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Matthew R Golden - Top 30 Publications

Integrating HIV Surveillance and Field Services: Data Quality and Care Continuum in King County, Washington, 2010-2015.

To assess how integration of HIV surveillance and field services might influence surveillance data and linkage to care metrics.

Increases in Neisseria gonorrhoeae with Reduced Susceptibility to Azithromycin among Men who have sex with Men (MSM), in Seattle, King County, Washington: 2012 - 2016.

Antimicrobial-resistant Neisseria gonorrhea is a major public health threat. The CDC recommends that clinicians treat gonorrhea with ceftriaxone 250mg plus azithromycin 1g. Resistance to azithromycin could affect gonorrhea control efforts.

Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States.

Public health field services for sexually transmitted infections (STIs) have not adequately evolved to address the expanding scale of the STI problem, its concentration among men who have sex with men, the emergence of new communication technologies and the availability of antiretroviral therapy as a cornerstone of human immunodeficiency virus (HIV) prevention. Field services need to modernize. Modernization should seek to expand field services objectives beyond sex partner STI testing and treatment to include: HIV testing of persons with bacterial STI and their partners, including efforts to promote frequent HIV/STI testing; increased condom access; linkage and relinkage to HIV care and promotion of viral suppression; preexposure prophylaxis promotion; linkage to long-acting contraception; and referral for health insurance. Field services programs cannot advance these new objectives while simultaneously doing all of the work they have traditionally done. Modernization will require a willingness to reconsider some longstanding aspects of field services work, including the centrality of face-to-face interviews and field investigations. Health departments seeking to modernize will need to carefully assess their ongoing activities and reorganize to align the use of field services resources with program priorities. In some instances, this may require reorganization to allow the staff greater specialization and closer integration with surveillance activities. Adapting programs will require new staff training, improvements in data management systems, and a greater investment in monitoring and evaluation. Although modernization is likely to evolve over many years, the time to start is now.

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men.

Seroadaptive behaviors among men who have sex with men (MSM) are common, but ascertaining behavioral information is challenging in clinical settings. To address this, we developed a single seroadaptive behavior question.

A Web Application to Facilitate Syphilis Reactor Grid Evaluations.

Many health departments use a "reactor grid" to determine which laboratory-reported syphilis serologic test results require investigation. We developed a Web-based tool, the Syphilis Reactor Grid Evaluator (SRGE), to facilitate health department reactor grid evaluations and test the tool using data from Seattle & King County, Washington.

Developing a Public Health Response to Mycoplasma genitalium.

Although Mycoplasma genitalium is increasingly recognized as a sexually transmitted pathogen, at present there is no defined public health response to this relatively newly identified sexually transmitted infection. Currently available data are insufficient to justify routinely screening any defined population for M. genitalium infection. More effective therapies, data on acceptability of screening and its impact on clinical outcomes, and better information on the natural history of infection will likely be required before the value of potential screening programs can be adequately assessed. Insofar as diagnostic tests are available or become available in the near future, clinicians and public health agencies should consider integrating M. genitalium testing into the management of persons with sexually transmitted infection (STI) syndromes associated with the infection (ie urethritis, cervicitis, and pelvic inflammatory disease) and their sex partners. Antimicrobial-resistant M. genitalium is a significant problem and may require clinicians and public health authorities to reconsider the management of STI syndromes in an effort to prevent the emergence of ever more resistant M. genitalium infections.

Evaluation of an Automated Express Care Triage Model to Identify Clinically Relevant Cases in a Sexually Transmitted Disease Clinic.

Many sexually transmitted disease (STD) clinics offer testing-only "express" visits. We evaluated the express care triage algorithm that is based on a computer-assisted self-interview (CASI) used in the Public Health-Seattle and King County STD Clinic.

Assisted partner services for HIV: ready to go global.

New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men.

Rectal sexually transmitted infections (STI) have been associated with human immunodeficiency virus (HIV) diagnosis, but inferring a causal association requires disentangling them from receptive anal intercourse (RAI).

Impact of an Electronic Medical Record-Based System to Promote Human Immunodeficiency Virus/Hepatitis C Virus Screening in Public Hospital Primary Care Clinics.

