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Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, past-year HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23–1.31) and SSP participation (aPR 1.19, 95% CI 1.13–1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00–1.28) but the link was not significant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment. [ABSTRACT FROM AUTHOR]

Persons who inject drugs (PWID) and exchange sex face disproportionate HIV rates. We assessed prevalence of exchange sex (receiving money/drugs for sex from ≥ 1 male partner(s) during the past year) among cisgender PWID, separately for women and men with a history of sex with men (MSM). We examined factors associated with exchange sex, including sociodemographic characteristics, sexual and drug use behaviors, and healthcare access/utilization. Over one-third of the 4657 participants reported exchange sex (women: 36.2%; MSM: 34.8%). Women who exchanged sex (WES) were significantly more likely to test HIV-positive than other women. Men who exchanged sex with men (MESM) showed a similar trend. WES and MESM shared many characteristics, including being uninsured, experiencing recent homelessness, condomless sex, polydrug use, and receptive/distributive needle sharing. These findings highlight a need to strengthen prevention interventions and address structural determinants of HIV for WES and MESM, particularly PWID who exchange sex. [ABSTRACT FROM AUTHOR]

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HIV rapid testing algorithms (RTAs) using any two orthogonal rapid tests (RTs) allow for on-site confirmation of infection. RTs vary in performance characteristics therefore the selection of RTs in an algorithm may affect identification of infection, particularly if acute. National HIV Behavioral Surveillance (NHBS) assessed RTAs among men who have sex with men recruited using anonymous venue-based sampling. Different algorithms were evaluated among participants who self-reported never having received a positive HIV test result prior to the interview. NHBS project areas performed sequential or parallel RTs using whole blood. Participants with at least one reactive RT were offered anonymous linkage to care and provided a dried blood spot (DBS) for testing at CDC. Discordant results (RT-1 reactive/RT-2 non-reactive) were tested at CDC with lab protocols modified for DBS. DBS were also tested for HIV-1 RNA (VL) and antiretroviral (ARV) drug levels. Of 6500 RTAs, 238 were RT-1 reactive; of those, 97.1% (231/238) had concordant results (RT-1/RT-2 reactive) and 2.9% (7/238) had discordant results. Five DBS associated with discordant results were available for confirmation at CDC. Four had non-reactive confirmatory test results that implied RT-1 false reactivity; one had ambiguous confirmatory test results which was non-reactive in further testing. Regardless of order and type of RT used, RTAs demonstrated high concordant results in the population surveyed. Additional laboratory testing on DBS following discordant results confirmed no infection. Implementing RTAs in the context of anonymous venue-based HIV testing could be an option when laboratory follow-up is not practicable. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) who have intersecting stigmatized identities or characteristics are differentially at risk for acquiring HIV. However, the relationships between specific identities, discrimination and stigma, and HIV risk behaviors require investigation to develop more effective interventions. Data from Boston's 2014 National HIV Behavioral Surveillance MSM cycle were used to assess associations between socio-demographics, structural factors, substance use, discrimination, HIV-stigma, and condomless anal sex. Of the total sample (n = 382), 17.6% reported verbal abuse, 8.3% work-place discrimination, 2.6% health discrimination, and 3.8% physical assault. HIV-stigma beliefs differed by race, sexual-orientation, and income. Those with histories of drug treatment were 9.47 (OR 95%CI: 2.09, 42.79) and 8.29 (OR 95%CI: 2.27, 30.21) times more likely to report health discrimination and physical assault, respectively. Healthcare discrimination and physical assault moderated relationships between substance use and number of condomless anal sex partners such that those who experienced discrimination and substance use reported more partners. Even in Massachusetts, MSM with identities or characteristics marginalized in society disproportionately experienced discrimination and stigma and healthcare discrimination or physical assault were associated with increased sexual risk behavior among MSM who use substances. Decreasing HIV transmission requires reducing discrimination and stigma among those most vulnerable, particularly those using substances. [ABSTRACT FROM AUTHOR]

The authors discuss the U.S. state Medicaid programs that are limiting access to new hepatitis C virus treatment. Topics include availability of drug sofosbuvir being marketed by Gilead Sciences for hepatitis C virus treatment under the brand name Sovaldi, a table listing U.S. states having prior authorization criteria for sofosbuvir prescription under state Medicaid fee-for-service programs and need of investigating effects of prior approval policies for new HCV treatments on patient outcomes.

Background The persistent incidence of HIV among people who inject drugs (PWID) underscores the urgency for HIV prevention efforts to end the HIV epidemic. Little is known about the role carceral settings play as touchpoints for HIV testing in this population. Methods Secondary analysis of cross-sectional survey data of PWID in the Boston metro area from the 2015 and 2018 cycles of the National HIV Behavioral Surveillance (NHBS). Among self-reported HIV-negative participants, we examined incarceration and HIV testing histories and used a multivariable modified Poisson regression model to evaluate the association between incarceration history (main exposure) and past-year HIV testing (primary outcome). Results Among 957 participants, average age was 38.9 (SD 11.1) years, 70.1% were male, 15.2% were Hispanic (of any race), 8.4% were non-Hispanic Black, and 68.1% were non-Hispanic White. Regarding incarceration experiences, 43.5% of participants reported past-year incarceration, and 41.8% reported a history of incarceration but only prior to the past year. Among those with past-year incarceration, 23.4% said their last HIV test was done at a jail or prison. Adjusting for other characteristics, compared to no incarceration history, past-year incarceration (PR 1.39; 95% CI: 1.29, 1.49) and incarceration prior to the the past year (PR 1.19; 95%CI: 1.02, 1.38) were both associated with a greater prevalence of past-year HIV testing. Conclusions Among PWID, incarceration was very common and was a substantial source of HIV testing. However, more testing is still needed-in both community and carceral settings-to reach optimal testing rates in this key population.

Eighty-six percent of those engaged in HIV medical care in Massachusetts achieved viral suppression, making Massachusetts's long-term goal of eliminating new infections of HIV a real possibility. In order to achieve this goal, Massachusetts is working to engage all individuals living with HIV/AIDS in HIV medical care, keep them retained in care, and render their viral load non-detectable. Currently, in Massachusetts, the data elements necessary to monitor the HIV care continuum are documented in siloed health information systems that do not communicate with each other. Massachusetts has engaged in a pilot project to enhance their health information technology (IT) capacity to monitor the HIV care continuum and identify gaps in care. Massachusetts Virtual Epidemiologic Network (MAVEN) will be enhanced to perform as a consolidated electronic system to document and triage clinic-, laboratory-, and patient-level surveillance, field epidemiology and HIV care continuum data. The consolidation will enhance identification of patients infected with HIV and provide timely, actionable data for engagement and retention in HIV medical care.