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Rogers, Brooke; Ramsey, Susan; Ames, Evan; Gomes, Nyx; Murphy, Matthew
Journal of Acquired Immune Deficiency Syndromes, 17.10.2024
Tilføjet 17.10.2024
Introduction: Within the United States, individuals experiencing incarceration are at higher risk for HIV acquisition compared to the general population, yet may face additional difficulty engaging in HIV prevention clinical services. HIV pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV transmission, and the Centers for Disease Control (CDC) recommends that PrEP be offered in carceral settings, particularly during the vulnerable community re-entry period. However, there have been few efforts to scale PrEP in this setting. Methods: Based on our experience implementing PrEP in Rhode Island’s state carceral system, we have identified potential approaches to overcoming barriers to PrEP use in this unique practice environment by utilizing the implementation research logic model (IRLM). We then evaluated specific implementation determinants and barriers as well as strategies used to overcome those barriers to effectively scale PrEP in this setting. Results: We developed a “toolkit,” or 14-step guide, for others in the field to use for implementing PrEP in carceral settings including the development and use of clinical protocols as well as community linkage strategies. Discussion: Our experiences with barriers in the carceral setting, identifying and leveraging implementation strategies, allowed us to develop a “toolkit” to guide other PrEP implementation projects in carceral settings. We encourage others to scale-out our work to other carceral settings to better reach and engage a group of individuals both at elevated risk for HIV and currently underserved by HIV prevention strategies, including PrEP. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedElisa de Lazzari, Daniel K. Nomah, Jose L. Blanco, Naira Rico, Xabier Filella, Natalia Egri, Raquel Ruiz, Maria Angeles Marcos, Maria del Mar Mosquera, Jose Alcamí, Sonsoles Sánchez-Palomino, Andreu Bruguera, Carmen Hurtado, Cristina Rovira, Juan Ambrosioni, Iván Chivite, Ana González-Cordón, Alexy Inciarte, Montserrat Laguno, María Martínez-Rebollar, Lorena de la Mora, Berta Torres, Yesika Díaz, Esteban Martínez, Josep Mallolas, Jose M. Miro, Hospital Clinic HIV investigators
International Journal of Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
Studies on HIV and COVID-19 coinfection are inconclusive especially in the context of unvaccinated individuals.[1] The severity of COVID-19 outcomes among people with HIV (PWH) can vary based on specific settings, health system conditions, and individual clinical attributes such as age and comorbidities.[2] The protective role of antiretroviral therapy (ART), particularly tenofovir, has been a subject of debate. The inclination towards tenofovir as a viable treatment option for SARS-CoV-2 infection stems from the nucleotide analogue\'s capacity to inhibit RNA-dependent RNA polymerase, a pivotal enzyme for SARS-CoV-2 replication, [3] with tenofovir disoproxil fumarate (TDF) exhibiting higher plasma concentrations compared to tenofovir alafenamide (TAF).[4] Nevertheless, the clinical effectiveness of tenofovir in COVID-19 patients remains uncertain, with conflicting findings emerging from studies among PWH.[1] The study aimed to determine the prevalence of SARS-CoV-2 infection among unvaccinated PWH and to explore the impact of different factors including ART on the SARS-CoV-2 acquisition and COVID-19 severity.
Læs mere Tjek på PubMedJournal of Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
Abstract Background Both HIV and hepatitis C virus (HCV) infection increase the risk of hepatic steatosis (HS), which in turn contributes to the severity and progression of liver disease. Direct acting antivirals (DAAs) can cure HCV but whether they reduce HS is unclear.Methods HS was assessed using the controlled attenuation parameter (CAP) and the hepatic steatosis index (HSI) in participants coinfected with HIV-HCV from the Canadian Coinfection Cohort. Changes in HS, before, during and after successful DAA treatment, were estimated using generalized additive mixed models, adjusted for covariates measured prior to treatment (age, sex, duration of HCV infection, body mass index, diabetes, prior exposure to dideoxynucleosides and hazardous drinking).Results 431 participants with at least one measure of CAP or HSI before treatment were included. CAP steadily increased over time: adjusted annual slope 3.3 dB/m (95% credible interval (CrI) 1.6, 4.9) before, and 3.9 dB/m (95% CrI: 1.9, 5.9) after DAA treatment, irrespective of pre-treatment CAP. In contrast, HSI changed little over time: annual slope 0.2 (95% CrI: -0.1, 0.5) before and 0.2 (95% CrI -0.1, 0.5) after, but demonstrated a marked reduction during treatment -4.5 (95% CrI -5.9, -3.1).Conclusions When assessed by CAP, HS was unaffected by DAA treatment and steadily increased over time. In contrast, HSI did not appear to reflect changes in HS, with the decrease during treatment likely related to resolution of hepatic inflammation. Ongoing HS may pose a risk for liver disease in coinfected people cured of HCV.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
Abstract Background The Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) aims to eradicate AIDS by 2030 through 95:95:95 targets: identifying 95% of persons living with HIV (PLHIV), initiating 95% of those identified on antiretroviral therapy (ART), and ensuring that 95% of those initiated on ART are virally suppressed. Virally suppressed patients pose minimal risk of HIV transmission. ART aims to suppress the HIV-viral load (VL) and increase immunity, reducing morbidity and mortality. This study aimed to determine the trends in VL suppression among HIV patients on ART from 2019 to 2023 at Asante Mampong Municipal Hospital. Methods This study adopted a retrospective Hospital-based design in which secondary data from 842 patients on ART from 2019 to 2023 were used. The study design specifically involved conducting serial cross-sectional studies to measure the prevalence of VL suppression each year from 2019 to 2023. This approach allowed the researchers to analyse the annual prevalence of VL suppression among study participants without following individual participants longitudinally throughout the entire period. The data were analysed via STATA version 17.0. Chi-square and logistic regressions were used to determine the associations between VL suppression and the independent variables at p
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
Abstract Background Cervical cancer remains a public health problem despite heavy global investment in health systems especially in low-and-middle-income countries (LMIC). Prophylactic vaccines against the most commonly detected human papillomavirus (HPV) types in cervical cancers are available and decisions on the selection of vaccine design depends on the prevalence of high-risk (hr) HPV genotypes for a particular region. In 2015, Botswana adopted the use of a quadrivalent HPV vaccine as a primary prevention strategy. Secondary prevention includes cervical smear screening whose uptake remains notably low among indigenous and marginalized communities despite efforts to improve access. Aim To determine the prevalence of hrHPV genotypes and cervical lesions’ burden in women from the indigenous and marginalized communities of Botswana. Methods This prospective survey enrolled 171 non-HPV vaccinated women aged 21 years and older. Face-to-face interviews, Pap smear screening, hr-HPV and Human Immuno-deficiency virus (HIV) testing were carried out. Conventional Papanicolau smears were analyzed and cervical brushes were preserved for hrHPV testing using the Ampfire Multiplex HR-HPV protocol which detects the following genotypes: HPV 16, 18, 31, 35, 39, 45, 51, 52, 53, 56, 58, 59 and 68. Results In this study, 168/171 (98.6%) of the women consented to HIV testing; 53/171 (31%) were living with HIV and self-reported enrolment on antiretroviral therapy. Among the women examined, 23/171 (13.5%) had cervical dysplasia with most presenting with Atypical Squamous Cells of Undetermined Significance 8/23 (35%), Low-Grade Squamous Intraepithelial Lesions 8/23 (35%), Atypical Squamous Cells-High Grade 4/23 (17%), Atypical Endocervical Cells 2/23 (9%) and Atypical Endocervical Cell favoring neoplasia 1/23(4%). However, no High-Grade Squamous Intraepithelial Lesions (HSIL) or squamous cell carcinoma (SCC) were detected. Overall hrHPV prevalence in this study was at 56/171 (32.7%). The most commonly detected hrHPV genotypes in women with cervical dysplasia were HPV39 (6.25%), HPV51 (14.5%), HPV52 (12.5%) and HPV56 (4%). Notably, HPV 16 and 18 were not found in women with cervical dysplasia. Conclusions Our study provides valuable insights into the prevalence and distribution of hrHPV genotypes in indigenous and marginalized communities in Botswana, and the need for further investigation of their potential role in cervical carcinogenesis in this population. These results may also serve as baseline data to facilitate future evaluation of the HPV vaccine needs.
