Syndemics Predict BioBehavioral HIV Sexual Transmission Risk Behavior
Syndemics Predict Bio-Behavioral HIV Sexual Transmission Risk Behavior Longitudinally in US HIV Clinics Satyanand Satyanarayana, Steven A. Safren, Brooke G. Rogers, Sierra Bainter, Katerina A. Christopoulos, Rob J. Fredericksen, William C. Mathews, Richard D. Moore, Michael J. Mugavero, Sonia Napravnik, Matthew J. Mimiaga, Kenneth H. Mayer, and Heidi M. Crane Syndemics • • Co-occurring psychosocial conditions that exacerbate risk for HIV transmission Usually studied in context of populations at risk of contracting HIV Less known about HIV transmission risk created by syndemics occurring in HIV-infected patients receiving clinical care Syndemics could help identify patients to receive psychosocial intervention to curb new HIV transmissions CNICS Sample by Risk Group and Race/Ethnicity CNICS • • Network of CFAR sites providing patients with clinical care Health information collected at patient visits with patient-reported outcomes (PROs) collected at visits at least 4 -6 months apart 15 727 pts from July 2000 to April 2017 68 984 total visits (mean 4. 4 visits/pt) Hispanic/Latinx - Race Unknown Other Race - Hispanic/Latinx Other Race - Non-Hispanic/Latinx White Hispanic/Latinx Black (incl. Hispanic/Latinx) White Non-Hispanic/Latinx 0 1000 2000 3000 4000 5000 6000 Cis Female Cis Heterosexual Male Cis MSM Cis Male (Sex. Orient. Unknown) 7000 8000 Trans Female Acknowledgments CNICS is an NIH-funded program (R 24 AI 067039) made possible by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Heart, Lung, and Blood Institute (NHLBI). The CFAR sites involved in CNICS include Univ of Alabama at Birmingham (P 30 AI 027767), Univ of Washington (P 30 AI 027757), Univ of California San Diego (P 30 AI 036214), Univ of California San Francisco (P 30 AI 027763), Case Western Reserve Univ (P 30 AI 036219), Johns Hopkins Univ (P 30 AI 094189, U 01 DA 036935), Fenway Health/Harvard (P 30 AI 060354), and Univ of North Carolina Chapel Hill (P 30 AI 50410). Author time was supported by 9 K 24 DA 040489 (Safren) and by the University of Miami Dean’s Fellowship. Conflicts of Interest No conflicts to disclose #AIDS 2018 | @AIDS_conference | www. aids 2018. org
Analysis Predictors • No. of syndemics • Depression (PHQ-9) • Anxiety (Brief PHQ) • Alcohol Use (AUDIT-C) • Drug Use (ASSIST) • Time (measured by visit number) • Behavioral risk group Outcome Bio-behavioral transmission risk behavior (TRB): condomless sex while virally detectable (HIV RNA > 400) with a partner of unknown or HIV-negative status Bio-Behavioral TRB at First Visit Trans Female Number of Syndemics by Risk Group at First Visit Cis Male (Sex. Orient. Unknown) 2500 All Pts Cis MSM Heterosexual Cis Male 2000 Cis Female 0 1500 1000 2000 3000 4000 5000 6000 7000 8000 Trans Female 1000 Cis Male (Sex. Orient. Unknown) Virally Detectable Pts 500 Cis MSM Heterosexual Cis Male Cis Female 0 0 Cis Female 1 Heterosexual Cis Male 2 Cis MSM 3 4 Cis Male (Sex. Orient. Unknown) Trans Female #AIDS 2018 | @AIDS_conference | www. aids 2018. org 0200400600800 1000 1200 1400 1600 1800 No TRB
Results } Cis women as referent group Conclusions • Identifying syndemics via patient-report-outcome measures in HIV clinics is feasible. • Integrating the identification and treatment of syndemic conditions within HIV clinical settings carries potential for reducing the number of new infections via bio-behavioral transmission risk behavior. #AIDS 2018 | @AIDS_conference | www. aids 2018. org
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