Defining the PrEP care continuum among recently incarcerated men at high risk for HIV infection (Preprint)

2021 ◽  
Author(s):  
Matthew Murphy ◽  
Colette Sosnowy ◽  
Brooke Rogers ◽  
Siena Napoleon ◽  
Drew Galipeau ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
Hiv Infection ◽  
Care Continuum ◽  
Increased Risk ◽  
Biomedical Intervention ◽  
Prep Implementation ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Prospective Longitudinal

BACKGROUND HIV disproportionately impacts criminal justice (CJ)-involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in CJ-systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. OBJECTIVE This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. METHODS Men incarcerated in the Rhode Island Department of Corrections, a correctional system composed of all of the state's sentenced and awaiting trial population, are screened for HIV acquisition risk during the course of routine clinical care. Those identified at high risk for HIV acquisition are referred for evaluation for PrEP initiation and enrollment in this study. Individuals who express interest in initiating PrEP and consent to the study are then followed in a prospective longitudinal cohort. RESULTS The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to incarceration and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. CONCLUSIONS Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the CJ-context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic.

scholarly journals HPV infection and the genital cytokine milieu in women at high risk of HIV acquisition

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Lenine J. P. Liebenberg ◽  
Lyle R. McKinnon ◽  
Nonhlanhla Yende-Zuma ◽  
Nigel Garrett ◽  
Cheryl Baxter ◽  
...  
Keyword(s):  
High Risk ◽  
Hiv Infection ◽  
Hpv Vaccination ◽  
Fold Increase ◽  
Hpv Infection ◽  
Hpv Prevalence ◽  
Hpv Status ◽  
Cytokine Milieu ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

AbstractHuman papillomavirus (HPV) infection correlates with higher rates of HIV acquisition, but the underlying biological mechanisms are unclear. Here we study associations between HPV and HIV acquisition and relate these to vaginal cytokine profiles in an observational cohort of women at high risk of HIV infection (CAPRISA 004, n = 779) and with 74% HPV prevalence. We report here that HPV infection associates with a 2.5-fold increase in HIV acquisition risk in this population (95% CI: 1.2–5.3). Among 48 vaginal cytokines profiled, cytokines associated with HPV infection overlap substantially with cytokines associated with HIV risk, but are distinct from those observed in HPV negative women. Although our data do not establish a causative link between HPV status and the risk of HIV, we suggest that increasing HPV vaccination coverage may carry an additional benefit of reducing the risk of contracting HIV infection, particularly in regions with high HPV prevalence.

scholarly journals Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis

2020 ◽  
pp. sextrans-2020-054706
Author(s):  
Meng Yin Wu ◽  
Hui Zi Gong ◽  
Kui Ru Hu ◽  
He-yi Zheng ◽  
Xia Wan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
High Risk ◽  
Meta Analysis ◽  
Risk Groups ◽  
Hiv Incidence ◽  
Syphilis Infection ◽  
High Risk Populations ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

ObjectivesCo-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations.MethodsFive electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics.ResultsA total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)).ConclusionsSyphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.

scholarly journals Cervicovaginal Levels of Lactoferrin, Secretory Leukocyte Protease Inhibitor, and RANTES and the Effects of Coexisting Vaginoses in Human Immunodeficiency Virus (HIV)-Seronegative Women with a High Risk of Heterosexual Acquisition of HIV Infection

2007 ◽  
Vol 14 (9) ◽  
pp. 1102-1107 ◽  
Author(s):  
Richard M. Novak ◽  
Betty A. Donoval ◽  
Parrie J. Graham ◽  
Lucy A. Boksa ◽  
Gregory Spear ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
High Risk ◽  
Hiv Infection ◽  
Protease Inhibitor ◽  
Genital Tract ◽  
Secretory Leukocyte Protease Inhibitor ◽  
Low Risk ◽  
High Risk Women ◽  
Increased Risk ◽  
Immunodeficiency Virus

ABSTRACT Innate immune factors in mucosal secretions may influence human immunodeficiency virus type 1 (HIV-1) transmission. This study examined the levels of three such factors, genital tract lactoferrin [Lf], secretory leukocyte protease inhibitor [SLPI], and RANTES, in women at risk for acquiring HIV infection, as well as cofactors that may be associated with their presence. Women at high risk for HIV infection meeting established criteria (n = 62) and low-risk controls (n = 33) underwent cervicovaginal lavage (CVL), and the CVL fluid samples were assayed for Lf and SLPI. Subsets of 26 and 10 samples, respectively, were assayed for RANTES. Coexisting sexually transmitted infections and vaginoses were also assessed, and detailed behavioral information was collected. Lf levels were higher in high-risk (mean, 204 ng/ml) versus low-risk (mean, 160 ng/ml, P = 0.007) women, but SLPI levels did not differ, and RANTES levels were higher in only the highest-risk subset. Lf was positively associated only with the presence of leukocytes in the CVL fluid (P < 0.0001). SLPI levels were lower in women with bacterial vaginosis [BV] than in those without BV (P = 0.04). Treatment of BV reduced RANTES levels (P = 0.05). The influence, if any, of these three cofactors on HIV transmission in women cannot be determined from this study. The higher Lf concentrations observed in high-risk women were strongly associated with the presence of leukocytes, suggesting a leukocyte source and consistent with greater genital tract inflammation in the high-risk group. Reduced SLPI levels during BV infection are consistent with an increased risk of HIV infection, which has been associated with BV. However, the increased RANTES levels in a higher-risk subset of high-risk women were reduced after BV treatment.

