The viral infection of the central nervous system is a significant public health concern. So far, most clinical cases of viral neuroinvasion are dealt with supportive and/or symptomatic treatments due to the unavailability of specific treatments. Thus, developing specific therapies is required to alleviate neurological symptoms and disorders. In this review, we shed light on molecular aspects of viruses\' entry into the brain which upon targeting with specific drugs have shown promising efficacy in vitro and in preclinical in vivo model systems. Further assessing the therapeutic potential of these drugs in clinical trials may offer opportunities to halt viral neuroinvasion in humans.

Since the identification of human immunodeficiency virus type 1 (HIV‐1) in 1983, many improvements have been made to control viral replication in the peripheral blood and to treat opportunistic infections. This has increased life expectancy but also the incidence of age‐related central nervous system (CNS) disorders and HIV‐associated neurodegeneration/neurocognitive impairment and depression collectively referred to as HIV‐associated neurocognitive disorders (HAND). HAND encompasses a spectrum of different clinical presentations ranging from milder forms such as asymptomatic neurocognitive impairment or mild neurocognitive disorder to a severe HIV‐associated dementia (HAD). Although control of viral replication and suppression of plasma viral load with combination antiretroviral therapy has reduced the incidence of HAD, it has not reversed milder forms of HAND. The objective of this review, is to describe the mechanisms by which HIV‐1 invades and disseminates in the CNS, a crucial event leading to HAND. The review will present the evidence that underlies the relationship between HIV infection and HAND. Additionally, recent findings explaining the role of neuroinflammation in the pathogenesis of HAND will be discussed, along with prospects for treatment and control.

Antimicrobial Agents and Chemotherapy, Ahead of Print.

Antimicrobial Agents and Chemotherapy, Ahead of Print.

Abstract Purpose As healthcare workers (HCW) have been disproportionally affected by COVID-19, its post-acute sequelae (PASC) in HCW can impact healthcare systems. We assessed the burden and course of PASC in HCW over a 30-month period. Methods In a prospective multicentre HCW cohort in Switzerland, PASC surveys were conducted in 03/2021, 09/2021, 06/2022, 04/2023, and 10/2023. Stratified by viral variant at first infection, the prevalence of PASC symptoms, self-experienced PASC and the Post-COVID Functional Status (PCFS) were analysed cross-sectionally in 10/2023, self-perceived success of therapeutic measures used was assessed. The evolution of PASC symptoms and PCFS in Wild-type and non-Wild-type infected HCW compared to uninfected controls was analysed longitudinally across all surveys. Results In cross-sectional analysis, 1704 HCW (median age 47 years, 82.2% female) were included. Thereof, 30.7% reported ≥ 1 PASC symptom in 10/2023, with 115 (6.7%) stating to have or have had PASC. Both were most common after Wild-type infection compared to other variants. Overall, 17/115 (15%) indicated relevant/severe restrictions in their daily activities and of 85 (74%) that tried ≥ 1 measure against their symptoms, 69 (81%) reported having benefitted. Longitudinal analysis (n = 653) showed a significantly higher proportion of Wild-type infected HCW to report PASC symptoms compared to controls in 03/2021 (+ 21%, 95% CI 4–39), with decreasing trend (+ 7%, 95%CI -10–25 in 10/2023). This effect was not evident for non-Wild-type infected HCW. Conclusions Over a 30 month period, overall PASC burden in our HCW cohort decreased, although 1% still experience relevant restrictions in their daily life; Wild-type infected individuals show the highest disease burden. …

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Journal of Medical Virology, Volume 96, Issue 11, November 2024.

Antimicrobial Resistance (AMR) is a global multi-faceted problem, often regarded as a “silent pandemic”, which is in part a consequence of misuse, overuse or negligent use of antimicrobials in the human, animal, plant, and environmental sectors [1,2].

Children responded robustly to successive waves of SARS-CoV-2 mounting IgG responses to spike antigen that were protective against subsequent waves. In the absence of vaccination almost all children were seropositive after the 5th wave but none were hospitalised suggesting natural immunity alone may be sufficient to protect children in a pandemic setting.

