Hafeez Rehman

Willingness to Take, Use of, and Indications for Pre-exposure Prophylaxis Among Men Who Have Sex With Men-20 US Cities, 2014.

BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at substantial risk of acquiring human immunodeficiency virus (HIV). To monitor the current state of PrEP use among men who have sex with men (MSM), we report on willingness to use PrEP and PrEP utilization. To assess whether the MSM subpopulations at highest risk for infection have indications for PrEP according to the 2014 clinical guidelines, we estimated indications for PrEP for MSM by demographics. METHODS We analyzed data from the 2014 cycle of the National HIV Behavioral Surveillance (NHBS) system among MSM who tested HIV negative in NHBS and were currently sexually active. Adjusted prevalence ratios and 95% confidence intervals were estimated from log-linked Poisson regression with generalized estimating equations to explore differences in willingness to take PrEP, PrEP use, and indications for PrEP. RESULTS Whereas over half of MSM said they were willing to take PrEP, only about 4% reported using PrEP. There was no difference in willingness to take PrEP between black and white MSM. PrEP use was higher among white compared with black MSM and among those with greater education and income levels. Young, black MSM were less likely to have indications for PrEP compared with young MSM of other races/ethnicities. CONCLUSIONS Young, black MSM, despite being at high risk of HIV acquisition, may not have indications for PrEP under the current guidelines. Clinicians may need to consider other factors besides risk behaviors such as HIV incidence and prevalence in subgroups of their communities when considering prescribing PrEP.

Condom use among high-risk heterosexual women with concurrent sexual partnerships, Houston, Texas, USA

Concurrent sexual partnerships allow for enhanced transmission of sexually transmitted infections (STIs). Condom use dynamics in this context may be an important factor for transmission of HIV. We conducted a cross-sectional study to describe the frequency of concurrency among high-risk heterosexual women in Houston, Texas and determine the factors associated with condom use. A total of 553 participants were recruited using respondent-driven sampling and completed an anonymous questionnaire; 256 (49%) were identified as having a concurrent partnership. The prevalence of condom use at last sexual encounter was 26%. Women were significantly more likely to use condoms if their sexual encounter was with a casual partner and if alcohol and/or drugs were not used. The high prevalence of concurrent partnerships suggests the presence of a dense sexual network which may enable the rapid spread of STIs and HIV. The risk of transmission may be additionally increased due to the low prevalence of condom use.

Early Linkage to HIV Care and Antiretroviral Treatment among Men Who Have Sex with Men — 20 Cities, United States, 2008 and 2011

Early linkage to care and antiretroviral (ARV) treatment are associated with reduced HIV transmission. Male-to-male sexual contact represents the largest HIV transmission category in the United States; men who have sex with men (MSM) are an important focus of care and treatment efforts. With the release of the National HIV/AIDS Strategy and expanded HIV treatment guidelines, increases in early linkage to care and ARV treatment are expected. We examined differences in prevalence of early linkage to care and ARV treatment among HIV-positive MSM between 2008 and 2011. Data are from the National HIV Behavioral Surveillance System, which monitors behaviors among populations at high risk of HIV infection in 20 U.S. cities with high AIDS burden. MSM were recruited through venue-based, time-space sampling. Prevalence ratios comparing 2011 to 2008 were estimated using linear mixed models. Early linkage was defined as an HIV clinic visit within 3 months of diagnosis. ARV treatment was defined as use at interview. Prevalence of early linkage to care was 79% (187/236) in 2008 and 83% (241/291) in 2011. In multivariable analysis, prevalence of early linkage did not differ significantly between years overall (P = 0.44). Prevalence of ARV treatment was 69% (790/1,142) in 2008 and 79% (1,049/1,336) in 2001. In multivariable analysis, ARV treatment increased overall (P = 0.0003) and among most sub-groups. Black MSM were less likely than white MSM to report ARV treatment (P = 0.01). While early linkage to care did not increase significantly between 2008 and 2011, ARV treatment increased among most sub-groups. Progress is being made in getting MSM on HIV treatment, but more efforts are needed to decrease disparities in ARV coverage.