scholarly journals Identifying Vulnerable Populations in Subtropical Brisbane, Australia: A Guide for Heatwave Preparedness and Health Promotion

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Margaret Loughnan ◽  
Nigel Tapper ◽  
Thu Phan
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Spatial Distribution ◽  
High Risk ◽  
Urban Areas ◽  
Spatiotemporal Analysis ◽  
Prevention Policy ◽  
Increased Risk ◽  
Risk Areas ◽  
Heat Events

Building healthy societies is a key step towards climate resilient communities. Ill health is related to increased risk during heat events and is disproportionally distributed within and between communities. To understand the differences in the spatial distribution of climate related health risks and how this will change in the future we have undertaken a spatiotemporal analysis of heatwave risks in urban populations in Brisbane, Australia. The aim of this was to advise emergency managers and public health authorities of high-risk areas during extreme heat events (EHEs). The spatial distribution of heat related morbidity identified areas of high healthcare service demand during EHEs. An index of risk was developed based on social and environmental determinants of vulnerability. Regression analysis was used to determine the key drivers of heat related morbidity from the index. A weighted map of population vulnerability was produced which identified the high risk areas and provided key information to target public health interventions and heat stress prevention policy. The predicted changes in high risk populations such as the proportion of elderly people living in urban areas were also mapped to support longer term adaptation and develop health care infrastructure and health promotion strategies.

scholarly journals 1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S595-S595
Author(s):  
Hampton Ocon ◽  
Samir Sabbag
Keyword(s):  
Public Health ◽  
High Risk ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Perceived Risk ◽  
Health Initiatives ◽  
History Of ◽  
Sex With Men ◽  
Public Health Initiatives

Abstract Background According to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection. Methods In an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing. Results Of the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595). Conclusion This suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk. Disclosures All authors: No reported disclosures.

Peer Crowd Identification and Adolescent Health Behaviors: Results From a Statewide Representative Study

2018 ◽  
Vol 46 (1) ◽  
pp. 40-52 ◽  
Author(s):  
Jeffrey W. Jordan ◽  
Carolyn A. Stalgaitis ◽  
John Charles ◽  
Patrick A. Madden ◽  
Anjana G. Radhakrishnan ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
High Risk ◽  
Health Behaviors ◽  
Representative Sample ◽  
Risky Behaviors ◽  
Risk Groups ◽  
Representative Study ◽  
Increased Risk ◽  
Peer Crowds

Purpose. Peer crowds are macro-level subcultures that share similarities across geographic areas. Over the past decade, dozens of studies have explored the association between adolescent peer crowds and risk behaviors, and how they can inform public health efforts. However, despite the interest, researchers have not yet reported on crowd size and risk levels from a representative sample, making it difficult for practitioners to apply peer crowd science to interventions. The current study reports findings from the first statewide representative sample of adolescent peer crowd identification and health behaviors. Methods. Weighted data were analyzed from the 2015 Virginia Youth Survey of Health Behaviors ( n = 4,367). Peer crowds were measured via the I-Base Survey™, a photo-based peer crowd survey instrument. Frequencies and confidence intervals of select behaviors including tobacco use, substance use, nutrition, physical activity, and violence were examined to identify high- and low-risk crowds. Logistic regression was used to calculate adjusted odds ratios for each crowd and behavior. Results. Risky behaviors clustered in two peer crowds. Hip Hop crowd identification was associated with substance use, violence, and some depression and suicidal behaviors. Alternative crowd identification was associated with increased risk for some substance use behaviors, depression and suicide, bullying, physical inactivity, and obesity. Mainstream and, to a lesser extent, Popular, identities were associated with decreased risk for most behaviors. Conclusions. Findings from the first representative study of peer crowds and adolescent behavior identify two high-risk groups, providing critical insights for practitioners seeking to maximize public health interventions by targeting high-risk crowds.

scholarly journals High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W Peng ◽  
Andrew Hayen ◽  
J a n e Maguire ◽  
J o n Adams ◽  
David Sibbritt
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cox Regression ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Stroke Survivors ◽  
Vigorous Exercise ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke. Methods Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or &gt; 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders. Results We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2). Conclusions High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors. Key messages It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

scholarly journals Food insecurity and the risk of HIV acquisition: Findings from population-based surveys in six sub-Saharan African countries (2016-2017)