Læs mere Tjek på PubMedBMC Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
Abstract Introduction During the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown. Methods A cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models. Results Between the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84). Conclusion A substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.
Læs mere Tjek på PubMedWaimar Tun, Mamaswatsi Kopeka, Donaldson F. Conserve, Jennifer Gomez-Berrospi, Samuel Janson, Courtney Johnson, Adedotun Ogunbajo, Ngozi Joy Idika, Jenesis Duran, Arianna Lendino, Bezawit Bekele, Maya Rezende Tsao, Sumaiya Nezam, Arona Dieng, Naana Koranteng-Yorke, Bridget Martin, BRIDGE Team, Demarc Hickson
PLoS One Infectious Diseases, 17.10.2024
Tilføjet 17.10.2024
by Waimar Tun, Mamaswatsi Kopeka, Donaldson F. Conserve, Jennifer Gomez-Berrospi, Samuel Janson, Courtney Johnson, Adedotun Ogunbajo, Ngozi Joy Idika, Jenesis Duran, Arianna Lendino, Bezawit Bekele, Maya Rezende Tsao, Sumaiya Nezam, Arona Dieng, Naana Koranteng-Yorke, Bridget Martin, BRIDGE Team , Demarc Hickson Pharmacy-based PrEP service delivery models can help address many of the barriers that inhibit the uptake of PrEP. In an increasing number of states, legislation has been passed, or is under consideration, to allow pharmacists to initiate PrEP without a prescription from a physician or other prescriber. However, there is not yet legislation in Washington, DC to allow pharmacy-based PrEP despite its potential to curb new cases of HIV, which disproportionately affect the Black community in the area. The DC Ends HIV Plan has a goal of less than 130 new cases of HIV per year by 2030, which would require that over 13,000 high-risk residents use PrEP. However, in 2021 only 6,724 Washingtonians were taking PrEP. This study seeks to address the absence of critical formative research into the factors that would influence the implementation of pharmacy-based PrEP in Washington DC using the Implementation Mapping (IM) framework. A needs assessment will be conducted through in-depth interviews (IDIs) with pharmacists (n = 6), PrEP providers (n = 6), current PrEP users (n = 6), DC Department of Health officials (n = 2), DC Board of Pharmacy officials (n = 4) and pharmacy-based PrEP experts (n = 4) to provide input on the operational aspects of pharmacy-based PrEP model as a strategy to increase PrEP uptake. Information gathered through this needs assessment will be used to develop standard operating procedures for the introduction of pilot pharmacy-based PrEP into community-based retail pharmacies.
Læs mere Tjek på PubMedChristine M. Durand, Allan Massie, Sander Florman, Tao Liang, Meenakshi M. Rana, Rachel Friedman-Moraco, Alexander Gilbert, Peter Stock, Sapna A. Mehta, Shikha Mehta, Valentina Stosor, Marcus R. Pereira, Michele I. Morris, Jonathan Hand, Saima Aslam, Maricar Malinis, Ghady Haidar, Catherine B. Small, Carlos A.Q. Santos, Joanna Schaenman, John Baddley, David Wojciechowski, Emily A. Blumberg, Karthik Ranganna, Oluwafisayo Adebiyi, Nahel Elias, Jose A. Castillo-Lugo, Emmanouil Giorgakis, Senu Apewokin, Diane Brown, Darin Ostrander, Yolanda Eby, Niraj Desai, Fizza Naqvi, Serena Bagnasco, Natasha Watson, Erica Brittain, Jonah Odim, Andrew D. Redd, Aaron A.R. Tobian, and Dorry L. Segevthe HOPE in Action Investigators*From the Departments of Medicine (C.M.D., T.L., D.B., D.O., Y.E., F.N., A.D.R.), Surgery (N.D.), and Pathology (S.B., A.A.R.T.), Johns Hopkins University School of Medicine, Baltimore, the Department of Medicine, University of Maryland School of Medicine (J.B.), and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (N.W., E.B., J.O., A.D.R.) — all in Maryland; the Department of Population Health, New York University (NYU) Grossman School of Medicine (A.M., D.L.S.), the Recanati-Miller Transplantation Institute, Mount Sinai Hospital (S.F.), the Department of Medicine, Icahn School of Medicine at Mount Sinai (M.M.R.), NYU Langone Transplant Institute (S.A.M., D.L.S.), the Department of Medicine, Columbia University Irving Medical Center (M.R.P.), and the Department of Medicine, Weill Cornell Medicine (C.B.S.) — all in New York; the Department of Medicine, Emory University, Atlanta (R.F.-M.); the Department of Medicine, Georgetown University, Washington, DC (A.G.); the Department of Surgery, University of California, San Francisco, San Francisco (P.S.), the Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla (S. Aslam), and the Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles (J.S.) — all in California; the Section of Transplant Nephrology, University of Alabama at Birmingham, Birmingham (S.M.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine (V.S.), and the Division of Infectious Diseases, Rush University Medical Center (C.A.Q.S.) — both in Chicago; the Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami (M.I.M.); the Department of Medicine, Ochsner Health, New Orleans (J.H.); the Section of Infectious Diseases, Yale School of Medicine, New Haven, CT (M.M.); the Department of Medicine, University of Pittsburgh, Pittsburgh (G.H.), and the Department of Medicine, Perelman School of Medicine at the University of Pennsylvania (E.A.B.), and the Department of Medicine, Drexel University College of Medicine (K.R.), Philadelphia — all in Pennsylvania; the Department of Medicine, University of Texas Southwestern Medical Center (D.W.), and the Department of Medicine, Methodist Health System Clinical Research Institute (J.A.C.-L.) — both in Dallas; the Department of Medicine, Indiana University Health, Indianapolis (O.A.); the Department of Surgery, Massachusetts General Hospital, Boston (N.E.); the Department of Surgery, University of Arkansas for Medical Sciences, Little Rock (E.G.); and the Department of Medicine, University of Cincinnati College of Medicine, Cincinnati (S. Apewokin).
New England Journal of Medicine, 17.10.2024
Tilføjet 17.10.2024
New England Journal of Medicine, Volume 391, Issue 15, Page 1390-1401, October 17, 2024.
Læs mere Tjek på PubMedElmi MullerFrom the Department of Surgery, Stellenbosch University, Stellenbosch, South Africa.
New England Journal of Medicine, 17.10.2024
Tilføjet 17.10.2024
New England Journal of Medicine, Volume 391, Issue 15, Page 1454-1455, October 17, 2024.
Læs mere Tjek på PubMedInfection, 16.10.2024
Tilføjet 16.10.2024
Abstract A 43-year-old male patient presented to the emergency department with progressive dyspnea. CT scan showed pronounced cystic lesions and ground glass opacitiy in both lungs and diagnosis of HIV infection was established. Bronchoscopy confirmed diagnosis of pneumocystis jirovecii pneumonia (PCP). The radiological presentation with perihilar large cysts is typical for PCP in HIV-infected patients, but rarely encountered today.
