Nanette Benbow

Mortality in Chicago attributed to the July 1995 heat wave.

OBJECTIVES This study assessed mortality associated with the mid-July 1995 heat wave in Chicago. METHODS Analyses focused on heat-related deaths, as designated by the medical examiner, and on the number of excess deaths. RESULTS In July 1995, there were 514 heat-related deaths and 696 excess deaths. People 65 years of age or older were overrepresented and Hispanic people underrepresented. During the most intense heat (July 14 through 20), there were 485 heat-related deaths and 739 excess deaths. CONCLUSIONS The methods used here provide insight into the great impact of the Chicago heat wave on selected populations, but the lack of methodological standards makes comparisons across geographical areas problematic.

Epidemiology of HIV infection in large urban areas in the United States.

Background While the U.S. HIV epidemic continues to be primarily concentrated in urban area, local epidemiologic profiles may differ and require different approaches in prevention and treatment efforts. We describe the epidemiology of HIV in large urban areas with the highest HIV burden. Methods/Principal Findings We used data from national HIV surveillance for 12 metropolitan statistical areas (MSAs) to determine disparities in HIV diagnoses and prevalence and changes over time. Overall, 0.3% to 1% of the MSA populations were living with HIV at the end of 2007. In each MSA, prevalence was >1% among blacks; prevalence was >2% in Miami, New York, and Baltimore. Among Hispanics, prevalence was >1% in New York and Philadelphia. The relative percentage differences in 2007 HIV diagnosis rates, compared to whites, ranged from 239 (San Francisco) to 1239 (Baltimore) for blacks and from 15 (Miami) to 413 (Philadelphia) for Hispanics. The epidemic remains concentrated, with more than 50% of HIV diagnoses in 2007 attributed to male-to-male sexual contact in 7 of the 12 MSAs; heterosexual transmission surpassed or equaled male-to-male sexual transmission in Baltimore, Philadelphia, and Washington, DC. Yet in several MSAs, including Baltimore and Washington, DC, AIDS diagnoses increased among men-who-have sex with men in recent years. Conclusions/Significance These data are useful to identify local drivers of the epidemic and to tailor public health efforts for treatment and prevention services for people living with HIV.

Willingness of US men who have sex with men (MSM) to participate in Couples HIV Voluntary Counseling and Testing (CVCT).

Background We evaluated willingness to participate in CVCT and associated factors among MSM in the United States. Methods 5,980 MSM in the US, recruited through MySpace.com, completed an online survey March-April, 2009. A multivariable logistic regression model was built using being “willing” or “unwilling” to participate in CVCT in the next 12 months as the outcome. Results Overall, 81.5% of respondents expressed willingness to participate in CVCT in the next year. Factors positively associated with willingness were: being of non-Hispanic Black (adjusted odds ratio [aOR]: 1.5, 95% confidence interval [CI]: 1.2–1.8), Hispanic (aOR: 1.3, CI: 1.1–1.6), or other (aOR: 1.4, CI: 1.1–1.8) race/ethnicity compared to non-Hispanic White; being aged 18–24 (aOR: 2.5, CI: 1.7–3.8), 25–29 (aOR: 2.3, CI: 1.5–3.6), 30–34 (aOR: 1.9, CI: 1.2–3.1), and 35–45 (aOR: 2.3, CI: 1.4–3.7) years, all compared to those over 45 years of age; and having had a main male sex partner in the last 12 months (aOR: 1.9, CI: 1.6–2.2). Factors negatively associated with willingness were: not knowing most recent male sex partner’s HIV status (aOR: 0.81, CI: 0.69–0.95) compared to knowing that the partner was HIV-negative; having had 4–7 (aOR: 0.75, CI: 0.61–0.92) or >7 male sex partners in the last 12 months (aOR: 0.62, CI: 0.50–0.78) compared to 1 partner; and never testing for HIV (aOR: 0.38, CI: 0.31–0.46), having been tested over 12 months ago (aOR: 0.63, CI: 0.50–0.79), or not knowing when last HIV tested (aOR: 0.67, CI: 0.51–0.89), all compared to having tested 0–6 months previously. Conclusions Young MSM, men of color, and those with main sex partners expressed a high level of willingness to participate in couples HIV counseling and testing with a male partner in the next year. Given this willingness, it is likely feasible to scale up and evaluate CVCT interventions for US MSM.

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.

Demographic Characteristics and Survival With AIDS: Health Disparities in Chicago, 1993–2001

OBJECTIVES We examined correlations between survival and race/ethnicity, age, and gender among persons who died from AIDS-related causes. METHODS We estimated survival among 11 022 persons at 12, 36, and 60 months after diagnosis with AIDS in 1993 through 2001 and reported through 2003 to the Chicago Department of Public Health. We estimated hazard ratios (HRs) by demographic and risk characteristics. RESULTS All demographic groups had higher 5-year survival rates after the introduction of highly active retroviral therapy (1996-2001) than before (1993-1995). The HR for non-Hispanic Blacks to Whites was 1.18 in 1993 to 1995 and 1.51 (P < .01) in 1996 to 2001. The HR for persons 50 years or older to those younger than 30 years was 1.63 in 1993-1995 and 2.28 (P < .01) in 1996-2001. The female-to-male HR was 0.90 in 1993-1995 and 1.20 (P < .02) in 1996-2001. CONCLUSIONS The risk of death was higher for non-Hispanic Blacks and Hispanics than for non-Hispanic Whites. Interventions are needed to increase early access to care for disadvantaged groups.

