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Objective: To assess geospatial patterns of HIV antiretroviral therapy (ART) treatment facility use and whether they were impacted by viral load suppression., Methods: We extracted data on the location and type of care services utilized by HIV-positive persons accessing ART between February 2015 and September 2016 from the Rakai Community Cohort Study in Uganda. The distance from Rakai Community Cohort Study households to facilities offering ART was calculated using the open street map road network. Modified Poisson regression was used to identify predictors of distance traveled and, for those traveling beyond their nearest facility, the probability of accessing services from a tertiary care facility., Results: In total, 1554 HIV-positive participants were identified, of whom 68% had initiated ART. The median distance from households to the nearest ART facility was 3.10 km (interquartile range, 1.65-5.05), but the median distance traveled was 5.26 km (interquartile range, 3.00-10.03, P < 0.001) and 57% of individuals travelled further than their nearest facility for ART. Those with higher education and wealth were more likely to travel further. In total, 93% of persons on ART were virally suppressed, and there was no difference in the distance traveled to an ART facility between those with suppressed and unsuppressed viral loads (5.26 vs. 5.27 km, P = 0.650)., Conclusion: Distance traveled to HIV clinics was increased with higher socioeconomic status, suggesting that wealthier individuals exercise greater choice. However, distance traveled did not vary by those who were or were not virally suppressed.

Introduction: To assess progress towards the UNAIDS 90-90-90 initiative targets, we examined the HIV care cascade in the population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups., Methods: Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ 2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART)., Results: From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77-0.91; ART initiation: adjPRR 0.75, 95% CI 0.69-0.82), persons aged 15-24 compared to those aged 30-39 (enrolment: adjPRR 0.72, 95% CI 0.63-0.82; ART: adjPRR 0.69, 95%CI 0.60-0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71-0.99; ART adjPRR 0.80, 95% CI 0.66-0.95), and new in-migrants (enrolment: adjPRR 0.75, 95% CI 0.67-0.83; ART: adjPRR 0.76, 95% CI 0.67-0.85). This cohort achieved 98-65-92 towards the UNAIDS "90-90-90" targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed., Conclusions: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach sub-populations., Competing Interests: The authors declare that they have no competing interests.

442 pre-ART, HIV-infected adults were randomized to peer support consisting of structured home visits to promote clinic attendance and preventive care intervention use or standard of care. At baseline, 62 % reported previously visiting an HIV clinic, 45 % reported taking cotrimoxazole prophylaxis, and 31 % were "care-naïve" (no previous clinic visit and not on cotrimoxazole). After 1 year, intervention participants were more likely to report being in care (92 vs 84 %; PRR 1.09, p = 0.039), on cotrimoxazole (89 vs 81 %; PRR 1.10, p = 0.047), and safe water vessel adherence (23 vs 14 %; PRR 1.64, p = 0.024). The effect was observed only among care-naïve participants (n = 139) with 83 % intervention versus 56 % controls reporting being in HIV care (PRR 1.47, p = 0.006), 78 versus 58 % on cotrimoxazole (PRR 1.35, p = 0.04), and 20 versus 4 % safe water vessel adherence (PRR 5.78, p = 0.017). Peer support may be an effective intervention to facilitate pre-ART care compliance in this important population.

We examined the relationship between religiosity and HIV-related drug risk behavior among individuals from communities with high rates of drug use who participated in the SHIELD (Self-Help in Eliminating Life-Threatening Disease) study. This analysis examined the dimensions of religious ideation, religious participation, and religious support separately to further understand the relationship with risk taking. Results indicate that greater religious participation appeared to be the dimension most closely associated with drug behaviors. Specifically, we found that those with greater religious participation are significantly less likely to report recent opiates or cocaine use; injection drug use; crack use; and needle, cotton or cooker sharing. Future work to understand the nature of these associations will assist in the development of interventions in communities with high rates of drug use.

Objectives: This report presents nationally representative estimates and trends for human immunodeficiency virus (HIV) testing among the U.S. household population aged 15-44. Data are presented for lifetime experience with HIV testing and HIV testing in the past year, including testing done as part of prenatal care., Methods: Data for this report come from the 2006-2010 National Survey of Family Growth (NSFG), consisting of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The overall response rate for the 2006-2010 NSFG was 77%: 78% for women and 75% for men., Results: Among U.S. women aged 15-44, the percentage ever tested for HIV outside of blood donation increased significantly from 35% in 1995 to 55% in 2002, and to 59% in 2006-2010. Among men aged 15-44, the percentage ever tested outside blood donation fell from 47% in 2002 to 42% in 2006-2010. Within gender groups in 2006-2010, the proportions ever tested for HIV outside of blood donation were similar for Hispanic and non-Hispanic white persons: roughly 6 out of 10 among women and 4 out of 10 among men. However, a higher percentage of non-Hispanic black women (75%) and non-Hispanic black men (61%) had ever been tested for HIV outside of blood donation. Based on 2006-2010 data, 21% of women were tested for HIV within the 12 months prior to interview, compared with 13% of men. While NSFG data cannot ascertain the temporal sequencing of risk-related behaviors and HIV testing, the data indicate that testing within the past year occurs more often among individuals reporting potential HIV risk-related behaviors.

Objective: This report presents national estimates of selected HIV risk-related behaviors among men and women 15-44 years of age in the United States, based on the 2006-2010 National Survey of Family Growth (NSFG). Data from the 2006-2010 NSFG are compared with data from the 2002 NSFG., Methods: Data for 2006-2010 were collected through in-person interviews with a national sample of 22,682 men and women aged 15-44 years in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self-interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The response rate for the 2006-2010 NSFG was 77%, 78% for women and 75% for men. HIV risk-related behavioral measures examined in this report include sexual risk, drug risk, and recent STD treatment., Results: Approximately 10% of men and 8% of women in 2006-2010 reported at least one of the HIV risk-related behavioral measures examined in this report, representing 6.5 million men and 4.9 million women in the general U.S. household population. This represents a decline from the 13% of men and 11% of women who reported one or more of these measures in 2002. This decline appears to be due to a decrease in sexual risk behaviors reported in 2006-2010, however further analysis as well as comparisons with other household surveys are needed to fully understand and describe trends over time. Significant variations were seen by demographic and socioeconomic characteristics including age, race and Hispanic origin, sex, education, and poverty level income. Among men, those with recent prison experience were more likely than other men to report one or more HIV risk-related behaviors in the past year.