Læs mere Tjek på PubMedInfection, 16.10.2024
Tilføjet 16.10.2024
Abstract Purposes Since 2016, the World Health Organization has recommended universal antiretroviral therapy (ART) for all people living with Human Immunodeficiency Virus (PLHIV). This recommendation may have influenced the characteristics and outcomes of PLHIV admitted to the Intensive Care Unit (ICU). This study aims to identify changes in the epidemiological and clinical characteristics of PLHIV admitted to the ICU, and their short- and medium-term outcomes before and after the implementation of universal ART (periods 2006–2015 and 2016–2019). Methods This retrospective, observational, single-center study included all adult PLHIV admitted to the ICU of a University Hospital in Barcelona from 2006 to 2019. Results The study included 502 admissions involving 428 patients, predominantly men (75%) with a median (P25-P75) age of 47.5 years (39.7–53.9). Ninety-one percent were diagnosed with HIV before admission, with 82% under ART and 60% admitted from the emergency department. In 2016–2019, there were more patients on ART pre-admission, reduced needs for invasive mechanical ventilation (IMV) and fewer in-ICU complications. ICU mortality was also lower (14% vs 7%). Predictors of in-ICU mortality included acquired immunodeficiency syndrome defining event (ADE)-related admissions, ICU complications, higher SOFA scores, IMV and renal replacement therapy (RRT) requirement. ART use during ICU admission was protective. Higher SOFA scores, admission from hospital wards, and more comorbidities predicted one-year mortality. Conclusions The in-ICU mortality of critically ill PLHIV has decreased in recent years, likely due to changes in patient characteristics. Pre- and ICU admission features remain the primary predictors of short- and medium-term outcomes.
Læs mere Tjek på PubMedBMC Infectious Diseases, 16.10.2024
Tilføjet 16.10.2024
Abstract Background Cervical cancer remains a public health problem despite heavy global investment in health systems especially in low-and-middle-income countries (LMIC). Prophylactic vaccines against the most commonly detected human papillomavirus (HPV) types in cervical cancers are available and decisions on the selection of vaccine design depends on the prevalence of high-risk (hr) HPV genotypes for a particular region. In 2015, Botswana adopted the use of a quadrivalent HPV vaccine as a primary prevention strategy. Secondary prevention includes cervical smear screening whose uptake remains notably low among indigenous and marginalized communities despite efforts to improve access. Aim To determine the prevalence of hrHPV genotypes and cervical lesions’ burden in women from the indigenous and marginalized communities of Botswana. Methods This prospective survey enrolled 171 non-HPV vaccinated women aged 21 years and older. Face-to-face interviews, Pap smear screening, hr-HPV and Human Immuno-deficiency virus (HIV) testing were carried out. Conventional Papanicolau smears were analyzed and cervical brushes were preserved for hrHPV testing using the Ampfire Multiplex HR-HPV protocol which detects the following genotypes: HPV 16, 18, 31, 35, 39, 45, 51, 52, 53, 56, 58, 59 and 68. Results In this study, 168/171 (98.6%) of the women consented to HIV testing; 53/171 (31%) were living with HIV and self-reported enrolment on antiretroviral therapy. Among the women examined, 23/171 (13.5%) had cervical dysplasia with most presenting with Atypical Squamous Cells of Undetermined Significance 8/23 (35%), Low-Grade Squamous Intraepithelial Lesions 8/23 (35%), Atypical Squamous Cells-High Grade 4/23 (17%), Atypical Endocervical Cells 2/23 (9%) and Atypical Endocervical Cell favoring neoplasia 1/23(4%). However, no High-Grade Squamous Intraepithelial Lesions (HSIL) or squamous cell carcinoma (SCC) were detected. Overall hrHPV prevalence in this study was at 56/171 (32.7%). The most commonly detected hrHPV genotypes in women with cervical dysplasia were HPV39 (6.25%), HPV51 (14.5%), HPV52 (12.5%) and HPV56 (4%). Notably, HPV 16 and 18 were not found in women with cervical dysplasia. Conclusions Our study provides valuable insights into the prevalence and distribution of hrHPV genotypes in indigenous and marginalized communities in Botswana, and the need for further investigation of their potential role in cervical carcinogenesis in this population. These results may also serve as baseline data to facilitate future evaluation of the HPV vaccine needs.
Læs mere Tjek på PubMedJournal of the American Medical Association, 15.10.2024
Tilføjet 15.10.2024
This Medical News article is an interview with Quarraisha Abdool Karim, PhD, and Salim S. Abdool Karim, MBChB, PhD, who received the award for their decades of work on AIDS in Africa.
Læs mere Tjek på PubMedInfection, 15.10.2024
Tilføjet 15.10.2024
Abstract A 43-year-old male patient presented to the emergency department with progressive dyspnea. CT scan showed pronounced cystic lesions and ground glass opacitiy in both lungs and diagnosis of HIV infection was established. Bronchoscopy confirmed diagnosis of pneumocystis jirovecii pneumonia (PCP). The radiological presentation with perihilar large cysts is typical for PCP in HIV-infected patients, but rarely encountered today.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.10.2024
Tilføjet 14.10.2024
Abstract Introduction During the mpox outbreak in 2022, the highest number of cases in Germany were registered in Berlin, almost all of them in men who have sex with men (MSM). However, the frequency of clinically undiagnosed infections is unknown. Methods A cross-sectional study was conducted among MSM in Berlin, Germany. Participants were recruited from private practices and community-based checkpoints specialised in HIV and STI care for MSM. They were asked to complete an online questionnaire on socio-demographic data, mpox diagnosis, vaccination history and sexual behaviour, and to provide a blood sample for serological analysis. The samples were tested for antibodies against a range of antigens to distinguish between antibodies induced by mpox infection and MVA vaccination, with pre-immune sera from childhood smallpox vaccination as a confounding factor. Associations of behavioural variables with reported and suspected mpox diagnosis as the outcome were tested using univariable and multivariable logistic regression models. Results Between the 11th April and 1st July 2023, 1,119 participants were recruited in eight private practices and two community-based checkpoints in Berlin. All participants provided a blood sample for serological testing. Information for the online questionnaire was provided by 728 participants; core data on age and mpox history for participants who did not provide questionnaire data were provided by the practices for an additional 218 participants. A previous diagnosis of mpox was reported for/by 70 participants (7.4%). Using a conservative and strict case definition, we serologically identified an additional 91 individuals with suspected undiagnosed mpox infection. Individuals with reported or suspected mpox infections reported more condomless anal sex partners in the past 3 months (OR = 5.93; 95% CI 2.10-18.35 for 5–10 partners; OR = 9.53; 95% CI 2.72–37.54 for > 10 partners) and were more likely to report sexual contact with partners diagnosed with mpox (OR = 2.87; 95% CI 1.39–5.84). Conclusion A substantial proportion of mpox infections were clinically undiagnosed. The number of condomless anal sex partners was strongly associated with both confirmed and suspected undiagnosed mpox infection. Therefore, mpox control measures based on clinical diagnosis of mpox are likely to have limited effectiveness in preventing mpox transmission in outbreak situations because many infections remain unrecognised and undiagnosed.
