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The U.S. Ryan White HIV/AIDS Program (RWHAP) funds comprehensive services for people living with HIV to support viral suppression (VS). We analyzed five years of RWHAP data from the Minneapolis-St. Paul region to (1) assess variation and (2) evaluate the causal effect of each RWHAP service on sustained VS by race/ethnicity. Sixteen medical and support services were included. Descriptive analyses assessed service use and trends over time. Causal analyses used generalized estimating equations and propensity scores to adjust for the probability of service use. Receipt of AIDS Drug Assistance Program and financial aid consistently showed higher probabilities of sustained VS, while food aid and transportation aid had positive impacts on VS at higher levels of service encounters; however, the impact of services could vary by race/ethnicity. For example, financial aid increased the probability of sustained VS by at least 3 percentage points for white, Hispanic and Black/African American clients, but only 1.6 points for Black/African-born clients. This study found that services addressing socioeconomic needs typically had positive impacts on viral suppression, yet service use and impact of services often varied by race/ethnicity. This highlights a need to ensure these services are designed and delivered in ways that equitably serve all clients. [ABSTRACT FROM AUTHOR]

Background: Gonorrhea incidence in the United States has risen by nearly 50% in the last decade, while screening rates have increased. Gonorrhea sequelae rates could indicate whether increased gonorrhea incidence is due to better screening. We estimated the association of gonorrhea diagnosis with pelvic inflammatory disease (PID), ectopic pregnancy (EP), and tubal factor infertility (TFI) in women and detected changes in associations over time. Materials and Methods: This retrospective cohort study included 5,553,506 women aged 18–49 tested for gonorrhea in the IBM MarketScan claims administrative database from 2013–2018 in the United States. We estimated incidence rates and hazard ratios (HRs) of gonorrhea diagnosis for each outcome, adjusting for potential confounders using Cox proportional hazards models. We tested the interaction between gonorrhea diagnosis and the initial gonorrhea test year to identify changes in associations over time. Results: We identified 32,729 women with a gonorrhea diagnosis (mean follow-up time in years: PID = 1.73, EP = 1.75, TFI = 1.76). A total of 131,500 women were diagnosed with PID, 64,225 had EP, and 41,507 had TFI. Women with gonorrhea diagnoses had greater incidence per 1000 person-years for all outcomes (PID = 33.5, EP = 9.4, TFI = 5.3) compared to women without gonorrhea diagnoses (PID = 13.9, EP = 6.7, TFI = 4.3). After adjustment, HRs were higher in women with a gonorrhea diagnosis vs. those without [PID = 2.29 (95% confidence interval, CI: 2.15–2.44), EP = 1.57, (95% CI: 1.41–1.76), TFI = 1.70 (95% CI: 1.47–1.97)]. The interaction of gonorrhea diagnosis and test year was not significant, indicating no change in relationship by initial test year. Conclusion: The relationship between gonorrhea and reproductive outcomes has persisted, suggesting a higher disease burden. [ABSTRACT FROM AUTHOR]

A three-armed drinking cessation trial in Vietnam found that both a brief and intensive version of an intervention effectively reduced hazardous drinking in people living with HIV. We used group-based trajectory modeling (GBTM) to assess the extent to which findings may vary by latent subgroups distinguished by their unique responses to the intervention. Using data on drinking patterns collected over the 12 months, GBTM identified five trajectory groups, three of which were suboptimal ["non-response" (17.2%); "non-sustained response" (15.7%), "slow response" (13.1%)] and two optimal ["abstinent" (36.4%); "fast response" (17.6%)]. Multinomial logistic regression was used to determine that those randomized to any intervention arm were less likely to be in a suboptimal trajectory group, even more so if randomized to the brief (vs. intensive) intervention. Older age and higher baseline coping skills protected against membership in suboptimal trajectory groups; higher scores for readiness to quit drinking were predictive of it. GBTM revealed substantial heterogeneity in participants' response to a cessation intervention and may help identify subgroups who may benefit from more specialized services within the context of the larger intervention. [ABSTRACT FROM AUTHOR]

