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HIV incidence remains high in the U.S. as do disparities in new HIV diagnosis between White and Black populations and access to preventive therapies like pre-exposure prophylaxis (PrEP). The federal Ending the HIV Epidemic (EHE) initiative was developed to prioritize resources to 50 jurisdictions with high HIV incidence.We conducted secondary analyses of data (2013-2019) from the CDC, Census Bureau, and AIDSVu to evaluate the correlation between PrEP use, HIV incidence, and HIV incidence disparities. We compared the PrEP-to-need ratio (PnR) with the ratio of Black and White HIV incidence rates in 46 EHE counties. Subsequent analyses were performed for the seven states that contained multiple EHE counties.These 46 counties represented 25.9% of the U.S. population in 2019. HIV incidence ranged from 10.5 in Sacramento County, CA, to 59.6 in Fulton County, GA (per 100,000). HIV incidence disparity ranged from 1.5 in Orleans Parish, LA, to 12.1 in Montgomery County, MD. PnR ranged from 26.8 in New York County, NY, to 1.46 in Shelby County, TN. Change in HIV incidence disparities and percent change in PnR were not significantly correlated (ρ = 0.06, p = 0.69). Change in overall HIV incidence was significantly correlated with increase in PnR (ρ = -0.42, p = 0.004).PrEP has the potential to significantly decrease HIV incidence; however, this benefit has not been conferred equally. Within EHE priority counties, we found significant HIV incidence disparities between White and Black populations. PrEP has decreased overall HIV incidence, but does not appear to have decreased HIV incidence disparity.

The COVID-19 pandemic has created increased need for telehealth appointments. To assess differences in appointment adherence for telehealth compared to in-person HIV medical care visits, we conducted a cross-sectional study of patients receiving HIV care in a safety-net hospital-based outpatient infectious disease clinic in a large urban area (Chicago, IL). The sample (N = 347) was predominantly Black (n = 251) and male (62.5%, n = 217); with a mean age of 44.2 years. Appointment attendance was higher for telehealth (78.9%) compared to in-person (61.9%) appointments. Compared to patients without drug use, those with drug use had 19.4 percentage point lower in-person appointment attendance. Compared to those with stable housing, those in unstable housing arrangements had 15.0 percentage point lower in-person appointment attendance. Telehealth as a modality will likely have some staying power as it offers patients newfound flexibility, but barriers to telehealth need to be assessed and addressed.

Objective A recommendation in March 2020 to expand hepatitis C virus (HCV) screening to all adults in the United States will likely increase the need for HCV treatment programs and guidance on how to provide this service for diverse populations. We evaluated a pharmacist-led HCV treatment program within a routine screening program in an urban safety-net health system in Chicago, Illinois. Methods We collected data on all patient treatment applications submitted from January 1, 2017, through June 30, 2019, and assessed outcomes of and patient retention in the treatment cascade. Results During the study period, 203 HCV treatment applications were submitted for 187 patients (>1 application could be submitted per patient): 49% (n = 91) were aged 55-64, 62% (n = 116) were male, 67% (n = 125) were Black, and 15% (n = 28) were Hispanic. Of the 203 HCV treatment applications, 87% (n = 176) of patients were approved for treatment, 91% (n = 161) of whom completed treatment. Of the 161 patients who completed treatment, 81% (n = 131) attended their sustained virologic response (SVR) follow-up visit, 98% (n = 129) of whom reached SVR. The largest drop in the treatment cascade was the 19% decline from receipt of treatment to SVR follow-up visit. Conclusion The pharmacist-led model for HCV treatment was effective in navigating patients through the treatment cascade and achieving SVR. Widespread implementation of pharmacist-led HCV treatment models may help to hasten progress toward 2030 HCV elimination goals.