Læs mere Tjek på PubMedHeffron, Renee; Muwonge, Timothy R.; Thomas, Katherine K.; Zewdie, Kidist; Ssebuliba, Timothy; Stein, Gabrielle; Morrison, Susan; Badaru, Josephine; Nakyanzi, Agnes; Bambia, Felix; Mugwanya, Kenneth; Wyatt, Christina; Matovu, Flavia; Yin, Michael T.; Mujugira, Andrew
AIDS, 13.10.2024
Tilføjet 13.10.2024
Background: Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV pre-exposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in BMD beyond those elicited by either product singly. Methods: From 2018–2022, we conducted a 2-year prospective study with women ages 16–25 years in Kampala, Uganda desiring pregnancy and HIV prevention. Women were provided condoms, injectable DMPA, and/or FTC/TDF, according to their choices and underwent annual dual x-ray absorptiometry (DXA) scans. We used tenofovir-diphosphate (TFV-DP) quantification in dried blood spots and DMPA injection dates to classify exposure. Linear regression models estimated the difference in % BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product. Results: Of 499 enrolled women, discontinuation and re-starting of contraception and PrEP was common. Women consistently using neither product (n = 39) experienced BMD increases. Women with consistent use of both products during 1 year (n = 22) experienced an average BMD loss of 1.04% at lumbar spine and hip and 1.77% at femoral neck. These losses were different relative to women who used neither agent: lumbar spine -3.35% (95% CI −5.13%, −1.56%, p = 0.001), total hip −2.24% (95% CI −3.87%, −0.60%, p = 0.009), and femoral neck −1.71% (95% CI −3.73%, 0.31%, p = 0.102). Conclusion: We observed a trend for women with concurrent DMPA and FTC/TDF PrEP use to have 1–3% lower BMD than unexposed women after 12 months. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedHeffron, Renee; Muwonge, Timothy R.; Thomas, Katherine K.; Zewdie, Kidist; Ssebuliba, Timothy; Stein, Gabrielle; Morrison, Susan; Badaru, Josephine; Nakyanzi, Agnes; Bambia, Felix; Mugwanya, Kenneth; Wyatt, Christina; Matovu, Flavia; Yin, Michael T.; Mujugira, Andrew
AIDS, 13.10.2024
Tilføjet 13.10.2024
Background: Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV pre-exposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in BMD beyond those elicited by either product singly. Methods: From 2018–2022, we conducted a 2-year prospective study with women ages 16–25 years in Kampala, Uganda desiring pregnancy and HIV prevention. Women were provided condoms, injectable DMPA, and/or FTC/TDF, according to their choices and underwent annual dual x-ray absorptiometry (DXA) scans. We used tenofovir-diphosphate (TFV-DP) quantification in dried blood spots and DMPA injection dates to classify exposure. Linear regression models estimated the difference in % BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product. Results: Of 499 enrolled women, discontinuation and re-starting of contraception and PrEP was common. Women consistently using neither product (n = 39) experienced BMD increases. Women with consistent use of both products during 1 year (n = 22) experienced an average BMD loss of 1.04% at lumbar spine and hip and 1.77% at femoral neck. These losses were different relative to women who used neither agent: lumbar spine -3.35% (95% CI −5.13%, −1.56%, p = 0.001), total hip −2.24% (95% CI −3.87%, −0.60%, p = 0.009), and femoral neck −1.71% (95% CI −3.73%, 0.31%, p = 0.102). Conclusion: We observed a trend for women with concurrent DMPA and FTC/TDF PrEP use to have 1–3% lower BMD than unexposed women after 12 months. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedHey, Molly; Thompson, Lucy; Portwood, Clara; Sexton, Harriet; Kumarendran, Mary; Brandon, Zoe; Kirtley, Shona; Hemelaar, Joris
AIDS, 13.10.2024
Tilføjet 13.10.2024
Objective: Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women. Design: Systematic review and meta-analysis Methods: We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987. Results: Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27–1.56), VPTB (1.94, 1.25–3.01), LBW (1.63, 1.30–2.04), SGA (1.53, 1.17–1.99) and VSGA (1.48, 1.16–1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55–2.28), VPTB (2.06, 1.01–4.18), sPTB (16.96, 1.01–284.08), LBW (2.90, 2.41–3.50), VLBW (4.35, 2.67–7.09) and VSGA (2.37, 1.84–3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06–1.30) and SGA (1.20, 1.08–1.33), compared with HIV-negative women. Conclusions: The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedHey, Molly; Thompson, Lucy; Portwood, Clara; Sexton, Harriet; Kumarendran, Mary; Brandon, Zoe; Kirtley, Shona; Hemelaar, Joris
AIDS, 13.10.2024
Tilføjet 13.10.2024
Objective: Women living with HIV (WLHIV) are at increased risk of adverse perinatal outcomes compared to HIV-negative women, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WLHIV receiving different classes of ART, compared to HIV-negative women. Design: Systematic review and meta-analysis Methods: We searched Medline, CINAHL, Global Health and EMBASE for studies published between 1 January 1980 and 14 July 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WLHIV receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor (PI)-based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to HIV-negative women. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WLHIV receiving either NNRTI-based, PI-based or INSTI-based ART, compared with HIV-negative women. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987. Results: Of 108,720 identified citations, 22 cohort studies including 191,857 women were eligible for analysis. We found that WLHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at increased risk of PTB (risk ratio (RR) 1.40, 95% confidence interval 1.27–1.56), VPTB (1.94, 1.25–3.01), LBW (1.63, 1.30–2.04), SGA (1.53, 1.17–1.99) and VSGA (1.48, 1.16–1.87), compared with HIV-negative women. WLHIV receiving PI-based ART (mainly lopinavir/ritonavir or unspecified) are at increased risk of PTB (1.88, 1.55–2.28), VPTB (2.06, 1.01–4.18), sPTB (16.96, 1.01–284.08), LBW (2.90, 2.41–3.50), VLBW (4.35, 2.67–7.09) and VSGA (2.37, 1.84–3.05), compared with HIV-negative women. WLHIV receiving INSTI-based ART (mainly dolutegravir) are at increased risk of PTB (1.17, 1.06–1.30) and SGA (1.20, 1.08–1.33), compared with HIV-negative women. Conclusions: The risks of adverse perinatal outcomes are higher among WLHIV receiving ART compared with HIV-negative women, irrespective of the class of ART drugs. This underlines the need to further optimise ART in pregnancy and improve perinatal outcomes of WLHIV. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedFilip, Iulia
AIDS, 13.10.2024
Tilføjet 13.10.2024
Filip, Iulia
AIDS, 13.10.2024
Tilføjet 13.10.2024
BMC Infectious Diseases, 12.10.2024
Tilføjet 12.10.2024
Abstract Background Human Immunodeficiency Virus (HIV) and malaria are two major diseases in sub-Saharan Africa. Co-infection can significantly impact the clinical outcomes of both conditions. We assessed the proportion of HIV-infected children at Korle Bu Teaching Hospital (KBTH) and Princess Marie Louise Hospital (PML) with malaria parasites. The association between asymptomatic malaria parasitaemia and virological non-suppression was also determined in these children. Methods This cross-sectional study of 277 asymptomatic malaria in children receiving care at paediatric HIV clinics at KBTH and PML was conducted from September to November 2022. Patients who had been on antiretroviral therapy (ART) for at least six months were eligible to participate. Structured questionnaires were used to collect socio-demographic information, malaria prevention behaviors, and ART-related data using in-person interviews. Microscopy and PCR were used to screen for malaria, and GeneXpert was used to determine viral load. To examine the determinants of malaria PCR positivity and virological non-suppression, chi-square tests and logistic regression were performed. Results The median age of the participants was 9 years (range: 6–12 years). Males comprised 158 (57%) of the study population. We detected 10 (3.6%) and 21 (7.6%) malaria cases by microscopy and PCR, respectively. Virological non-suppression (VL > 1000 copies/ml) was observed in 82 (29.6%) of the 277 participants. Among the suppressed individuals, 62 (22.4%) exhibited low-level viraemia (VL level 40-1000 copies/ml) and 133 (48%) had undetectable viral load levels. No factors were associated with the presence of malaria PCR positivity carriage. Poor adherence to ART was associated with a five-fold increase in the risk of viral load non-suppression (AOR = 4.89 [CI = 2.00-11.98], p = 0.001). Conclusion The proportion of children living with HIV with asymptomatic malaria parasitaemia was low. Approximately one-third of the study population had virological non-suppression. The interaction between malaria parasitemia and viral replication may not be the main cause for virological non-suppression in this low transmission area.
Læs mere Tjek på PubMedClinical Infectious Diseases, 12.10.2024
Tilføjet 12.10.2024
Abstract Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a lifespan approaching that of people without HIV, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the lifespan. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive health care for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while also attending to HIV-specific health concerns. Clinicians must address issues specific to preventive health, including cancer screening, providing recommended vaccinations, as well as promoting sexual health, including sexually transmitted infection diagnosis, treatment, and prevention. Clinicians also must address issues for specific populations, including persons of childbearing potential, including during preconception and pregnancy; children; adolescents; and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates the previous 2020 HIV Primary Care Guidance.
Læs mere Tjek på PubMedRichmond Owusu, Serwaa Akoto Bawua, Emmanuel Bugyei Kwarteng, Leonard Baatiema, Justice Nonvignon
PLoS One Infectious Diseases, 12.10.2024
Tilføjet 12.10.2024
by Richmond Owusu, Serwaa Akoto Bawua, Emmanuel Bugyei Kwarteng, Leonard Baatiema, Justice Nonvignon Introduction The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. Methods The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. Results The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Conclusion Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV.