Increases in Recent HIV Testing Among Men Who Have Sex With Men Coincide With the Centers for Disease Control and Prevention's Expanded Testing Initiative

According to National HIV Behavioral Surveillance system data, human immunodeficiency virus (HIV) testing increased among gay, bisexual, and other men who have sex with men from 2008 to 2011 in cities funded by the Centers for Disease Control and Preventions Expanded Testing Initiative, suggesting that focused HIV testing initiatives might have positive effects.

Factors associated with hospitalization due to streptococcal infection in Houston, Texas 2015-2016

Objective To study the factors associated with streptococcal infection that led to hospitalization in Houston, Texas for years 2015-2016 Introduction Different studies have shown that Streptococcal infections in adults are more common among older age, blacks, and underlying chronic medical conditions like diabetes, cardiovascular and kidney diseases. In specific, other studies have demonstrated that streptococcal pyogenes can cause severe illnesses and dramatic hospital outbreaks. Furthermore, community-acquired pneumonia studies had also suggested that cardiovascular disease, severe renal disease, chronic lung disease and diabetes were associated with increased odds of hospitalization. Methods Data were extracted from Houston Electronic Disease Surveillance System (HEDSS) beginning January 1, 2015 to December 31, 2016. A total of 512 confirmed cases were investigated and analyzed during the study period. Frequencies and percentages were calculated and chi square test was used to examine the association between hospitalization and other risk factors. Odds ratio was calculated using unconditional logistic regression to determine the association of risk factors with hospitalization in streptococcal patients. Results A total of 414 patients (81 %) of the confirmed cases were hospitalized. Age, race, fever, sepsis, diabetes, cardiovascular and kidney diseases were significantly associated with hospitalization in the bivariate analysis. Logistic regression analysis adjusted for confounding factors demonstrated that among clinical characteristics, fever (OR 2.9; 95% CI 1.66-5.38) was three times more prevalent among hospitalized patients with streptococcal infection. Patients with diabetes (OR 7.92; 95% CI 3.08-20.36) were almost eight times more likely to be hospitalized than patients without diabetes among streptococcal patients, followed by cardiovascular disease (OR 2.84; CI 1.32-6.10) which was three times more likely to be present. Conclusions Common clinical sign like fever was associated with hospitalization among streptococcal patient. Similarly, risk factors like diabetes and cardiovascular diseases were significantly associated with hospitalization in streptococcal patients. Prevention strategies need to be focused on streptococcal patients with chronic risk factors like diabetes, and cardiovascular disease. References Parks t, Barret L, Jones N. Invasive streptococcal disease: a review for clinicians. British Med Bulletin, 2015; 115 (7): 77-89. Skoff TH, Farley MM, Petit S, et al. Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990-2007. CID 2009; 49 (7): 85-92.

Epidemiological Distribution of Reported Cryptosporidiosis cases in Houston, Texas, 2013-2016

