acknowledgements

1. Nonadherence to HIV Testing Guidelines and Late HIV Testing Is Common Among US Black Men Who Have Sex with Men (MSM) S. Mannheimer, L. Wang, H.V. Tieu, C. del Rio, S. Buchbinder, L. Wilton, S.N. Glick, V. Cummings, and K.H. Mayer for the HPTN 061 Study group

2. Sponsored by NIAID, NIDA, NIMH under Cooperative Agreement # UM1 AI068619 acknowledgements

3. Background Black men who have sex with men (MSM) are disproportionately affected by HIV in the US US CDC guidelines recommend at least annual HIV testing for those at increased risk – including sexually active MSM Nonadherence to HIV testing guidelines and late HIV diagnosis may contribute to HIV transmission among US Black MSM

4. Study Objectives Among US Black MSM: To determine the prevalence of not having an HIV test in the prior 12 months To determine the prevalence of late HIV diagnosis (CD4 < 200) To determine correlates of nonadherence to HIV testing guidelines and of late HIV diagnosis

5. HPTN 061 study was designed to determine the feasibility and acceptability of a multi-component prevention intervention for Black MSM Black MSM were recruited from the community or referred by sexual partners in 6 US cities (Atlanta, GA; Boston, MA; New York, NY; Los Angeles, CA; San Francisco, CA; and Washington, D.C.) from 7/09 to 10/10 Eligibility: self-identified as man or male at birth Black age > 18 years old unprotected anal intercourse with a man in prior 6 months Analysis utilized HPTN 061 Study Data

6. Methods for HIV Testing Analysis HIV testing history assessed at baseline among HPTN 061 participants who reported being HIV negative or HIV status unknown prior to study HIV testing performed at enrollment Definitions: Nonadherence to HIV testing guidelines: Participants reporting past HIV-uninfected or unknown status at enrollment and no HIV testing within the prior 12 months Late HIV diagnosis: Participants (self-reported prior HIV negative or unknown status) with newly diagnosed HIV at enrollment and CD4 count < 200 (AIDS) at the time of HIV diagnosis

7. Data Analysis Correlates of nonadherence to testing guidelines were analyzed using logistic regression models Correlates of late testing were assessed by Fisher's exact tests Variables examined as possible correlates included baseline participant demographics, sexual identity, substance use, incarceration, depression, HIV risk behaviors, partner’s HIV status, prior health care utilization, and site

8. HPTN 061 HIV Testing Uptake 1553 Black MSM enrolled in HPTN 061 1379 had no prior HIV diagnosis 1327 (96%) accepted HIV testing at enrollment 52 (4%) refused testing at enrollment 18/52 who initially refused later agreed to HIV testing

9. BASELINE CHARACTERISTICS of HPTN 061 PARTICIPANTS ELIGIBLE FOR HIV TESTING

10. Nonadherence to HIV testing guidelines 23% (319 of 1379) participants at enrollment reported no HIV testing in prior 12 months 14% (188 of 1379) participants reported never having an HIV test prior to enrollment

11. Correlates of Nonadherence to HIV Testing Guidelines

12. HPTN 061 Enrollment HIV Test Results 12% Previously Undiagnosed HIV at Enrollment: 165 of 1327 participants who reported prior HIV negative or unknown status and agreed to HIV testing had a confirmed positive HIV test at enrollment

13. Undiagnosed HIV Infection (Testing HIV+ at Study Enrollment) by Adherence to HIV Testing Guidelines Nonadherent (no HIV Test within 1 year) 31% HIV + (94/305) Adherent (reported HIV Test within 1 year) 7% HIV + (70/1002) Undiagnosed HIV was significantly associated with nonadherence to testing guidelines (p < 0.0001)

14. Late HIV Diagnosis Among 165 HPTN 061 participants with new HIV diagnosis at enrollment, 90% (148/165) had CD4 count performed at time of HIV diagnosis • 19% (28/148) were late testers (CD4 < 200) • Median CD4 count was439 cells/ml3 (range 20-1849)

15. Correlates of Late HIV Diagnosis *Only age >35 was significantly associated with Late HIV Diagnosis(CD4<200)

16. Late HIV Diagnosis by Prior Adherence to HIV Test Guidelines Adherent(HIV Test within 1 year)25% Late diagnosis (15/61) Nonadherent(no HIV Test within 1 year)15% Late diagnosis (13/86) Nonadherence to HIV testing guidelines was not significantly associated with Late HIV diagnosis (p = 0.20)

17. Summary 23% of participants at enrollment reported no HIV testing in prior 12 months; 14% reported never HIV testing prior to this study Nonadherence to testing guidelines was associated with age > 35, unemployment, not having seen a medical provider in the last 6 months, and higher rates of undiagnosed HIV infection 97.5% of HPTN 061 participants agreed to HIV testing through the study 19% of participants with previously undiagnosed HIV infection had CD4 < 200 when diagnosed (late HIV diagnosis) Late HIV diagnosis was associated with age > 35

18. Conclusions Nonadherence to HIV testing guidelines and late HIV testing were common Not having an HIV test in prior 12 months was associated with higher rates of previously undiagnosed HIV HIV testing had high acceptability in this US Black MSM study population Seeing a medical provider was associated with better adherence to HIV testing guidelines HPTN 061 findings highlight the need for additional HIV testing and prevention efforts for reaching US Black MSM

19. HPTN 061 Acknowledgements • National Institutes of Health: NIAID, NIDA, NIMH • Protocol Co-Chairs: • Beryl Koblin, PhD • Kenneth Mayer, MD • Darrell Wheeler, PhD, MPH • HPTN 061 Protocol Team Members • HPTN 061 Study Participants • HPTN Network Laboratory, Johns Hopkins Univ. School of Medicine • Statistical and Data Management Center, SCHARP • HPTN CORE Operating Center, FHI 360 • Black Gay Research Group Clinical Research Sites, Staff and CABs • Emory University • Fenway Institute • GWU School of Public Health and Health Services • Harlem Prevention Center • New York Blood Center • San Francisco Department of Public Health • UCLA