Objective Hepatitis C virus (HCV) is a major threat to public health in the United States. We describe and evaluate an HCV screening and linkage-to-care program, including emergency department, inpatient, and outpatient settings, in an urban safety-net health system in Chicago. Methods Sinai Health System implemented a universal HCV screening program in September 2016 that offered patient navigation services (ie, linkage to care) to patients with a positive result for HCV on an RNA test. We collected data from February 1, 2017, through January 31, 2019, on patient demographic characteristics, risk factors, and various outcomes (eg, number of patients screened, test results, proportions of new diagnoses, number of patients eligible for patient navigation services, and proportion of patients who attended their first medical appointment). We also examined outcomes by patients’ knowledge of infection. Results Of 21 018 people screened for HCV, 6% (1318/21 018) had positive test results for HCV antibody, 68% (878/1293) of whom had positive HCV RNA test results. Of these 878 patients, 68% were born during 1945-1965, 68% were male, 65% were Black, 19% were Latino, 55% were newly diagnosed, and 64% were eligible for patient navigation services. Risk factors included past or current drug use (53%), unemployment (30%), and ever incarcerated (21%). Of 562 patients eligible for navigation services, 281 (50%) were navigated to imaging services, and 203 (72%) patients who completed imaging attended their first medical appointment. Conclusion Patient navigation played a critical role in linkage success, but securing stable, long-term financial support for patient navigators is a challenge.

Despite decreases in overall HIV mortality in the U.S., large racial inequities persist. Most previous analyses of HIV mortality and mortality inequities have utilized national- or state-level data.Using vital statistics mortality data and American Community Survey population estimates, we calculated HIV mortality rates and Black:White HIV mortality rate ratios (RR) for the 30 most populous U.S. cities at two time points, 2010-2014 (T1) and 2015-2019 (T2).Almost all cities (28) had HIV mortality rates higher than the national rate at both time points. At T2, HIV mortality rates ranged from 0.8 per 100,000 (San Jose, CA) to 15.2 per 100,000 (Baltimore, MD). Across cities, Black people were approximately 2-8 times more likely to die from HIV compared to White people at both time points. Over the decade, these racial disparities decreased at the national level (T1: RR = 11.0, T2: RR = 9.8), and in one city (Charlotte, NC).We identified large geographic and racial inequities in HIV mortality in U.S. urban areas. These city-specific data may motivate change in cities and can help guide city leaders and other health advocates as they implement, test, and support policies and programming to decrease HIV mortality.

Background The rapid spread of COVID-19 in recent months has caused local and regional governments to enact protective measures that have hindered economies and imposed demanding restrictions on daily life. Households may be experiencing physical, psychological, social, and economic challenges due to these preventative measures. Populations with fewer resources and/or pre-existing conditions may be at higher risk for these negative, life-altering effects. Therefore, we investigated COVID-19 impact on daily life among persons living with HIV (PLH) in Chicago’s under-resourced, largely minority, west and southwest side communities. Methods We modified the EPII, a survey designed to measure pandemic disease impact over nine domains of life, to assess how COVID-19 affected PLH receiving outpatient HIV care. From 5/11–29/2020, participants (n=49) completed the survey online or over the phone and received a $10 grocery gift card. We present the proportion of respondents who reported that they or any household member was impacted by select survey items. Results More than half of respondents reported a household member getting laid off and/or furloughed (63%), increased mental health (45%) or sleep problems (51%), less physical activity (61%), and increased screen time (82%); 45% were unable to pay important bills. Positive changes included eating healthier foods (53%), more time for enjoyable activities (63%), more quality time with friends or family (65%), and paying more attention to personal health (76%). We observed differences by gender, age, and race/ethnicity over all domains (Table 1). Finally, 80% of those who participated in telehealth services were satisfied with their experience. Table 1. Conclusion Overall, respondents struggled with employment, emotional and physical health effects of COVID-19, yet also experienced aspects of positive life change. In the future, these results should be compared with results from a general population to determine whether PLH are disproportionately burdened. Regardless, COVID-19 has negatively impacted daily life for everyone, including PLH, and these individuals may need additional resources compared to their less resource-challenged counterparts. Disclosures All Authors: No reported disclosures

