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AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care for people living with HIV in the US. Maintaining enrollment in the programs is challenging, and a large proportion of clients in Washington state (WA) fail to recertify and are disenrolled. In this study we sought to quantify the impact of disenrollment from ADAPs on viral suppression. We conducted a retrospective cohort study of the 5238 clients in WA ADAP from 2017 to 2019 and estimated the risk difference (RD) of viral suppression before and after disenrollment. We performed a quantitative bias analysis (QBA) to assess the effect of unmeasured confounders, as the factors that contribute to disenrollment and medication discontinuation may overlap. Of the 1336 ADAP clients who disenrolled ≥1 time, 83% were virally suppressed before disenrollment versus 69% after (RD 12%, 95%CI 9–15%). The RD was highest among clients with dual Medicaid-Medicare insurance (RD 22%, 95%CI 9–35%) and lowest among privately insured individuals (RD 8%, 95%CI 5–12%). The results of the QBA suggest that unmeasured confounders do not negate the overall RD. The ADAP recertification procedures negatively impact the care of clients who struggle to stay in the program; alternative procedures may reduce this impact.

Background Data on criminal justice system involvement can support public health efforts in ways that have been recognized for decades, but data protections and jurisdictional boundaries can make data sharing difficult. In many jurisdictions, carceral facilities are required to publish lists of currently incarcerated individuals. Automated collection of these lists may be one way for public health to access this information. The purpose of this project was to evaluate the availability, completeness, and utility of carceral data collected from public-facing registers in Washington State. Methods Program staff at the Washington State Department of Health catalogued the websites of all carceral facilities in Washington State and identified what information was available about currently incarcerated individuals. This information was downloaded daily from 1/1/2023 to 12/31/2023 using R software. The completeness of this data was compared relative to the Washington State Jail Booking and Release System (JBRS) during the same time frame. To evaluate the utility of the scraped data (which may contain only partial identifiers) for record linkage, we performed a set of simulated linkages between two external datasets with a known relationship (King County Jail bookings and a surveillance list of people living with HIV who may be out of care). We applied a simple match algorithm to copies of these datasets that had been reduced to match the different combinations of identifier variables available in the public data (full names and ages, partial names, etc.) We compared the sensitivity and positive predictive value (PPV) of the algorithm applied to the reduced datasets and calculated an estimate for the entire dataset weighted by incarcerated population size. Results At the time of the project, 61 of 71 facilities in Washington State published information about current inmates. 100% of these 61 published names of inmates, 33% age or date of birth, and 13% other identifiers. We collected data from 58 facilities over the project span. 89% of individuals in JBRS were present in the daily scraped data and 95% of individuals in JBRS who were incarcerated for more than 24 h. We estimated that the collected data had 87.7% sensitivity of and 88.8% PPV in linkages with HIV registries. Conclusions Public facing carceral data in Washington State constitute a data source with high completeness and adequate information for record linkage.

Jeanne M. Marrazzo and colleagues join PLOS Medicine's Collection on the prevention, diagnosis, and treatment of STIs with a Perspective on HIV research imperatives in our time of effective viral suppression and pre-exposure prophylaxis.