Læs mere Tjek på PubMedMooketsi Molefi, Olanrewaju Oladimeji
PLoS One Infectious Diseases, 12.10.2024
Tilføjet 12.10.2024
by Mooketsi Molefi, Olanrewaju Oladimeji The lack of culturally and contextually appropriate adaptations of health-related quality of life (HRQoL) tools hinders HIV patient outcomes. This study aims to assess the validity and reliability of a Tswana version of the Medical Outcome Survey-HIV (MOS-HIV) tool among diverse HIV sub-populations in Botswana. In terms of the methodology the study will comprise of several steps. Firstly, forward and back-translation of the original U.S. English MOS-HIV tool into Setswana, followed by the review of the translated tool. Phase 1 will evaluate content, construct validity, and reliability of the newly developed tool among HIV outpatients at Gaborone Infectious Diseases Clinics (IDCC). A Cronbach’s alpha coefficient >0.7 across the 35 items and 11 dimensions of the MOS-HIV tool will indicate internal consistency reliability. Phase 2 will employ the use of logistic regression models to identify predictors of poor HRQoL among randomly selected IDCC sites, both in urban and rural centers. Phase 3 will investigate predictors of poor HRQoL among inpatients receiving treatment for HIV-associated cryptococcal meningitis (CM) using longitudinal data analysis methods. Ethical approval has been obtained from the University of Botswana, Walter Sisulu University, Human Research and Development Unit, Ministry of Health, and Princess Marina Hospital. Prospective participants will provide written informed consent, with proxy consent explored when feasible. Voluntary participation and confidentiality will be ensured during data collection and analysis. Data will be securely stored under lock-and-key. Dissemination of study findings will adhere to strict privacy protocols, avoiding the sharing of personal identifiers.
Læs mere Tjek på PubMedInfection, 12.10.2024
Tilføjet 12.10.2024
Abstract Purposes Since 2016, the World Health Organization has recommended universal antiretroviral therapy (ART) for all people living with Human Immunodeficiency Virus (PLHIV). This recommendation may have influenced the characteristics and outcomes of PLHIV admitted to the Intensive Care Unit (ICU). This study aims to identify changes in the epidemiological and clinical characteristics of PLHIV admitted to the ICU, and their short- and medium-term outcomes before and after the implementation of universal ART (periods 2006–2015 and 2016–2019). Methods This retrospective, observational, single-center study included all adult PLHIV admitted to the ICU of a University Hospital in Barcelona from 2006 to 2019. Results The study included 502 admissions involving 428 patients, predominantly men (75%) with a median (P25-P75) age of 47.5 years (39.7–53.9). Ninety-one percent were diagnosed with HIV before admission, with 82% under ART and 60% admitted from the emergency department. In 2016–2019, there were more patients on ART pre-admission, reduced needs for invasive mechanical ventilation (IMV) and fewer in-ICU complications. ICU mortality was also lower (14% vs 7%). Predictors of in-ICU mortality included acquired immunodeficiency syndrome defining event (ADE)-related admissions, ICU complications, higher SOFA scores, IMV and renal replacement therapy (RRT) requirement. ART use during ICU admission was protective. Higher SOFA scores, admission from hospital wards, and more comorbidities predicted one-year mortality. Conclusions The in-ICU mortality of critically ill PLHIV has decreased in recent years, likely due to changes in patient characteristics. Pre- and ICU admission features remain the primary predictors of short- and medium-term outcomes.
Læs mere Tjek på PubMedCamille Vellas, Amira Doudou, Sofiane Mohamed, Stéphanie Raymond, Nicolas Jeanne, Justine Latour, Sofia Demmou, Noémie Ranger, Dimitri Gonzalez, Pierre Delobel, Jacques Izopet
Journal of Medical Virology, 12.10.2024
Tilføjet 12.10.2024
BMC Infectious Diseases, 12.10.2024
Tilføjet 12.10.2024
Abstract Background Since the implementation of universal antiretroviral therapy, kidney transplantation (K-Tx) has become a valuable option for treatment of end-stage kidney disease for people with HIV (PWH) with similar patient and graft survival as compared to HIV-uninfected patients. Little is known about the hazards and manifestations of infectious disease (ID) events occurring in kidney transplant recipients with HIV. Methods Using linked information collected in the Swiss HIV Cohort Study (SHCS) and the Swiss Transplant Cohort Study (STCS), we described in-depth demographical and clinical characteristics of PWH who received a K-Tx since 2008. Further, we performed recurrent time to event analyses to understand whether HIV was an independent risk factor for ID events. Results Overall, 24 PWH with 57 ID events were included in this study (100% match of SHCS to STCS). Of these, 17 (70.8%) patients had at least one ID event: 22 (38.6%) viral (HIV not counted), 18 (31.6%) bacterial, one (1.8%) fungal and 16 (28.1%) probable infections. Most ID events affected the respiratory tract (25, 37.3%) or the urinary tract (13, 19.4%). Pathogen types and infection sites were similar in PWH and a matched control group of HIV-uninfected patients. HIV was not an independent risk factor for ID events (adjusted hazard ratio 0.94, p = 0.9). Conclusion By linking data from two large national Swiss cohorts, we provided in-depth information on ID events in PWH receiving a K-Tx in Switzerland. HIV infection was not associated with an increased hazard for ID events after K-Tx.
Læs mere Tjek på PubMedGeorge Mrema, Ally Hussein, Welema Magoge, Vida Mmbaga, Azma Simba, Robert Balama, Emmanuel Nkiligi, Paul Shunda, Deus Kamara, Riziki Kisonga, Gideon Kwesigabo
PLoS One Infectious Diseases, 11.10.2024
Tilføjet 11.10.2024
by George Mrema, Ally Hussein, Welema Magoge, Vida Mmbaga, Azma Simba, Robert Balama, Emmanuel Nkiligi, Paul Shunda, Deus Kamara, Riziki Kisonga, Gideon Kwesigabo Background Leprosy is caused by Mycobacterium leprae which affects skin, nerves, eyes, and nasal mucosa. Despite global elimination efforts, Tanzania remains among 13 countries reporting more than 1000 leprosy cases annually. In 2021, Tanzania identified 1,511 new cases, with 10% having grade II disability. Moreover, 14 councils recorded leprosy rates exceeding 10 cases per 100,000 population. This study aimed to assess the burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020. Methodology A retrospective cross-sectional study was conducted to investigate all registered treated leprosy patients from January 2017 to December 2020. The Leprosy Burden Score (LBS) was used to assess the disease burden, while binary logistic regression was employed to evaluate the risk factors for disability. Result A total of 6,963 leprosy cases were identified from 2017 to 2020. During this period, the point prevalence of leprosy declined from 0.32 to 0.25 per 10,000 people, and the new case detection rate decreased from 3.1 to 2.4 per 100,000 people; however, these changes were not statistically significant (p > 0.05). Independent risk factors for leprosy-related disabilities included male sex (Adjusted Odds Ratio (AOR) = 1.38, 95% Confidence Interval (CI) 1.22–1.57), age 15 years and above (AOR = 2.42, 95% CI 1.60–3.67), previous treatment history (AOR = 2.18, 95% CI 1.69–2.82), and positive Human Immunodeficiency Virus (HIV) status (AOR = 1.60, 95% CI 1.11–2.30). Conclusion This study identified male sex, older age, positive HIV status, and prior treatment history as independent risk factors for leprosy-related disabilities. Additionally, despite the observed decline in point prevalence and new case detection rates, these changes were not statistically significant. To address leprosy-related disabilities, it is crucial to implement specific prevention strategies that focus on high-risk groups. This can be accomplished by enhancing screening and contact tracing efforts for early patient identification to prevent delays in intervention. Further research is warranted to analyze the burden of leprosy over a more extended period and to explore additional risk factors not covered in this study.
Læs mere Tjek på PubMedMontrosse-Moorhead, B., Sutter, A., Phiri, C., De La Cruz Perdomo, L.
