National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention

Syphilis is one of the oldest known diseases. Approximately 209,000 cases were reported in the United States in 2023 — the highest number of reported cases since 1950 — including nearly 4000 congenital syphilis cases, which resulted in 279 stillbirths or infant deaths.2 Our ability to prevent and control this infection has been limited by relatively few advances in the diagnosis and treatment of syphilis in the past 75 years. Diagnosis continues to rely on serologic markers of infection, which do not differentiate between treated and untreated infection and are difficult even for a syphilologist to interpret. Treatment has relied .

Data from 3 US public health surveillance systems indicate that an estimated 67 400 people acquired hepatitis C virus infections in 2022, 2.2 million adults had hepatitis C during January 2017-March 2020, and 12 717 people died in 2022 from hepatitis C-related causes, despite the availability of curative treatment since 2013. The 3 surveillance systems that provided these data-the National Notifiable Diseases Surveillance System, the National Health and Nutrition Examination Survey, and the National Vital Statistics System-were selected to monitor progress toward elimination of hepatitis C as a public health threat in the United States by 2030. However, some limitations of these surveillance systems compel the use of additional data sources with more timely information for the general population and for populations with higher incidence, prevalence, or mortality of hepatitis C, such as those experiencing homelessness, incarceration, or injection drug use. Commercial laboratories, health systems, and programs serving these populations could provide such data. This topical review of hepatitis C surveillance describes the history, long-term trends, and recent investments in public health surveillance for hepatitis C. Strengthening and modernizing the hepatitis C surveillance workforce and systems, improving data system interoperability, linking complementary data sources, and leveraging multiple data systems can aid in the measurement of public health efforts to meet hepatitis C elimination goals.

The global mpox outbreak of 2022, caused by the Clade IIb strain of monkeypox virus, underscored the potential of this virus to pose a significant public health threat on a global scale. The Democratic Republic of Congo is currently facing multiple outbreaks associated with Clade I. Effectively controlling localized community transmission within endemic areas through vaccination can reduce the likelihood of broader regional or even global outbreaks. Large-scale community vaccination in DRC is challenged by limited resources, including vaccine availability during early outbreaks in remote areas, whereas limited surveillance, contact tracing, and accessibility to remote locations can reduce the effectiveness of targeted ring vaccination. Furthermore, recent outbreaks in DRC have been driven by both sexual and non-sexual close contact transmissions. Here, we used an agent-based model with stochastic transmission within and between households to assess the effectiveness of ring vaccination for controlling localized community transmission in the presence of incomplete case reporting and delay in vaccination. We consider both nonsexual close contact and sexual transmission. We found that ring vaccination, even with 25-50% reporting, is effective in reducing outbreak cluster sizes and the likelihood of large cluster sizes (>5 cases), particularly when implemented shortly after detection of initial cases. The effectiveness of ring vaccination reduces with the inclusion of sexual transmission. We show that outbreak size and the likelihood of large clusters are reduced when responding to every reported infection, even with 2-3 weeks of delay. Settings with strong surveillance systems characterized by high levels of reporting will have earlier case detection, enabling earlier response and improving the effectiveness of ring vaccination.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM's unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.

Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States (US) are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study. 11 US states, February 2020-February 2021. BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the healthcare provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time-motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment via dating versus general interest sites. The total cost was $275,776 to enroll 1,306 participants through dating sites, and support 1,005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment via dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios (ICERs) of $218/HIVST used and $1,196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. ICERs were higher for HLMSM versus BMSM. HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.

Abstract BackgroundUpdated estimates of the productivity losses per HIV infection due to premature HIV mortality are needed to help quantify the economic burden of HIV and inform cost-effectiveness analyses.MethodsWe used the human capital approach to estimate the productivity loss due to HIV mortality per HIV infection in the United States. We incorporated published data on age-specific annual productivity, life expectancy at HIV diagnosis, life years lost from premature death among persons with HIV (PWH), the number of years from HIV infection to diagnosis, and the percentage of deaths in PWH attributable to HIV. For the base case, we used 2018 life expectancy data for all PWH in the United States. We also examined scenarios using life expectancy in 2010 and life expectancy for cohorts on antiretroviral therapy (ART). We conducted sensitivity analyses to understand the impact of key input parameters.ResultsWe estimated the base case overall average productivity loss due to HIV mortality per HIV infection at $65,300 in 2022 US dollars. The base case results showed a 45% decrease in the estimated productivity loss compared to the results when applying life expectancy data from 2010. Productivity loss was 83% lower for cohorts of PWH on ART compared to the base case scenario. Results were sensitive to assumptions about percentage of deaths attributable to HIV and heterogeneity in age at death.ConclusionThis study provides valuable insights into the economic impact of HIV mortality, illustrating reductions in productivity losses over time due to advancements in treatments.DisclaimerThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.FundingThis work was done as regular official duties of the authors as employees of the Centers for Disease Control and Prevention.Conflicts of InterestAll authors report no conflicts of interest.Previous PresentationPresented in part as a poster presentation at the ISPOR 2024 Conference, May 5-8, 2024, Atlanta, GA.HighlightsUpdated estimates of productivity losses per HIV infection due to premature HIV mortality can help assess the total economic burden of HIV in the United States.This study estimates productivity losses per HIV infection for overall, by sex, and by varying ages of HIV infection.Advancement in treatment has contributed to significant reduction in productivity losses due to premature HIV mortality in the United States over the past decade.