United States guidelines recommend that all adolescents and adults be tested for human immunodeficiency virus (HIV) and that persons born between 1945 and 1965 be tested for hepatitis C virus (HCV).

Projected demographic composition of the United States population of people living with diagnosed HIV.

The transformation of HIV from a fatal disease to lifelong disease has resulted in an HIV-infected population that is growing and aging, placing new and increasing demands on public programs and health services. We used National HIV Surveillance System and US census data to project the demographic composition of the population of people living with diagnosed HIV (PLWDH) in the United States through 2045. The input parameters for the projections include: (1) census projections, (2) number of people with an existing HIV diagnosis in 2013, (3) number of new HIV diagnoses in 2013, and (4) death rate within the PLWDH population in 2013. Sex-, risk group-, and race-specific projections were estimated through an adapted Leslie Matrix Model for age-structured populations. Projections for 2013-2045 suggest that the number of PLWDH in the U.S. will consistently grow, from 917,294 to 1,232,054, though the annual growth rate will slow from 1.8% to 0.8%. The number of PLWDH aged 55 years and older will increase from 232,113 to 470,221. The number of non-Hispanic (NH) African Americans/Blacks and Hispanics is projected to consistently grow, shifting the racial/ethnic composition of the US PLWDH population from 32 to 23% NH-White, 42 to 38% NH-Black, and 20-32% Hispanic between 2013 and 2045. Given current trends, the composition of the PLWDH population is projected to change considerably. Public health practitioners should anticipate large shifts in the age and racial/ethnic structure of the PLWDH population in the United States.

Jail Booking as an Occasion for HIV Care Reengagement: A Surveillance-Based Study.

To examine population and HIV care outcomes of people living with HIV/AIDS (PLWHA) at their first incarceration of 2014 in 2 county jails in King County, Washington.

Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010-2014).

The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain.

Emerging Regional and Racial Disparities in the Lifetime Risk of Human Immunodeficiency Virus Infection Among Men who Have Sex With Men: A Comparative Life Table Analysis in King County, WA and Mississippi.

Little is known about the lifetime risk of human immunodeficiency virus (HIV) diagnosis among US men who have sex with men (MSM), trends in risk and how risk varies between populations.

Operationalizing the Measurement of Seroadaptive Behaviors: A Comparison of Reported Sexual Behaviors and Purposely-Adopted Behaviors Among Men who have Sex with Men (MSM) in Seattle.

Seroadaptive behaviors are traditionally defined by self-reported sexual behavior history, regardless of whether they reflect purposely-adopted risk-mitigation strategies. Among MSM attending an STD clinic in Seattle, Washington 2013-2015 (N = 3751 visits), we used two seroadaptive behavior measures: (1) sexual behavior history reported via clinical computer-assisted self-interview (CASI) (behavioral definition); (2) purposely-adopted risk-reduction behaviors reported via research CASI (purposely-adopted definition). Pure serosorting (i.e. only HIV-concordant partners) was the most common behavior, reported (behavioral and purposely-adopted definition) by HIV-negative respondents at 43% and 60% of visits, respectively (kappa = 0.24; fair agreement) and by HIV-positive MSM at 30 and 34% (kappa = 0.25; fair agreement). Agreement of the two definitions was highest for consistent condom use [HIV-negative men (kappa = 0.72), HIV-positive men (kappa = 0.57)]. Overall HIV test positivity was 1.4 but 0.9% for pure serosorters. The two methods of operationalizing behaviors result in different estimates, thus the choice of which to employ should depend on the motivation for ascertaining behavioral information.

"Out of Care" HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US.

HIV care continuum estimates derived from laboratory surveillance typically assume that persons without recently reported CD4 count or viral load results are out of care.

Optimizing the Timing of HIV Screening as Part of Routine Medical Care.

