and potential use of an over-the-counter rapid HIV test (OTCRT) among men who have sex with men who have never tested for HIV (NTMSM) are unknown. METHODS: We evaluated these correlates among 946 NTMSM from 6 US cities who participated in an internet-based survey in 2007. FINDINGS: Main reasons for not testing were low perceived risk (32.2%), structural barriers (25.1%), and fear of testing positive (18.1%). Low perceived risk was associated with having fewer unprotected anal intercourse (UAI) partners and less frequent use of the internet for HIV information; structural barriers were associated with younger age and more UAI partners; fear of testing positive was associated with black and Hispanic race/ethnicity, more UAI partners, and more frequent use of the internet for HIV information. Strong testing intentions were held by 25.9% of all NTMSM and 14.8% of those who did not test because of low perceived risk. Among NTMSM who were somewhat unlikely, somewhat likely, and very likely to test for HIV, 47.4%, 76.5%, and 85.6% would likely use an OTCRT if it was available, respectively. CONCLUSIONS: Among NTMSM who use the internet, main reasons for not testing for HIV vary considerably by age, race/ethnicity, UAI, and use of the internet for HIV information. To facilitate HIV testing of NTMSM, programs should expand interventions and services tailored to address this variation. If approved, OTCRT might be used by many NTMSM who might not otherwise test for HIV.

Evaluation of the impact of news coverage of an HIV multiclass drug-resistant cluster in Seattle, Washington.

OBJECTIVES: In February 2007, Public Health-Seattle and King County issued a press release describing a cluster of multiclass drug-resistant HIV cases among men who had sex with men (MSM). We evaluated the effect of the press release among MSM in the Seattle area. METHODS: We administered a rapid assessment survey at venues where MSM congregate. Eligible participants were men who had sex with men in the past year, were older than 18 years, and were residents of western Washington State. RESULTS: Among 325 participants, 57% heard or saw messages related to the press release. Of these, 87% remembered 1 or more key points, but only 5% remembered key prevention messages. Ninety-eight percent of participants thought it was important for the health department to get the message out about drug-resistant HIV. CONCLUSIONS: The press release was found to be a useful and well-received method to inform the public about an HIV drug-resistant cluster. Low retention and nonprominent coverage of key prevention messages suggests that health departments using press releases as a prevention tool need to carefully consider placement and emphasis of those messages in a press statement.

The role of formative research in the National HIV Behavioral Surveillance System.

The National Human Immunodeficiency Virus (HIV) Behavioral Surveillance System (NHBS) is the Centers for Disease Control and Prevention's (CDC's) newest system for measuring HIV risk behaviors among three adult populations at highest risk for HIV infection in the U.S.: men who have sex with men, injecting drug users, and heterosexuals at risk of HIV infection. The system is implemented by state and local health departments in designated metropolitan statistical areas with the highest HIV/acquired immunodeficiency syndrome (AIDS) prevalence in the U.S. Prior to implementing the behavioral surveillance survey, project sites conduct a series of formative research activities. The data collected during this preparatory phase provide contextual information about HIV risk behaviors within the study population of interest and help project sites make decisions about field operations and other logistical issues. This article describes the activities undertaken in preparation for the first round of NHBS (2003-2007) and how those activities enhanced data collection for each behavioral surveillance cycle.

Evaluating the Evidence for More Frequent Than Annual HIV Screening of Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From a Systematic Review and CDC Expert Consultation.

The Centers for Disease Control and Prevention (CDC) recommended in 2006 that sexually active gay, bisexual, and other men who have sex with men (MSM) be screened for human immunodeficiency virus (HIV) at least annually. A workgroup comprising CDC and external experts conducted a systematic review of the literature, including benefits, harms, acceptability, and feasibility of annual versus more frequent screening among MSM, to determine whether evidence was sufficient to change the current recommendation. Four consultations with managers of public and nonprofit HIV testing programs, clinics, and mathematical modeling experts were conducted to provide input on the programmatic and scientific evidence. Mathematical models predicted that more frequent than annual screening of MSM could prevent some new HIV infections and would be more cost-effective than annual screening, but this evidence was considered insufficient due to study design. Evidence supports CDC's current recommendation that sexually active MSM be screened at least annually. However, some MSM might benefit from more frequent screening. Future research should evaluate which MSM subpopulations would benefit most from more frequent HIV screening.