Last data update: Oct 28, 2024. (Total: 48004 publications since 2009)
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Query Trace: Crim SM[original query] |
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Progress toward achieving national HIV/AIDS strategy goals for quality of life among persons aged ≥50 years with diagnosed HIV - medical monitoring project, United States, 2017-2023
Beer L , Tie Y , Crim SM , Weiser J , Taussig J , Craw JA , Buchacz KA , Dobbs A , Collins CB Jr , Johnston ME , De Los Reyes A , Gelaude D , Hughes K , Desamu-Thorpe R , Prejean J . MMWR Morb Mortal Wkly Rep 2024 73 (36) 781-787 Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH. |
Self-rated health and HIV outcomes among adults with diagnosed HIV - Medical Monitoring Project, United States, 2020-21
Cholli PA , Buchacz KM , Harris NS , Crim SM , Yuan X , Tie Y , Koenig LJ , Beer L . Aids 2024 OBJECTIVES: To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection. DESIGN: We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3,692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics. RESULTS: Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI:0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI:0.43-0.59) and anxiety (aPR 0.60, 95% CI:0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI:0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI:0.69-0.80), as well as having a mean CD4 count <200 cells/mm3 vs. CD4 >500 cells/mm3 (aPR 0.70, 95% CI:0.57-0.86). CONCLUSIONS: Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the U.S. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH. |
Do HIV care outcomes differ by provider type?
Weiser J , Tie Y , Crim SM , Riedel DJ , Shouse RL , Dasgupta S . J Acquir Immune Defic Syndr 2024 BACKGROUND: We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce. SETTING: U.S. METHODS: We analyzed data from CDC's Medical Monitoring Project collected during 6/2019-5/2021 from 6,323 adults receiving HIV medical care. Provider types were infectious disease physicians only (ID physicians), non-ID physicians only (non-ID physicians), nurse practitioners only (NPs), physician assistants only (PAs), and ID physicians plus NPs and/or PAs (mixed providers). We measured patient characteristics, social determinants of health (SDOH), and clinical outcomes including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust. RESULTS: Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and SDOH associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different, however higher percentages of patients of non-ID physicians, NPs, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had STI testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively). CONCLUSION: Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, NPs, and mixed providers were more likely to be retained in care and have recommended STI testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes. |
Sexual and reproductive health among cisgender women with HIV aged 18-44 years
Dasgupta S , Crim SM , Weiser JK , Blackwell A , Lu JF , Lampe MA , Dieke A , Fanfair RN . Am J Prev Med 2024 INTRODUCTION: The sexual and reproductive health of cisgender women with HIV is essential for overall health and well-being. Nationally representative estimates of sexual and reproductive health outcomes among women with HIV were assessed in this study. METHODS: Data from the Centers for Disease Control and Prevention's Medical Monitoring Project-including data on sexual and reproductive health-were collected during June 2018-May 2021 through interviews and medical record abstraction among women with HIV and analyzed in 2023. Among women with HIV aged 18-44 years (n=855), weighted percentages were reported, and absolute differences were assessed between groups, highlighting differences ≥|5%| with CIs that did not cross the null. RESULTS: Overall, 86.4% of women with HIV reported receiving a cervical Pap smear in the past 3 years; 38.5% of sexually active women with HIV had documented gonorrhea, chlamydia, and syphilis testing in the past year; 88.9% of women with HIV who had vaginal sex used ≥1 form of contraception in the past year; and 53.4% had ≥1 pregnancy since their HIV diagnosis-of whom 81.5% had ≥1 unintended pregnancy, 24.6% had ≥1 miscarriage or stillbirth, and 9.8% had ≥1 induced abortion. Some sexual and reproductive health outcomes were worse among women with certain social determinants of health, including women with HIV living in households <100% of the federal poverty level compared with women with HIV in households ≥139% of the federal poverty level. CONCLUSIONS: Many women with HIV did not receive important sexual and reproductive health services, and many experienced unintended pregnancies, miscarriages/stillbirths, or induced abortions. Disparities in some sexual and reproductive health outcomes were observed by certain social determinants of health. Improving sexual and reproductive health outcomes and reducing disparities among women with HIV could be addressed through a multipronged approach that includes expansion of safety net programs that provide sexual and reproductive health service coverage. |
