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Papers by Guoshen Wang

JAIDS Journal of Acquired Immune Deficiency Syndromes

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2021

BACKGROUND Transgender persons are at high risk for HIV infection. Testing is a key component of ... more BACKGROUND Transgender persons are at high risk for HIV infection. Testing is a key component of the national effort to end the HIV epidemic in the United States. SETTING Sixty-one local and state health departments (HDs) and 150 community-based organizations (CBOs) funded by the Centers for Disease Control and Prevention (CDC) to conduct HIV testing programs. METHODS We analyzed HIV testing data submitted to CDC by funded HDs and CBOs during 2012-2017. Descriptive analysis examined patterns of HIV testing and key outcomes (diagnosis of HIV infection, linkage to HIV medical care, and interview for partner services) among transgender persons. Multivariate robust Poisson regression was used to assess associations between HIV testing outcomes and demographic characteristics, census region, and test setting. RESULTS A total of 82,818 HIV tests were provided to transgender persons. Of these, 2,280 (2.8%) transgender persons were diagnosed with HIV infection; 1,556 (1.9%) received a new and 724 (0.9%) a previous diagnosis with HIV infection. The highest percentage of new HIV diagnosis was found among persons tested in correctional settings (4.6%), non-Hispanic Blacks (3.5%) and transgender women (2.4%).Among newly diagnosed persons, 85.0% were linked to HIV medical care ≤90 days after diagnosis and 63.5% were interviewed for partner services. CONCLUSIONS HIV positivity was high, and the delivery of partner services was low, among transgender persons. HIV testing outcomes among transgender persons varied significantly by demographic characteristics and test setting. HIV prevention programs that are responsive to the needs of transgender persons may address gender-related disparities in HIV testing outcomes.

Journal of Community Health, 2021

Understanding the contribution of CDC-funded testing toward diagnosing HIV informs efforts to end... more Understanding the contribution of CDC-funded testing toward diagnosing HIV informs efforts to end the HIV epidemic. Due to differences in surveillance data and CDC program data, which sometimes rely on self-reported information, the number of new diagnoses cannot be directly compared. CDC recently asked grantees to check surveillance data to inform the identification of new diagnoses from CDC-funded tests. In this analysis, we use this newly available information to estimate the percent of all HIV diagnoses from 2010 to 2017 in the United States that result from CDC-funded tests. Among tests with surveillance information, correlates of correct categorization using self-report only were assessed. Weights were calculated from that analysis and used to estimate the total number of CDC-funded new diagnoses. Estimates are presented overall and by demographics/transmission risk group. We estimate that one third of all HIV diagnoses in the United States from 2010 to 2017 resulted from a CDC-funded test. The percent of diagnoses that resulted from CDC-funded tests was higher among some high-risk groups: 41% among 20–29-year-olds and 39% among blacks/African Americans. When compared to total diagnoses in the United States from 2010 to 2017, a large proportion resulted from CDC-funded tests, particularly among young individuals and blacks/African Americans. CDC’s contribution to new HIV diagnoses was previously unknown. CDC-funded testing is an important part of the national effort to diagnose all people with HIV as early as possible after infection.

MMWR. Morbidity and Mortality Weekly Report, 2021

PrEP referral when they meet the clinical criteria for PrEP prescription based on CDC guidelines ... more PrEP referral when they meet the clinical criteria for PrEP prescription based on CDC guidelines or local protocols. PrEP awareness among persons tested for HIV infection was defined by an affirmative response documented by HIV test providers to the question, "Has the client ever heard of PrEP?" Similarly, PrEP referral among persons eligible for referral was defined by an affirmative response documented by HIV test providers to the question, "Was the client given a referral to a PrEP provider?" PrEP awareness and referrals among Hispanic persons were compared with those of persons of other racial and ethnic groups. PrEP measures among Hispanic persons were also compared by age, gender, race, † † ethnicity, § § test setting, ¶ ¶ U.S. Census region,*** and population groups † † Race refers to the client's self-reported classification or classifications of the biologic heritage with which they most closely identify. For this report, Hispanic persons are stratified into three race groups: Black or African American (Black), White, and other, which includes American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander persons, or those with more than one race. § § Ethnicity refers to the client's self-report of whether they are of Hispanic or Latino origin. ¶ ¶ For each CDC-funded test, test setting is the location where the test was administered. Health care settings are clinical settings in which both medical diagnostic and treatment services were provided (e.g., primary care clinics, community health centers, emergency departments). Non-health care settings are nonclinical settings in which neither medical diagnostic nor treatment services are provided (e.g., schools or educational facilities, faithbased facilities, and field testing sites). *** State and local health department jurisdictions were categorized into the four U.S. Census regions (Northeast, Midwest, South, and West) (https://www2. census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf). Puerto Rico and the U.S. Virgin Islands were grouped into the category "U.S. territories."

