High Tuberculosis Strain Diversity among New York City Public Housing Residents

OBJECTIVES:

We sought to better understand tuberculosis (TB) epidemiology among New York City Housing Authority (NYCHA) residents, after a recent TB investigation identified patients who had the same TB strain.

METHODS:

The study population included all New York City patients with TB confirmed during 2001 through 2009. Patient address at diagnosis determined NYCHA residence. We calculated TB incidence, reviewed TB strain data, and identified factors associated with TB clustering.

RESULTS:

During 2001 to 2009, of 8953 individuals in New York City with TB, 512 (6%) had a NYCHA address. Among the US-born, TB incidence among NYCHA residents (6.0/100 000 persons) was twice that among non-NYCHA residents (3.0/100 000 persons). Patients in NYCHA had high TB strain diversity. US birth, younger age, and substance use were associated with TB clustering among NYCHA individuals with TB.

CONCLUSIONS:

High TB strain diversity among residents of NYCHA with TB does not suggest transmission among residents. These findings illustrate that NYCHA's higher TB incidence is likely attributable to its higher concentration of individuals with known TB risk factors.

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By:  Dawson P1, Perri BR1, Ahuja SD1.

• 1All authors are with the New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control, Queens, NY. Patrick Dawson is also with Columbia University Mailman School of Public Health Department of Epidemiology, New York, NY. 
• Am J Public Health. 2016 Mar;106(3):563-8. doi: 10.2105/AJPH.2015.302910. Epub 2015 Dec 21.

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Do Sexual Networks of Men Who Have Sex with Men in New York City Differ by Race/Ethnicity?

The United States HIV epidemic disproportionately affects Black and Hispanic men who have sex with men (MSM). This disparity might be partially explained by differences in social and sexual network structure and composition. 

A total of 1267 MSM in New York City completed an ACASI survey and egocentric social and sexual network inventory about their sex partners in the past 3 months, and underwent HIV testing. Social and sexual network structure and composition were compared by race/ethnicity of the egos: black, non-Hispanic (N = 365 egos), white, non-Hispanic (N = 466), and Hispanic (N = 436). 21.1% were HIV-positive by HIV testing; 17.2% reported serodiscordant and serostatus unknown unprotected anal/vaginal intercourse (SDUI) in the last 3 months. Black MSM were more likely than white and Hispanic MSM to report exclusively having partners of same race/ethnicity. Black and Hispanic MSM had more HIV-positive and unknown status partners than white MSM. White men were more likely to report overlap of social and sex partners than black and Hispanic men. No significant differences by race/ethnicity were found for network size, density, having concurrent partners, or having partners with ≥10 years age difference. 

Specific network composition characteristics may explain racial/ethnic disparities in HIV infection rates among MSM, including HIV status of sex partners in networks and lack of social support within sexual networks. Network structural characteristics such as size and density do not appear to have such an impact. 

These data add to our understanding of the complexity of social factors affecting black MSM and Hispanic MSM in the U.S.

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By:  Hong-Van Tieu, MD, MS,¹ Vijay Nandi, MPH,² Donald R. Hoover, PhD,³ Debbie Lucy, MS,¹ Kiwan Stewart,BPS,¹ Victoria Frye, DrPH,⁴ Magdalena Cerda, DrPH,⁵ Danielle Ompad, PhD,⁶ Carl Latkin, PhD,⁷ and Beryl A. Koblin, PhD,¹ on behalf of the NYC M2M Study Team

¹Laboratory of Infectious Disease Prevention, New York Blood Center, New York City, New York.

²Laboratory of Analytical Sciences, New York Blood Center, New York City, New York.

³Department of Biostatistics, Rutgers University, New Brunswick, New Jersey.

⁴Laboratory of Behavioral and Social Sciences, New York Blood Center, New York City, New York.

⁵Department of Emergency Medicine, University of California, Davis, California.

⁶New York University Steinhardt School of Culture, Education, and Human Development, New York City, New York.

⁷Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Address correspondence to:

Hong Van Tieu, MD, MS

Laboratory of Infectious Disease Prevention

Lindsley F. Kimball Research Institute

New York Blood Center

310 E. 67^th Street Suite 3-110

New York, NY 10065

E-mail: htieu@nybloodcenter.org

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Sexual Risk and HIV Infection among Drug Users in New York City

Measures of sexual health were assessed during 2008–2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study’s limitations are noted.