The capacity of HIV care facilities to implement strategies recommended by the Ending the HIV Epidemic-The Medical Monitoring Project Facility Survey
Beer L , Williams D , Tie Y , McManus T , Yuan AX , Crim SM , Demeke HB , Creel D , Blackwell AD , Craw JA , Weiser J . J Acquir Immune Defic Syndr 2023 94 (4) 290-300 BACKGROUND: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING: US HIV care facilities. METHODS: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION: Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports. |
Unmet needs for HIV ancillary services among persons with diagnosed HIV aged 55 years and older
Byrd KK , Buchacz K , Crim SM , Beer L , Lu JF , Dasgupta S . J Acquir Immune Defic Syndr 2023 BACKGROUND: Approximately two in five persons with HIV (PWH) in the United States are aged ≥55 years. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged ≥55 years. SETTING: Medical Monitoring Project is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States. METHODS: We used MMP data collected during 6/2019-5/2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged ≥55 years with unmet needs for ancillary services, overall and by selected characteristics (N=3,200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals (CIs) with predicted marginal means. RESULTS: Overall, 37.7% of cisgender men and women with HIV aged ≥55 years had ≥1 unmet need for ancillary services. Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services. There were no statistically significant differences in unmet needs for services by gender. The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR=1.70), and those without any private insurance (PR range: 1.49-1.83). CONCLUSION: A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed. |
Unmet needs for ancillary services and associations with clinical outcomes among transgender women with diagnosed HIV: Medical monitoring project, United States, 2015-2020
Espinosa CC , Crim SM , Carree T , Dasgupta S . LGBT Health 2023 Purpose: Access to ancillary services-including HIV support services, non-HIV clinical services, and subsistence services-can support care engagement and viral suppression and reduce disparities among people with HIV (PWH). We used representative U.S. data to assess differences in unmet needs for ancillary services between transgender women with HIV and other PWH. In addition, we examined associations between unmet needs and clinical outcomes among transgender women. Methods: We analyzed 2015-2020 Medical Monitoring Project data among transgender women (N = 362), cisgender men (N = 17,319), and cisgender women (N = 6016) with HIV. We reported weighted percentages for characteristics, and reported adjusted prevalence ratios (aPRs) controlling for race/ethnicity and age, and 95% confidence intervals (CI) using logistic regression with predicted marginal means to assess differences between groups. Results: Among transgender women, unmet needs were highest for dental care (24.9%), shelter or housing (13.9%), and transportation assistance (12.6%). Transgender women were more likely than cisgender men to have unmet subsistence needs. Among transgender women, unmet needs for ancillary services were negatively associated with many clinical outcomes after adjusting for age and race/ethnicity. Unmet needs for subsistence services were associated with higher levels of antiretroviral therapy nonadherence (aPR: 1.39; 95% CI: 1.13-1.70) and detectable viral loads (aPR: 1.47; 1.09-1.98), emergency room visits (aPR: 1.42; 1.06-1.90), and depression (aPR: 2.74; 1.83-4.10) or anxiety (aPR: 3.20; 2.05-5.00) symptoms. Conclusions: Transgender women with HIV were more likely than cisgender men with HIV to experience unmet needs for subsistence services-likely a reflection of substantial socioeconomic disadvantage. Addressing unmet needs is an essential step for improving care outcomes among transgender women with HIV. |
Intersectional discrimination in HIV healthcare settings among persons with diagnosed HIV in the United States, Medical Monitoring Project, 2018-2019