Annals of Epidemiology, 2020

Purpose: Multiple imputation (MI) is a widely acceptable approach to missing data problems in epi... more Purpose: Multiple imputation (MI) is a widely acceptable approach to missing data problems in epidemiological studies. Composite variables are often used to summarize information from multiple, correlated items. This study aims to assess and compare different MI methods for handling missing categorical composite variables. Methods: We investigate the problem in the context of a real application: estimating the prevalence of HIV transmission category, which is a composite variable generated by applying a hierarchical algorithm to a group of binary risk source variables from a national program data set. We use simulation studies to compare and assess the performance of alternative MI strategies. These methods include the active imputation, just another variable, and the passive imputation approaches. Results: Our study suggests that the passive imputation approach performs better than the direct imputation approach and the inclusive and general imputation model (i.e. passive imputation with interactions) performs the best. There is no need to embed the information from the variable-combining algorithm in the passive imputation modeling. Conclusion: We recommend practitioners adopting an inclusive and general passive imputation modeling strategy. Published by Elsevier Inc.

MMWR. Morbidity and Mortality Weekly Report, 2020

National Black HIV/AIDS Awareness Day (NBHAAD) is observed each year on February 7 to highlight t... more National Black HIV/AIDS Awareness Day (NBHAAD) is observed each year on February 7 to highlight the continuing disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on the U.S. black or African American (black) population. During 2018, blacks represented 13% of the U.S. population but accounted for 43% of all newly diagnosed HIV infections (1). In February 2019, a new national initiative, Ending the HIV Epidemic: A Plan for America (EHE), was proposed. The plan calls for intensified efforts to diagnose, treat, prevent, and respond to HIV infections in the United States, with an overall goal of reducing new HIV infections by ≥90% by 2030 (2). A study reported in this MMWR issue presents data on CDC-funded HIV testing and outcomes among blacks who were tested in jurisdictions that are the initial focus of EHE. In these jurisdictions during 2017, blacks accounted for 43.2% of CDC-funded tests and 49.1% of newly diagnosed HIV infections (3). CDC supports a range of efforts for reducing the risk for acquiring or transmitting HIV infection among blacks.

MMWR. Morbidity and Mortality Weekly Report, 2020

Transgender women* in the United States are disproportionately affected by human immunodeficiency... more Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments † during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care * Transgender persons are those whose current gender identity differs from their sex assigned at birth. In this analysis, transgender women included those who identified themselves as "male-to-female transgender" or those who identified "male" as their sex assigned at birth and "female" as their current gender.

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 26, 2018

Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HI... more Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HIV-positive women to experience poor health outcomes. Given these disparities, we compared receipt of HIV testing and other preventive services among Black, White, and Hispanic women participating in HIV prevention programs funded by the Centers for Disease Control and Prevention in 2015. Data came from 61 health department jurisdictions and 123 community-based organizations. Using Wald χ tests, we assessed racial/ethnic differences in HIV testing by demographic characteristics, risk factors, HIV status, HIV service delivery, and (using unlinked data) participation in evidence-based HIV prevention interventions among women. We also assessed temporal changes in Black women's receipt of preventive services (2012-2015). In 2015, there were 1,326,589 HIV testing events (single sessions in which one or more HIV tests are performed to determine HIV status) that occurred among Black, White, ...

Sexually transmitted diseases, 2018

Increased HIV testing efforts have resulted in retesting previously diagnosed persons. This study... more Increased HIV testing efforts have resulted in retesting previously diagnosed persons. This study examined Centers for Disease Control and Prevention (CDC)-funded HIV testing programs to evaluate how the needs of previously diagnosed persons are being addressed. The following were examined by demographic and test setting among previously diagnosed HIV-positive persons in 2015: CDC-funded HIV testing, previously diagnosed HIV positivity, current care status, and linkage to care. In addition, trends of HIV positivity and previously diagnosed HIV-positivity were examined from 2011 to 2015. In 2015, CDC funded 3,026,074 HIV tests, and 27,729 were HIV-positive tests. Of those, 13,528 (48.8%) were previously diagnosed persons. Only 11.6% of previously diagnosed persons reported already being in HIV care; after excluding them, 62.1% of previously diagnosed persons were linked within 90 days. In addition, the percentage of previously diagnosed persons steadily increased from 2011 (25.9%) to...