Women account for 25% of all people living with HIV and 19% of new diagnoses in the United States. African American (AA) women are disproportionately affected. Yet, differences in the care continuum entry are not well understood between patient populations and healthcare sites. We aim to examine gender differences in diagnosis and linkage to care (LTC) in the Expanded HIV Testing and Linkage to Care (X-TLC) program within healthcare settings. Data were collected from 14 sites on the South and West sides of Chicago. Multivariate logistic regression analysis was used to determine the differences in HIV diagnoses and LTC by gender and HIV status. From 2011 to 2016, X-TLC performed 281,017 HIV tests; 63.7% of those tested were women. Overall HIV seroprevalence was 0.57%, and nearly one third (29.4%) of HIV-positive patients identified were cisgender women. Of newly diagnosed HIV-positive women, 89% were AA. 58.5% of new diagnoses in women were made at acute care hospitals, with the remainder at community health centers. Women who were newly diagnosed had a higher baseline CD4 count at diagnosis compared with men. Overall, women had lower odds of LTC compared with men (adjusted odds ratio = 0.58, 95% confidence interval 0.44–0.78) when controlling for patient demographics and newly versus previously diagnosed HIV status. Thus, interventions that focus on optimizing entry into the care continuum for AA women need to be explored.

While data on HIV testing prevalence is readily available at the national, state, and more rarely at the city level, few data are available on HIV testing at the community level, where public health initiatives may be most effectively implemented. Community-level data are necessary given that city, state, and national estimates mask variation occurring at the community level in large urban areas. This type of data is crucial for informing education efforts both within the community and among providers. The current study uses the Sinai Community Health Survey 2.0, a cross-sectional, population-based probability survey of adults in selected Chicago communities to determine the prevalence of ever tested for HIV by community area, sex, race/ethnicity, and age (n = 1496). Across the surveyed community areas, ever tested prevalence ranged from a low of 35% in Norwood Park (predominantly White) to a high of 85% in North Lawndale (predominantly Black). Ever tested differences by community area were statistically significant (Rao Scott chi-square p = 0.003). Across the sampled communities, 65% of females, 55% of males, 80% of Blacks, 62% of Puerto Ricans, 53% of Mexicans, and 44% of Whites had ever been tested for HIV (Rao Scott chi-square p 0.01). Ever tested prevalence was highest in the 35-44 age group (72%) and lowest in the 65+ age group (33%) (Rao Scott chi-square p = 0.001). Local-level HIV screening data are integral to understanding where (geographically and among which sub-populations) additional services are needed and may also help in directing and securing funding for such services. The evidence suggests that success in identifying and linking HIV positive individuals to care is most likely to be found through a combination of healthcare- and non-healthcare-based initiatives. Ideally, efforts will be coordinated to encompass both of these settings.

Objective. This study describes routine HIV screening implementation and outcomes in three hospitals in Chicago, Illinois. Methods. Retrospective data from three hospitals were examined, and routine testing procedures, testing volume, reactive test results, and linkage-to-care outcomes were documented. Results. From January 2012 through March 2014, 40,788 HIV tests were administered at the three hospitals: 18,603 (46%) in the emergency department (ED), 7,546 (19%) in the inpatient departments, and 14,639 (36%) in outpatient clinics. The screened patients varied from 1% to 22% of the total eligible patient population across hospitals. A total of 297 patients tested positive for HIV for a seropositivity rate of 0.7%; 129 (43%) were newly diagnosed and 168 (57%) were previously diagnosed, with 64% of those previously diagnosed out of care at the time of screening. The inpatient areas had the highest seropositivity rate (0.6%). The percentage of newly diagnosed patients overall who were linked to care was 77%. Of newly diagnosed patients, 51% had ≥1 missed opportunity for testing (with a mean of 3.8 visits since 2006), and 30% of patients with missed opportunities were late testers (baseline CD4+ counts Conclusion. Routine screening is an essential tool for identifying new infections and patients with known infection who are out of care. Hospitals need to provide HIV screening in inpatient and outpatient settings—not just EDs—to decrease missed opportunities. Routine screening success will be driven by how notification and testing are incorporated into the normal medical flow, the level of leadership buy-in, the ability to conduct quality assurance, and local testing laws.