US federal guidelines recommend that medical providers test all adolescents and adults for HIV infection at least once before the age of 64. The wide age range included in these guidelines may limit their utility and impact. We created an arithmetic model to estimate how HIV screening at different ages would impact the total number of years of undiagnosed HIV infection in the population and the number of persons developing clinical manifestations of HIV/AIDS. Our base case model assumed that age of infection in the screened population was the same as the estimated age of infection among all persons diagnosed with HIV in the United States in 2010. We parameterized a second model assuming age of infection was similar to the younger age distribution observed in African Americans. In the base case model, the number of years of undiagnosed HIV infection and number of persons with clinical manifestations of HIV/AIDS were both minimized by screening at age 34. If age of infection was similar to that estimated to occur among African Americans, testing at age 24 and 27 would minimize the number of years of undiagnosed infection and clinical cases, respectively. For both parameterization scenarios, testing between the ages of 21 and 38 resulted in outcomes within 10% of the model's estimated optimal age for screening. Focusing HIV screening on a narrower age range than is currently recommended may improve the impact of routine HIV screening efforts.

Assisted partner services for HIV in Kenya: a cluster randomised controlled trial.

Assisted partner services for index patients with HIV infections involves elicitation of information about sex partners and contacting them to ensure that they test for HIV and link to care. Assisted partner services are not widely available in Africa. We aimed to establish whether or not assisted partner services increase HIV testing, diagnoses, and linkage to care among sex partners of people with HIV infections in Kenya.

Acceptability and Effectiveness of Assisted Human Immunodeficiency Virus Partner Services in Mozambique: Results From a Pilot Program in a Public, Urban Clinic.

Assisted partner services (APS) involves offering persons with human immunodeficiency virus (HIV) assistance notifying and testing their sex partners. Assisted partner services is rarely available in sub-Saharan Africa. We instituted a pilot APS program in Maputo, Mozambique.

Changes in Condomless Sex and Serosorting Among Men Who Have Sex With Men After HIV Diagnosis.

Among men who have sex with men (MSM) diagnosed with HIV, high-risk sexual behaviors may decline in the year after diagnosis. The sustainability of these changes is unknown.

Evaluation of a Computer-Based Recruitment System for Enrolling Men Who Have Sex With Men Into an Observational HIV Behavioral Risk Study.

Enrolling large numbers of high-risk men who have sex with men (MSM) into human immunodeficiency virus (HIV) prevention studies is necessary for research with an HIV outcome, but the resources required for in-person recruitment can be prohibitive. New methods with which to efficiently recruit large samples of MSM are needed. At a sexually transmitted disease clinic in Seattle, Washington, in 2013-2014, we used an existing clinical computer-assisted self-interview that collects patients' medical and sexual history data to recruit, screen, and enroll MSM into an HIV behavioral risk study and compared enrollees with men who declined to enroll. After completing the clinical computer-assisted self-interview, men aged ≥18 years who reported having had sex with men in the prior year were presented with an electronic study description and consent statement. We enrolled men at 2,661 (54%) of 4,944 visits, including 1,748 unique individuals. Enrolled men were younger (mean age = 34 years vs. 37 years; P < 0.001) and reported more male sex partners (11 vs. 8; P < 0.001) and more methamphetamine use (15% vs. 8%; P < 0.001) than men who declined to enroll, but the HIV test positivity of the two groups was similar (1.9% vs. 2.0%; P = 0.80). Adapting an existing computerized clinic intake system, we recruited a large sample of MSM who may be an ideal population for an HIV prevention study.

Evidence of Local HIV Transmission in the African Community of King County, Washington.

Little is known about the frequency of ongoing HIV transmission within U.S. African immigrant communities. We used HIV surveillance and partner services data to describe African-born persons newly reported with HIV infection in King County (KC), WA from 1/1/2010 to 12/31/2013. We performed phylogenetic clustering analysis of HIV-1 pol to identify putative transmission events within this population. From 2010 to 2013, 1148 KC adults were reported with HIV, including 102 (9 %) born in Africa. Forty-one African-born cases were interviewed and reported diagnosis after arrival in the U.S. Fourteen (34 %) reported ≥1 negative test prior to diagnosis, and 9 (26 %) reported ≥1 negative test after U.S. arrival. Pol genotypes were available for seven of these nine. For two of these seven, a KC case was the nearest phylogenetic neighbor; two others were infected with subtype B virus. We found substantial evidence of ongoing HIV transmission in the African community of KC.