McCree DH , Beer L , Crim SM , Kota KK , Baugher A , Jeffries WLth , Patel D , Marcus R , Yuan XA , Luke Shouse R . AIDS Behav 2023 27 (11) 3623-3631 Experiences with stigma and discrimination in healthcare settings are associated with negative health outcome for persons with HIV (PWH). PWH may experience discrimination due to the intersection of multiple marginalized social identities. Describing these experiences is important for informing interventions and strategies to reduce stigma and discrimination. We report experiences with discrimination in HIV healthcare settings attributed to multiple characteristics, e.g., sexual orientation, race/ethnicity, income, or social class, and/or injection drug use, among a nationally representative sample of persons with diagnosed HIV in the United States using data from the Medical Monitoring Project (MMP). We calculated weighted prevalences and associated 95% confidence intervals for any discrimination and discrimination attributed to multiple characteristics (intersectional discrimination). Among those experiencing discrimination, nearly 1 in 4 persons reported intersectional discrimination, with a higher burden among key populations of focus for HIV prevention and treatment. Discrimination was attributed to HIV status (62.5%), sexual orientation (60.4%), and race/ethnicity (54.3%). Persons who experienced intersectional discrimination were less likely to have a regular HIV care provider, have trust in HIV care or treatment information from healthcare providers, and be antiretroviral treatment or HIV care visit adherent. Future studies should explore methods to operationalize and assess experiences with intersectional stigma and discrimination and use the outcomes to inform qualitative research that provides more context and a deeper understanding of experiences with intersectional discrimination among PWH. |
Antibiotic prescribing for acute gastroenteritis during ambulatory care visits-United States, 2006-2015
Collins JP , King LM , Collier SA , Person J , Gerdes ME , Crim SM , Bartoces M , Fleming-Dutra KE , Friedman CR , FrancoisWatkins LK . Infect Control Hosp Epidemiol 2022 43 (12) 1-10 OBJECTIVE: To describe national antibiotic prescribing for acute gastroenteritis (AGE). SETTING: Ambulatory care. METHODS: We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen. RESULTS: We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%-71.9%), Campylobacter (44.8%; 95% CI, 41.5%-48.1%), Shigella (39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis. CONCLUSIONS: Overall, 13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings. |
Sexually transmitted infection testing among unstably housed, sexually active persons with HIV in the United States, 2018-2019
Marcus R , Tie Y , Dasgupta S , Crim SM , Beer L , Williams SP , Weiser J . Sex Transm Dis 2022 49 (12) 841-843 Unstably housed sexually active people with HIV (PWH) experience both a high incidence of sexually transmitted infections (STIs) and barriers to annual STI screening recommended by CDC guidelines. We used Medical Monitoring Project data to describe STI testing among unstably housed PWH by attendance at Ryan White HIV/AIDS Program-funded facilities. |
Assessing concordance of HIV risk behaviors collected by different surveillance systems
Panneer N , Balaji AB , Crim SM , Bosh KA , Shouse RL , Fagan JL , Beer L . AIDS 2022 36 (12) 1725-1729 OBJECTIVES: Assess concordance of assigned transmission category between National HIV Surveillance System (NHSS) and Medical Monitoring Project (MMP); assess persistence of behaviors by comparing transmission category to current behavior. DESIGN: Retrospective analysis of HIV surveillance data. METHODS: For 4034 participants in the 2016 MMP cycle, transmission category was assigned in NHSS and MMP by applying a hierarchy to acquisition risk behaviors and selecting the most likely risk behavior that led to HIV acquisition. We assessed concordance of transmission category between systems, the number of persons with an updated transmission category in NHSS after incorporating MMP data, and concordance of transmission category and current behavior. RESULTS: Concordance of transmission category between NHSS and MMP was 87% for men with evidence of male-to-male sexual contact and ranged from 27% to 62% in persons with other transmission categories. Transmission category in NHSS was updated for 9% of persons after incorporating MMP data, mostly affecting those with no identified risk in NHSS. Current behavior aligned with updated NHSS transmission category in 56% of men with a transmission category of male-to-male sexual contact. However, only 8% of men and 5% of women with a transmission category of injection drug use had recently injected drugs. CONCLUSION: HIV surveillance systems can better inform prevention efforts with more complete risk information. Sexual behaviors are more persistent over time than injection drug use. In addition to promoting viral suppression, routinely assessing risk and tailoring prevention activities accordingly can improve health outcomes. |
Unmet needs for HIV ancillary care services by healthcare coverage and Ryan White HIV/AIDS program assistance.
