CDC Issues Revised STD Treatment Guidelines, Funds HIV Prevention Work

By Eric Brus

CDC recently published its new Sexually Transmitted Diseases Treatment Guidelines, 2015 for the care of persons who have or are at risk for sexually transmitted diseases (STDs). According to CDC, the 2015 guidelines include discussions of the following health issues: 1) alternative treatment regimens for gonorrhea; 2) diagnostic tests for trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium bacteria in urethritis/cervicitis and implications for treating these conditions; 5) human papillomavirus vaccine recommendations and counseling messages; 6) STD management in transgender persons; 7) annual HCV testing in persons with HIV infection; 8) diagnosis of urethritis; and 9) retesting to detect repeat infection.

CDC has developed several resources to help health care providers access, understand, and use the 2015 guidelines effectively, including:

� Wall Chart -- This poster-sized chart provides an overview of the 2015 guidelines, and is designed for use in physician offices, nurses' stations, and other clinical settings.
� Pocket Guide -- This compact summary of the 2015 guidelines can fit in a lab coat, pocket, or desk drawer.
� Apple STD Tx Guide 2015 App -- This free app gives providers ready access to STD treatment and diagnostic information. An Android version of the app is expected to be available later this summer.
� Evidence Tables -- These background documents provide the basis for the STD screening, diagnostic, and treatment recommendations included in the 2015 STD Treatment Guidelines.

Limited quantities (in print) of the Wall Chart and Pocket Guide may be ordered through CDC's Information on Demand system.

CDC Awards $216M for HIV Prevention

On July 1, CDC announced the awarding of $216 million over five years to 90 community-based organizations (CBOs) nationwide (including Fenway Health) that are involved in HIV prevention. According to CDC, this funding will support the delivery of effective HIV prevention strategies to those at greatest risk, including people of color, men who have sex with men (MSM), transgender persons, and people who inject drugs.

"The organizations we're funding have a strong foothold in the hardest-hit communities," noted Jonathan Mermin, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "They have the credibility and experience needed to deliver the most effective HIV prevention strategies to those who need them most." CBOs will use the new funding to deliver high-impact HIV prevention strategies, including:
� providing HIV testing to those at high risk to increase the proportion of people who are aware of their HIV status;
� engaging HIV-positive people in ongoing care and treatment, helping them adhere to antiretroviral Therapy, and ensuring they receive prevention and support services;
� ensuring high-risk, HIV-negative individuals have access to prevention and support services such as pre-exposure prophylaxis, post-exposure prophylaxis, high-impact behavioral interventions, and screening for sexually transmitted infections; and
� distributing condoms to HIV-positive and high-risk, HIV-negative individuals.

CDC Tracks Progress in HIV Testing, Care

In conjunction with National HIV Testing Day on June 27, CDC published two new reports on HIV testing, diagnoses, and linkages to care in the Morbidity and Mortality Weekly Report. In the first report, Prevalence of Diagnosed and Undiagnosed HIV Infection - United States, 2008-2012, researchers from CDC and Emory University used HIV surveillance data to estimate the prevalence of diagnosed and undiagnosed HIV infection in U.S. states and the District of Columbia (D.C.) for the period 2008 through 2012.

They found that, for the U.S. as a whole, about 87 percent of persons infected with HIV had been diagnosed with the virus. In the 42 jurisdictions with numerically stable estimates, HIV diagnosis rates ranged from 77 percent in Louisiana to greater than 90 percent in Colorado, Connecticut, Delaware, Hawaii, and New York. HIV prevalence rates varied widely, from a low of 110 per 100,000 persons in Iowa to a high of 3,936 per 100,000 persons in D.C.

"The results presented in this report show that although the overall percentage of persons living with HIV who have received a diagnosis of HIV infection is high, additional efforts are needed to ensure that all jurisdictions meet the goals of the [National HIV/AIDS] Strategy," (NHAS) according to the researchers. One key objective of the NHAS is to increase the percentage of persons living with HIV who know their status to greater than 90 percent. "Continued efforts to implement routine HIV screening in health care settings and focus on targeted testing in non-health care settings to access populations in communities with disproportionately high HIV burden... might help further reduce undiagnosed HIV infection."

In the second report, Identifying New Positives and Linkage to HIV Medical Care -- 23 Testing Site Types, United States, 2013, CDC researchers analyzed data for 23 HIV testing site types to determine: 1) the number of HIV tests conducted; 2) the percentage of persons with new diagnoses of HIV infection (referred to as "new positives"); and 3) the percentage of persons who were linked to HIV medical care within 90 days after receiving HIV diagnoses. They found that, in health care settings, primary care, and sexually transmitted disease (STD) clinics accounted for substantially more HIV tests than did other sites, and STD clinics identified more new positives. In non-health care settings, HIV counseling and testing sites accounted for the most tests and identified the highest number of new positives.

"No HIV testing site met the National HIV/AIDS Strategy goal of 85.0 percent linked to HIV medical care within 90 days of diagnosis based on the minimum percentages calculated," the researchers noted. However, when they used the maximum percentages for linkage-to-care rates, they found that the goal was met by 8 of the 12 site types among health care settings and 7 of 11 site types among non-health care settings.

To evaluate linkage-to-care rates for different testing site types, the CDC researchers calculated two values: a minimum percentage and a maximum percentage. The minimum percentage consisted of the number of persons linked to care divided by the total number of persons diagnosed, including persons for whom data were missing. The maximum percentage consisted of the number of persons linked to care divided by the total number of persons diagnosed, excluding persons for whom data were missing. According to CDC, the minimum percentages likely underestimate the sites' actual linkage-to-care performance, while the maximum percentages likely overestimate performance.

"Activities to reduce behavioral risk factors and improve linkage to care are critical to improve health and prevent HIV transmission to partners," the CDC researchers concluded. "Focusing HIV testing efforts on the most effective sites in both health care and non-health care settings and increasing linkage to medical care could have a large impact on identifying new positives and ensuring that they receive recommended services."

Eric Brus is the Director of Health Information at AIDS Action Committee. This report is produced by the Health Library of the AIDS Action Committee in collaboration with the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available online.