Evaluation & the Health Professions, 2017

Missing data create challenges for determining progress made in linking HIV-positive persons to H... more Missing data create challenges for determining progress made in linking HIV-positive persons to HIV medical care. Statistical methods are not used to address missing program data on linkage. In 2014, 61 health department jurisdictions were funded by Centers for Disease Control and Prevention (CDC) and submitted data on HIV testing, newly diagnosed HIV-positive persons, and linkage to HIV medical care. Missing or unusable data existed in our data set. A new approach using multiple imputation to address missing linkage data was proposed, and results were compared to the current approach that uses data with complete information. There were 12,472 newly diagnosed HIV-positive persons from CDC-funded HIV testing events in 2014. Using multiple imputation, 94.1% (95% confidence interval (CI): [93.7%, 94.6%]) of newly diagnosed persons were referred to HIV medical care, 88.6% (95% CI: [88.0%, 89.1%]) were linked to care within any time frame, and 83.6% (95% CI: [83.0%, 84.3%]) were linked t...

AIDS (London, England), 2017

To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testi... more To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testing in nonhealthcare facilities reaches adolescent MSM, identifies new HIV infections, and links those newly diagnosed to medical care. We describe HIV testing, newly diagnosed positivity, and linkage to medical care for adolescent MSM who received a CDC-funded HIV test in a nonhealthcare facility in 2015. We assess outcomes by race/ethnicity, HIV-related risk behaviors, and US geographical region. Of the 703 890 CDC-funded HIV testing events conducted in nonhealthcare facilities in 2015, 6848 (0.9%) were provided to adolescent MSM aged 13-19 years. Among those tested, 1.8% were newly diagnosed with HIV, compared with 0.7% among total tests provided in nonhealthcare facilities regardless of age and sex. The odds of testing positive among black adolescent MSM were nearly four times that of white adolescent MSM in multivariable analysis (odds ratio = 3.97, P < 0.001). Among adolescent MS...

MMWR. Morbidity and Mortality Weekly Report, 2016

prevalence,** and certain target populations (i.e., MSM, persons who inject drugs, heterosexual m... more prevalence,** and certain target populations (i.e., MSM, persons who inject drugs, heterosexual males, and heterosexual females). † † Data to identify target populations are required for all test events conducted in non-health care settings and are only required for HIV-positive persons from health care settings. Target population data included in the analysis were only from non-health care settings. Valid HIV test events were tests for which the results (i.e., positive or negative) were known. Analyses included persons who tested positive for HIV during the most current test event in 2014 and were not previously reported in the health department's HIV surveillance system. Clients' self-reported data regarding previous HIV status were used for grantees who were not able to verify earlier test results within the grantee's surveillance system. The outcomes among Hispanics/Latinos with HIV infection diagnosed in 2014 included linkage to HIV medical care within any timeframe (e.g., attendance at first medical care appointment); linkage to HIV medical care within 90 days; interview for partner services (i.e., soliciting information from HIV-positive persons about their sex partners and drug-injecting partners, who can then be notified of their potential exposures and offered services to protect their health) (4); and referral to HIV risk-reduction services (i.e., services aimed at reducing the risk for HIV transmission, such as behavioral interventions and risk-reduction counseling. HIV risk-reduction services exclude HIV posttest counseling, mental health services, and housing needs) (5). During 2014, a total of 3,049,845 CDC-funded HIV test events were conducted in the United States, Puerto Rico, and the U.S. Virgin Islands. Hispanics/Latinos accounted for 22.6% (687,777) of all test events conducted, and for 25.3% and 25.8% of HIV test events among persons aged 30-39 years and 40-49 years, respectively, as well as 31.4%

Journal of Bioinformatics and Computational Biology, 2010

In order to predict future patients' survival time based on their microarray gene expression ... more In order to predict future patients' survival time based on their microarray gene expression data, one interesting question is how to relate genes to survival outcomes. In this paper, by applying a semi-parametric additive risk model in survival analysis, we propose a new approach to conduct a careful analysis of gene expression data with the focus on the model's predictive ability. In the proposed method, we apply the correlation principal component regression to deal with right censoring survival data under the semi-parametric additive risk model frame with high-dimensional covariates. We also employ the time-dependent area under the receiver operating characteristic curve and root mean squared error for prediction to assess how well the model can predict the survival time. Furthermore, the proposed method is able to identify significant genes, which are significantly related to the disease. Finally, the proposed useful approach is illustrated by the diffuse large B-cell l...

2008 IEEE International Conference on Granular Computing, 2008

... RK R ZY , where { }* , , RK R ZY denotes { }* , K ZY with the information on subjects i R ∈ r... more ... RK R ZY , where { }* , , RK R ZY denotes { }* , K ZY with the information on subjects i R ∈ removed. ... [11] Bair, E. and Tibishirani, R. Semi-Supervised methods to predict patient survival from gene expression data. PLos Biology, 2004, 2, 0511-0522.