Abstract Background While there is evidence that COVID-19 vaccination protects against development of post-COVID conditions (PCC) after severe infection data are limited on whether vaccination reduces the risk after cases of less-severe non-hospitalized COVID-19 disease with more recent SARS-CoV-2 variant viruses. This study assessed whether COVID-19 vaccination was protective against subsequent development of PCC in persons with predominantly mild initial infections during both Delta and Omicron variant predominance.Methods This study utilized a case-control design, nested within the HEROES-RECOVER cohort. Participants aged ≥18 years with PCR-confirmed SARS-CoV-2 infection between 6/28/2021 and 9/14/2022 were surveyed for PCC, defined by symptoms lasting >1 month after initial infection Cases were participants self-reporting PCC and controls were participants that did not self-report PCC. The exposure was mRNA COVID-19 vaccination (2 or 3 monovalent doses) versus no COVID-19 vaccination. Logistic regression was used to compare the odds of PCC among vaccinated and unvaccinated persons; additional analyses evaluating PCC subtypes were also performed.Results A total of 936 participants with documented SARS-CoV-2 infection were included; of these 23.6% (221) reported PCC and 83.3% (779) were vaccinated. Participants who received a 3rd COVID-19 monovalent mRNA dose prior to infection had lower odds of PCC-related gastrointestinal, neurological, and other symptoms compared to unvaccinated participants (aOR: 0.37; 95% CI: 0.16-0.85; aOR: 0.56; 95% CI: 0.32-0.97; aOR:0.48; 95% CI: 0.25-0.91).Conclusions COVID-19 vaccination protected against development of PCC among persons with mild infection during both Delta and Omicron variant predominance, supporting vaccination as an important tool for PCC prevention.

ObjectivesTo investigate the use of maintenance immunosuppressive treatments following liver transplantation and to compare their risk–benefit profiles in clinical practice. DesignRetrospective multicentrer cohort study. SettingFour Italian regions (Lombardy, Veneto, Lazio, Sardinia). MethodsData were integrated from the national transplant information system and administrative claims data from four Italian regions. All adults who underwent incident liver transplantation between 2009 and 2019 were identified and categorised into two groups: cirrhosis or hepatocellular carcinoma (HCC). The trend of immunosuppressive treatment over years was analysed, and their effectiveness/safety profiles were compared using multivariate Cox models (HR; 95% CI). Main outcome measuresMortality, transplant reject/graft failure, incidence of severe infections, cancer, diabetes, major adverse cardiovascular events and lipid-modifying agents use. ResultsThe study comprised 750 subjects in the cirrhosis cohort and 1159 in the HCC cohort. Over the study years, there was a decline in the use of cyclosporine-CsA, while combination therapy involving tacrolimus with other drugs increased compared with monotherapy. Overall, tacrolimus monotherapy use was slightly over 40% in both groups, followed by tacrolimus+mycophenolate (39.5%-cirrhosis; 30.6%-HCC) and tacrolimus+molecular target of rapamycin inhibitors (mTORi) (8.5%-cirrhosis; 13.3%-HCC). No significant differences emerged in risk–benefit profile of different tacrolimus-based therapies, except for a higher risk of mortality in cirrhosis subjects under tacrolimus monotherapy compared with tacrolimus+mycophenolate (HR: 2.07; 1.17 to 3.65). ConclusionsThe study highlights a shift over time in postliver transplant therapeutic patterns, favouring the use of tacrolimus in combination with mycophenolate or mTORi, rather than monotherapy. Moreover, a potential association between tacrolimus monotherapy and increased mortality in the cirrhosis cohort was identified. Further research is warranted to investigate these findings more deeply and to optimise treatment strategies for liver transplant recipients. …

ObjectivesThe significance of the systemic inflammation response index (SIRI) for predicting prognostic outcomes in patients with non-small cell lung cancer (NSCLC) has been analysed in previous studies, but no consistent conclusions have been obtained. Consequently, the present meta-analysis was performed to identify the significance of SIRI in predicting the prognosis of NSCLC. DesignThis study followed the PRISMA guidelines. Data sourcesPubMed, Web of Science and Embase databases were searched between their inception and 26 November 2023. Eligibility criteria for selecting studiesStudies investigating the relationship between SIRI and survival outcomes of patients with NSCLC were included. Data extraction and synthesisThe value of SIRI in predicting prognosis in NSCLC cases was predicted using combined hazard ratios (HRs) and 95% CIs. ResultsNine articles with 3728 cases were enrolled in this study. Based on our combined data, a higher SIRI value was markedly linked with poor overall survival (OS) (HR=2.08, 95% CI 1.68 to 2.58, p

