The high incidence of HIV infection places St Petersburg among the worst IDU-concentrated epidemics in Europe. Interventions targeting psychostimulant and heroin users and their accompanying behaviors such as frequent injections and increased sexual activity are needed immediately.

IMPORTANCEAchieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits.OBJECTIVE To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. DESIGN, SETTING, AND PARTICIPANTSA large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, to financial incentives or standard of care.INTERVENTIONS Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed.MAIN OUTCOMES AND MEASURES Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4 + and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System.RESULTS A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95% CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95% CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9% higher (95% CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7% higher (95% CI, 4.2%-13.2%; P < .001) at financial incentive sites. CONCLUSIONS AND RELEVANCE Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01152918

BackgroundCross-sectional assessment of HIV incidence relies on laboratory methods to discriminate between recent and non-recent HIV infection. Because HIV diversifies over time in infected individuals, HIV diversity may serve as a biomarker for assessing HIV incidence. We used a high resolution melting (HRM) diversity assay to compare HIV diversity in adults with different stages of HIV infection. This assay provides a single numeric HRM score that reflects the level of genetic diversity of HIV in a sample from an infected individual.MethodsHIV diversity was measured in 203 adults: 20 with acute HIV infection (RNA positive, antibody negative), 116 with recent HIV infection (tested a median of 189 days after a previous negative HIV test, range 14–540 days), and 67 with non-recent HIV infection (HIV infected >2 years). HRM scores were generated for two regions in gag, one region in pol, and three regions in env.ResultsMedian HRM scores were higher in non-recent infection than in recent infection for all six regions tested. In multivariate models, higher HRM scores in three of the six regions were independently associated with non-recent HIV infection.ConclusionsThe HRM diversity assay provides a simple, scalable method for measuring HIV diversity. HRM scores, which reflect the genetic diversity in a viral population, may be useful biomarkers for evaluation of HIV incidence, particularly if multiple regions of the HIV genome are examined.

Introduction Randomized clinical trials have demonstrated the efficacy of antiretroviral pre‐exposure prophylaxis (Pr EP ) in preventing HIV acquisition among men who have sex with men ( MSM ). However, limited research has examined initiation and adherence to Pr EP among Black MSM ( BMSM ) in the United States ( US ) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 ( HPTN 073) study aimed to examine Pr EP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client‐centered care coordination (C4) model. Methods The HPTN 073 study enrolled and followed 226 HIV ‐uninfected Black MSM in three US cities (Los Angeles, CA ; Washington DC ; and Chapel Hill, NC ) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir ( FTC / TDF ) Pr EP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results Of the 226 men enrolled, 178 participants initiated Pr EP (79%), and of these 64% demonstrated Pr EP utilization at week 26 (mid‐point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV ‐infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of Pr EP initiation (adjusted odds ratio ( OR ) 4.4, 95% confidence interval ( CI ) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money ( OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking Pr EP before sex ( OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of Pr EP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who init...

In HPTN 061, a study of Black Men Who Have Sex with Men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41% were uninsured, and 38% had an annual household income < $10,000. Overall, 19% reported healthcare-specific racial discrimination directed toward family, friend, or self; 61% saw a healthcare provider in the previous 6 months and 81% HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider (adjusted odds ratio (AOR)=1.4 [1.0, 2.0]) and HIV testing (AOR=1.6 [1.1, 2.4]) suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

In the US, Latino MSM are disproportionately affected by HIV, yet there is a paucity of data for this risk group. To this end, we examined data on Latino and non-Latino white MSM who participated across six cities in a 2-year randomized behavioral intervention study—Project EXPLORE. At baseline, Latinos reported significantly more serodiscordant unprotected anal intercourse (SDUA) than non-Latinos. Longitudinal predictors of SDUA included marijuana, poppers, amphetamines and heavy drinking, as well as lower self-efficacy, poorer communication skills, weaker safe-sex norms and more enjoyment of risky sex. For HIV infection, Latinos had significantly higher seroconversion rate over follow-up than non-Latinos. Longitudinal predictors of seroconversion among Latinos included poppers and SDUA. Intervention effects did not significantly differ between Latino and non-Latinos. Findings support HIV intervention work with Latino MSM that includes skills training/counseling to address attitudes about safe sex and impact of substance use on HIV-risk behavior and acquisition.

Background Use of antiretroviral therapy (ART) to prevent HIV transmission has received substantial attention following a recent trial demonstrating efficacy of ART to reduce HIV transmission in HIV-discordant couples. Objective To assess practices and attitudes of HIV clinicians regarding early initiation of ART for treatment and prevention of HIV at sites participating in the HPTN 065 study. Design Cross-sectional internet-based survey. Methods ART-prescribing clinicians (n=165 physicians, nurse-practitioners, physician assistants) at 38 HIV care sites in Bronx, NY and Washington, DC completed a brief anonymous internet survey, prior to any participation in the HPTN 065 study. Analyses included associations between clinician characteristics and willingness to prescribe ART for prevention. Results Almost all respondents (95%), of whom 59% were female, 66% white and 77% HIV specialists, “strongly agreed/agreed” that early ART can decrease HIV transmission. Fifty-six percent currently recommend ART initiation for HIV-infected patients with CD4+ count ≤500 cells/mm3, and 14 percent indicated that they initiate ART irrespective of CD4+ count. Most (75%) indicated that they would consider initiating ART earlier than otherwise indicated for patients in HIV-discordant sexual partnerships, and 40% would do so if a patient was having unprotected sex with a partner of unknown HIV status. There were no significant differences by age, gender, or clinician type in likelihood of initiating ART for reasons including HIV transmission prevention to sexual partners. Conclusions This sample of US clinicians indicated support for early ART initiation to prevent HIV transmission, especially for situations where such transmission would be more likely to occur.

Introduction:Modeling studies suggest intensified HIV testing, linkage-to-care and antiretroviral treatment to achieve viral suppression may reduce HIV transmission and lead to control of the epidemic. To study implementation of strategy, population-level data are needed to monitor outcomes of these interventions. US HIV surveillance systems are a potential source of these data.Methods:HPTN065 (TLC-Plus) Study is evaluating the feasibility of a test, linkage-to-care, and treat strategy for HIV prevention in two intervention communities - the Bronx, NY, and Washington, DC. Routinely collected laboratory data on diagnosed HIV cases in the national HIV surveillance system were used to select and randomize sites, and will be used to assess trial outcomes.Results:To inform study randomization, baseline data on site-aggregated study outcomes was provided from HIV surveillance data by New York City and Washington D.C. Departments of Health. The median site rate of linkage-to-care for newly diagnosed cases was 69% (IQR 50%-86%) in the Bronx and 54% (IQR 33%-71%) in Washington, D.C. In participating HIV care sites, the median site percent of patients with viral suppression (<400 copies/mL) was 57% (IQR 53%-61%) in the Bronx and 64% (IQR 55%-72%) in Washington, D.C.Conclusions:In a novel use of site-aggregated surveillance data, baseline data was used to design and evaluate site randomized studies for both HIV test and HIV care sites. Surveillance data have the potential to inform and monitor sitelevel health outcomes in HIV-infected patients.