Sexually Transmitted Diseases, 2015

Background-Because of health disparities, incarcerated persons are at higher risk for multiple he... more Background-Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. Methods-Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. Results-Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. Conclusions-Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease.

MMWR. Morbidity and mortality weekly report, Jan 20, 2017

Diagnoses of human immunodeficiency virus (HIV) infection among women declined 17% during 2011-20... more Diagnoses of human immunodeficiency virus (HIV) infection among women declined 17% during 2011-2015, and a total of 7,498 women received a diagnosis of HIV infection in 2015 (1). Although black or African American (black) women accounted for only 12% of the U.S. female population, 60% of women with newly diagnosed HIV infection were black (1,2). By the end of 2014, an estimated 255,900 women were living with HIV infection (3), including approximately 12% who did not know they were infected; in addition, approximately 45% of women who had received a diagnosis had not achieved viral suppression (3). HIV testing is an important public health strategy for identifying women with HIV infection and linking them to HIV medical care. Analysis of CDC-funded program data submitted by 61 health departments in 2015 indicated that among 4,749 women tested who received a diagnosis of HIV infection, 2,951 (62%) had received a diagnosis in the past (previous diagnosis), and 1,798 (38%) were receivin...

Journal of Public Health Management and Practice, 2016

In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality... more In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality assessment and feedback system for CDC-funded HIV testing program data. Our objective was to analyze data quality before and after feedback. Coinciding with required quarterly data submissions to CDC, each health department received data quality feedback reports and a call with CDC to discuss the reports. Data from 2008 to 2011 were analyzed. Fifty-nine state and local health departments that were funded for comprehensive HIV prevention services. Data collected by a service provider in conjunction with a client receiving HIV testing. National data quality assessment and feedback system. Before and after intervention implementation, quality was assessed through the number of new test records reported and the percentage of data values that were neither missing nor invalid. Generalized estimating equations were used to assess the effect of feedback in improving the completeness of variables. Data were included from 44 health departments. The average number of new records per submission period increased from 197 907 before feedback implementation to 497 753 afterward. Completeness was high before and after feedback for race/ethnicity (99.3% vs 99.3%), current test results (99.1% vs 99.7%), prior testing and results (97.4% vs 97.7%), and receipt of results (91.4% vs 91.2%). Completeness improved for HIV risk (83.6% vs 89.5%), linkage to HIV care (56.0% vs 64.0%), referral to HIV partner services (58.9% vs 62.8%), and referral to HIV prevention services (55.3% vs 63.9%). Calls as part of feedback were associated with improved completeness for HIV risk (adjusted odds ratio [AOR] = 2.28; 95% confidence interval [CI], 1.75-2.96), linkage to HIV care (AOR = 1.60; 95% CI, 1.31-1.96), referral to HIV partner services (AOR = 1.73; 95% CI, 1.43-2.09), and referral to HIV prevention services (AOR = 1.74; 95% CI, 1.43-2.10). Feedback contributed to increased data quality. CDC and health departments should continue monitoring the data and implement measures to improve variables of low completeness.

American Journal of Public Health, 2015

We examined HIV testing services, seropositivity, and the characteristics associated with newly i... more We examined HIV testing services, seropositivity, and the characteristics associated with newly identified, confirmed HIV-positive tests among transgender individuals. We analyzed data (2009-2011) using bivariate and multivariable logistic regression to examine the relationships between HIV positivity and sociodemographic and risk characteristics among male-to-female transgender individuals. Most of the testing was conducted in females (51.1%), followed by males (48.7%) and transgender individuals (0.17%). Tests in male-to-female transgender individuals had the highest, newly identified confirmed HIV positivity (2.7%), followed by males (0.9%), female-to-male transgender individuals (0.5%), and females (0.2%). The associated characteristics with an HIV-positive test among male-to-female transgender individuals included ages 20 to 29 and 40 to 49 years (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.4, 5.6 and AOR = 2.8; 95% CI = 1.3, 5.9, respectively), African American (AOR = 4.6; 95% CI = 2.7, 7.9) or Hispanic/Latino (AOR = 2.6; 95% CI = 1.5, 4.5) race/ethnicity, and reporting sex without condom within the past year (AOR = 1.9; 95% CI = 1.3, 2.6), sex with an HIV-positive person (AOR = 1.5; 95% CI = 1.1, 2.0), or injection drug use (AOR = 2.0; 95% CI = 1.3, 3.0). High levels of HIV positivity among transgender individuals, particularly male-to-female transgender individuals, underscore the necessity for targeted HIV prevention services that are responsive to the needs of this population.

