Massachusetts Department of Public Health

The persistent incidence of HIV among people who inject drugs (PWID) underscores the urgency for HIV prevention efforts to end the HIV epidemic. Little is known about the role carceral settings play as touchpoints for HIV testing in this population. The objectives of this study were to characterize patterns and sources of HIV testing among PWID and to understand how carceral facilities fit into this population’s HIV testing landscape. Secondary analysis of cross-sectional survey data of PWID in the Boston metro area from the 2015 and 2018 cycles of the National HIV Behavioral Surveillance (NHBS). Among self-reported HIV-negative participants, we examined incarceration and HIV testing histories and used a multivariable modified Poisson regression model to evaluate the association between incarceration history (main exposure) and past-year HIV testing (primary outcome). Among 957 participants, average age was 38.9 (SD 11.1) years, 70.1% were male, 15.2% were Hispanic (of any race), 8.4% were non-Hispanic Black, and 68.1% were non-Hispanic White. Regarding incarceration experiences, 43.5% of participants reported past-year incarceration, and 41.8% reported a history of incarceration but only prior to the past year. Among those with past-year incarceration, 23.4% said their last HIV test was done at a jail or prison. Adjusting for other characteristics, compared to no incarceration history, past-year incarceration (PR 1.39; 95% CI: 1.29, 1.49) and incarceration prior to the past year (PR 1.19; 95%CI: 1.02, 1.38) were both associated with a greater prevalence of past-year HIV testing. Among PWID, incarceration was very common and was a substantial source of HIV testing. However, more testing is still needed—in both community and carceral settings—to reach optimal testing rates in this key population.

SARS-CoV-2 has been responsible for extensive morbidity and mortality in Massachusetts, especially during the 2021-2022 time period. The true burden of infection is unknown as official reporting data during 2021 and 2022 was not able to capture subclinical/asymptomatic infections nor the results from home-based lateral flow tests (LFTs). This study was designed to better characterize the exposure of Massachusetts residents to SARS-CoV-2, and to understand demographic and behavioral factors associated with SARS-CoV-2 exposure during the highest burden years of the pandemic. A series of five sequential state-wide serosurveys were conducted with oversampling for underrepresented demographic groups from June 2021 to September 2022. These mail-based, repeated cross-sectional surveys (RCSs) captured data at periods of rapid vaccine uptake when different viral variants were predominant. This study also included collection of at-home nasal swabs for PCR-based SARS-CoV-2 virological testing, and collection of dried blood spot cards for ELISA-based testing of SARS-CoV-2 IgG antibody seromarkers including spike and nucleocapsid protein, reported as seroprevelences. Neutralizing antibodies to spike-RBD were also measured. Of the randomly selected 52,000 Massachusetts households invited to participate in this survey, a total of 2220 participants completed the demographic questionnaire and submitted valid specimens for analysis. Of these participants, ten were PCR-positive for SARS-CoV-2 at time of survey. Across all five repeated cross-sectional surveys (RCS), spike antibody positivity ranged from 83.1% to 96.4%. Additionally, levels of the spike neutralizing antibody increased with each RCS; point prevalence values ranged from 20.5% in RCS 1/2 to 73.5% in RCS 5. Using weighted data, the seroprevalence of nucleocapsid protein remained relatively constant throughout the RCSs except for RCS 3. Multivariable regression results found a positive association between vaccination status and seromarkers of SARS-CoV-2 exposure; individuals who had been vaccinated were more likely to be seropositive for all seromarkers. Factors including race, age, income, and occupation did not show any statistically significant associations with serostatus. This survey indicates that while there was an increase in antibodies to spike protein and to associated neutralizing antibodies over time, there were no differences in neutralizing antibodies by socio-demographic factors, suggesting no major health disparities existed at the time of surveys in either vaccine coverage or infection-related antibody titers across the state. Response rates were higher among some demographic groups (Caucasians, households with a high income, and women), thus, oversampling and weighting allowed estimates of the larger Massachusetts population. Our findings that there were no statistically significant differences in neutralizing antibodies across demographic groups suggesting all groups were similarly protected from SARS-CoV-2 infection. These results highlight the success of Massachusetts in protecting individuals across all demographics.

This cross-sectional study examines trends in Lyme disease incidence using data from the Massachusetts Department of Public Health's electronic health record–based surveillance platform.