HIV VIRAL SUPPRESSION AND PRE-EXPOSURE PROPHYLAXIS IN HIV AND SYPHILIS CONTACT TRACING NETWORKS: AN ANALYSIS OF DISEASE SURVEILLANCE AND PRESCRIPTION CLAIMS DATA.

Abstract

BACKGROUND\nHIV and syphilis contact tracing networks offer efficient platforms for HIV treatment and prevention interventions, but intervention coverage within these networks has not been characterized.\n\n\nSETTING\nHIV and syphilis sexual contact tracing networks among men who have sex with men (MSM) in North Carolina (NC).\n\n\nMETHODS\nUsing surveillance data, we identified two types of network events occurring between January 2013 and June 2017 among NC MSM: being diagnosed with early syphilis or being named as a recent sexual contact of a person diagnosed with HIV or early syphilis. We estimated prevalent and incident HIV viral suppression among persons diagnosed with HIV before the network event, and we assessed the effect of contact tracing services on six-month cumulative incidence of viral suppression among previously HIV-diagnosed, virally unsuppressed persons. Using linked prescription claims data, we also evaluated prevalent and incident pre-exposure prophylaxis (PrEP) use in an insured subset of HIV-negative network members.\n\n\nRESULTS\nViral suppression prevalence among previously HIV-diagnosed persons was 52.6%. The six-month cumulative incidence of viral suppression was 35.4% overall and 13.1 (95% CI: 8.8-17.4) percentage points higher among persons reached vs. not reached by contact tracing services. Few HIV-negative persons had prevalent (5.4%) or incident (4.1%) PrEP use in the six months before or after network events, respectively.\n\n\nCONCLUSIONS\nSub-optimal viral suppression and PrEP use among NC MSM in HIV/syphilis contact networks indicate a need for intensified intervention efforts. In particular, expanded services for previously HIV-diagnosed persons could improve viral suppression and reduce HIV transmission within these networks.