JAIDS Journal of Acquired Immune Deficiency Syndromes

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2021

BACKGROUND Transgender persons are at high risk for HIV infection. Testing is a key component of ... more BACKGROUND Transgender persons are at high risk for HIV infection. Testing is a key component of the national effort to end the HIV epidemic in the United States. SETTING Sixty-one local and state health departments (HDs) and 150 community-based organizations (CBOs) funded by the Centers for Disease Control and Prevention (CDC) to conduct HIV testing programs. METHODS We analyzed HIV testing data submitted to CDC by funded HDs and CBOs during 2012-2017. Descriptive analysis examined patterns of HIV testing and key outcomes (diagnosis of HIV infection, linkage to HIV medical care, and interview for partner services) among transgender persons. Multivariate robust Poisson regression was used to assess associations between HIV testing outcomes and demographic characteristics, census region, and test setting. RESULTS A total of 82,818 HIV tests were provided to transgender persons. Of these, 2,280 (2.8%) transgender persons were diagnosed with HIV infection; 1,556 (1.9%) received a new and 724 (0.9%) a previous diagnosis with HIV infection. The highest percentage of new HIV diagnosis was found among persons tested in correctional settings (4.6%), non-Hispanic Blacks (3.5%) and transgender women (2.4%).Among newly diagnosed persons, 85.0% were linked to HIV medical care ≤90 days after diagnosis and 63.5% were interviewed for partner services. CONCLUSIONS HIV positivity was high, and the delivery of partner services was low, among transgender persons. HIV testing outcomes among transgender persons varied significantly by demographic characteristics and test setting. HIV prevention programs that are responsive to the needs of transgender persons may address gender-related disparities in HIV testing outcomes.

Journal of Community Health, 2021

Understanding the contribution of CDC-funded testing toward diagnosing HIV informs efforts to end... more Understanding the contribution of CDC-funded testing toward diagnosing HIV informs efforts to end the HIV epidemic. Due to differences in surveillance data and CDC program data, which sometimes rely on self-reported information, the number of new diagnoses cannot be directly compared. CDC recently asked grantees to check surveillance data to inform the identification of new diagnoses from CDC-funded tests. In this analysis, we use this newly available information to estimate the percent of all HIV diagnoses from 2010 to 2017 in the United States that result from CDC-funded tests. Among tests with surveillance information, correlates of correct categorization using self-report only were assessed. Weights were calculated from that analysis and used to estimate the total number of CDC-funded new diagnoses. Estimates are presented overall and by demographics/transmission risk group. We estimate that one third of all HIV diagnoses in the United States from 2010 to 2017 resulted from a CDC-funded test. The percent of diagnoses that resulted from CDC-funded tests was higher among some high-risk groups: 41% among 20–29-year-olds and 39% among blacks/African Americans. When compared to total diagnoses in the United States from 2010 to 2017, a large proportion resulted from CDC-funded tests, particularly among young individuals and blacks/African Americans. CDC’s contribution to new HIV diagnoses was previously unknown. CDC-funded testing is an important part of the national effort to diagnose all people with HIV as early as possible after infection.

MMWR. Morbidity and Mortality Weekly Report, 2021

PrEP referral when they meet the clinical criteria for PrEP prescription based on CDC guidelines ... more PrEP referral when they meet the clinical criteria for PrEP prescription based on CDC guidelines or local protocols. PrEP awareness among persons tested for HIV infection was defined by an affirmative response documented by HIV test providers to the question, "Has the client ever heard of PrEP?" Similarly, PrEP referral among persons eligible for referral was defined by an affirmative response documented by HIV test providers to the question, "Was the client given a referral to a PrEP provider?" PrEP awareness and referrals among Hispanic persons were compared with those of persons of other racial and ethnic groups. PrEP measures among Hispanic persons were also compared by age, gender, race, † † ethnicity, § § test setting, ¶ ¶ U.S. Census region,*** and population groups † † Race refers to the client's self-reported classification or classifications of the biologic heritage with which they most closely identify. For this report, Hispanic persons are stratified into three race groups: Black or African American (Black), White, and other, which includes American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander persons, or those with more than one race. § § Ethnicity refers to the client's self-report of whether they are of Hispanic or Latino origin. ¶ ¶ For each CDC-funded test, test setting is the location where the test was administered. Health care settings are clinical settings in which both medical diagnostic and treatment services were provided (e.g., primary care clinics, community health centers, emergency departments). Non-health care settings are nonclinical settings in which neither medical diagnostic nor treatment services are provided (e.g., schools or educational facilities, faithbased facilities, and field testing sites). *** State and local health department jurisdictions were categorized into the four U.S. Census regions (Northeast, Midwest, South, and West) (https://www2. census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf). Puerto Rico and the U.S. Virgin Islands were grouped into the category "U.S. territories."