AIDS-related Kaposi sarcoma (KS) is a vascular malignancy that usually presents with mucocutaneous lesions. Bronchopulmonary involvement as an initial manifestation is a rare phenomenon. This case describes a young male presenting with pulmonary symptoms mimicking HIV-related opportunistic infection who was eventually diagnosed with primary pulmonary KS. The aim of this report is to emphasize that KS should be recognized as a differential diagnosis in AIDS patients presenting with pulmonary symptoms. Making the diagnosis may be a difficult task, at times, requiring invasive procedures such as lung biopsy. Keywords: Kaposi sarcoma, Mucocutaneous lesions, Pulmonary, Bronchoscopy, Biopsy, Visceral

As HIV/AIDS continues to disproportionately affect African American communities, the need for culturally appropriate, tailored interventions for this clientele is growing. Although prevention efforts often include information about individual coping and mental health, not all programs address the role of traumatic events, including community violence in relation to HIV risk. The authors implemented the Treatment Advocacy Program-Sinai with HIV-positive individuals at a large urban hospital. After controlling for demographics and other psychosocial factors, they found that a history of traumatic events—domestic, sexual, and community violence—were associated with sexual risk behavior for men and women in our sample; however, community violence was overwhelming associated with sexual risk for women. Based on the prevalence of violence and the relationship with sexual risk, they discuss implications for prevention interventions in urban clinic settings.

Human immunodeficiency virus preexposure prophylaxis (PrEP) uptake remains low in high-risk populations. Sexually transmitted infection (STI) clinics reach PrEP-eligible persons and may be ideal settings to model PrEP implementation.Consenting PrEP-eligible patients identified at Chicago Department of Public Health STI Clinics were actively referred to PrEP partner sites between June 1, 2015, and May 31, 2016. Outcomes included successful contact by a partner site, linkage to a partner site, and receipt of a PrEP prescription. Bivariable and time to event analyses were conducted to determine significant associations of outcomes.One hundred thirty-seven patients were referred; 126 (92%) were men who have sex with men, and mean age was 29 years. Ninety-eight (72%) were contacted by a PrEP partner, 43 (31%) were linked, and 40 (29%) received a prescription. Individuals aged 25 years and older were more likely to link (odds ratio, 3.10; 95% confidence interval, 1.30-7.41) and receive a PrEP prescription (odds ratio, 2.70; 95% confidence interval, 1.12-6.45) compared with individuals 24 years and younger. The average time between each step was greater for those 24 years and younger compared with those aged 25 years and older for all steps. Time to event analyses revealed that those aged 25 years and older were significantly more likely to receive a prescription compared to those aged 24 years and younger (hazard ratio, 3.62; 95% risk limits, 1.47-8.92).Preexposure prophylaxis active referrals from STI clinics to partner sites are feasible, though drop out was prominent in the initial steps of the continuum. Youth were less likely to link or receive prescriptions, indicating the need for tailored interventions for this vulnerable population.