BMJ Open, 11.10.2024
Tilføjet 11.10.2024
IntroductionYouth participatory evaluation is one model for monitoring global outcomes and assessing interventions to improve young people’s health equity and well-being while embracing principles of participation and empowerment. Little is known about the use of this approach in practise. This scoping review will identify and synthesise descriptions of how youth participatory evaluation is enacted, to what extent it occurs, and describe the relationship between context and inclusion. Methods and analysisScoping review methods will adhere to those outlined by Arksey and O’Malley. The study will also follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The review will use publicly available evaluation reports (grey literature) for programmes funded by the US National Science Foundation through the Advancing Informal science, technology, engineering and mathematics (STEM) Learning programme and whose reports are archived in the repository hosted by the Reimagining Equity and Values in Informal STEM education (REVISE) Center. This scoping review is limited to education, one of the domains of the social determinants of health, more precisely STEM education, due to the report publication parameters set by the REVISE Center repository. A research team member will download citations for and PDFs of reports. These citations and reports will be managed using Zotero and exported to Covidence, a web-based program designed to manage systematic and scoping reviews. Evaluation report selection will occur in a two-step process by trained coders with clear criteria. Inclusion criteria will include: (1) report is for an evaluation study; (2) evaluation has a focus on young people, aged 10–24; (3) evaluation is for a programme serving young people, aged 10–24; and (4) report written and uploaded to the REVISE Center repository between 2017 and 2022. All reports hosted on the REVISE Center repository are based in the USA and written in English. Data charting will also be done by trained coders and facilitated by Covidence and a codebook. Several procedures will be used to uphold rigour and consistency during this process. Data analysis will be done with Dedoose. Ethics and disseminationHuman subjects research approval will not be required. This scoping review will rely on publicly available evaluation reports. No human research participants will be involved in this review. Findings will be shared through dissemination strategies, such as peer-reviewed journals, international and national conferences, and social media affiliated with academic institutions and professional associations. Study registrationThis study is preregistered on Open Science Framework (https://osf.io/23jdx/). Registration DOI: https://doi.org/10.17605/OSF.IO/K6J98.
Læs mere Tjek på PubMedClinical Infectious Diseases, 10.10.2024
Tilføjet 10.10.2024
Abstract Background In countries with low tuberculosis (TB) burden, the risk of TB in people with HIV (PWH) once HIV virological suppression is achieved is not fully understood.Methods In a nationwide cohort, we included all adult PWH from the Danish HIV Cohort initiating antiretroviral therapy (ART) (1995-2017) without prior TB disease. We used Kaplan-Meier estimation and Poisson regression to calculate TB incidence rate (IR) after six months of ART, along with associated risk factors and mortality rates (MR).Results Among 6,849 PWH initiating ART (median follow-up 7.4 years), 84 developed TB (IR 1.4/1000 person-year [PY]), 54 of them beyond six months of ART initiation, IR 0.97/1000 PY (95%CI:1.17-1.79): 1.95 (95%CI:1.34-2.76) in non-Danish born, 0.36 (95%CI:0.21-0.62) in Danish-born without injection drug use (IDU), and 2.95 (95%CI:1.53-5.66) in Danish-born with IDU. Danish-born with suppressed viremia, and no IDU or known TB exposures had the lowest risk (IR 0.05/1000 PY).In the adjusted analysis, being non-Danish born (aIRR 4.27[95%CI:2.36-7.72]), IDU (aIRR 4.95[95%CI:2.55-9.62]), and previous AIDS-defining events (aIRR 2.05[95%CI:1.06-3.94]) raised TB risk, while suppressed HIV-RNA (aIRR 0.58[95%CI:0.34-0.99]) reduced it. The overall MR for HIV/TB co-infected post- ART was high, at 48.9/1000 PY (95%CI:30.4-78.7).Conclusions The TB risk remains elevated in PWH beyond six months of ART initiation, especially among migrants, IDU, those without suppressed HIV-RNA, and individuals exposed to high TB endemic areas or with social risk determinants of health. Conversely, PWH without these risk factors have a TB risk similar to the general population and would not require targeted TB screening strategies.
Læs mere Tjek på PubMedVeronica Martinez Martinez, Hermen Ormel, Eline L. M. Op de Coul
PLoS One Infectious Diseases, 10.10.2024
Tilføjet 10.10.2024
by Veronica Martinez Martinez, Hermen Ormel, Eline L. M. Op de Coul Background Heterosexual migrant men and women in the Netherlands often face barriers to accessing health services, including HIV testing, that may lead to late-stage HIV diagnoses. This study explored factors of influence in the usage of HIV testing among heterosexual migrants. Methods Qualitative evaluation with semi-structured interviews at the Amsterdam-based AIDS Healthcare Foundation (AHF) Checkpoint and one focus group discussion (FGD) conducted during June-July 2023 with 19 participants: interviews with 12 heterosexual migrants from low- or middle-income countries (LMICs) and FGD (n = 5) and interviews (n = 2) with 7 key informants from the (public) health sector. Recorded interviews were transcribed and thematically analyzed, using the framework of Andersen’s Expanded Behavioral Model of Health Services Use. Results In total, 55 themes emerged from the interviews and the FGD. Examples include insufficient availability of information on HIV and testing services, and difficulty in accessing these services (e.g. the barrier of the online appointment system of the Centre for Sexual Health (CSH)). HIV test participants expressed free, rapid testing, no appointment required, and a positive experience during their HIV test as enablers to test in the future. Results from key informants showed that poor health literacy and lack of clarity on the healthcare system’s guidelines were barriers for heterosexual migrants in accessing information on HIV and testing services. It also revealed past initiatives and interventions that were successful in reaching at-risk groups such as the integration of HIV testing into sexually transmitted infection (STI) testing, but that were subsequently discontinued due to financial constraints. Conclusion Factors contributing to a low HIV test uptake were participants’ perception of limited accessibility of CSH facilities, insufficient available information on HIV (testing) services, and low perception of HIV risk. Unclear policies on accessing HIV/STI testing services at CSHs, and potential missed opportunities for HIV testing at general practitioners were contributing factors identified by key informants.
Læs mere Tjek på PubMedVincent Guilamo-Ramos, Marco Thimm-Kaiser, and Adam BenzekriFrom the Center for Latino Adolescent and Family Health (V.G.-R., M.T.-K., A.B.), and the Institute for Policy Solutions, School of Nursing (V.G.-R., M.T.-K., A.B.), Johns Hopkins University; and the U.S. Presidential Advisory Council on HIV/AIDS (V.G.-R.) — both in Washington, DC; and the Department of Epidemiology, Mailman School of Public Health, Columbia University (M.T.-K.), and the Department of Applied Psychology, Steinhardt School of Culture, Education, and Human Development, New York University (A.B.) — both in New York.
