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Original Research |

HIV Acquisition Among Women From Selected Areas of the United States: A Cohort Study

Sally L. Hodder, MD; Jessica Justman, MD; James P. Hughes, PhD; Jing Wang, MS; Danielle F. Haley, MPH; Adaora A. Adimora, MD; Carlos Del Rio, MD; Carol E. Golin, MD; Irene Kuo, PhD; Anne Rompalo, MD; Lydia Soto-Torres, MD; Sharon B. Mannheimer, MD; LeTanya Johnson-Lewis, BS; Susan H. Eshleman, MD, PhD; Wafaa M. El-Sadr, MD; for the HIV Prevention Trials Network 064, the Women's HIV SeroIncidence Study Team
[+] Article and Author Information

From the New Jersey Medical School, Newark, New Jersey; International AIDS Care and Treatment Program, Joseph L. Mailman School of Public Health, College of Physicians and Surgeons, Columbia University and Harlem Hospital Center, New York, New York; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington; 5FHI 360, Durham, North Carolina; University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina; Rollins School of Public Health and Center for AIDS Research, Emory University, Atlanta, Georgia; George Washington University School of Public Health and Health Services, Washington, DC; Johns Hopkins University School of Medicine, Baltimore, Maryland; and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

Disclaimer: The views expressed herein are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institutes of Health, the HPTN, or its funders.

Acknowledgment: The authors thank the study participants, community stakeholders, and staff from each study site. In particular, they acknowledge Lynda Emel, Jonathan Lucas, Nirupama Sista, Kathy Hinson, Elizabeth DiNenno, Ann O'Leary, Lisa Diane White, Waheedah Shabaaz-El, Quarraisha Abdool-Karim, and Sten Vermund.

Grant Support: By the National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, and National Institute of Mental Health (cooperative agreement UM1 AI068619, U01-AI068613, and UM1-AI068613); Centers for Innovative Research to Control AIDS, Mailman School of Public Health, Columbia University (5UM1A1069466); University of North Carolina Clinical Trials Unit (AI069423); University of North Carolina Clinical Trials Research Center of the Clinical and Translational Science Award (RR 025747); University of North Carolina Center for AIDS Research (AI050410); Emory University HIV/AIDS Clinical Trials Unit (5UO1AI069418), Center for AIDS Research (P30 AI050409), and Clinical and Translational Science Award (UL1 RR025008); Johns Hopkins Adult AIDS Clinical Trials Unit (AI069465) and Clinical and Translational Science Award (ULI RR025008); Johns Hopkins Clinical and Translational Science Award (ULI RR025005); and The Terry Beirn Community Programs for Clinical Research on AIDS Clinical Trials Unit.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1057.

Reproducible Research Statement: Study protocol: Available at www.HPTN.org. Statistical code and data set: Not available.

Requests for Single Reprints: Sally L. Hodder, MD, Department of Medicine, Division of Infectious Diseases, New Jersey Medical School, 185 South Orange Avenue, MSB I-506, Newark, NJ 07101-1709; e-mail, hoddersa@umdnj.edu.

Current Author Addresses: Dr. Hodder: Department of Medicine, Division of Infectious Diseases, New Jersey Medical School, 185 South Orange Avenue, MSB I-506, Newark, NJ 07101-1709.

Dr. Justman: Columbia University, 722 West 168th Street, Room 1315, New York, NY 10032.

Dr. Hughes: University of Washington, Mailstop 359931, Seattle, WA 98195.

Ms. Wang: Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North MP-1195, Seattle, WA 98109-1024.

Ms. Haley: FHI360, Science Facilitation, PO Box 13950, Research Triangle Park, NC 27709.

Dr. Adimora: University of North Carolina, Chapel Hill, School of Medicine, CB# 7030, 130 Mason Farm Road, 2nd Floor Bioinformatics, Chapel Hill, NC 27599.

Dr. Del Rio: Hubert Department of Global Health, Rollins School of Public Health of Emory University, Claudia Nance Rollins Building, Room 7011, 1518 Clifton Road Northeast, Mailstop 1518-002-7BB, Atlanta, GA 30322.

Dr. Golin: University of North Carolina, Chapel Hill, Gillings School of Global Public Health, 725 Airport Road, CB# 7590, Chapel Hill, NC 27599.

Dr. Kuo: George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, 2100 West Pennsylvania Avenue Northwest, 8th Floor, Washington, DC 20037.

Dr. Rompalo: Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Suite 4000, Room 427, Baltimore, MD 21224.

