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    • DIS used standard methods for locating and contacting person

    2022-01-11

    DIS used standard methods for locating and contacting persons for interview, including the use of phone calls, letters, in person contact, and contact through social media. During this time period, contacts of persons with diagnosed HIV (first-generation contacts) were tested for HIV and, regardless of their HIV status, interviewed by DIS for risk behaviors and elicitation of contacts (second-generation contacts). DIS also tested and interviewed second-generation contacts. A few second-generation contacts also named their contacts (n = 8 contacts); for the purposes of this analysis, these contacts were also defined as second-generation contacts. These contacts were not elicited purposively by the DIS but were included for investigational purposes because they were reachable for interview and determined to have similar levels of HIV risk to the second-generation contacts. Contacts who had HIV diagnosed in 2017 were classified as having a 2017 diagnosis and not as contacts. Demographic characteristics (Table 1) were self-reported during DIS interviews, whereas clinical characteristics were available from surveillance data (Table 2). Past 12-month risk behaviors (Table 3) were also self-reported during DIS interviews. All persons with diagnosed HIV had an initial positive rapid test or standard blood test result that was later confirmed by Western blot at the West Virginia state laboratory. Transmission category (based on reported lifetime risk behaviors) and viral suppression (defined as <200 copies/mL, or undetectable) status were abstracted from West Virginia's HIV surveillance data. Viral suppression data were last abstracted on February 15, 2018, to allow for reporting delays. The most recent viral load for each person up to this date was included in analyses. ddhUTP to care was defined as having any viral load measurement available in surveillance data. We described demographic and clinical characteristics of persons with HIV diagnosed during 2017 and demographic characteristics of their contacts. We also described past 12-month behavioral characteristics among those interviewed by a DIS. Connections between persons with HIV diagnosed in 2017 and their contacts (including persons with HIV diagnosed before 2017) are illustrated and described by HIV status and past 12-month IDU risk in a network diagram produced in MicrobeTrace [10]. To determine HIV transmission potential from persons with 2017 diagnoses to PWID, we assessed viral suppression status, HIV status of contacts, and IDU risk behaviors of persons living with HIV and contacts.
    Results There were 47 persons with HIV diagnosed in 2017 in the 15 southern West Virginia counties of interest based on their county of residence at diagnosis (Fig. 1). The majority (87%) were male (Table 1). Most persons with HIV diagnoses were aged 20–29 years (55%) with 30–39 years (21%) being the second largest age group, and 70% were non-Hispanic white. As of early February 2018, 83% of persons with an HIV diagnosis had been interviewed by a DIS. The 39 persons who were interviewed by DIS named 192 sexual, injection drug, or social contacts. Like persons with 2017 diagnoses, most contacts were male (89%) and aged 20–39 years (84%). Nearly 87% of contacts were non-Hispanic white, and 12% had a previous HIV diagnosis. DIS located and interviewed 20% (39/192) of contacts. Other persons with 2017 diagnoses and contacts could not be located or reached for interview. Based on the lifetime risk behaviors of persons with 2017 diagnoses, 62% likely acquired HIV through male-to-male sexual contact, 11% through injection drug use, and 8% through either male-to-male sexual contact or injection drug use (Table 2). More than one-fifth (21%) of persons had HIV stage 3 [AIDS] at the time of their HIV diagnosis, 47% had evidence of viral suppression as of February 2018, whereas another 36% were linked to HIV care but not yet achieved viral suppression. DIS interviewed 78 people as part of logistic growth model investigation, of whom half were persons with 2017 diagnoses and half were their contacts (Table 3). In the 12 months before interview, 13% of persons with 2017 diagnoses and 21% of their contacts injected drugs, whereas 8% of persons with 2017 diagnoses and 16% of their contacts shared needles or other injection equipment. Most men had sex with at least one male partner (71% of males with diagnosed HIV and 86% of male contacts), whereas fewer had sex with female partners (32% of males with diagnosed HIV and 24% of male contacts). A larger proportion of persons with 2017 diagnoses had anal or vaginal condomless sex than contacts (85% vs. 73%, respectively). More contacts than persons with HIV had sex with a PWID (30% vs. 19%, respectively).