New England Journal of Medicine, 10.10.2024
Tilføjet 10.10.2024
Raccagni, Angelo Roberto; Passini, Flavia; Diotallevi, Sara; Lolatto, Riccardo; Bruzzesi, Elena; Piromalli, Girolamo; Candela, Caterina; Castagna, Antonella; Nozza, Silvia
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Background: The aim of this study is to assess the acceptability of HIV pre-exposure prophylaxis (PrEP) among individuals eligible for prophylaxis. Setting: Retrospective study of individuals receiving their first HIV test at the Infectious Diseases Unit of IRCCS San Raffaele Scientific Institute, Milan, Italy. Methods: People i) who received their first HIV test (baseline date) between January 2018 (availability of PrEP in Italy) and December 2023 (data lock), ii) with an indication for PrEP based on condomless sex were included; those already on PrEP were excluded. Individuals with a negative HIV test result were offered PrEP counselling and prescription according to guidelines. Characteristics of people who accepted or declined HIV PrEP were compared using Mann-Whitney or Chi-square tests, as appropriate. Results: A total of 2627 people were tested for HIV: 175 (6.6%) were diagnosed with HIV. Of the 2452 people with negative HIV test results, 2165 (88.3%) were men; median age was 34.3 years (interquartile range, IQR=28.7-42.4). Sexually transmitted infections (STIs) were detected in 478/2452 (19.5%), most commonly gonorrhoea (206/2452, 8.4%). Overall, 982/2452 (40.0%) people accepted PrEP, including only three women. Non-acceptance was higher among women (p
Læs mere Tjek på PubMedFinn, Black; Vanessa, McMahan; Xochitl, Luna Marti; Emily, Pope; John, Walker; Albert, Liu; Oliver, Coffin Phillip
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Kota, Krishna Kiran; Eppink, Samuel; Gant, Zanetta; Chesson, Harrell; McCree, Donna Hubbard
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Background: To compare racial and ethnic disparities in HIV diagnosis rates among adults in census tracts with most disadvantaged vs advantaged levels of social determinants of health (SDOH). Methods: In this ecological analysis, we used the National HIV Surveillance System data in 2021 and SDOH data from 2017–2021 American Community Survey. We measured racial and ethnic disparities stratified by sex in the most disadvantaged quartiles and advantaged quartiles for: 1) Poverty 2) Education level 3) Median household income and 4) Insurance coverage. We calculated 8 relative disparity measures (Black-to-White rate ratio [RR], Hispanic/Latino-to-White RR, Index of Disparity [ID], population-weighted ID, Mean Log Deviation, Theil Index, Population Attributable Proportion, Gini coefficient) and 4 absolute disparity measures (Black-to-White rate difference [RD], Hispanic/Latino-to-White RD, absolute ID, and population-weighted absolute ID). Results: Comparing the most disadvantaged quartiles to the most advantaged quartiles, all four absolute disparity measures decreased, but 7 of the 8 relative disparity measures increased: the median percentage decrease in the absolute measures for males and females respectively was 38.1% and 47.6% for poverty, 12.4% and 42.6% for education level, 43.6% and 44.0% for median household income, and 44.2% and 45.4% for insurance coverage. The median percentage increases for the relative measures for males and females respectively were 44.3% and 61.3% for poverty, 54.9% and 95.3% for education level, 19.6% and 90.0% for median household income, and 32.8% and 46.4% for insurance coverage. Conclusion: Racial and ethnic disparities in the most disadvantaged and advantaged quartiles highlight the need for strategies addressing the root causes of disparities. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBurnett, Janet; Olansky, Evelyn; Baugher, Amy R.; Lee, Kathryn; Callens, Steven; Wejnert, Cyprian; for the NHBS-Trans Study Group
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Background: Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women compared to cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women to a general sample of people who inject drugs (PWID). Methods: Participants from National HIV Behavioral Surveillance were recruited via respondent-driven sampling, interviewed, and tested for HIV infection in 2019-2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics. Results: Among 1,561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (aPR=1.5, 95%CI=1.2-1.8) than those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (aPR=0.8, 95%CI=0.7-1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%). Conclusion: Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to non-judgmental and culturally competent harm reduction services. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedColer, Brahm; Smith, Gordon Honerkamp; Arora, Anish K.; Wells, Adam; Solso, Stephanie; Dullano, Cheryl; Concha-Garcia, Susanna; Hill, Eddie; Riggs, Patricia K.; Korolkova, Anastasia; Deiss, Robert; Smith, Davey; Sundermann, Erin E.; Gianella, Sara; Chaillon, Antoine; Dubé, Karine
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Background: As people living with HIV (PWH) age, they face new challenges that can have a negative impact on their quality of life (QOL) and mental health. Setting: This study enrolled PWH at the end of life (EOL) who were actively engaged in cure-related research in Southern California, United States. EOL was defined as having a prognosis of six months or less to live. We examined the relationship between QOL, mental health, and research participation. Methods: Structured assessments were used to collect comprehensive data on QOL and mental health. Results: From 2017 to 2023, 35 PWH in their final stages of life who were actively engaged in cure-related research were enrolled. Their median age was 62.7 years, and most were White or otherwise non-Hispanic/non-Latino (90.6%), and male (86.7%). Changes in QOL and the presence of neurologic and psychiatric conditions, with a focus on depression and anxiety, were the primary outcomes assessed in this study. Participants had stable QOL scores throughout the study. There was an inverse relationship between QOL and BDI scores, with higher mean QOL scores being associated with lower mean BDI scores (p < 0.001). Conclusion: QOL remained stable among PWH who participate in cure-related research at EOL. The inverse relationship between QOL and depressive symptoms suggests that participation in cure-related research may improve QOL or reduce depressive symptoms in this population. Future interventions should look into ways to improve the well-being of PWH at EOL through research and customized mental health interventions. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedOkegbe, Tishina; Bishop, Kristina Monroe; Rose, Jessica; Srivastava, Meena; Baptiste, Anne Jean
Journal of Acquired Immune Deficiency Syndromes, 10.10.2024
Tilføjet 10.10.2024
Introduction: Adolescents 10-19 years account for a growing proportion of people living with HIV (PLHIV). In 2023, 140,000 adolescents were diagnosed with HIV, yet knowledge of HIV status and uptake of testing services remain critically low. Index testing – offering testing to contacts of PLHIV – is an important case-finding strategy. In 2021, PEPFAR expanded guidance to explicitly include older adolescents 15 to 19 years. We reviewed index testing data to assess uptake and case-finding trends among biological adolescent-aged children and siblings of PLHIV 10-19 years. Methods: Routinely collected programmatic data from 27 USAID-supported PEPFAR country and regional programs were analyzed for fiscal years (FY) 2017 through FY2022 (October 2016 - September 2022). We compared the volume of index testing and subsequent new diagnoses across FYs and countries among biological adolescent-aged children and siblings of PLHIV, and disaggregated by age, 10-14 and 15-19 years, and sex. Results: Index testing among adolescents 10-19 years increased from FY17 to FY22, nearly doubling from 147,088 to 291,534. Similarly, new diagnoses among adolescents increased between FY17 and FY22 (3,721 vs 10,730). Overall, across FYs, index testing uptake and case-finding were higher among females than males, and the gap in testing uptake between sexes was larger for older than younger adolescents. Conclusion: Index testing uptake has increased substantially among adolescents over time, with rebounded gains for adolescents 15-19 years noted beginning in FY21. However, uptake across age and sex remained uneven, highlighting an opportunity to ensure targeted testing strategies are employed to reach adolescents 15-19 years and males. Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
Læs mere Tjek på PubMedEkirapa, E., Jordan, M., Nong, T., Marton, T. E., Balidawa, H., Ssempala, R., Ssebagereka, A., Kagaayi, J., Nandakumar, A., McBain, R. K.
BMJ Open, 10.10.2024
Tilføjet 10.10.2024
ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country. DesignA cross-sectional study. SettingThis study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals. Participants1119 persons receiving HIV services in 2020. MethodsWe conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time. ResultsThe mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p
Læs mere Tjek på PubMedBMC Infectious Diseases, 10.10.2024
Tilføjet 10.10.2024
Abstract Background Identifying risk factors for respiratory syncytial virus (RSV)–associated severe acute respiratory illness (SARI) will assist with targeting vaccine interventions. Methods Using surveillance data from South Africa (2012–2018), we compared the characteristics of individuals with RSV-associated influenza-like illness (ILI) (reference group) to those with RSV-associated SARI to describe factors associated with SARI using a multivariable analysis. Results RSV was detected in 6% (483/7792) of ILI cases and 15% (844/5672) of SARI cases. Factors associated with SARI in children included age
Læs mere Tjek på PubMedMichinobu KuwaeYusuke YokoyamaStephen TimsMichaela FroehlichL. Keith FifieldTakahiro AzeNarumi TsugekiHideyuki DoiYoshiki SaitoaCenter for Marine Environmental Studies, Ehime University, Matsuyama 790-8577, JapanbAtmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa 277-8564, JapancResearch School of Physics, The Australian National University, Canberra, ACT 2601, AustraliadThe Faculty of Law, Matsuyama University, Matsuyama 790-8578, JapaneGraduate School of Informatics, Kyoto University, Kyoto 606-8501, JapanfEstuary Research Center, Shimane University, Matsue 690-8504, JapangGeological Survey of Japan, The National Institute of Advanced Industrial Science and Technology, Tsukuba 305-8567, Japan
Proceedings of the National Academy of Sciences, 10.10.2024
Tilføjet 10.10.2024
Proceedings of the National Academy of Sciences, Volume 121, Issue 41, October 2024.