Study objective Newer combination HIV antigen-antibody tests allow detection of HIV sooner after infection than previous antibody-only immunoassays because, in addition to HIV-1 and -2 antibodies, they detect the HIV-1 p24 antigen, which appears before antibodies develop. We determine the yield of screening with HIV antigen-antibody tests and clinical presentations for new diagnoses of acute and established HIV infection across US emergency departments (EDs). Methods This was a retrospective study of 9 EDs in 6 cities with HIV screening programs that integrated laboratory-based antigen-antibody tests between November 1, 2012, and December 31, 2015. Unique patients with newly diagnosed HIV infection were identified and classified as having either acute HIV infection or established HIV infection. Acute HIV infection was defined as a repeatedly reactive antigen-antibody test result, a negative HIV-1/HIV-2 antibody differentiation assay, or Western blot result, but detectable HIV ribonucleic acid (RNA); established HIV infection was defined as a repeatedly reactive antigen-antibody test result and a positive HIV-1/HIV-2 antibody differentiation assay or Western blot result. The primary outcomes were the number of new HIV diagnoses and proportion of patients with laboratory-defined acute HIV infection. Secondary outcomes compared reason for visit and the clinical presentation of acute HIV infection. Results In total, 214,524 patients were screened for HIV and 839 (0.4%) received a new diagnosis, of which 122 (14.5%) were acute HIV infection and 717 (85.5%) were established HIV infection. Compared with patients with established HIV infection, those with acute HIV infection were younger, had higher RNA and CD4 counts, and were more likely to have viral syndrome (41.8% versus 6.5%) or fever (14.3% versus 3.4%) as their reason for visit. Most patients with acute HIV infection displayed symptoms attributable to acute infection (median symptom count 5 [interquartile range 3 to 6]), with fever often accompanied by greater than or equal to 3 other symptoms (60.7%). Conclusion ED screening using antigen-antibody tests identifies previously undiagnosed HIV infection at proportions that exceed the Centers for Disease Control and Prevention's screening threshold, with the added yield of identifying acute HIV infection in approximately 15% of patients with a new diagnosis. Patients with acute HIV infection often seek ED care for symptoms related to seroconversion.

Background Persons with acute HIV infection have high viral loads and are highly infectious compared with those with chronic infection. Rapid linkage to care and initiation of therapy, facilitated by new testing algorithms, allows for immunologic preservation and rapid virologic control, which benefits the individual and decreases transmission events. Methods We analyzed testing data (2016–2017) from the xTLC Program, a collaborative effort between 13 healthcare centers on the South and West sides of Chicago. For acute HIV infections, we assessed linkage to care, initiation of antiretroviral therapy (ART) and viral suppression across sites. Results Of 334 new HIV diagnoses in xTLC, 33 (9.9%) had acute infection across six sites (five acute care hospitals/emergency departments, one clinic). Baseline viral load (VL) was 2.19 million copies/mL (IQR 0.47–5.00) and baseline CD4 count was 440.5/µL (IQR 287.5–568.5). Table 1 shows care continuum outcomes for patients with acute HIV infection. Table 1: Care Continuum Outcomes for Acute HIV Infections Diagnosed Through X-TLC Site (N) Days to Linkage* (IQR) Days to ART* (IQR) Days to ≥2 Log Reduction in VL* (IQR) Days to VL ≤ 200* (IQR) Retained in Care** (%) Virally Suppressed (%) A (1) 27 (27–27) 9 (9–9) 55 (55–55) 55 (55–55) 1 (100.0) 1 (100.0) B (6) 11 (6–58) 21.5 (7–58) 48 (34–62) 132.5 (48–321) 4 (66.7) 4 (100.0) C (2) 39 (39–39) 53 (53–53) 95 (95–95) 162 (162–162) 1 (50.0) 1 (100.0) D (4) 3.5 (1.5–4.5) 4 (3–6) 31 (29–33) 31 (29–33) 3 (75.0) 3 (100.0) E (14) 8.5 (4–18) 5.5 (4–21) 55 (47–131) 124 (55–162) 10 (71.4) 10 (100.0) F (6) 14 (13–21) 25.5 (23–34) 92.5 (62–471) 329.5 (186–643) 4 (66.7) 4 (100.0) Total (33) 11 (5–19.5) 15 (5–27) 58.5 (42–117) 131 (54–188) 23 (69.7) 23 (100.0) *Median. **Currently in care. Conclusion Patients with acute HIV infection can be successfully managed in existing programs for HIV screening and linkage to care. The xTLC program had a high linkage to care rate, timely initiation of ART, and relatively quick reduction in viral loads. Our outcomes approach those seen for intensive immediate therapy programs, but without additional costs beyond those of the xTLC program. This will likely create similar public health benefits as dedicated programs for rapid initiation of therapy. Disclosures B. Hunt, Gilead: supported by Gilead FOCUS grant, Salary. A. Tobin, Gilead: supported by Gilead FOCUS grant, Salary. A. B. Maheswaran, Gilead: supported by Gilead FOCUS grant, Salary. J. Lin, Gilead: Grant Investigator, Grant recipient. R. Novak, Gilead: Scientific Advisor, Consulting fee. Viiv: Scientific Advisor, Consulting fee. Theratech: Scientific Advisor, Consulting fee. B. Sha, Gilead Sciences: Grant Investigator and Investigator, Grant recipient and Research grant. Viiv Healthcare: Investigator, Research grant. D. Pitrak, Gilead: Grant Investigator, Grant recipient and Research grant. N. Glick, Gilead: Grant Investigator and Scientific Advisor, Grant recipient