Objective To demonstrate the demographic and clinical distribution of reported Cryptosporidiosis cases in Houston, Texas, from 2013-2016 Introduction Cryptosporidiosis is a diarrheal disease caused by microscopic parasite Cryptosporidium . Modes of transmission include eating undercooked food contaminated with the parasite, swallowing something that has come into contact with human or animal feces, or swallowing pool water contaminated with the parasite. The disease is clinically manifested usually with chronic diarrhea and abdominal cramps. It is found to be more prevalent in immunocompromised patients like HIV and AIDS. Cryptosporidiosis usually causes potentially life-threatening disease in people with AIDS. Methods Data were extracted from the Houston Electronic Disease Surveillance System (HEDSS) from January 1, 2013 to December 31, 2016. A total of 170 confirmed cases received during the study period were analyzed and crossed check against national Enhanced HIV/AIDS Reporting System (eHARS) database to examine epidemiological distribution. SAS 9.4 was used to analyze demographics, clinical characteristics as well as transmission factors. Results Approximately, 72% of the cases were males and 28% were females. The 35-44 year old age group (37%) had the highest prevalence. African Americans (49%) and Hispanics (30%) had the highest number of confirmed Cryptosporidiosis cases. 133 of the 170 cases, 78% were previously reported to the eHARS national database as HIV/AIDS cases. Among the cases reported to eHARS, 90% had AIDS. 10% of the reported cases were found to be deceased in eHARS database. Among the 170 reported cases, 30% were hospitalized. Clinical presentations were diarrhea (44%), followed by abdominal cramps (23%), and nausea and vomiting (18%). Most common transmission factors among cryptosporidiosis cases were found to be men who have sex with men (MSM) (34%), followed by heterosexual contact with HIV/AIDS patients (14%), and MSM with Intravenous/Injection drug user (IDU) (5%). Among the reported cases, 70% were receiving ongoing medical services for their HIV/AIDS status. Conclusions Cryptosporidiosis in patients with HIV/AIDS diagnosis is mostly prevalent in males, African American adults and those between 35-44 years of age, with common clinical presentations of diarrhea and abdominal cramps. The prevalence of cryptosporidiosis is found to be more common in AIDS patients. Prevention strategies should be focused on raising awareness among immunocompromised patients with HIV and symptoms of cryptosporidiosis so they get evaluated and treated quickly to prevent conversion to AIDS disease. References 1. Caccio SM, Pozio E. Advances in the epidemiology, diagnosis and treatment of cryptosptidiosis. Expert Review of Anti-infective Therapy. 2006; 4(3): 429-443. 2. Hunter PR, Nichols G. Epidemiology ad clinical features of cryptosporidium infection in immunocompromised patients. Clinical Microbiology Reviews. 2002 Jan; 15(1): 145-154. 3. http://www.cdc.gov/parasites/crypyo/gen_info/infect.html

Carbapenem Resistant Enterobacteriaceae infections in Houston, Texas: An outline

Objective To examine demographic as well as clinical characteristics of the Carbapenam Resistant Enteriobacteriacae (CRE) Organisms cases in Houston, Texas, 2015-2016 Introduction According to CDC, CRE is used to describe bacteria that are non- susceptible to one or more carbapenems; doripenem, meropenem or imipenem and resistant to third generation cephalosporins like ceftriaxone, cefotaxime and ceftazidime. These organisms cause infections that are associated with high mortality rates and they have the potential to spread widely. Antibiotic resistant bacteria cause more than 2 million illnesses and at least 23,000 deaths each year in United States. CREs are found in many health care settings like acute care hospitals, long term care facilities, nursing homes, rehabilitation facilities and other health care settings. Although CREs includes a number of species, reporting in State of Texas is limited to CRE- Klebsiella species and CRE- E.coli . Methods Population-based surveillance data was generated from Houston’s electronic disease surveillance system reported to Houston Health Department (HHD) from October 2015 to July 2016. Descriptive analysis was performed to examine demographic and clinical characteristics across different age groups, gender and race/ethnicity. HHD has received a total of 463 CRE cases during the time period, out of which 72 were non-reportable and did not meet the case criteria, 187 were out of jurisdiction. The remaining 204 cases were included in this study. Results Out of a total of 204 cases, males and females were represented equally (50% each). The mean age of the cases was 67 years (age ranges from 22-98). Majority of the cases were in the older age group, 70 years and above 53 (26%), followed by 48 (24%) in age group 80 and above years. Among the different race/ethnic groups, African-Americans comprised of 82 (40%), followed by Whites 67 (33%) and Hispanics 33 (16%). Out of 204 cases, 156 (76%) were hospitalized, which included acute care hospital, long-term acute care or nursing home. Out of 156 hospitalized cases, 71 (34%) were in Intensive Care Unit (ICU) and 136 (67%) had an invasive or indwelling device. Of all the cases, 80% had CRE Klebsiella pneumoniae , followed by 11% who had CRE- E coli. The cases were distributed evenly across the city when plotted on ArcGIS with their residential addresses. Conclusions CRE cases are found to be more common among older age groups, African American population and in hospitalized patients. CRE can be a ground for increasing infectious diseases in the community and one of the reason may be unnecessary use of antimicrobial agents. This study provides a glimpse into the number of CRE cases reported in Houston since CREs are classified a separate disease in Texas. Further studies are needed to explore the occurrence of anti-microbial drug resistance among the specific population groups and how the case investigation efforts can be targeted to enhance prevention.