2021 ◽  
Author(s):  
Andrea Low ◽  
Elizabeth Gummerson ◽  
Amee Schwitters ◽  
Rogerio Bonifacio ◽  
Mekleet Teferi ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Food Insecurity ◽  
Risk Behaviors ◽  
Population Based ◽  
Adjusted Relative Risk ◽  
African Countries ◽  
The Past ◽  
Increased Risk ◽  
Hiv Acquisition ◽  
Recent Hiv Infection

Introduction: Food insecurity has a bidirectional relationship with HIV infection, with hunger driving compensatory risk behaviors, while infection can increase poverty. We used a laboratory recency assay to estimate the timing of HIV infection vis-a-vis the timing of severe food insecurity (SFI). Methods: Data from population-based surveys in Zambia, Eswatini, Lesotho, Uganda, and Tanzania and Namibia were used. We defined SFI as having no food ≥three times in the past month. Recent HIV infection was identified using the HIV-1 LAg avidity assay, with a viral load (>1000 copies/ml) and no detectable antiretrovirals indicating an infection in the past 6 months. Logistic regression was conducted to assess correlates of SFI. Poisson regression was conducted on pooled data, adjusted by country to determine the association of SFI with recent HIV infection and risk behaviors, with effect heterogeneity evaluated for each country. All analyses were done using weighted data. Results: Of 112,955 participants aged 15-59, 10.3% lived in households reporting SFI. SFI was most common in urban, woman-headed households. Among women and not men, SFI was associated with a two-fold increase in risk of recent HIV infection (adjusted relative risk [aRR] 2.08, 95% CI 1.09-3.97), with lower risk in high prevalence countries (Eswatini and Lesotho). SFI was associated with transactional sex (aRR 1.28, 95% CI 1.17-1.41), a history of forced sex (aRR 1.36, 95% CI 1.11-1.66), and condom-less sex with a partner of unknown or positive HIV status (aRR 1.08, 95% CI 1.02-1.14) in all women, and intergenerational sex (partner ≥10 years older) in women aged 15-24 (aRR 1.23, 95% CI 1.03-1.46), although this was heterogeneous. Recent receipt of food support was protective (aRR 0.36, 95% CI 0.14-0.88). Conclusion: SFI increased risk for HIV acquisition in women by two-fold. Worsening food scarcity due to climactic extremes could imperil HIV epidemic control.

scholarly journals Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum (Preprint)

2020 ◽  
Author(s):  
Bonnie R Chivers ◽  
Rhonda M Garad ◽  
Jacqueline A Boyle ◽  
Helen Skouteris ◽  
Helena J Teede ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
Sentiment Analysis ◽  
Thematic Analysis ◽  
Public Discourse ◽  
External Environment ◽  
Perinatal Period ◽  
System Level ◽  
Anticipatory Grief ◽  
Increased Risk

BACKGROUND The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. OBJECTIVE The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. METHODS A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included “COVID,” “corona,” and “pandemic.” A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. RESULTS The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including “worried” (n=165, 19.9%), “risk” (n=143, 17.2%), “anxiety” (n=98, 11.8%), “concerns” (n=74, 8.8%), and “stress” (n=69, 8.3%). CONCLUSIONS Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.

scholarly journals Echocardiographic Assessment of Asymptomatic US Air Force Members with Early HIV Infection

2019 ◽  
Author(s):  
Gadiel Rafael Alvarado ◽  
Courtney Usry ◽  
Rosco Gore ◽  
James Watts ◽  
Jason Okulicz
Keyword(s):  
Hiv Infection ◽  
Air Force ◽  
Global Longitudinal Strain ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Cvd Risk ◽  
Us Air Force ◽  
Increased Risk ◽  
Hiv Acquisition ◽  
Living With Hiv

Abstract Objective People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD) and development of subclinical echocardiographic abnormalities. The pathogenicity of HIV induced cardiotoxicity has been described however the time to development of echocardiographic abnormalities after HIV acquisition remains unclear. In this study we describe the echocardiographic evaluations of asymptomatic US Air Force members who were diagnosed with HIV infection. Results Patients (n=50) were predominantly male (96%), mostly black (60%), with a mean age of 28 years. At HIV diagnosis, the mean viral load was 112,585 copies/mL and CD4 count was 551 cells/uL; 2 patients were diagnosed with AIDS. All were found to have normal systolic ejection fraction (EF) and global longitudinal strain (GLS) however evidence of right ventricular dilatation and cardiac remodeling was observed in 7 (14%) and 13 (26%) patients, respectively. Subgroup analyses showed no significant differences in echocardiographic findings by HIV disease severity or CVD risk factors (p >0.05 for all). This study suggests that untreated HIV may have a low impact on the development of echocardiographic abnormalities shortly after seroconversion. Longitudinal studies are warranted to determine the optimal CVD risk assessment strategies for PLHIV.

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