...The drug users recruited for this study would appear to be the ideal target of a sexual health intervention. Among the 102 drug users recruited in the first stage, 62% were eligible for the intervention; i.e., they reported recent unprotected sex with more than one partner. In this second-stage sample, 66% of NIDUs and 33% of IDUs were HIV positive, and only 64% of HIV positives were aware of their status. In addition, 75% had antibody to HSV-2, and only 12% had ever been told they had genital herpes. Thus, this method of recruitment led to a set of individuals who may greatly benefit from an intervention that seeks to reduce both HIV acquisition and transmission to uninfected partners and among whom efforts to address HSV-2 facilitation of HIV acquisition and transmission may be particularly important. The high prevalence of HSV-2 in this population is very similar to the rate (60%) observed in another New York City study of drug users and to the rates reported in other studies of crack users (Des Jarlais, Hagan, et al., 2007; Jones et al., 1998;Ross, Hwang, Leonard, Teng, & Duncan, 1999). Although it is understood that HSV-2 facilitates HIV transmission, it is unclear at this stage how to manage HSV-2 infection to reduce this risk (Celum et al., 2010).

The high prevalence of HIV in this sample was unexpected, as it was substantially higher than rates observed in other New York City studies of opiate users of 15%–20% (Des Jarlais, Arasteh, et al., 2007). The sample was also unique in the degree to which injectors, former injectors, noninjectors, and sexual minorities overlapped. Gay, lesbian, and bisexual participants were more likely to be crack users than were heterosexuals, and bisexuals were more likely to be involved in sex trade. As noted by Des Jarlais et al. in this issue, many injectors in New York City have stopped injecting and returned to smoking or inhaling drugs. This transition to noninjection drug use may have led to new social and sexual linkages between former injectors with high HIV prevalence and lower-prevalence noninjection users. Crack use, along with the buying and using of other drugs, may create linkages between sexual minorities and heterosexuals in New York. Crack use, in particular, appears to identify very high-risk subsets of drug users in New York City. This finding of great overlap between gay, lesbian, bisexual, and heterosexual injection and noninjection users of heroin and cocaine has several implications for the development of interventions, including that strategies should use social, sexual, and drug-use-related linkages to locate and intervene with persons at high risk of HIV acquisition and transmission. In addition, interventions should address multiple sources of risk for HIV exposure in a linked population...

Below:  Diagram showing relative overlap among drug injection, crack cocaine use, and gay or bisexual orientation among heroin and cocaine users, New York City

Full article at:   http://goo.gl/9zI5A0

By:   Holly Hagan,1 David C. Perlman,2 and Don C. Des Jarlais3

¹College of Nursing, New York University, New York, New York, USA

²Department of Medicine, Beth Israel Medical Center, New York, New York, USA

³Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA

Address correspondence to Dr. Holly Hagan, New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003; Email:ude.uyn@05hh

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Cervical Cancer Screening among Homeless Women of New York City Shelters

Introduction

Homeless persons have minimal opportunities to complete recommended cancer screening. The rates and predictors of cervical cancer screening are understudied among homeless women in the US.

Methods

We enrolled 297 homeless women 21-65 years old residing in 6 major New York City shelters from 2012 to 2014. We used a validated national survey to determine the proportion and predictors of cervical cancer screening using cytology (Pap test).

Results

Mean age was 44.72 (±11.96) years. Majority was Black, heterosexual, single, with high school or lower education; 50.9 % were smokers and 41.7 % were homeless more than a year. Despite a 76.5 % proportion of self-reported Pap test within the past 3 years, 65 % of women assumed their Pap test results were normal or did not get proper follow up after abnormal results. Forty-five-point-nine percent of women did not know about frequency of Pap test or causes of cervical cancer. Lower proportion of up-to-date Pap test was associated with lack of knowledge of recommended Pap test frequency (p < 0.01) and relationship between HPV and an abnormal Pap test (p < 0.01).

Conclusions

Self-reported Pap testing in homeless women was similar to a national sample. However, the majority of women surveyed were not aware of their results, received limited if any follow up and had significant education gaps about cervical cancer screening. We recommend improved counseling and patient education, patient navigators to close screening loops, and consideration of alternative test-and-treat modalities to improve effective screening.

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By:  Asgary R1,2, Alcabes A3, Feldman R4, Garland V3, Naderi R5, Ogedegbe G6, Sckell B3.