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.

“Scaling-out” evidence-based interventions to new populations or new health care delivery systems

BackgroundImplementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials.DiscussionIn this paper, we introduce a new concept for implementation called “scaling-out” when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest.ConclusionIn scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes “borrow strength” from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.

HIV Infection and Linkage to HIV-Related Medical Care in Large Urban Areas in the United States, 2009.

Background:Residents of urban areas have accounted for the majority of persons diagnosed with HIV disease in the United States. Linking persons recently diagnosed with HIV to primary medical care is an important indicator in the National HIV/AIDS Strategy. Methods:We analyzed data reported to the HIV Surveillance System in 18 urban areas in the United States. Standardized executable SAS programs were distributed to determine the number of HIV cases living through 2008, number of HIV cases diagnosed in 2009, and the percentage of those diagnosed in 2009 who had reported CD4 lymphocyte or HIV viral load test results within 3 months of HIV diagnosis. Data were presented by jurisdiction, age group at diagnosis, race/ethnicity, sex at birth, birth country, disease stage, and transmission category. Results:By jurisdiction, the percentage of persons diagnosed in 2009 with at least 1 CD4 or HIV viral load test within 3 months of diagnosis ranged from 48.5% to 92.5% (median: 70.9). The percentage of persons linked to care varied by age group and by racial/ethnic groups. Fourteen of the 18 areas reported that the percentage of persons linked to care was greater than 65%, the baseline measure indicated in the National HIV/AIDS Strategy. Conclusions:A wide range in percent linked to HIV medical care was observed between residents of 18 urban areas in the United States with noted age and racial disparities. Routine testing and linkage efforts and intensified prevention efforts should be considered to increase access to primary HIV-related medical care.

The big cities health inventory, 1997.

This manuscript reports on the publication of a unique document, The Big Cities Health Inventory, 1997: The Health of Urban U.S.A. , which was released in July 1997 by the Chicago Department of Public Health (CDPH). The report presents data on 20 important health indicators such as AIDS, cancers, tuberculosis, sexually transmitted diseases, homicide, heart disease, infant mortality and low birthweight. Indicators of morbidity are gathered from participating local health departments and indicators of mortality and maternal and child health are obtained from vital records files provided by the National Center for Health Statistics (NCHS). The data are displayed and analyzed in two sections. The first consists of a series of tables presenting overall rates, gender and race/ethnicity-specific rates and city rankings according to these measures. These rankings provide meaningful comparisons between and within cities for specific demographic characteristics. The second component presents sample analyses which illustrate the possible uses of this information. The report represents an important tool for health professionals, researchers, policy makers and community advocates dedicated to promoting healthier cities. Such array of city-level data, to our knowledge not available from any other source, could indeed begin to lead to public health interventions that will impact the well-being of residents of large urban areas.

Anal Intercourse and HIV Risk Among Low-Income Heterosexual Women: Findings from Chicago HIV Behavioral Surveillance

Background: Anal intercourse (AI) is a highly efficient route for HIV transmission and has not been well elucidated among heterosexual (HET) women. Heterosexual women living in impoverished urban areas in the US are at increased risk for HIV acquisition. We aim to describe rates of AI and characteristics associated with AI among heterosexual women at increased risk for HIV acquisition living in Chicago. Methods: The Chicago Department of Public Health conducted a survey of HET during 2007 as part of the National HIV Behavioral Surveillance System. Venue-based, time-location sampling was used to select participants from venues in high-risk areas (census tracts with concurrently high rates of heterosexual AIDS and household poverty). Eligible participants were interviewed anonymously and offered a HIV test. Results: In total, 407 heterosexual women were interviewed. Seventy-one (17%) women reported having AI in the past 12 months, with 61 of the 71 (86%) reporting unprotected AI. In multivariate analysis, women who engaged in AI were more than three times as likely to have three or more sex partners in the past 12 months (OR=3.27, 95% CI 1.53-6.99). AI was also independently associated with STI diagnosis in the past 12 months (2.13, 95% CI 1.06-4.26), and having sexual intercourse for the first time before the age of 15 years (2.23, 95% CI 1.28-3.89). Conclusion: AI was associated with multiple high risk behaviors including a greater number of sexual partners, STI diagnosis, and earlier age at first sex. The combination of risk factors found to be associated with AI call for new HIV prevention services tailored to the needs of women and young girls living in poverty.