Background: For older adults with relapsing-onset multiple sclerosis (MS), limited information is available to inform if, or when, disease-modifying drugs (DMDs) may be safely discontinued. Objective: The aim of this study was to project the outcomes of DMD discontinuation among older adults with relapsing-onset MS. Methods: We projected the 10-year outcomes of discontinuation of a DMD (interferon-β, fingolimod, or natalizumab) among older adults (aged 55 or 70 years) who were relapse-free for 5 or more years and had not reached an Expanded Disability Status Scale (EDSS) score of 6. Outcomes included the percentage of people who had at least one relapse or reached EDSS 6, and quality-adjusted life-years (QALYs), which incorporated both relapses and disability. We used a simulation modeling approach. With increased age, relapses decreased and the effectiveness of DMDs for disability outcomes also decreased. Results: We found lower projected benefits for DMD continuation at 70 years of age than at 55 years of age. Compared with discontinuation, the projected benefit of DMD continuation ranged from 0.007 to 0.017 QALYs at 55 years of age and dropped to 0.002–0.006 at 70 years of age. The annual projected benefits of DMD continuation (0.1–3.0 quality-adjusted life-days) were very low compared with typical patient preferences regarding treatment burden. Conclusion: The benefits of DMDs may not be substantial among older adults with relapsing-onset MS. Direct clinical evidence remains limited and the decision of whether to discontinue a DMD should also take into account patient preferences. It is important to gain a better understanding of how age-related changes in the trajectory of relapsing-onset MS affect treatment effectiveness among older adults. [ABSTRACT FROM AUTHOR]

Retention in care is essential to the health of people living with HIV and also for their communities. We sought to quantify the value of integrating HIV surveillance data with clinical records for improving the accuracy of retention-in-care estimates and the efficiency of efforts to re-engage out-of-care patients. Electronic medical records (EMRs) of HIV+ patients ‡18 years old from a public, hospital-based clinic in Minneapolis, MN between 2008 and 2014 were merged with state surveillance data on HIV-related laboratory tests, out-of-state relocation, and mortality. We calculated levels of retention and estimated the number of required case investigations to re-engage patients who appeared to be out of care over the study period with and without surveillance data integration. Retention was measured as the proportion of years in compliance with Health Resources and Services Administration (HRSA) guidelines (two clinical encounters >90 days apart annually) and the proportion of patients experiencing a gap in care >12 months. With data integration, retention estimates improved from an average HRSA compliance of 70.3% using EMR data alone to 77.5% with surveillance data, whereas the proportion of patients experiencing a >12-month gap in care decreased from 45.0% to 34.4%. If case investigations to re-engage patients were initiated after a 12-month gap in care, surveillance data would avoid 330 (29.3%) investigations over the study period. Surveillance data integration improves the accuracy of retention-in-care estimates and would avert a substantial number of unnecessary case investigations for patients who appear to be out of care but, in fact, receive care elsewhere or have died. [ABSTRACT FROM AUTHOR]

Objectives. We examined the impact of undetected infections, adult immunity, and waning vaccine-acquired immunity on recent age-related trends in pertussis incidence. Methods. We developed an agent-based model of pertussis transmission in Dakota County, Minnesota using case data from the Minnesota Department of Health. For outbreaks in 2004, 2008, and 2012, we fit our model to incidence in 3 children's age groups relative to adult incidence. We estimated parameters through model calibration. Results. The duration of vaccine-acquired immunity after completion of the 5-dose vaccination series decreased from 6.6 years in the 2004 model to approximately 3.0 years in the 2008 and 2012 models. Tdap waned after 2.1 years in the 2012 model. A greater percentage of adults were immune in the 2008 model than in the 2004 and 2012 models. On average, only 1 in 10 adult infections was detected, whereas 8 in 10 child infections were detected. Conclusions. The observed trends in relative pertussis incidence in Dakota County can be attributed in part to fluctuations in adult immunity and waning vaccine-acquired immunity. No single factor accounts for current pertussis trends. [ABSTRACT FROM AUTHOR]

Identifying co-occurring community risk factors, specific to rural communities, may suggest new strategies and partnerships for addressing sexual health issues among rural youth. We conducted an ecological analysis to identify the county-level correlates of pregnancy and chlamydia rates among adolescents in rural (nonmetropolitan) counties in Minnesota. Pregnancy and chlamydia infection rates among 15-19 year-old females were compared across Minnesota's 87 counties, stratified by rural/urban designations. Regression models for rural counties (n = 66) in Minnesota were developed based on publicly available, county-level information on behaviors and risk exposures to identify associations with teen pregnancy and chlamydia rates in rural settings. Adolescent pregnancy rates were higher in rural counties than in urban counties. Among rural counties, factors independently associated with elevated county-level rates of teen pregnancy included inconsistent contraceptive use by 12th-grade males, fewer 12th graders reporting feeling safe in their neighborhoods, more 9th graders reporting feeling overweight, fewer 12th graders reporting 30 min of physical activity daily, high county rates of single parenthood, and higher age-adjusted mortality ( P < .05 for all associations). Factors associated with higher county level rates of chlamydia among rural counties were inconsistent condom use reported by 12th-grade males, more 12th graders reporting feeling overweight, and more 12th graders skipping school in the past month because they felt unsafe. This ecologic analysis suggests that programmatic approaches focusing on behavior change among male adolescents, self-esteem, and community health and safety may be complementary to interventions addressing teen sexual health in rural areas; such approaches warrant further study. [ABSTRACT FROM AUTHOR]