Annals of Epidemiology, 2020

Purpose: Multiple imputation (MI) is a widely acceptable approach to missing data problems in epi... more Purpose: Multiple imputation (MI) is a widely acceptable approach to missing data problems in epidemiological studies. Composite variables are often used to summarize information from multiple, correlated items. This study aims to assess and compare different MI methods for handling missing categorical composite variables. Methods: We investigate the problem in the context of a real application: estimating the prevalence of HIV transmission category, which is a composite variable generated by applying a hierarchical algorithm to a group of binary risk source variables from a national program data set. We use simulation studies to compare and assess the performance of alternative MI strategies. These methods include the active imputation, just another variable, and the passive imputation approaches. Results: Our study suggests that the passive imputation approach performs better than the direct imputation approach and the inclusive and general imputation model (i.e. passive imputation with interactions) performs the best. There is no need to embed the information from the variable-combining algorithm in the passive imputation modeling. Conclusion: We recommend practitioners adopting an inclusive and general passive imputation modeling strategy. Published by Elsevier Inc.

MMWR. Morbidity and Mortality Weekly Report, 2020

National Black HIV/AIDS Awareness Day (NBHAAD) is observed each year on February 7 to highlight t... more National Black HIV/AIDS Awareness Day (NBHAAD) is observed each year on February 7 to highlight the continuing disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on the U.S. black or African American (black) population. During 2018, blacks represented 13% of the U.S. population but accounted for 43% of all newly diagnosed HIV infections (1). In February 2019, a new national initiative, Ending the HIV Epidemic: A Plan for America (EHE), was proposed. The plan calls for intensified efforts to diagnose, treat, prevent, and respond to HIV infections in the United States, with an overall goal of reducing new HIV infections by ≥90% by 2030 (2). A study reported in this MMWR issue presents data on CDC-funded HIV testing and outcomes among blacks who were tested in jurisdictions that are the initial focus of EHE. In these jurisdictions during 2017, blacks accounted for 43.2% of CDC-funded tests and 49.1% of newly diagnosed HIV infections (3). CDC supports a range of efforts for reducing the risk for acquiring or transmitting HIV infection among blacks.

MMWR. Morbidity and Mortality Weekly Report, 2020

Transgender women* in the United States are disproportionately affected by human immunodeficiency... more Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments † during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care * Transgender persons are those whose current gender identity differs from their sex assigned at birth. In this analysis, transgender women included those who identified themselves as "male-to-female transgender" or those who identified "male" as their sex assigned at birth and "female" as their current gender.

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 26, 2018

Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HI... more Black women who are positive for human immunodeficiency virus (HIV) are more likely than other HIV-positive women to experience poor health outcomes. Given these disparities, we compared receipt of HIV testing and other preventive services among Black, White, and Hispanic women participating in HIV prevention programs funded by the Centers for Disease Control and Prevention in 2015. Data came from 61 health department jurisdictions and 123 community-based organizations. Using Wald χ tests, we assessed racial/ethnic differences in HIV testing by demographic characteristics, risk factors, HIV status, HIV service delivery, and (using unlinked data) participation in evidence-based HIV prevention interventions among women. We also assessed temporal changes in Black women's receipt of preventive services (2012-2015). In 2015, there were 1,326,589 HIV testing events (single sessions in which one or more HIV tests are performed to determine HIV status) that occurred among Black, White, ...

Sexually transmitted diseases, 2018

Increased HIV testing efforts have resulted in retesting previously diagnosed persons. This study... more Increased HIV testing efforts have resulted in retesting previously diagnosed persons. This study examined Centers for Disease Control and Prevention (CDC)-funded HIV testing programs to evaluate how the needs of previously diagnosed persons are being addressed. The following were examined by demographic and test setting among previously diagnosed HIV-positive persons in 2015: CDC-funded HIV testing, previously diagnosed HIV positivity, current care status, and linkage to care. In addition, trends of HIV positivity and previously diagnosed HIV-positivity were examined from 2011 to 2015. In 2015, CDC funded 3,026,074 HIV tests, and 27,729 were HIV-positive tests. Of those, 13,528 (48.8%) were previously diagnosed persons. Only 11.6% of previously diagnosed persons reported already being in HIV care; after excluding them, 62.1% of previously diagnosed persons were linked within 90 days. In addition, the percentage of previously diagnosed persons steadily increased from 2011 (25.9%) to...