IntroductionTraumatic brain injury (TBI) is one of the prevalent critical illnesses encountered in clinical practice, often resulting in a spectrum of consciousness disorders among survivors. Prolonged states of impaired consciousness can significantly elevate the susceptibility to complications such as urinary tract infections and pulmonary issues, consequently leading to a compromised prognosis and substantially impacting the quality of life for affected individuals. Clinical studies have reported that median nerve electrical stimulation (MNES) may have a therapeutic effect in the treatment of disorders of consciousness (DOC). We plan to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of MNES in the management of DOC subsequent to TBI. Methods and analysisWe will conduct a comprehensive literature search in the following electronic databases: Web of Science, Embase, PubMed, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database. The search will be performed from the inception of the databases until 30 September 2024. Furthermore, we will search for relevant ongoing trials in the International Clinical Trial Registry Platform, ClinicalTrials.gov and China Clinical Trial Registry. Grey literature will also be sourced from reputable sources like GreyNet International, Open Grey and Google Scholar. We will include eligible randomised controlled trials. The primary outcome of interest will be the assessment of consciousness disorder severity. To ensure rigour and consistency, two independent reviewers will screen the studies for inclusion, extract relevant data and assess the risk of bias. Any discrepancies will be resolved through discussion or consultation with a third reviewer. The quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data synthesis and meta-analysis will be conducted using STATA 15.1 software. Ethics and disseminationThis systematic review and meta-analysis do not involve the collection or use of any individual patient data, thereby obviating the necessity for ethical review. The research findings will be disseminated through publication in peer-reviewed scientific journals. PROSPERO registration numberCRD42024533359. …

ObjectivesIn Tanzania, only 45% of babies are still exclusively breast feeding at 4–5 months of age and maternal employment contributes to suboptimal breastfeeding practices. The objective of this study was to determine the prevalence and factors associated with exclusive breast feeding up to 6 months among mothers in formal employment in Dar es Salaam, Tanzania. DesignThis was a cross-sectional study. SettingThe study was conducted at reproductive and child health clinics of three hospitals in Dar es Salaam, Tanzania. Participants327 mothers in formal employment were recruited during their infants’ 9-month vaccination visit. Primary and secondary outcome measuresA self-administered questionnaire was used to collect data on exclusive breast feeding and associated factors. Pearson’s 2 was used to test for association and multivariable logistic regression was used to determine independent variables associated with exclusive breast feeding. ResultsThe prevalence of exclusive breast feeding up to 6 months was 38.5% (95% CI 33%, 44%). Having rooms to express milk, breastfeeding policies and flexible work schedules were associated with exclusive breast feeding in 2 analysis. In multivariable analysis, mothers who had flexible schedules were two times more likely to practice exclusive breast feeding compared with those who did not have flexible schedules: aOR 2.58 (95% CI 1.15, 5.78). ConclusionRates of exclusive breast feeding among mothers in formal employment are lower than the national average. Policies and programmes that offer flexible work schedules to this population can support exclusive breast feeding. …

Abstract Background Hospital-associated infection (HAI) is an important issue in intensive care units (ICUs). We still lack direct evidence on whether the ICU patients and/or the medical system can benefit from single isolated laminar-air-flow (LAF) wards. Methods High-touched-surface (HTS) swabs from 5 sites in two kinds of wards with different ventilation systems were longitudinally collected for 16 S rRNA sequencing and Type IIB restriction site-associated DNA sequencing for Microbiome (2bRAD-M). Samples were collected for 3 months. The clinical data of patients admitted to different wards during the sampling time and the whole year were collected and compared. Results The α-diversity of single wards with isolated LAF was significantly higher than open regions without LAF (p