Dasgupta S , Crim SM , Dawson L , Kates J , Weiser J , Klein PW , Dempsey A , Hauck H , Lu JF , Shu F , Beer L . AIDS 2022 36 (10) 1399-1407 OBJECTIVE: To investigate unmet needs for HIV ancillary care services by health care coverage type and Ryan White HIV/AIDS Program (RWHAP) assistance among adults with HIV. DESIGN: We analyzed data using the 2017-2019 cycles of the CDC Medical Monitoring Project, an annual, cross-sectional study designed to produce nationally representative estimates of characteristics among adults with diagnosed HIV. METHODS: Unmet need was defined as needing, but not receiving, ≥1 HIV ancillary care service. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) using predicted marginal means to examine associations between health care coverage type and unmet needs for HIV ancillary care services, adjusting for age. Associations were stratified by receipt of RWHAP assistance. RESULTS: Unmet needs for HIV ancillary care services were highest among uninsured persons (58.7%) and lowest among those with private insurance living ≥400% of the federal poverty level (FPL; 21.7%). Uninsured persons who received RWHAP assistance were less likely than those who did not receive RWHAP assistance to have unmet needs for HIV clinical support services (aPR: 0.21; 95% CI: 0.16-0.28) and other medical services (aPR: 0.75; 95% CI: 0.59-0.96), but not subsistence services (aPR: 0.97; 95% CI: 0.74-1.27). Unmet needs for other medical services and subsistence services did not differ by RWHAP assistance among those with Medicaid, Medicare, or other health care coverage. CONCLUSIONS: RWHAP helped reduce some needs for uninsured persons. However, with growing socioeconomic inequities following the COVID-19 pandemic, expanding access to needed services for all people with HIV could improve key outcomes. |
Clinical outcomes of adults with diagnosed HIV living in ending the HIV epidemic priority areas, medical monitoring project, 2018
Chowdhury PP , Beer L , Crim SM , Bosh KA , Desamu-Thorpe RG , Shouse LR . Public Health Rep 2022 138 (1) 333549221074339 OBJECTIVES: The Ending the HIV Epidemic (EHE) initiative prioritizes treatment and prevention efforts in counties where most new HIV diagnoses occur and states with substantial incidence of new HIV diagnoses in rural areas. Understanding the characteristics of adults with HIV living in EHE priority areas, and how these characteristics compare with adults with HIV living in non-EHE priority areas, can inform EHE efforts. METHODS: We analyzed data from the 2018 Medical Monitoring Project (MMP) to understand the characteristics of adults with HIV living in 36 of 48 EHE priority counties; San Juan, Puerto Rico; and 1 of 7 EHE priority states. We calculated weighted percentages of sociodemographic characteristics, behaviors, and clinical outcomes of adults with diagnosed HIV living in MMP EHE priority areas and compared them with characteristics of adults who did not live in MMP EHE priority areas using prevalence ratios (PRs) with predicted marginal means. RESULTS: Living in an MMP EHE priority area was more common among adults who were non-Hispanic Black or Hispanic, experienced homelessness, or were food insecure compared with adults who were non-Hispanic White (59.3% and 58.4% vs 41.0%), not experiencing homelessness (60.9% vs 51.9%), or not food insecure (59.8% vs 51.0%). Adults who lived in MMP EHE priority areas were significantly less likely to be adherent to their HIV medications (PR = 0.95; 95% CI, 0.91-0.99) and durably virally suppressed (PR = 0.94; 95% CI, 0.91-0.97), and more likely to miss scheduled appointments for HIV care (PR = 1.31; 95% CI, 1.10-1.56) than adults who did not live in MMP EHE priority areas. CONCLUSION: To increase viral suppression and reduce HIV transmission, it is essential to strengthen public health efforts to improve medication and appointment adherence in this population. |
Vital Signs: HIV Infection, Diagnosis, Treatment, and Prevention Among Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2010-2019
Pitasi MA , Beer L , Cha S , Lyons SJ , Hernandez AL , Prejean J , Valleroy LA , Crim SM , Trujillo L , Hardman D , Painter EM , Petty J , Mermin JH , Daskalakis DC , Hall HI . MMWR Morb Mortal Wkly Rep 2021 70 (48) 1669-1675 BACKGROUND: Men who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population. METHODS: CDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma. RESULTS: The estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25-34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13-24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0-100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18-24 years had the lowest adherence to ART (45%) and the highest median stigma score (39). CONCLUSION: Improving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States. |
Sociodemographic correlates of self-reported discrimination in HIV health care settings among persons with diagnosed HIV in the United States, Medical Monitoring Project, 2018-2019