Evaluation & the Health Professions, 2017

Missing data create challenges for determining progress made in linking HIV-positive persons to H... more Missing data create challenges for determining progress made in linking HIV-positive persons to HIV medical care. Statistical methods are not used to address missing program data on linkage. In 2014, 61 health department jurisdictions were funded by Centers for Disease Control and Prevention (CDC) and submitted data on HIV testing, newly diagnosed HIV-positive persons, and linkage to HIV medical care. Missing or unusable data existed in our data set. A new approach using multiple imputation to address missing linkage data was proposed, and results were compared to the current approach that uses data with complete information. There were 12,472 newly diagnosed HIV-positive persons from CDC-funded HIV testing events in 2014. Using multiple imputation, 94.1% (95% confidence interval (CI): [93.7%, 94.6%]) of newly diagnosed persons were referred to HIV medical care, 88.6% (95% CI: [88.0%, 89.1%]) were linked to care within any time frame, and 83.6% (95% CI: [83.0%, 84.3%]) were linked t...

AIDS (London, England), 2017

To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testi... more To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testing in nonhealthcare facilities reaches adolescent MSM, identifies new HIV infections, and links those newly diagnosed to medical care. We describe HIV testing, newly diagnosed positivity, and linkage to medical care for adolescent MSM who received a CDC-funded HIV test in a nonhealthcare facility in 2015. We assess outcomes by race/ethnicity, HIV-related risk behaviors, and US geographical region. Of the 703 890 CDC-funded HIV testing events conducted in nonhealthcare facilities in 2015, 6848 (0.9%) were provided to adolescent MSM aged 13-19 years. Among those tested, 1.8% were newly diagnosed with HIV, compared with 0.7% among total tests provided in nonhealthcare facilities regardless of age and sex. The odds of testing positive among black adolescent MSM were nearly four times that of white adolescent MSM in multivariable analysis (odds ratio = 3.97, P < 0.001). Among adolescent MS...

MMWR. Morbidity and Mortality Weekly Report, 2016

prevalence,** and certain target populations (i.e., MSM, persons who inject drugs, heterosexual m... more prevalence,** and certain target populations (i.e., MSM, persons who inject drugs, heterosexual males, and heterosexual females). † † Data to identify target populations are required for all test events conducted in non-health care settings and are only required for HIV-positive persons from health care settings. Target population data included in the analysis were only from non-health care settings. Valid HIV test events were tests for which the results (i.e., positive or negative) were known. Analyses included persons who tested positive for HIV during the most current test event in 2014 and were not previously reported in the health department's HIV surveillance system. Clients' self-reported data regarding previous HIV status were used for grantees who were not able to verify earlier test results within the grantee's surveillance system. The outcomes among Hispanics/Latinos with HIV infection diagnosed in 2014 included linkage to HIV medical care within any timeframe (e.g., attendance at first medical care appointment); linkage to HIV medical care within 90 days; interview for partner services (i.e., soliciting information from HIV-positive persons about their sex partners and drug-injecting partners, who can then be notified of their potential exposures and offered services to protect their health) (4); and referral to HIV risk-reduction services (i.e., services aimed at reducing the risk for HIV transmission, such as behavioral interventions and risk-reduction counseling. HIV risk-reduction services exclude HIV posttest counseling, mental health services, and housing needs) (5). During 2014, a total of 3,049,845 CDC-funded HIV test events were conducted in the United States, Puerto Rico, and the U.S. Virgin Islands. Hispanics/Latinos accounted for 22.6% (687,777) of all test events conducted, and for 25.3% and 25.8% of HIV test events among persons aged 30-39 years and 40-49 years, respectively, as well as 31.4%

Journal of Bioinformatics and Computational Biology, 2010

In order to predict future patients' survival time based on their microarray gene expression ... more In order to predict future patients' survival time based on their microarray gene expression data, one interesting question is how to relate genes to survival outcomes. In this paper, by applying a semi-parametric additive risk model in survival analysis, we propose a new approach to conduct a careful analysis of gene expression data with the focus on the model's predictive ability. In the proposed method, we apply the correlation principal component regression to deal with right censoring survival data under the semi-parametric additive risk model frame with high-dimensional covariates. We also employ the time-dependent area under the receiver operating characteristic curve and root mean squared error for prediction to assess how well the model can predict the survival time. Furthermore, the proposed method is able to identify significant genes, which are significantly related to the disease. Finally, the proposed useful approach is illustrated by the diffuse large B-cell l...

2008 IEEE International Conference on Granular Computing, 2008

... RK R ZY , where { }* , , RK R ZY denotes { }* , K ZY with the information on subjects i R ∈ r... more ... RK R ZY , where { }* , , RK R ZY denotes { }* , K ZY with the information on subjects i R ∈ removed. ... [11] Bair, E. and Tibishirani, R. Semi-Supervised methods to predict patient survival from gene expression data. PLos Biology, 2004, 2, 0511-0522.