Abstract Shortly after the first case of SARS-CoV-2 was diagnosed a public health emergency (PHE) was declared and a multi-agency response was initiated within the US federal government to create and propagate testing capacity. As part of this response, an unprecedented program designated Rapid Acceleration of Diagnostics (RADx) Tech was established by the National Institutes of Health (NIH) to facilitate the development of point-of-care tests for the COVID-19. The RADx Tech Clinical Studies Core (CSC), located at the University of Massachusetts Chan Medical School (UMass Chan), with partnering academic, private, and non-governmental organizations around the country, was tasked with developing clinical studies to support this work. This manuscript details development of a biorepository specifically focused on the collection and storage of samples designed for diagnostic platform development. It highlights the unified collection and annotation process that enabled gathering a diverse set of samples. This diversity encompasses the geography and backgrounds of the participants as well as sample characteristics such as variant type and RT-PCR cycle threshold (CT) value of the corresponding reference sample on a uniform clinical reference platform. …

Abstract Background Schistosoma japonicum, the causative agent of schistosomiasis, heavily relies on its single intermediate host, the Oncomelania hupensis snail, for its life cycle. Controlling these snails effectively plays a pivotal role in curbing the transmission and prevalence of this disease. While prior research has extensively investigated the impact of environmental factors such as temperature and vegetation on snail survival, growth, and reproduction, the contribution of water physicochemical properties has been notably underexplored. This study presents laboratory experiments designed to comprehensively explore the influence of water physicochemical properties on snail survival, offering valuable insights into environmental factors for more precise predictions of snail distribution. Methods We meticulously conducted laboratory snail survival experiments using water from different sources (river water/tap water), and employed a statistical approach amalgamating principal component analysis with Cox regression to preliminarily investigate the effects of different water physicochemical properties on the survival of snails. Results Our analysis indicates that after a 6-month laboratory snail survival experiment, the survival rate in the tap water group was significantly higher than that in the river water group for infected snails (χ2 = 7.74, p = 0.005), while the difference in survival rates for non-infected snails was not statistically significant (χ2 = 0.61, p = 0.434). The Principal Component-Cox regression analysis revealed that in the infected snail group, total phosphorus, pH value, five-day biochemical oxygen demand, conductivity, and nitrite were protective factors for snail survival, while phosphate and total nitrogen were risk factors. In the non-infected snail group, total phosphorus, pH value, five-day biochemical oxygen demand, conductivity, and nitrite were protective factors for snail survival, and total nitrogen, ammonia nitrogen, phosphate, and nitrate were risk factors. Conclusions This study underscores the substantial impact of water quality’s physicochemical properties on snail survival. The effects of water quality on snails are complex, and maintaining an appropriate level of organic matter content and controlling the pH value at a weak alkalescency level prove beneficial for snail survival. These findings hold significant promise for advancing our understanding of snail-borne diseases and optimizing control strategies. …

Abstract Background Influenza is a major cause of morbidity and mortality. Influenza A virus (IAV) is one of the most important pathogens causing influenza and often causes global pandemics due to its tendency to mutate. We aim to use epidemiology based on wastewater and respiratory specimens to understand the occurrence of influenza A virus infections in Taiyuan City. Methods A retrospective epidemiology surveillance was carried out at the First Hospital of Shanxi Medical University (FHSMU) and five wastewater treatment plants (WTPs) in Taiyuan city from 2023 to 2024. Reverse transcription real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was used to detect influenza A viruses in wastewater and respiratory specimens. High-throughput whole genome sequencing was performed on 17 strains obtained in this study, and subsequent analyses included characterization, phylogenetic construction, amino acid mutation analysis, and antigenic structural variability assessment. Results 520 wastewater samples and 1,203 throat swab samples were collected. We detected RNA concentration from pH1N1 and H3N2 viruses in wastewater and got 17 genome sequences (5 of pH1N1 and 12 of H3N2) in respiratory specimens. Whole-genome sequencing showed co-prevalence of pH1N1 viruses in the branches of 6B.1 A.5a.2a.1 and H3N2 viruses in the branches of 3 C.2a1b.2a.2a.3a.a in Taiyuan from 2023 to 2024. Moreover, a HA mutation (N138D), predicted to be of high phenotypic consequence, was found in 8 Taiyuan H3N2 sequences. Conclusion This study highlights the predominant presence of pH1N1 and H3N2 strains in Taiyuan. The analysis also identified amino acid site variations in the HA antigenic epitopes in H3N2 strains, which may contribute to immune escape. …