McCree DH , Beer L , Jeffries WL 4th , Tie Y , Fagan J , Crim SM . J Acquir Immune Defic Syndr 2021 88 (5) 457-464 BACKGROUND: HIV-related discrimination in health care settings is associated with negative health outcomes among persons with HIV (PWH). This paper describes and compares differences in the prevalence of self-reported experiences with discrimination in health care settings by sociodemographic and clinical care factors among persons with diagnosed HIV in the United States. METHODS: We analyzed interview and medical record data collected 6/2018-5/2019 from 3850 PWH who had received HIV care in the past 12 months. We calculated weighted percentages and associated 95% confidence intervals and assessed the association between any experience of discrimination and selected sociodemographic and clinical characteristics using prevalence ratios with predicted marginal means. RESULTS: About 25% of PWH who had an HIV care visit in the past 12 months reported experiencing any discrimination. Experiences with discrimination were significantly more prevalent among persons 18-29 years (34%); transgender persons (41%); persons of gay (25%), bisexual (31%), or other (40%) sexual orientations; and persons who did not have a regular provider (39%), lived at/below poverty level (28%), were homeless (39%) or incarcerated (37%) in the past 12 months. PWH who experienced discrimination were more likely to have missed at least one HIV care visit, not be taking ART, and have missed ART doses. Recent and sustained viral suppression were not significantly associated with experiencing any discrimination. CONCLUSIONS: Interventions that address the sociocultural and structural factors associated with discrimination in all health care settings are needed to improve health outcomes among PWH and end the HIV epidemic in the United States. |
Sexually transmitted infection testing among transgender women living with HIV in the United States: Medical Monitoring Project, 2015-2019
Town K , Tie Y , Dasgupta S , Kirkcaldy RD , Crim SM , Weiser J , Bernstein K . Clin Infect Dis 2021 73 (5) 899-902 National guidelines recommend annual STI testing for sexually active people living with HIV, including transgender women. Using data from the US Medical Monitoring Project during 2015-2019, in the previous 12 months, 63.3% of sexually active HIV-positive transgender women were tested for syphilis, 56.6% for chlamydia, and 54.4% for gonorrhea. |
Attribution of illnesses transmitted by food and water to comprehensive transmission pathways using structured expert judgment, United States
Beshearse E , Bruce BB , Nane GF , Cooke RM , Aspinall W , Hald T , Crim SM , Griffin PM , Fullerton KE , Collier SA , Benedict KM , Beach MJ , Hall AJ , Havelaar AH . Emerg Infect Dis 2021 27 (1) 182-195 Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke's classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler-related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions. |
Barriers to antiretroviral therapy adherence among HIV-positive Hispanic and Latino men who have sex with men -United States, 2015-2019
Crim SM , Tie Y , Beer L , Weiser J , Dasgupta S . MMWR Morb Mortal Wkly Rep 2020 69 (40) 1437-1442 During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission. |
Postinfectious irritable bowel syndrome after Campylobacter infection
Scallan Walter EJ , Crim SM , Bruce BB , Griffin PM . Am J Gastroenterol 2019 114 (10) 1649-1656 OBJECTIVES: Postinfectious irritable bowel syndrome (PI-IBS) is an important sequela of Campylobacter infection. Our goal is to estimate the incidence of Campylobacter-associated PI-IBS in the United States. METHODS: Data from January 1, 2010 to December 31, 2014, were obtained from the MarketScan Research Commercial Claims and Encounters Database. We identified patients with an encounter that included an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for "intestinal infection due to Campylobacter" (008.43) and individually matched them (on age group, sex, and length of enrollment) to a group of persons without a diagnosed Campylobacter infection (non-cases). The primary outcome of interest was a new diagnosis of IBS (International Classification of Diseases, Ninth Revision, Clinical Modification 564.1). RESULTS: Our final matched cohort included 4,143 cases and 20,491 non-cases. At 1 year, the incidence rate of IBS was 33.1 and 5.9 per 1,000 among cases and non-cases, respectively, with an unadjusted risk ratio of 5.6 (95% confidence interval [CI]: 4.3-7.3). After adjusting for healthcare utilization, the Cox proportional hazard ratio was 4.6 (95% CI: 3.5-6.1). Excluding those who received an IBS diagnosis within 90 days, the 1-year incidence rate of IBS was 16.7 and 3.9 per 1,000 among cases and non-cases, respectively, with an unadjusted risk ratio of 4.3 (95% CI: 3.0-6.2). DISCUSSION: Persons with a Campylobacter infection have a much higher risk of developing IBS compared with those not diagnosed with Campylobacter infection. The burden of Campylobacter-associated PI-IBS should be considered when assessing the overall impact of Campylobacter infections. |
Incidence of Campylobacter-associated Guillain-Barre syndrome estimated from health insurance data