HIV provider and patient perspectives on the Development of a Health Department "Data to Care" Program: a qualitative study.

U.S. health departments have not historically used HIV surveillance data for disease control interventions with individuals, but advances in HIV treatment and surveillance are changing public health practice. Many U.S. health departments are in the early stages of implementing "Data to Care" programs to assists persons living with HIV (PLWH) with engaging in care, based on information collected for HIV surveillance. Stakeholder engagement is a critical first step for development of these programs. In Seattle-King County, Washington, the health department conducted interviews with HIV medical care providers and PLWH to inform its Data to Care program. This paper describes the key themes of these interviews and traces the evolution of the resulting program.

Integrating HIV Testing as an Outcome of STD Partner Services for Men Who Have Sex with Men.

Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk for HIV infection, but often do not test for HIV at time of STD diagnosis. We instituted and evaluated a program promoting HIV testing through STD partner services (PS). In May 2012, health departments in Washington State modified STD PS programs with the objective of providing PS to all MSM with early syphilis, gonorrhea, or chlamydial infection and ensuring that those without a prior HIV diagnosis tested for HIV infection. We used chi-square tests and logistic and log-binomial regression to compare the percentage of MSM who received PS, HIV tested, and were newly HIV diagnosed before (January 1, 2010 to April 30, 2012) and during the revised program (May 1, 2012 to August 31, 2014). Among MSM without a prior HIV diagnosis, 2008 (62%) of 3253 preintervention and 3712 (76%) of 4880 during the intervention received PS (p < 0.001). HIV testing among PS recipients increased from 63% to 91% (p < 0.001). PS recipients were more likely to be newly HIV diagnosed than nonrecipients during the preintervention (2.5% vs. 0.93%, p = 0.002) and intervention periods (2.4% vs. 1.4%, p = 0.050). The percentage of MSM with newly diagnosed HIV infection who had a concurrent STD diagnosis increased from 6.6% to 13% statewide (p < 0.0001). Among all MSM with bacterial STDs, 61 (1.9%) preintervention and 104 (2.1%) during the intervention were newly diagnosed with HIV infection (adjusted relative risk = 1.34, p = 0.07). In conclusion, promoting HIV testing through STD PS is feasible and increases HIV testing among MSM. Our findings suggest that integrating HIV testing promotion into STD PS may increase HIV case finding.

Single Viral Load Measurements Overestimate Stable Viral Suppression Among HIV Patients in Care: Clinical and Public Health Implications.

The HIV continuum of care paradigm uses a single viral load test per patient to estimate the prevalence of viral suppression. We compared this single-value approach with approaches that used multiple viral load tests to examine the stability of suppression.

Achieving the Goals of the National HIV/AIDS Strategy: Declining HIV Diagnoses, Improving Clinical Outcomes, and Diminishing Racial/Ethnic Disparities in King County, WA (2004-2013).

The US National HIV/AIDS Strategy defines national objectives related to HIV prevention and care. The extent to which US cities are meeting those objectives is uncertain.

Public Health-Seattle & King County and Washington State Department of Health Preexposure Prophylaxis Implementation Guidelines, 2015.

HIV Incidence Among Men Who Have Sex With Men After Diagnosis With Sexually Transmitted Infections.

Men who have sex with men (MSM) are at high risk for acquiring HIV infection after diagnosis with other sexually transmitted infections (STIs). Identifying the STIs associated with the greatest risk of subsequent HIV infection could help target prevention interventions, particularly preexposure prophylaxis (PrEP).

Editorial Commentary: When to Perform a Test of Cure for Gonorrhea: Controversies and Evolving Data.

Trends in Serosorting and the Association With HIV/STI Risk Over Time Among Men Who Have Sex With Men.

Serosorting among men who have sex with men (MSM) is common, but recent data to describe trends in serosorting are limited. How serosorting affects population-level trends in HIV and other sexually transmitted infection (STI) risk is largely unknown.