Læs mere Tjek på PubMedAdam W. CarricoDaniel T. RyanJohnny BeronaBenjamin S. DominguezJoshua M. SchrockThomas W. McDadeMichael NewcombRichard T. D’AquilaBrian MustanskiaHealth Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199bBiobehavioral Consulting, Miami Shores, FL 33138cInstitute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL 60611dDepartment of Anthropology, Northwestern University, Evanston, IL 60208eDepartment of Medicine Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611
Proceedings of the National Academy of Sciences, 10.10.2024
Tilføjet 10.10.2024
Proceedings of the National Academy of Sciences, Volume 121, Issue 41, October 2024.
Læs mere Tjek på PubMedEmma Starbuck
Lancet Infectious Diseases, 9.10.2024
Tilføjet 9.10.2024
Viral times: reflections on the COVID-19 and HIV pandemics explores how the COVID-19 pandemic can shape our understanding of the HIV pandemic, and vice versa. The book is a compilation of 16 papers written by 28 authors, and includes case studies from eleven different countries. The book was edited by Jaime García-Iglesias, Maurice Nagington, and Peter Aggleton, and it is targeted towards a range of specialist backgrounds, as well as the general reader.
Læs mere Tjek på PubMedKristen Andreatta, Michelle L. D'Antoni, Silvia Chang, Aiyappa Parvangada, Ross Martin, Christiana Blair, Debbie Hagins, Princy Kumar, Jason T. Hindman, Hal Martin, Christian Callebaut
Journal of Medical Virology, 9.10.2024
Tilføjet 9.10.2024
Lena Pracher, Markus Zeitlinger
Clinical Microbiology and Infection, 9.10.2024
Tilføjet 9.10.2024
Viral diseases represent a substantial global health challenge, necessitating the urgent development of effective antiviral medications.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.10.2024
Tilføjet 9.10.2024
Abstract Background Drug-drug interactions (DDIs) between antiretroviral therapy (ART) and commonly used co-medications in HIV patients, especially women, impact treatment efficacy and patient safety. Objective This study aimed to study the prevalence and types of drug-drug interactions (DDIs) between antiretroviral therapy drugs (ARTs) and comedications among a female population with HIV. Additionally, the study investigates the association of these DDIs with ART medication changes and treatment adherence. Methods This cross-sectional study included 632 adult women living with HIV (WLHIV). Data was retrospectively extracted from patient files. Drug.com interaction checker website was used to assess DDIs between ART and non-ART medications. Changes to the ART regimen previously attributed to ART side effects or patient non-adherence were considered drug changes. Results A total of 429 WLHIV (mean age: 44.05 ± 9.50) were eligible. The prevalence of DDIs between ART and non-ART medications was 21.4%, with 4.7% minor, 18.4% moderate, and 8.9% major interactions. The highest prevalence of DDI was among cardiovascular medication users (71.7%), followed by central nervous system drugs (69.2%). Changing medications resulted in a decrease in DDIs, with significant reductions in total and minor interactions. Participants without DDIs had better adherence to ART. DDI between ART and non-ART medications was significantly associated with ART drug change, even after accounting for side effects attributed to ARTs, indicating an independent twofold association (OR = 1.99, CI 1.04–3.77). Moreover, further adjustments for HIV viral load and CD4 + cell count did not change the significance of the association (OR = 2.01, CI 1.03–3.92). Conclusion DDIs in WLHIV impact adherence to ART. Altering ART may not be directly related to ART side effects, but rather primarily due to interactions with non-ART medications. Modifying non-ART drug regimens can reduce the likelihood of DDIs.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.10.2024
Tilføjet 9.10.2024
Abstract Objective To develop and validate a machine learning model for predicting mortality-associated prognostic factors in order to reduce in-hospital mortality rates among HIV/AIDS patients with Cryptococcus infection in Guangxi, China. Methods This retrospective prognostic study included HIV/AIDS patients with cryptococcosis in the Fourth People’s Hospital of Nanning from October 2011 to June 2019. Clinical features were extracted and used to train ten machine learning models, including Logistic Regression, KNN, DT, RF, Adaboost, Xgboost, LightGBM, Catboost, SVM, and NBM, to predict the outcome of HIV patients with cryptococcosis infection. The sensitivity, specificity, AUC, and F1 value were applied to assess model performance in both the testing and training sets. The optimal model was selected and interpreted. Results A total of 396 patients were included in the study. The average in-hospital mortality of HIV/AIDS patients with cryptococcosis was 12.9% from 2012 to 2019. After feature screening, 20 clinical features were selected for model construction, accounting for 93.8%, including ART, Electrolyte disorder, Anemia, and 17 laboratory tests. The RF model (AUC 0.9787, Sensitivity 0.9535, Specificity 0.8889, F1 0.7455) and the SVM model (AUC 0.9286, Sensitivity 0.7907, Specificity 0.9786, F1 0.8293) had excellent performance. The SHAP analysis showed that the primary risk factors for prognosis prediction were identified as BUN/CREA, Electrolyte disorder, NEUT%, Urea, and IBIL. Conclusions RF and SVM machine learning models have shown promising predictive abilities for the prognosis of hospitalized HIV/AIDS patients with cryptococcosis, which can aid clinical assessment and treatment decisions for patient prognosis.
Læs mere Tjek på PubMedClinical Infectious Diseases, 8.10.2024
Tilføjet 8.10.2024
Abstract Background The need for frequent travel to a clinic could impair access to injectable antiretroviral therapy for persons living with human immunodeficiency virus type 1 (HIV-1) infection. We hypothesized that allowing persons receiving treatment with long-acting injectable cabotegravir plus rilpivirine (LA CAB/RPV) to receive and store the medication in their own refrigerator prior to in-home administration by a healthcare provider would be as safe and effective as receiving treatment in a clinic.Methods Persons prescribed LA CAB/RPV in the Infectious Diseases clinic at the Medical University of South Carolina were offered enrollment in this non-randomized, observational study between August 2021 and December 2022. After in-clinic receipt of the initial LA CAB/RPV injection, participants chose to receive each subsequent injection over the following 12-months either in clinic or at home.Results The 33 enrolled participants were primarily Black (64%), male (73%), and had a median age of 46. Three participants stopped LA CAB/RPV and transitioned to oral antiretroviral therapy due to allergy (n = 1), loss of virologic suppression (n = 1), and visit adherence (n = 1) concerns. A comparable number of participants received treatment primarily in clinic (n = 18) relative to at home (n = 15). Injection site pain/soreness was common (52% of injections) but did not differ between groups. There were no differences in safety or efficacy between groups and both groups reported high treatment satisfaction. All participants were virologically suppressed and retained in care at the end of the study.Conclusions At-home administration of LA CAB/RPV by a healthcare provider was comparably safe, effective, and associated with high participant satisfaction relative to in-clinic administration.
Læs mere Tjek på PubMedClinical Infectious Diseases, 8.10.2024
Tilføjet 8.10.2024
Abstract Introduction Since its global reemergence in 2022, monkeypox (mpox) has demonstrated increased incidence and severity among people with human immunodeficiency virus (HIV [PWH]). Predictors of mpox diagnosis, vaccination, and outcomes among PWH are limited.Methods We included PWH with primary care visits after 1 January 2022 at 9 US sites participating in the Centers for AIDS Research Network of Integrated Clinic Systems Network. We identified mpox diagnosed between 1 June 2022 and 31 May 2023, through a combination of polymerase chain reaction result, diagnosis code, and/or tecovirimat receipt. We examined validated clinical diagnoses, laboratory results, vaccine data, and patient reported outcomes. We evaluated relative risks (RR) of mpox diagnosis, hospitalization, tecovirimat treatment, and vaccine receipt.Findings Among 19 777 PWH in care, 413 mpox cases (all male sex at birth) occurred (2.2 cases/100 person-years). Age
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