• 1Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA. ramin.asgary@caa.columbia.edu.
• 2Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA. ramin.asgary@caa.columbia.edu.
• 3Community Medicine Program, NYU Lutheran Family Health Centers, 317 Bowery Street, New York, NY, 10003, USA.
• 4Department of OBGYN, The Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
• 5New York University School of Medicine, 227 E30th Street, New York, NY, 10016, USA.
• 6Departments of Population Health and Medicine, New York University School of Medicine, 227 E30th Street, Room 639, New York, NY, 10016, USA.
• Matern Child Health J. 2015 Dec 9.  

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Food Insecurity with Hunger Is Associated with Obesity among HIV-Infected & At Risk Women in Bronx, NY

Food insecurity, insufficient quality and quantity of nutritionally adequate food, affects millions of people in the United States (US) yearly, with over 18 million Americans reporting hunger. Food insecurity is associated with obesity in the general population. Due to the increasing prevalence of obesity and risk factors for cardiovascular disease among HIV-infected women, we sought to determine the relationship between food insecurity and obesity in this cohort of urban, HIV-infected and -uninfected but at risk women.

Using a cross-sectional design, we collected data on food insecurity, body mass index and demographic and clinical data from 231 HIV-infected and 119 HIV-negative women enrolled in Bronx site of the Women's Interagency HIV Study (WIHS). We used multivariate logistic regression to identify factors associated with obesity.

Food insecurity was highly prevalent, with almost one third of women (110/350, 31%) reporting food insecurity over the previous six months and over 13% of women reported food insecurity with hunger. Over half the women were obese with a Body Mass Index (BMI) of ≥ 30. In multivariate analyses, women who were food insecure with hunger had higher odds of obesity after adjusting for HIV status, age, race, household status, income, drug and alcohol use.

Food insecurity with hunger was associated with obesity in this population of HIV-infected and -uninfected, urban women. Both food insecurity and obesity are independent markers for increased mortality; further research is needed to understand this relationship and their role in adverse health outcomes.

Full article at:  http://goo.gl/N9qlcT

By: Sirotin N1, Hoover DR2, Shi Q3, Anastos K4, Weiser SD5.

• 1Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
• 2Department of Statistics and Biostatistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, United States of America.
• 3Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York, United States of America.
• 4Departments of Medicine and Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America.
• 5Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, California, United States of America. 

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Prevention And Treatment Produced Large Decreases In HIV Incidence In A Model Of People Who Inject Drugs

Via http://ht.ly/OEXIL  .@HealthyBrown

People who inject drugs continue to be at greatly increased risk of HIV infection in the United States. We modeled HIV transmission in a dynamic network of drug users and non-drug users (representing the New York metropolitan statistical area population) to estimate the effectiveness of various combination prevention scenarios. We first assumed that current approaches continue (status quo), and then compared projected HIV incidence at 2020 and 2040 to those derived from hypothetical initiatives: (1) scale-up HIV testing, (2) increased access to substance abuse treatment, (3) improved coverage of needle and syringe programs, (4) scaling up Treatment as Prevention; and (5), “high-impact“ combination prevention, combining strategies (1) through (4). No strategy completely eliminated HIV transmission. High-impact prevention produced the largest decrease in HIV incidence, a 62% reduction compared to the status quo. Increased resources for and investment in multi-modality HIV prevention approaches will be required to eliminate HIV transmission among people who inject drugs.

Below:  Projected HIV incidence (per 1,000 person-years) at 2040 among PWID residing in the New York metropolitan area, for hypothetical HIV prevention strategies

Risk Factors for Serogroup C Meningococcal Disease during Outbreak among Men who Have Sex with Men, New York City, New York, USA

Read at: http://ht.ly/Q6Ap5 HT @CDC_EIDjournal

Risk factors for illness during a serogroup C meningococcal disease outbreak among men who have sex with men in New York City, New York, USA, in 2012–2013 included methamphetamine and cocaine use and sexually transmitted infections. Outbreak investigations should consider routinely capturing information regarding drug use and sex-related risk factors.

In the United States, meningococcal disease, a nationally reportable bacterial disease caused by Neisseria meningitidis, has a case-fatality rate of 10%–15% (1). Clusters of serogroup C meningococcal disease have been reported among men who have sex with men (MSM) in Chicago, Illinois, USA; Toronto, Ontario, Canada; and Europe (2–4). However, case–control studies to evaluate unique risk factors among this population are lacking.

During August 2010–February 2013, New York City (NYC), New York, had a protracted outbreak of serogroup C meningococcal disease among MSM, which is described elsewhere in this issue (5). To more fully understand risk factors associated with the outbreak, the NYC Department of Health and Mental Hygiene (DOHMH) conducted a case–control study.