The risk of HIV pre-exposure prophylaxis (PrEP) failure with sufficient medication adherence is extremely low but has occurred due to transmission of a viral strain with mutations conferring resistance to PrEP components tenofovir (TDF) and emtricitabine (FTC). The extent to which such strains are circulating in the population is unknown. We used HIV surveillance data to describe primary and overall TDF/FTC resistance and concurrent viremia among people living with HIV (PLWH). HIV genotypes conducted for clinical purposes are reported as part of HIV surveillance. We examined the prevalence of HIV strains with mutations conferring intermediate to high level resistance to TDF/FTC, defining primary resistance (predominantly K65R and M184I/V mutations) among sequences reported within 3 months of HIV diagnosis and total resistance for sequences reported at any time. We examined trends in primary resistance during 2010-2019 and total resistance among all PLWH in 2019. We also monitored resistance with viremia ([greater than or equal to]1,000 copies/mL) at the end of 2019 among PLWH. Between 2010 and 2019, 2,172 King County residents were diagnosed with HIV; 1,557 (72%) had a genotypic resistance test within three months; three (0.2%) had primary TDF/FTC resistance with both K65R and M184I/V mutations. Adding isolated resistance for each drug resulted in 0.3% with primary TDF resistance and 0.8% with primary FTC resistance. Of 7,056 PLWH in 2019, 4,032 (57%) had genotype results, 241 (6%) had TDF/FTC resistance and 15 (0.4% of those with a genotype result) had viremia and TDF/FTC resistance. Primary resistance and viremia combined with TDF/FTC resistance are uncommon in King County. Monitoring trends in TDF/FTC resistance coupled with interventions to help ensure PLWH achieve and maintain viral suppression may help ensure that PrEP failure remains rare.

In 2004, President George W. Bush launched an initiative to supplement ADAPs in 10 states with ADAP waiting lists, underscoring the need to avert delays in HIV treatment initiation. Because RWHAP authorization formally expired in 2013, each subsequent Congress has funded the program through the annual appropriations process. Using data from public ADAP reports, the Ryan White Compass Dashboard, and Centers for Disease Control and Prevention-funded HIV surveillance, McManus et al. enumerate and describe the characteristics of PWH who received ADAP services, estimate the proportion of PWH supported by ADAP, and describe utilization trends over time. Because ADAP eligibility data vary by state and are not available, the investigators estimated utilization among the total population of PWH. Differences in health outomes by race, ethnicity, geography, and socioeconomic status are a persistent feature of the country's HIV epidemic.4 The article of McManus et al. comes at a critical moment, when funding for HIV research and prevention programs is being eliminated.5 Funding for research explicitly focused on health disparities has been foremost among the cuts, and the National Institutes of Health has labeled equity objectives as \"nonscientific\" in termination letters sent to researchers.6 Nonetheless, health disparities are very real. The central goal of the current presidential administration's Make America Healthy Again initiative is to end the chronic disease epidemic in the United States.9,10 ADAP and the RWHAP offer a proven model for the treatment of chronic diseases, as HIV is itself a complex chronic disease, and PWH are disproportionately diagnosed with associated chronic diseases, such as diabetes, cardiovascular disease, mental health disorders, and cancer.

In an open-label, randomized study involving men who have sex with men, doxycycline use after high-risk sexual exposure reduced the incidence of sexually transmitted infections (chlamydia, gonorrhea, and syphilis).

Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.

[This corrects the article DOI: 10.1371/journal.pone.0129551.].

Background Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic. Methods In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings. Results Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager’s ability to embody the clinic’s culture facilitated engagement among patients who completed intakes. Conclusions Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care. Trial registration Not applicable.

We develop a new approach for estimating the undiagnosed fraction of HIV cases, the first step in the HIV Care Cascade. The goal is to address a critical blindspot in HIV prevention and treatment planning, with an approach that simplifies data requirements and can be implemented with open-source software. The primary data required is HIV testing history information on newly diagnosed cases. Two methods are presented and compared. The first is a general methodology based on simplified back-calculation that can be used to assess changes in the undiagnosed fraction over time. The second makes an assumption of constant incidence, allowing the estimate to be expressed as a simple closed formula calculation. We demonstrate the methods with an application to HIV diagnoses among men who have sex with men (MSM) from Seattle/King County. The estimates suggest that 6% of HIV-infected MSM in King County are undiagnosed, about one-third of the comparable national estimate. A sensitivity analysis on the key distributional assumption gives an upper bound of 11%. The undiagnosed fraction varies by race/ethnicity, with estimates of 4.9% among white, 8.6% of African American, and 9.3% of Hispanic HIV-infected MSM being undiagnosed.