Interventions for people with HIV/AIDS became a national priority in 2003. While the importance of involving HIV-positive people in the design, delivery, and evaluation of prevention programs is widely recognized, information about how to implement peer-based services in clinic settings is sparse. The four projects described in this article implemented peer-based interventions as part of larger, multi-site Special Projects of National Significance (SPNS) initiative. Common themes reported by Project Directors/Evaluators describe the challenges and benefits of peer-based interventions across these programs, including infrastructural, clinical and research-related issues. We also discuss the benefits to Peers, researchers, and the clinics sites.

Objective: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. Method: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. Results: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen’s d = 0.84). Conclusion: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general.

Background Women account for 25 % of HIV infections nationally, and African American (AA) women are disproportionately affected. We report important gender differences observed in an expanded HIV testing and linkage to care (X-TLC) program conducted on the South and West Sides of Chicago. Methods X-TLC is funded by CDPH with CDC prevention B funds. X-TLC has expanded from 3 sites to 14 sites, including acute care hospitals (academic, community), community health centers (CHCs), and family planning clinics. We report descriptive stats, group comparisons by Chi-square, and multivariate analyses adjusted for demographics. Results Since 2011, X-TLC has conducted 308,038 HIV screens, and 63.7 % of those tested were women. Overall seroprevalence for HIV was 0.56 %, and 30.5 % of HIV patients identified were cis-gender women (seroprevalence 0.15 %). The seroprevalence for women testing in EDs was higher (0.44 %). Similar to men, only 52.9 % of HIV positive women were new diagnoses. Women accounted for 28.5 % of all new diagnoses, compared with 15.4 % for Chicago overall. In 2016 X-TLC screened 91,865 persons for HIV, and 65.2 % of those tested were women. There were 193 new diagnosis and 32.1 % (62) were women, 85.7 % AA. In comparison, in 2015 there were 139 women with a new HIV diagnosis for all of Chicago. Women newly diagnosed were less likely to be linked to care (adjusted odds ratio, aOR, 0.54, 0.35–0.85). Linkage was lower for women diagnosed at CHCs (84.6 % vs. 76.3 %, P = 0.02). Most CHCs did not have on site HIV providers. At our site, however, women linked to care were more likely to be retained in care (aOR 0.58, 0.43–0.78). We also conduct targeted outreach testing, partner services (PS) testing, and social network strategy (SNS) testing, but women are not identified by these programs (16/171 tested women, 8 new diagnoses were men for PS; 507 tested, 471 men and 36 trans-gender women, 38 new positives, 0 cis-gender women for SNS). Conclusion More women than men were offered and/or accept HIV screening in healthcare settings. The proportion of seropositive women identified was higher than the national average. X-TLC is reaching a large proportional of AA women with HIV unaware of their status. Other testing strategies will rarely identify cis-gender women with HIV infection. Gender differences in linkage to and retention in care will require strategies targeted at women. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; N. Glick, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