Abstract Background Intestinal parasitic infections (IPIs) are serious global public health issues, especially in low and middle-income countries. These parasites can cause high morbidity and mortality, especially in immunocompromised individuals, and can easily be transmitted by consumption of contaminated food or water or by penetration of skin and mucous membranes. Methods We retrospectively analyzed all archived data from stool examination reports at the Parasitology Unit of Precise Health Diagnostic Services, Berekum for the prevalence and trends of parasitic infections spanning a period of 9 years (2013–2021). The data was retrieved and exported to IBM SPSS v.26 for statistical analysis. Descriptive data was summarized as proportions and presented in tables and charts. Pearson Chi-Square test (χ2) or Fisher’s exact test was used to test for a statistical association between demographic factors and intestinal parasitic infections. P value was significant at

Abstract Background Intestinal parasitic (IP) infections caused by helminths are among the most significant public health concerns that mainly affect deprived people in Sub-Sahara African countries. The current study aimed to determine the prevalence and associated risk factors of intestinal parasitic helminths among patients attending Mekaneselam hospital. Method In this cross-sectional study conducted from August 2022 to February 2023, stool specimens were collected and examined microscopically to detect intestinal helminths using direct wet-mount and formal-ether concentration techniques. A structured questionnaire was employed to obtain information regarding the socio-demographic characteristics and associated risk factors. Data were analyzed via appropriate univariate and multivariable logistic regression methods using SPSS version 25.0. Result The overall prevalence of the parasitic helminths was 51 (12.6%) out of 404 patients attending in Mekaneselam town during the study period. In this study, seven species of intestinal helminths were detected, with Ascaris lumbricoides (5.7%) being the most prevalent followed by Trichuris trichiura (2.2%). Significant positive associations were observed between intestinal helminths infection and the socio-demographic characteristics including marital status (χ2 = 7.97, p = 0.047), educational level (χ2 = 9.34, p = 0.025) and residence (χ2 = 3.90, p = 0.048). The odds of being infected with IP were three times higher among divorced patients than married individuals (AOR = 3.21, CI = 1.15–8.96, p = 0.03). Illiterate individuals were three times (AOR = 2.61, CI = 1.24–5.49, p = 0.011) and those who attended primary school were two times (AOR = 2.3, CI = 1.029–5.143, p = 0.042), more likely to have helminthic infections. Participants who did not wash their hands after using the toilet were five times more likely to acquire IP helminths than those who did (AOR = 4.36, CI = 2.83–6.72, p = 0.000). In the case of the feeding habit, study subjects who ate unwashed vegetables were more likely to acquire helminths than those who did not eat unwashed vegetables (AOR = 5. 43, CI = 4.33–23.77, p = 0.000). Conclusion This study highlighted a substantial prevalence of intestinal helminths infections (12.6%) in the study area, warranting the urgent need for attention and interventions from relevant public health authorities. …

Abstract Background The primary objectives of our research were to analyze Lyme serology results from pediatric patients, identify the clinical reasons for ordering these tests, and assess the clinical relevance of the serology results in the context of Lyme disease. Methods Our study, conducted at a reference pediatric hospital in a non-endemic region for Lyme disease, included all pediatric patients for whom Lyme serology was requested. ELISA and Western blot results were documented. Presenting complaints and findings at the time of admission were recorded. Diagnostic tests were categorized as first-step tests if conducted during the initial visit. Subsequent tests, sent due to the inability to establish a diagnosis based on the results of the first-line tests, were defined as second and third-step tests, respectively. Results 219 patients, for whom Lyme serology had been requested for varying reasons, were included in our study. The most prevalent complaints and indications observed in the presentations of patients with serology requests were as follows: headache(24.7%), paresis/paresthesia(14.6%), and painful or blurred vision(13.2%). Serology was primarily requested in the presence of neurological(59.4%) and ocular symptoms(13.2%). 68% of the tests were requisitioned during the initial consultation. Nevertheless, it was discerned that no patient received a diagnosis of Lyme disease. Conclusion According to the guidelines, Lyme serology should only be performed when there is a realistic possibility of exposure to infected ticks, particularly in patients who have had untreated erythema migrans or those with a history of a tick bite presenting with unexplained joint or neurological symptoms. Our data, in line with these guidelines, suggests that unnecessary Lyme serology testing in non-endemic areas, where exposure is highly unlikely, may lead to false-positive results and unnecessary follow-up testing, as illustrated by the high rate of false-positive ELISAs in our cohort. …

