The aim of the study was to assess the median time between HIV diagnosis and entry into primary HIV medical care in a large urban area and to assess the potential individual, diagnosing facility, and community level factors influencing entry into care. One thousand two hundred and sixty-six individuals diagnosed with HIV in Philadelphia between 1 July 2005 and 30 June 2006 were followed until entry into care through 15 June 2007. Time to entry into care was calculated as a survival time variable and was defined as the time in months between the date of HIV diagnosis and the date more than 3 weeks after diagnosis when a CD4 cell count or percentage and/or HIV viral load were obtained. The median time to entry into care for all individuals was 8 months, with a range of 1–26 months. Factors associated with delayed entry into care included age more than 40 years [hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.75–0.97] and diagnosis as an inpatient in the hospital (HR = 0.37; 95% CI = 0.37–0.57). Factors associated with earlier entry into care included Hispanic ethnicity (HR = 1.39; 95% CI = 1.05–1.84), male sex with men as HIV transmission risk factor (HR = 1.27; 95% CI = 1.03–1.56), and residence in a census tract with a high poverty rate (HR = 1.68; 95% CI = 1.22–2.30). Individuals newly diagnosed with HIV in Philadelphia demonstrated marked delays in accessing care highlighting the tremendous need for interventions to improve overall linkage. These interventions should especially be targeted at those aged more than 40 years and those diagnosed in the hospital.
This paper will describe several examples of creating presentation quality graphs using SAS/GRAPH® and the annotate facility. SAS/GRAPH® options will be used to set axis parameters, customize graph output, create and enhance legends and combine multiple graphs into one output graph. The first example creates a combination GPLOT/GCHART graph. The GREPLAY procedure is used to overlay two graphs and enhance the resolution of the output graph using the XPIXELS and YPIXELS options. A second example creates a reverse double bar graph, containing two HBAR graphs side-by-side, facing in opposite directions, for visual comparison of data. The third example creates a VBAR graph using event-level data. This graph includes using GROUP and SUBGROUP options, RAXIS, MAXIS and GAXIS statements, and options for adding and clipping reference lines. Other features described in this paper include using PROC TRANSPOSE and PROC SUMMARY to create datasets for annotating, using the annotate facility to include text boxes for sample size and customizing value labels and legend elements, using and understanding coordinate systems, and setting pattern, symbol and color options. Finally, working with the graphics catalogue, saving graphics to output files and using different SAS/GRAPH® devices will also be discussed.
Abstract Observational studies demonstrated 30–40% effectiveness of OMV meningococcal serogroup-B vaccines against gonorrhea. To explore whether healthy vaccinee bias influenced such findings, we examined effectiveness of MenB-FHbp, a non-OMV vaccine that is not protective against gonorrhea. MenB-FHbp was ineffective against gonorrhea. Healthy vaccinee bias likely did not confound earlier studies of OMV vaccines.
Objectives. We estimated the risk of HIV associated with sexually transmitted infection (STI) history during adolescence. Methods. We retrospectively studied a cohort of adolescents (n = 75 273, born in 1985–1993) who participated in the Philadelphia High School STD Screening Program between 2003 and 2010. We matched the cohort to STI and HIV surveillance data sets and death certificates and performed Poisson regression to estimate the association between adolescent STI exposures and subsequent HIV diagnosis. Results. Compared with individuals reporting no STIs during adolescence, adolescents with STIs had an increased risk for subsequent HIV infection (incidence rate ratio [IRR] for adolescent girls = 2.6; 95% confidence interval [CI] = 1.5, 4.7; IRR for adolescent boys = 2.3; 95% CI = 1.7, 3.1). Risk increased with number of STIs. The risk of subsequent HIV infection was more than 3 times as high among those with multiple gonococcal infections during adolescence as among those with none. Conclusions. Effective interventions that reduce adolescent STIs are needed to avert future STI and HIV acquisition. Focusing on adolescents with gonococcal infections or multiple STIs might have the greatest impact on future HIV risk.
Comparisons of antiretroviral therapy (ART) prescription and viral suppression among people in HIV care across US metropolitan areas are limited. Medical Monitoring Project, 2011-2013, data were used to describe and compare associations between sociodemographics and ART prescription and viral suppression for persons receiving HIV care.
This paper describes how to use SAS/GIS® and PROC GMAP to create presentation-quality maps of geographic data. Topics discussed include using U.S. Census Bureau TIGER/Line® files for geocoding address data, using PROC GMAP and the annotate facility to display map datasets in a variety of formats, importing map files from other software products, and assigning geocoded cases to polygons based on spatial location. Additional topics include coordinate systems and map projections, PROC GMAP options that control appearance of maps, annotating polygon borders, creating and combining annotate datasets, using annotate macros (%maplabel), summarizing data and handling missing values, creating map output files using device options, loop processing with NULL datasets, replaying graphics with high resolution, and customizing map legends with legend options and annotating. GETTING STARTED Maps can be an effective method for presenting data that varies geographically. Maps provide a spatial picture of the data, and allow end-users to easily see clusters or areas of concentration. Spatial data refers to anything that can be referenced based on its physical location, such as census tracts, zipcodes, and street addresses. Geocoding is the process of adding spatial information to existing data based this physical location. Address geocoding attempts to match a street address in a SAS dataset with spatial information in a SAS spatial database. If a match is found, the coordinates for the address location (x,y) are added to the observation. Additional information about the address location (e.g. census tract) can also be added to the address dataset. Data points can be displayed on a map discretely or aggregated to some geographic unit. TIGER/LINE DATA The U.S. Census website contains TIGER/Line® files for all counties in the United States. The term TIGER® refers to the Topologically Integrated Geographic Encoding and Referencing system used by the U.S. Census Bureau. Each TIGER/Line file set contains a series of data files that contain spatial information for geographic features such as roads, rail lines and rivers, as well as boundary lines for census tracts, census blocks and counties. The data include digital information such as location in latitude and longitude, the names and types of features, address ranges (from-to, left-right), and relationships between features (e.g. where rails cross streets, or census blocks are contained within census tracts). The steps to download and import TIGER/Line files are outlined in a previous paper.
An outbreak of cyclosporiasis occurred in attendees of a wedding reception held in Philadelphia, Pennsylvania, on June 10, 2000. In a retrospective cohort study, 54 (68.4%) of the 79 interviewed guests and members of the wedding party met the case definition. The wedding cake, which had a cream filling that included raspberries, was the food item most strongly associated with illness (multivariate relative risk, 5.9; 95% confidence interval, 3.6 to 10.5). Leftover cake was positive for Cyclospora DNA by polymerase chain reaction analyses. Sequencing of the amplified fragments confirmed that the organism was Cyclospora cayetanensis. The year 2000 was the fifth year since 1995 that outbreaks of cyclosporiasis definitely or probably associated with Guatemalan raspberries have occurred in the spring in North America. Additionally, this is the second documented U.S. outbreak, and the first associated with raspberries, for which Cyclospora has been detected in the epidemiologically implicated food item.