Dr. Soto-Torres: Prevention Sciences Program, Division of Acquired Immunodeficiency Syndrome, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 6700B Rockledge Drive, Room 5120, Bethesda, MD 20892-7628.

Dr. Mannheimer: Harlem Hospital Center, 506 Lenox Avenue, Room 3101A, New York, NY 10037.

Ms. Johnson-Lewis: Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology Building Room 313, Baltimore, MD 21287.

Dr. Eshleman: Department of Pathology, Johns Hopkins University School of Medicine, Ross Building, Room 646, 720 Rutland Avenue, Baltimore, MD 21287.

Dr. El-Sadr: Columbia University, 722 West 168th Street, Room 715, New York, NY 10032.

Author Contributions: Conception and design: S.L. Hodder, J. Justman, J.P. Hughes, D.F. Haley, C.E. Golin, L. Soto-Torres, S.H. Eshleman, W.M. El-Sadr.

Analysis and interpretation of the data: S.L. Hodder, J. Justman, J.P. Hughes, J. Wang, A.A. Adimora, C. Del Rio, C.E. Golin, S.B. Mannheimer, L. Johnson-Lewis, S.H. Eshleman, W.M. El-Sadr.

Drafting of the article: S.L. Hodder, J. Justman, J.P. Hughes, D.F. Haley, A.A. Adimora, C. Del Rio, L. Soto-Torres, S.B. Mannheimer, S.H. Eshleman, W.M. El-Sadr.

Critical revision of the article for important intellectual content: S.L. Hodder, J. Justman, J.P. Hughes, D.F. Haley, A.A. Adimora, C.E. Golin, I. Kuo, A. Rompalo, S.B. Mannheimer, L. Johnson-Lewis, S.H. Eshleman, W.M. El-Sadr.

Final approval of the article: S.L. Hodder, J. Justman, J.P. Hughes, D.F. Haley, A.A. Adimora, C. Del Rio, C.E. Golin, I. Kuo, A. Rompalo, L. Soto-Torres, S.B. Mannheimer, S.H. Eshleman, W.M. El-Sadr.

Provision of study materials or patients: S.L. Hodder, J. Justman, D.F. Haley, C. Del Rio, C.E. Golin, I. Kuo, A. Rompalo, S.B. Mannheimer.

Statistical expertise: J.P. Hughes, J. Wang.

Obtaining of funding: S.L. Hodder, J. Justman, C.E. Golin, W.M. El-Sadr.

Administrative, technical, or logistic support: D.F. Haley, W.M. El-Sadr.

Collection and assembly of data: S.L. Hodder, C. Del Rio, C.E. Golin, I. Kuo, A. Rompalo, S.H. Eshleman.


Ann Intern Med. 2013;158(1):10-18. doi:10.7326/0003-4819-158-1-201301010-00004
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Chinese translation

Background: Women account for 23% of newly diagnosed HIV infections in the United States, but there are few recent, well-characterized cohorts of U.S. women in whom behavior characteristics and HIV acquisition have been well-described.

Objective: To evaluate HIV incidence and describe behaviors among U.S. women residing in areas of high HIV prevalence.

Design: Multisite, longitudinal cohort of women who had HIV rapid testing and audio computer-assisted self-interviews at baseline and every 6 months for up to 12 months. (ClinicalTrials.gov: NCT00995176)

Setting: 10 urban and periurban communities with high HIV prevalence and poverty rates, located in the northeastern and southeastern United States.

Patients: Venue-based sampling was used to recruit women aged 18 to 44 years who recently had unprotected sex and had 1 or more additional personal or partner risk factors and no self-reported previous HIV diagnosis.

Measurements: HIV prevalence and incidence, frequency of HIV risk behaviors, and health status perceptions.

Results: Among 2099 high-risk women (85.9% black and 11.7% of Hispanic ethnicity), 32 (1.5%) were diagnosed with HIV infection at enrollment. Annual HIV incidence was 0.32% (95% CI, 0.14% to 0.74%). Older age, substance use, and knowing a partner had HIV were associated with HIV prevalence. Ten women died during the study (0.61% per year).

Limitations: Longitudinal assessment of risk behaviors was limited to a maximum of 12 months. There were few incident HIV infections, precluding identification of characteristics predictive of HIV acquisition.

Conclusion: This study enrolled a cohort of women with HIV incidence substantially higher than the Centers for Disease Control and Prevention national estimate in the general population of U.S. black women. Concerted efforts to improve preventive health care strategies for HIV and overall health status are needed for similar populations.

Primary Funding Source: National Institutes of Health.

Topics

hiv ; women ; hiv infection

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