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Proceedings of the National Academy of Sciences, Volume 121, Issue 46, November 2024.

Objective: The possible differences in comorbidity burden were examined between people with longstanding HIV infection and those with shorter HIV duration of the same calendar age. Design: We performed a single-centre retrospective cohort analysis comparing long-term HIV survivors (LTS) diagnosed with HIV before 1996 (pre-HAART), with an age-matched and gender-matched group diagnosed after 2006 [modern ART era (mART)]. Methods: Demographic and outcome data up to 1 May 2023 were obtained from electronic health records as well as from digitalized paper charts. Nine comorbidity domains were defined to overlook the comorbidity burden as on 1 May 2023: cardiovascular, musculoskeletal, neurological, oncological, liver, pulmonary, renal, psychiatric/cognitive, and metabolic. Results: Eighty-eight LTS and 88 people diagnosed in the modern ART era were included in the analysis. Median age in both groups was 60 years. LTS had a higher mean number of comorbidity domains than controls (2.6 vs. 1.9; P = .001). In both LTS and mART groups, metabolic and cardiovascular comorbidity was most prevalent (metabolic 70.5 and 52.3%, respectively, cardiovascular 44.3 and 38.6%, respectively). When stratified according to age, the distribution of the number of comorbidities for LTS roughly resembled the 10 years older mART subgroup. In a multivariate analysis, total ART duration and age were found to be statistically significantly associated with the number of comorbidity domains. Conclusion: Our analysis suggests that LTS have a higher comorbidity burden compared with people diagnosed in the modern ART era of similar calendar age. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Objectives: To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities. Design: Quantitative data analyses in a racially and gender diverse, mixed-serostatus prospective cohort, the MACS/WIHS Combined Cohort Study. Methods: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021—September 2022 (n=3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether a) medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and b) vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 non-vaccination. Results: Participants’ mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of white participants). Black-identified participants had higher odds of non-vaccination than white participants (aOR = 1.72; 95% CI: 1.08, 2.72). Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46.0% of the effect (p …

Objective: To identify predictors of HIV acquisition in Botswana. Design: We applied machine learning approaches to identify HIV risk predictors using existing data from a large, well-characterized HIV incidence cohort. Methods: We applied machine learning (randomForestSRC) to analyze data from a large population-based HIV incidence cohort enrolled in a cluster-randomized HIV prevention trial in 30 communities across Botswana. We sought to identify the most important risk factors for HIV acquisition, starting with 110 potential predictors. Results: During a median 29-month follow-up of 8,551 HIV-negative adults, 147 (1.7%) acquired HIV. Our machine learning analysis found that for females, the most important variables for predicting HIV acquisition were the use of injectable hormonal contraception, frequency of sex in the prior 3 months with the most recent partner and residing in a community with HIV prevalence of 29% or higher. For the small proportion (0.3%) of females who had all three risk factors, their estimated probability of acquiring HIV during 29 months of follow-up was 34% (approximate annual incidence of 14%). For males, non-long-term relationships with the most recent partner and community HIV prevalence of 34% or higher were the most important HIV risk predictors. The 6% of males who had both risk factors had a 5.1% probability of acquiring HIV during the follow-up period (approximate annual incidence of 2.1%). Conclusions: Machine learning approaches allowed us to analyze a large number of variables to efficiently identify key factors strongly predictive of HIV risk. These factors could help target HIV prevention interventions in Botswana. Clinical Trials Registration: NCT01965470 Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.