Scallan Walter EJ , Crim SM , Bruce BB , Griffin PM . Foodborne Pathog Dis 2019 17 (1) 23-28 Guillain-Barre syndrome (GBS) is sometimes preceded by Campylobacter infection. We estimated the cumulative incidence of Campylobacter-associated GBS in the United States using a retrospective cohort design. We identified a cohort of patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "intestinal infection due to Campylobacter" (008.43) using MarketScan Research Databases for 2004-2013. Campylobacter patients with an encounter for "acute infective polyneuritis" (AIP; ICD-9-CM 357.0) were identified. Patients with an inpatient encounter having AIP as the principal diagnosis were considered probable GBS cases. Patients with probable GBS </=8 weeks after the Campylobacter encounter were considered probable Campylobacter-associated GBS cases. For comparison, we repeated this analysis for patients with "other Salmonella infections" (ICD-9-CM: 003). Among 9315 Campylobacter patients, 16 met the case definition for probable GBS. Two were hospitalized with probable GBS </=8 weeks after the encounter listing a Campylobacter diagnosis (9 and 54 days) and were considered probable cases of Campylobacter-associated GBS; this results in an estimated cumulative incidence of 21.5 per 100,000 Campylobacter patients (95% confidence interval [CI]: 3.7-86.6), or 5% of all estimated GBS cases. The remaining 14 patients were diagnosed with probable GBS on the same encounter (n = 12) or 1-3 days (n = 2), before the encounter listing the Campylobacter diagnosis. Including these cases increased the cumulative incidence to 172 per 100,000 Campylobacter cases (95% CI: 101.7-285.5), 41% of estimated GBS cases. This study, using a method not previously applied to United States data, supports other data that Campylobacter is an important contributor to GBS, accounting for at least 5% and possibly as many as 41% of all GBS cases. These data can be used to inform estimates of the burden of Campylobacter infections, including economic cost. |
Salmonella enterica serotype Newport infections in the United States, 2004-2013: Increased incidence investigated through four surveillance systems
Crim SM , Chai SJ , Karp BE , Judd MC , Reynolds J , Swanson KC , Nisler A , McCullough A , Gould LH . Foodborne Pathog Dis 2018 15 (10) 612-620 Newport is the third most common Salmonella enterica serotype identified among the estimated 1.2 million human salmonellosis infections occurring annually in the United States. Risk factors for infection and food items implicated in outbreaks vary by antimicrobial resistance pattern. We conducted a descriptive analysis of data from four enteric disease surveillance systems capturing information on incidence, demographics, seasonality, geographic distribution, outbreaks, and antimicrobial resistance of Newport infections over a 10-year period from 2004 through 2013. Incidence increased through 2010, then declined to rates similar to those in the early years of the study. Incidence was highest in the South and among children <5 years old. Among isolates submitted for antimicrobial susceptibility testing, 88% were susceptible to all antimicrobials tested (pansusceptible) and 8% were resistant to at least seven agents, including ceftriaxone. Rates of pansusceptible isolates were also highest in the South and among young children, particularly in 2010. Pansusceptible strains of Newport have been associated with produce items and environmental sources, such as creek water and sediment. However, the role of environmental transmission of Newport in human illness is unclear. Efforts to reduce produce contamination through targeted legislation, as well as collaborative efforts to identify sources of contamination in agricultural regions, are underway. |
Temporal patterns in principal Salmonella serotypes in the USA; 1996-2014
Powell MR , Crim SM , Hoekstra RM , Williams MS , Gu W . Epidemiol Infect 2018 146 (4) 1-5 Analysing temporal patterns in foodborne illness is important to designing and implementing effective food safety measures. The reported incidence of illness due to Salmonella in the USA. Foodborne Diseases Active Surveillance Network (FoodNet) sites has exhibited no declining trend since 1996; however, there have been significant annual trends among principal Salmonella serotypes, which may exhibit complex seasonal patterns. Data from the original FoodNet sites and penalised cubic B-spline regression are used to estimate temporal patterns in the reported incidence of illness for the top three Salmonella serotypes during 1996-2014. Our results include 95% confidence bands around the estimated annual and monthly curves for each serotype. The results show that Salmonella serotype Typhimurium exhibits a statistically significant declining annual trend and seasonality (P < 0.001) marked by peaks in late summer and early winter. Serotype Enteritidis exhibits a significant annual trend with a higher incidence in later years and seasonality (P < 0.001) marked by a peak in late summer. Serotype Newport exhibits no significant annual trend with significant seasonality (P < 0.001) marked by a peak in late summer. |
Disparities in severe shigellosis among adults - Foodborne Diseases Active Surveillance Network, 2002-2014