Background Audio Computer-Assisted Self Interviewing (ACASI) has improved the reliability and accuracy of self-reported HIV health and risk behavior data, yet few studies account for how participants experience the data collection process. Methodology/Principal Findings This exploratory qualitative analysis aimed to better understand the experience and implications of using ACASI among HIV-positive women participating in sexual risk reduction interventions in Chicago (n = 12) and Philadelphia (n = 18). Strategies of Grounded Theory were used to explore participants' ACASI experiences. Conclusion/Significance Key themes we identified included themes that could be attributed to the ACASI and other methods of data collection (e.g., paper-based self-administered questionnaire or face-to-face interviews). The key themes were usability; privacy and honesty; socially desirable responses and avoiding judgment; and unintentional discomfort resulting from recalling risky behavior using the ACASI. Despite both positive and negative findings about the ACASI experience, we conclude that ACASI is in general an appropriate method for collecting sensitive data about HIV/AIDS risk behaviors among HIV-positive women because it seemed to ensure privacy in the study population allowing for more honest responses, minimize socially desirable responses, and help participants avoid actual or perceived judgment.

Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.

Study objective We assess the feasibility, effectiveness, and cost of routinely recommended HIV/sexually transmitted disease screening in an urban emergency department (ED). Methods From April 2003 to August 2004, patients aged 15 to 54 years were offered rapid HIV testing, and those aged 15 to 25 years were also offered gonorrhea and chlamydia testing (nucleic acid amplification), Monday through Friday, 11 am to 8 pm. Infected patients were referred for treatment and care. Prevalence, treatment rates, and cost were assessed. Results Among 3,030 patients offered HIV testing, 1,447 (47.8%) accepted, 8 (0.6%) tested positive, and 3 (37.5%) were linked to care. Among 791 patients offered sexually transmitted disease testing, 386 (48.8%) accepted, 320 provided urine (82.9%), 48 (15.0%) tested positive, and 42 (87.5%) were treated for gonorrhea or chlamydia. The program cost was $72,928. Costs per HIV-infected patient identified and linked to care were, respectively, $9,116 and $24,309; cost per sexually transmitted disease–infected patient treated was $1,736. The program cost for HIV/sexually transmitted disease screening was only $14,340 more than if we screened only for HIV. Conclusion Through ED-based HIV/sexually transmitted disease screening, we identified and treated many sexually transmitted disease–infected patients but identified few HIV-infected patients and linked even fewer to care. However, sexually transmitted disease screening can be added to HIV screening at a reasonable cost.

In an effort to help fight the HIV epidemic, we offered standard HIV testing to high-risk and symptomatic patients attending an urban emergency department (ED) located in a high-prevalence area. We assessed rates of consent, HIV infection, and linkage into care by demographic and risk characteristics. Consent rates were consistently greater than 50% across the various demographics and risk groups. The HIV prevalence rate was 3% and ranged from 0% to 50% across groups. Of those eligible to enter care 69% attended their first infectious disease clinic appointment. One recommendation to increase the number of people who are aware of their serostatus is to offer HIV testing in underutilized venues, such as an urban ED. The results of this project offer suggestions for future pursuits.

Objective and design To determine whether the female genital tract contains factors that affect HIV-1 replication. Cervicovaginal lavage (CVL) samples were collected from HIV-1-seropositive and seronegative women and added to cell cultures. Methods HIV p24 production was used to measure the effects of CVL on replication of HIVMN in a T-cell line, of a primary isolate in peripheral blood mononuclear cells, or on HIV expression by the latently-infected monocytic U1 cell line. The effects of CVL on the HIV long terminal repeat (LTR) were determined in 1G5 T cells by measuring luciferase activity. Results Increased replication of HIVMN and a primary isolate were observed in T cells cultured with CVL samples from three out of 38 HIV-infected women, one out of four uninfected high-risk women, and none of 12 low-risk women. The CVL factor increased replication by enhancing virus expression via activation of the HIV LTR. The HIV-inducing activity was highly stable to heat but was sensitive to proteases, indicating that the activity was distinct from heat-labile cytokines including tumour necrosis factor-alpha. Conclusions This is the first study to show that a factor which can stimulate HIV-1 replication is present at biologically active levels in the reproductive tract of women. This factor could potentially affect sexual or vertical transmission of HIV-1 by altering genital tract virus load or virus expression.