1. Syndemics Predict Bio-Behavioral HIV Sexual Transmission Risk Behavior Longitudinally in US HIV Clinics Satyanand Satyanarayana, Steven A. Safren, Brooke G. Rogers, Sierra Bainter, Katerina A. Christopoulos, Rob J. Fredericksen, William C. Mathews, Richard D. Moore, Michael J. Mugavero, Sonia Napravnik, Matthew J. Mimiaga, Kenneth H. Mayer, and Heidi M. Crane
Syndemics
Co-occurring psychosocial conditions that exacerbate risk for HIV transmission
Usually studied in context of populations at risk of contracting HIV
Less known about HIV transmission risk created by syndemics occurring in HIV-infected patients receiving clinical care
Syndemics could help identify patients to receive psychosocial intervention to curb new HIV transmissions
CNICS
Network of CFAR sites providing patients with clinical care
Health information collected at patient visits with patient-reported outcomes (PROs) collected at visits at least 4-6 months apart
pts from July 2000 to April 2017
total visits (mean 4.4 visits/pt)
Acknowledgments
CNICS is an NIH-funded program (R24 AI067039) made possible by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Heart, Lung, and Blood Institute (NHLBI). The CFAR sites involved in CNICS include Univ of Alabama at Birmingham (P30 AI027767), Univ of Washington (P30 AI027757), Univ of California San Diego (P30 AI036214), Univ of California San Francisco (P30 AI027763), Case Western Reserve Univ (P30 AI036219), Johns Hopkins Univ (P30 AI094189, U01 DA036935), Fenway Health/Harvard (P30 AI060354), and Univ of North Carolina Chapel Hill (P30 AI50410). Author time was supported by 9K24 DA (Safren) and by the University of Miami Dean’s Fellowship.
Conflicts of Interest
No conflicts to disclose

2. Analysis Predictors Outcome No. of syndemics
Bio-behavioral transmission risk behavior (TRB): condomless sex while virally detectable (HIV RNA > 400) with a partner of unknown or HIV-negative status
Depression (PHQ-9)
Anxiety (Brief PHQ)
Alcohol Use (AUDIT-C)
Drug Use (ASSIST)
Time (measured by visit number)
Behavioral risk group

3. Results }
Cis women as referent group
Conclusions
Identifying syndemics via patient-report-outcome measures in HIV clinics is feasible.
Integrating the identification and treatment of syndemic conditions within HIV clinical settings carries potential for reducing the number of new infections via bio-behavioral transmission risk behavior.