McCrickard LS , Crim SM , Kim S , Bowen A . BMC Public Health 2018 18 (1) 221 BACKGROUND: Shigella causes approximately 500,000 illnesses, 6000 hospitalizations, and 40 deaths in the United States annually, but incidence and populations at risk for severe shigellosis among adults are unclear. This study describes severe shigellosis among US adults. METHODS: We analyzed Foodborne Diseases Active Surveillance Network data for infections caused by Shigella among adults >/=18 years old during 2002-2014. Criteria to define severe shigellosis included hospitalization, bacteremia, or death. We estimated annual incidence of shigellosis per 100,000 among adult populations, and conducted multivariable mixed-effects logistic regression to assess associations between severe shigellosis, demographic factors and Shigella species among adults with shigellosis. RESULTS: Among 9968 shigellosis cases, 2764 (28%) were severe. Restricting to cases due to S. sonnei and S. flexneri, median annual incidence of severe shigellosis among adults was 0.56 and highest overall incidence was among black males 18-49 years old (1.58). Among adults with shigellosis, odds of severe disease were higher among males than females aged 18-49 years old (OR [95% CI] = 1.32 [1.15-1.52], p < 0.001) and among males than females with S. flexneri infections (OR [95% CI] =1.39 [1.10-1.75], p = 0.005). The odds of severe shigellosis were higher among blacks than whites (OR [95% CI] = 1.36 [1.22-1.52], p < 0.001). CONCLUSIONS: Among adults, men 18-49 years old, particularly blacks, have the highest incidence of severe shigellosis. Among adults with shigellosis, severe shigellosis was associated with being male in age group 18-49 years, with infections caused by S. flexneri, and with black race. Future research should assess associations between severe shigellosis and sexual practices, antimicrobial resistance, comorbidities, and access to care. |
Epidemiology of Salmonella enterica serotype Dublin infections among humans, United States, 1968-2013
Harvey RR , Friedman CR , Crim SM , Judd M , Barrett KA , Tolar B , Folster JP , Griffin PM , Brown AC . Emerg Infect Dis 2017 23 (9) 1493-501 Salmonella enterica serotype Dublin is a cattle-adapted bacterium that typically causes bloodstream infections in humans. To summarize demographic, clinical, and antimicrobial drug resistance characteristics of human infections with this organism in the United States, we analyzed data for 1968-2013 from 5 US surveillance systems. During this period, the incidence rate for infection with Salmonella Dublin increased more than that for infection with other Salmonella. Data from 1 system (FoodNet) showed that a higher percentage of persons with Salmonella Dublin infection were hospitalized and died during 2005-2013 (78% hospitalized, 4.2% died) than during 1996-2004 (68% hospitalized, 2.7% died). Susceptibility data showed that a higher percentage of isolates were resistant to >7 classes of antimicrobial drugs during 2005-2013 (50.8%) than during 1996-2004 (2.4%). |
Evaluation of the use of zero-augmented regression techniques to model incidence of Campylobacter infections in FoodNet
Tremblay M , Crim SM , Cole DJ , Hoekstra RM , Henao OL , Dopfer D . Foodborne Pathog Dis 2017 14 (10) 587-592 The Foodborne Diseases Active Surveillance Network (FoodNet) is currently using a negative binomial (NB) regression model to estimate temporal changes in the incidence of Campylobacter infection. FoodNet active surveillance in 483 counties collected data on 40,212 Campylobacter cases between years 2004 and 2011. We explored models that disaggregated these data to allow us to account for demographic, geographic, and seasonal factors when examining changes in incidence of Campylobacter infection. We hypothesized that modeling structural zeros and including demographic variables would increase the fit of FoodNet's Campylobacter incidence regression models. Five different models were compared: NB without demographic covariates, NB with demographic covariates, hurdle NB with covariates in the count component only, hurdle NB with covariates in both zero and count components, and zero-inflated NB with covariates in the count component only. Of the models evaluated, the nonzero-augmented NB model with demographic variables provided the best fit. Results suggest that even though zero inflation was not present at this level, individualizing the level of aggregation and using different model structures and predictors per site might be required to correctly distinguish between structural and observational zeros and account for risk factors that vary geographically. |
Bacterial enteric infections among older adults in the United States: Foodborne Diseases Active Surveillance Network, 1996-2012
