ArticleJournal of the International AIDS Society2021
Estimating HIV transmissions in a large U.S. clinic-based sample: effects of time and syndemic conditions.
Article in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Trajectories of Pain Impact and Pain Self-Efficacy in People With HIV and Chronic Pain: Extending Findings From the Skills TO Manage Pain Randomized Clinical Trial.Journal of acquired immune deficiency syndromes (1999) · 2025Trial
- Facilitators and barriers to anal cancer screening among men with HIV and their providers in Alabama.AIDS care · 2026Article
- Depression Improves the Predictive Accuracy of the VACS Index 2.0 for All-Cause Mortality Among Sexual Minority Men Living With HIV in the Multicenter AIDS Cohort Study.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- Implementation of Trauma-Informed Care into Clinical HIV Prevention and Care Settings: A Decade of Limited Progress.Current HIV/AIDS reports · 2025Review
- Integration of Patient Reported Outcomes Data among People with HIV in Washington, DC: A sub-cohort of the DC Cohort Longitudinal Study.Journal of public health (Berlin, Germany) · 2025Article
- Longitudinal Analysis of Overlapping Psychosocial Factors Predicting Incident Hospitalization Among Mixed HIV Serostatus Men who have Sex with Men in the Multicenter AIDS Cohort Study.AIDS and behavior · 2024Article
- Asymptomatic Rectal Bacterial Pathogens Show Large Prospective Relationships With HIV Incidence in a Cohort of Young Sexual and Gender Minorities: Implications for STI Screening and HIV Prevention.Open forum infectious diseases · 2024Article
- Sexual risk characteristics, social vulnerability, and anal cancer screening uptake among men living with HIV in the deep south.AIDS care · 2024Article
- Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS).AIDS and behavior · 2023Article
- Estimating HIV transmissions in a large U.S. clinic-based sample: effects of time and syndemic conditions.Journal of the International AIDS Society · 2021Article
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Authors and funding
14 authors.
Funding
Abstract
introductionLittle is known about onward HIV transmissions from people living with HIV (PLWH) in care. Antiretroviral therapy (ART) has increased in potency, and treatment as prevention (TasP) is an important component of ending the epidemic. Syndemic theory has informed modelling of HIV risk but has yet to inform modelling of HIV transmissions.
methodsData were from 61,198 primary HIV care visits for 14,261 PLWH receiving care through the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) at seven United States (U.S.) sites from 2007 to 2017. Patient-reported outcomes and measures (PROs) of syndemic conditions - depressive symptoms, anxiety symptoms, drug use (opiates, amphetamines, crack/cocaine) and alcohol use - were collected approximately four to six months apart along with sexual behaviours (mean = 4.3 observations). Counts of syndemic conditions, HIV sexual risk group and time in care were modelled to predict estimated HIV transmissions resulting from sexual behaviour and viral suppression status (HIV RNA < 400/mL) using hierarchical linear modelling.
resultsPatients averaged 0.38 estimated HIV transmissions/100 patients/year for all visits with syndemic conditions measured (down from 0.83, first visit). The final multivariate model showed that per 100 patients, each care visit predicted 0.05 fewer estimated transmissions annually (95% confidence interval (CI): 0.03 to 0.06; p < 0.0005). Cisgender women, cisgender heterosexual men and cisgender men of undisclosed sexual orientation had, respectively, 0.47 (95% CI: 0.35 to 0.59; p < 0.0005), 0.34 (95% CI: 0.20 to 0.49; p < 0.0005) and 0.22 (95% CI: 0.09 to 0.35; p < 0.005) fewer estimated HIV transmissions/100 patients/year than cisgender men who have sex with men (MSM). Each within-patient syndemic condition predicted 0.18 estimated transmissions/100 patients/year (95% CI: 0.12 to 0.24; p < 0.0005). Each between-syndemic condition predicted 0.23 estimated HIV transmissions/100 patients/year (95% CI: 0.17 to 0.28; p < 0.0005).
conclusionsEstimated HIV transmissions among PLWH receiving care in well-resourced U.S. clinical settings varied by HIV sexual risk group and decreased with time in care, highlighting the importance of TasP efforts. Syndemic conditions remained a significant predictor of estimated HIV transmissions notwithstanding the effects of HIV sexual risk group and time in care.
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