Sexually Transmitted Diseases, 2015

Background-Because of health disparities, incarcerated persons are at higher risk for multiple he... more Background-Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. Methods-Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. Results-Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. Conclusions-Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease.

MMWR. Morbidity and mortality weekly report, Jan 20, 2017

Diagnoses of human immunodeficiency virus (HIV) infection among women declined 17% during 2011-20... more Diagnoses of human immunodeficiency virus (HIV) infection among women declined 17% during 2011-2015, and a total of 7,498 women received a diagnosis of HIV infection in 2015 (1). Although black or African American (black) women accounted for only 12% of the U.S. female population, 60% of women with newly diagnosed HIV infection were black (1,2). By the end of 2014, an estimated 255,900 women were living with HIV infection (3), including approximately 12% who did not know they were infected; in addition, approximately 45% of women who had received a diagnosis had not achieved viral suppression (3). HIV testing is an important public health strategy for identifying women with HIV infection and linking them to HIV medical care. Analysis of CDC-funded program data submitted by 61 health departments in 2015 indicated that among 4,749 women tested who received a diagnosis of HIV infection, 2,951 (62%) had received a diagnosis in the past (previous diagnosis), and 1,798 (38%) were receivin...

Journal of Public Health Management and Practice, 2016

In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality... more In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality assessment and feedback system for CDC-funded HIV testing program data. Our objective was to analyze data quality before and after feedback. Coinciding with required quarterly data submissions to CDC, each health department received data quality feedback reports and a call with CDC to discuss the reports. Data from 2008 to 2011 were analyzed. Fifty-nine state and local health departments that were funded for comprehensive HIV prevention services. Data collected by a service provider in conjunction with a client receiving HIV testing. National data quality assessment and feedback system. Before and after intervention implementation, quality was assessed through the number of new test records reported and the percentage of data values that were neither missing nor invalid. Generalized estimating equations were used to assess the effect of feedback in improving the completeness of variables. Data were included from 44 health departments. The average number of new records per submission period increased from 197 907 before feedback implementation to 497 753 afterward. Completeness was high before and after feedback for race/ethnicity (99.3% vs 99.3%), current test results (99.1% vs 99.7%), prior testing and results (97.4% vs 97.7%), and receipt of results (91.4% vs 91.2%). Completeness improved for HIV risk (83.6% vs 89.5%), linkage to HIV care (56.0% vs 64.0%), referral to HIV partner services (58.9% vs 62.8%), and referral to HIV prevention services (55.3% vs 63.9%). Calls as part of feedback were associated with improved completeness for HIV risk (adjusted odds ratio [AOR] = 2.28; 95% confidence interval [CI], 1.75-2.96), linkage to HIV care (AOR = 1.60; 95% CI, 1.31-1.96), referral to HIV partner services (AOR = 1.73; 95% CI, 1.43-2.09), and referral to HIV prevention services (AOR = 1.74; 95% CI, 1.43-2.10). Feedback contributed to increased data quality. CDC and health departments should continue monitoring the data and implement measures to improve variables of low completeness.

American Journal of Public Health, 2015

We examined HIV testing services, seropositivity, and the characteristics associated with newly i... more We examined HIV testing services, seropositivity, and the characteristics associated with newly identified, confirmed HIV-positive tests among transgender individuals. We analyzed data (2009-2011) using bivariate and multivariable logistic regression to examine the relationships between HIV positivity and sociodemographic and risk characteristics among male-to-female transgender individuals. Most of the testing was conducted in females (51.1%), followed by males (48.7%) and transgender individuals (0.17%). Tests in male-to-female transgender individuals had the highest, newly identified confirmed HIV positivity (2.7%), followed by males (0.9%), female-to-male transgender individuals (0.5%), and females (0.2%). The associated characteristics with an HIV-positive test among male-to-female transgender individuals included ages 20 to 29 and 40 to 49 years (adjusted odds ratio [AOR] = 2.8; 95% confidence interval [CI] = 1.4, 5.6 and AOR = 2.8; 95% CI = 1.3, 5.9, respectively), African American (AOR = 4.6; 95% CI = 2.7, 7.9) or Hispanic/Latino (AOR = 2.6; 95% CI = 1.5, 4.5) race/ethnicity, and reporting sex without condom within the past year (AOR = 1.9; 95% CI = 1.3, 2.6), sex with an HIV-positive person (AOR = 1.5; 95% CI = 1.1, 2.0), or injection drug use (AOR = 2.0; 95% CI = 1.3, 3.0). High levels of HIV positivity among transgender individuals, particularly male-to-female transgender individuals, underscore the necessity for targeted HIV prevention services that are responsive to the needs of this population.