Scallan E , Crim SM , Runkle A , Henao OL , Mahon BE , Hoekstra RM , Griffin PM . Foodborne Pathog Dis 2015 12 (6) 492-9 BACKGROUND: A growing segment of the population-adults aged ≥65 years-is more susceptible than younger adults to certain enteric (including foodborne) infections and experience more severe disease. MATERIALS AND METHODS: Using data on laboratory-confirmed infections from the Foodborne Diseases Active Surveillance Network (FoodNet), we describe trends in the incidence of Campylobacter spp., Escherichia coli O157, Listeria monocytogenes, and nontyphoidal Salmonella infections in adults aged ≥65 years over time and by age group and sex. We used data from FoodNet and other sources to estimate the total number of illnesses, hospitalizations, and deaths in the United States caused by these infections each year using a statistical model to adjust for underdiagnosis (taking into account medical care-seeking, stool sample submission, laboratory practices, and test sensitivity). RESULTS: From 1996 to 2012, 4 pathogens caused 21,405 laboratory-confirmed infections among older adults residing in the FoodNet surveillance area; 49.3% were hospitalized, and 2.6% died. The average annual rate of infection was highest for Salmonella (12.8/100,000) and Campylobacter (12.1/100,000). Salmonella and Listeria led as causes of death. Among older adults, rates of laboratory-confirmed infection and the percentage of patients who were hospitalized and who died generally increased with age. A notable exception was the rate of Campylobacter infections, which decreased with increasing age. Adjusting for underdiagnosis, we estimated that these pathogens caused about 226,000 illnesses ( approximately 600/100,000) annually among U.S. adults aged ≥65 years, resulting in approximately 9700 hospitalizations and approximately 500 deaths. CONCLUSIONS: Campylobacter, E. coli O157, Listeria, and Salmonella are major contributors to illness in older adults, highlighting the value of effective and targeted intervention. |
Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2006-2014
Crim SM , Griffin PM , Tauxe R , Marder EP , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Wolpert B , Henao OL . MMWR Morb Mortal Wkly Rep 2015 64 (18) 495-9 Foodborne illnesses represent a substantial, yet largely preventable, health burden in the United States. In 10 U.S. geographic areas, the Foodborne Diseases Active Surveillance Network* (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food. This report summarizes preliminary 2014 data and describes changes in incidence compared with 2006-2008 and 2011-2013. In 2014, FoodNet reported 19,542 infections, 4,445 hospitalizations, and 71 deaths. The incidence of Shiga toxin-producing Escherichia coli (STEC) O157 and Salmonella enterica serotype Typhimurium infections declined in 2014 compared with 2006-2008, and the incidence of infection with Campylobacter, Vibrio, and Salmonella serotypes Infantis and Javiana was higher. Compared with 2011-2013, the incidence of STEC O157 and Salmonella Typhimurium infections was lower, and the incidence of STEC non-O157 and Salmonella serotype Infantis infections was higher in 2014. Despite ongoing food safety efforts, the incidence of many infections remains high, indicating that further prevention measures are needed to make food safer and achieve national health objectives. |
Incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006-2013
Crim SM , Iwamoto M , Huang JY , Griffin PM , Gilliss D , Cronquist AB , Cartter M , Tobin-D'Angelo M , Blythe D , Smith K , Lathrop S , Zansky S , Cieslak PR , Dunn J , Holt KG , Lance S , Tauxe R , Henao OL . MMWR Morb Mortal Wkly Rep 2014 63 (15) 328-32 Foodborne disease continues to be an important problem in the United States. Most illnesses are preventable. To evaluate progress toward prevention, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites, covering approximately 15% of the U.S. population. This report summarizes preliminary 2013 data and describes trends since 2006. In 2013, a total of 19,056 infections, 4,200 hospitalizations, and 80 deaths were reported. For most infections, incidence was well above national Healthy People 2020 incidence targets and highest among children aged <5 years. Compared with 2010-2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall.dagger Since 2006-2008, the overall incidence has not changed significantly. More needs to be done. Reducing these infections requires actions targeted to sources and pathogens, such as continued use of Salmonella poultry performance standards and actions mandated by the Food Safety Modernization Act (FSMA). FoodNet provides federal and state public health and regulatory agencies as well as the food industry with important information needed to determine if regulations, guidelines, and safety practices applied across the farm-to-table continuum are working. |
Calculating a measure of overall change in the incidence of selected laboratory-confirmed infections with pathogens transmitted commonly through food in the Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2010
Henao OL , Crim SM , Hoekstra RM . Clin Infect Dis 2012 54 Suppl 5 S418-20 To measure overall change in the incidence of illness, we combined data for infections caused by 6 bacterial pathogens monitored by the Foodborne Diseases Active Surveillance Network for which >50% of illnesses are estimated to be transmitted by food. The overall incidence for these pathogens was 23% lower in 2010 than during the period 1996-1998. This estimate provides a summary of changes in incidence of infection for these pathogens. |
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