Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Ragonnet‐Cronin, Manon; Hué, Stéphane; Hodcroft, Emma B.; Tostevin, Anna; Dunn, David; Fawcett, Tracy; Pozniak, Anton; Brown, Alison E; Delpech, Valérie; Brown, Andrew

doi:10.1016/s2352-3018(18)30062-6

Cited by 39 publications

(32 citation statements)

References 26 publications

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“…Older people were more likely to be infected through heterosexual contact (113/126, 89.68%), in contrast, the proportion of MSM (117/207, 56.52%) was higher than whom infected through heterosexual contact (89/207, 43.00%) in non-old aged group. Although there is the possibility of misclassification of MSM as heterosexuals and it has been confirmed in investigations conducted in UK, [25, 26] older people influenced by Chinese traditional culture especially in underdeveloped areas of China are more likely to be heterosexual, and it is also found that some of them are even involved in drug-used heterosexual activities [27].…”

Section: Resultsmentioning

confidence: 99%

Phylogenetic analysis highlights the role of older people in the transmission of HIV-1 in Fuyang, Anhui Province, China

Shen

Wang

et al. 2019

BMC Infect Dis

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Background The proportion of older HIV-1 infected people in China has increased rapidly in recent years. Elucidation of the transmission characteristics of this high-risk population subgroup is helpful for the development of tailored interventions. Methods A phylogenetic analysis was performed that uses available HIV-1 pol sequences amplified with nested RT-PCR from plasma samples of all newly diagnosed participants spanning from October 2017 to September 2018 in Fuyang, Anhui Province. Transmission clusters were identified as two or more sequences that shared a corresponding node with an aLRT-SH value ≥90 in the maximum-likelihood phylogenetic tree and had an overall mean genetic distance of ≤1.5%. A local transmission cluster was defined as a cluster that had more than 80% of its sequences from Fuyang. The role of older people in local HIV-1 transmission was determined using an integration of molecular and demographic data. Results Of 362 available sequences, 14 subtypes, and 28 local transmission clusters were identified. It was found that the proportion of older people in the local transmission cluster (69/77, 89.61%) was much higher than that of younger people (46/114, 40.35%) (χ 2 test, P < 0.001). In the pretreatment drug resistance analysis, the proportion of sequences with PDRMs in the local transmission cluster was not significantly different between the older people group (57.14%, 4/7) and non-old-aged group (11.11%, 1/9) (Fisher’s exact test, P > 0.05). Conclusion By combining phylogenetic analyses with demographic data, more detailed information was provided about the local transmission structure in Fuyang. These findings suggested that older people play an important role in local transmission, and more tailored interventions for this population subgroup are urgently needed.

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Section: Resultsmentioning

confidence: 99%

Phylogenetic analysis highlights the role of older people in the transmission of HIV-1 in Fuyang, Anhui Province, China

Shen

Wang

et al. 2019

BMC Infect Dis

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“…For example, having met a sexual partner online was identified by random forest analysis to be the strongest discriminator of small and large clusters. The random forest analysis indicates that those participants found among the largest clusters were Black men who reported meeting partners online but reported no risk factors, suggesting the important role of non-disclosure of MSM as a risk factor for HIV infection [29]. The discrepancy between the numbers of named and claimed high-risk partners, taken to be the number of anonymous partners herein, was also associated with large clusters.…”

Section: Discussionmentioning

confidence: 89%

Phylodynamic Analysis Complements Partner Services by Identifying Acute and Unreported HIV Transmission

Campbell

Patala

Shankar

et al. 2020

Viruses

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Tailoring public health responses to growing HIV transmission clusters depends on accurately mapping the risk network through which it spreads and identifying acute infections that represent the leading edge of cluster growth. HIV transmission links, especially those involving persons with acute HIV infection (AHI), can be difficult to uncover, or confirm during partner services investigations. We integrated molecular, epidemiologic, serologic and behavioral data to infer and evaluate transmission linkages between participants of a prospective study of AHI conducted in North Carolina, New York City and San Francisco from 2011–2013. Among the 547 participants with newly diagnosed HIV with polymerase sequences, 465 sex partners were reported, of whom only 35 (7.5%) had HIV sequences. Among these 35 contacts, 23 (65.7%) links were genetically supported and 12 (34.3%) were not. Only five links were reported between participants with AHI but none were genetically supported. In contrast, phylodynamic inference identified 102 unreported transmission links, including 12 between persons with AHI. Importantly, all putative transmission links between persons with AHI were found among large clusters with more than five members. Taken together, the presence of putative links between acute participants who did not name each other as contacts that are found only among large clusters underscores the potential for unobserved or undiagnosed intermediaries. Phylodynamics identified many more links than partner services alone and, if routinely and rapidly integrated, can illuminate transmission patterns not readily captured by partner services investigations.

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“…Most of the articles focused on this issue stress that, until solved, the problem of MSM non-disclosure for various reasons constitutes a blind spot in HIV epidemiology (Hué et al, 2014;Ragonnet-Cronin et al, 2018). The articles also often highlight that non-disclosed MSM must be uncovered because they are a potential bridge between MSM HIV and heterosexual HIV dynamics (Ragonnet-Cronin et al, 2019).…”

Section: Content Analysis Andmentioning

confidence: 99%

The ethical and epistemological pitfalls of translating phylogenetic HIV testing: from patient-centered care to surveillance

Sandset

2020

Humanit Soc Sci Commun

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In both HIV science and public health policy, efforts to end the HIV epidemic are increasingly focusing on molecular HIV surveillance as a helpful tool for identifying, intervening in and controlling the disease. HIV surveillance is meant to identify clusters of genetically similar viral strains in near real-time in communities and areas where transmissions occur, and then to intervene by means of enhanced public health approaches. This article critically engages with how molecular HIV surveillance-a practice and technology portrayed as a benign public health intervention-empties and purifies many of the social and political contexts of HIV transmissions. McClelland et al. (Crit Public Health 1-7, 2019) see the rise of molecular HIV surveillance as a form of "repurposing" of clinical phylogenetic testing done in the context of HIV care. In this article, I argue that this so-called repurposing can be understood as a form of "translation". Looking at how phylogenetic HIV testing has been translated from clinical, patient-centered use to a form of molecular HIV surveillance, I seek to map some of the potential ethical and epistemological pitfalls of such a translational process. More specifically, I look at the unintended consequences of translating a particular evidence-based practicephylogenetic HIV testing-from one usage to another. To this end, I engage with Michel Foucault and his work on the biopower of medicine, exploring how such power disciplines subjects into undergoing a form of medical surveillance that influences norms and behaviors. Ultimately, I argue that the translation of phylogenetic testing from patient-centered care in the clinic to a form of epidemiological surveillance needs to be critically examined in order to avoid ethical and potentially detrimental consequences for HIV-affected communities.

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Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Abstract: National Institutes of Health.

Cited by 39 publications

References 26 publications

Phylogenetic analysis highlights the role of older people in the transmission of HIV-1 in Fuyang, Anhui Province, China

Phylogenetic analysis highlights the role of older people in the transmission of HIV-1 in Fuyang, Anhui Province, China

Phylodynamic Analysis Complements Partner Services by Identifying Acute and Unreported HIV Transmission

The ethical and epistemological pitfalls of translating phylogenetic HIV testing: from patient-centered care to surveillance

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