This article describes an updated spreadsheet tool that sexually transmitted infection (STI) prevention programs in the United States can use to estimate the health and economic benefits of their STI and HIV prevention activities. The development of the updated tool, Sexually Transmitted Infection Costs (STIC) Figure 2.0, involved 2 main components. First, we revised the tool to be more useful and user-friendly based on feedback from focus groups and usability testing. Second, we updated the mathematical model behind the calculations by (1) revising the model to reflect current STI and HIV prevention activities in the United States, (2) updating the epidemiological and economic parameters in the model using the best available evidence, and (3) including ranges (not just point estimates) in the model output. To demonstrate the use of STIC Figure 2.0, we applied it to estimate the impact of a hypothetical prevention program, consistent with that of a health department or large STI clinic in a metropolitan area. STIC Figure 2.0 incorporated new features, including an interactive user interface to explore findings and create customized charts for use in reports and presentations. The hypothetical example we analyzed illustrated how providing STI treatment to 2680 people and HIV prevention services to 325 people could avert 1253 adverse outcomes and save more than $2 million in medical costs and productivity costs. Although subject to important limitations, STIC Figure 2.0 allows state and local programs, including STI clinics, to calculate evidence-based estimates of the impact of their program activities.

The Gonococcal Isolate Surveillance Project (GISP) was established to monitor antimicrobial resistance (AR) in Neisseria gonorrhoeae in the United States. Isolates collected in GISP undergo antimicrobial susceptibility testing allowing for estimates of resistance, based on exceeding minimum inhibitory concentrations (MICs), to be calculated. We estimated the annual number and proportion of gonococcal infections with antibiotic resistance or elevated MICs (AR/eMICs) against 6 antibiotics for men and women aged 15 to 39 years in the United States using male urethral specimens collected in GISP during 2008-2019. Although GISP only measured MICs for male gonococcal infections, this study estimated AR/eMICs in women using data from men with female sex partners. GISP data were weighted against national gonorrhea case report data based on 4 variables (age group, year of report, US Census region, and race/Hispanic ethnicity) to estimate annual, national proportions of gonococcal infections with AR/eMICs. These weighted proportions were then multiplied by national estimates of incident gonococcal infections to calculate the number of incident gonococcal infections with AR/eMICs nationally. Women had a higher estimated number of cases with AR/eMICs compared with men (440,900 vs. 387,200 in 2019), although the estimated percentage of gonococcal infections with AR/eMICs was lower in women (50.7% vs. 54.4% in 2019). Elevated MICs to ceftriaxone remained below 1% throughout the study period. Our analysis indicates that there are more women with AR/eMICs gonorrhea than men. Although the proportion of cases that are resistant to any one antimicrobial is increasing, eMICs to ceftriaxone remains low.

Using data from the nationally representative National Immunization Survey (NIS), we applied conditional linear regression tree methodology to examine relationships between demographic and geographic factors and propensity of receiving various doses of COVID-19 vaccine over time; these analyses identified temporal changes in these relationships that heretofore had not been identified using conventional logistical regression methodologies.Three regression tree models were built using an R package, Recursive Partitioning for Modeling Survey (rpms), to examine propensities over time of receiving a (1) first dose of a two-dose COVID-19 mRNA primary vaccination series or single dose of the Janssen vaccine (vaccine initiation), (2) primary series completion, and (3) monovalent booster dose, using a conditional linear effect model. Persons ≥50 years were more likely to complete a primary series and receive a first booster dose; persons reporting having received non-COVID-19 vaccines recently were more likely to initiate vaccination, complete the primary series, and get a first booster dose; persons reporting having work or school requirements were more likely to complete the primary series. Persons not reporting having received non-COVID-19 vaccines in 2 years but reporting having work or school vaccination requirements were more likely to initiate vaccination than those without work/school requirements. Among persons not reporting having received non-COVID-19 vaccines in 2 years and not reporting having work or school vaccination requirements, those aged ≥50 years were more likely to initiate vaccination than were younger adults. Propensity of receiving various doses was correlated with age, having recently received non-COVID 19 vaccines, and having vaccination requirements at work or school.Regression tree methodology enabled modeling of different COVID-19 vaccination dose propensities as a linear effect of time, revealed changes in relationships over time between demographic factors and propensity of receipt of different doses, and identified populations that may benefit from vaccination outreach efforts.