OBJECTIVES: Homelessness increased by 31% from 2022 to 2023 in Denver, Colorado. We surveyed people experiencing homelessness in Denver to evaluate their health conditions and service needs and to identify factors associated with new or worsening health conditions after housing loss. METHODS: From October 28 through November 15, 2023, we surveyed 356 people experiencing homelessness in Denver. We fit multivariable logistic regression models using backward-fitting procedures to identify factors associated with reporting new or worsening health conditions after housing loss. RESULTS: The mean (SD) age of participants was 46.0 (13.7) years, 227 (63.7%) reported physical health conditions, and 207 (58.1%) reported mental health conditions that were new or worsening after experiencing homelessness. Chronic pain (n = 61; 17.1%) and depression (n = 123; 34.6%) were the most reported conditions. Eye care (n = 131; 36.8%), dental care (n = 95; 26.7%), and pain management (n = 54; 15.2%) were among the top service needs. Self-rated health declined by 22% after housing loss, from 3.4 (good or very good) before experiencing homelessness to 2.7 (fair or good) at the time of the survey, with a larger decline among those experiencing unsheltered homelessness than among those who were sheltered (0.95 vs 0.57; P = .006). As compared with men, women had higher odds of reporting new or worsening health conditions, whether physical (adjusted odds ratio [AOR] = 1.93; 95% CI, 1.14-3.29) or mental (AOR = 2.14; 95% CI, 1.23-3.81). Experiencing violence was associated with reporting new or worsening mental health conditions (AOR = 2.01; 95% CI, 1.20-3.37) after housing loss. CONCLUSION: Targeted interventions are needed to address the unique needs of unhoused women and those experiencing unsheltered homelessness in Denver.

BACKGROUND: According to the Centers for Disease Control and Prevention (CDC), there was a 480 % increase in overdose deaths among all women from 1999 to 2021 (Jones et al., 2024). Women are uniquely impacted by substance use and overdose due to biological and cultural differences compared to men. CDC launched the Overdose Data to Action (OD2A) cooperative agreement in 2019 with the goal of helping to mitigate the opioid overdose crisis across the United States by supporting state and local health departments. METHODS: This study focused on a review of programmatic data submitted by OD2A jurisdictions that detail their prevention activities to identify how jurisdictions implemented activities to address the unique needs of women. The team conducted systematic content analysis using multiple rounds of coding. RESULTS: Most activities were tailored for pregnant women or women who had recently given birth and focused on expanding capacity to meet their needs. The most common activities were capacity-building activities to enhance efforts to address overdose needs for women (specifically pregnant women), resource development/sharing, and implementation/evaluation of best or promising practices for women. CONCLUSION: While it is important that activities tailored for pregnant women continue, our study showed a gap in activities tailored to other populations of women where the problem may be the greatest, such as women who are incarcerated, women who engage in sex work, and other female sub-populations. To address overdose rates in women, future efforts would benefit from continuing activities for pregnant women but also attempting to reach other at-risk female populations.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a fatal, progressive neurodegenerative disease that typically results in death within 3-5 years from symptom onset. However, little is known about the environmental exposures, clinical aspects, or social determinants of health factors that may be associated with the disease. Multistep modeling has been previously applied to cancer research, demonstrating a linear relationship between logs of incidence and age. This method may help to understand the mechanisms involved in the development of ALS in the United States (e.g., environmental exposures, genetic mutations). We aim to assess whether ALS is a multistep process among patients enrolled in the largest ALS registry in the world-the United States' National ALS Registry. METHODS: Incident ALS cases, defined as confirmed and likely, cases between 2012 and 2019 were obtained from the National ALS Registry. Age-standardized incidence was calculated for all cases and by sex. The log incidence of ALS was regressed against the log of age (years) at case determination, on average, for each year and by sex. FINDINGS: Between 2012 and 2019, there was a mean of 5253 incident ALS cases (confirmed or likely) per year. We identified a linear relationship between the log of the average incidence and log age overall (r(2) = 0.99), for men (r(2) = 0.99), and for women (r(2) = 0.98). The incidence slope estimates were 4.8 (95% CI: 4.4-5.1) overall, 4.7 (95% CI: 4.4-5.1) for men, and 5.0 (95% CI: 4.5-5.5) for women. INTERPRETATION: The linear relationships observed overall, for men, and for women are consistent with a multi-step process. The slope estimates, on average, are approximately 5.0, which suggests that the development of ALS is a six-step process. Further investigation of these steps can elucidate potential risk factors and treatments for ALS.

BACKGROUND: We sought to determine real-world effectiveness of doxycycline post-exposure prophylaxis (doxy PEP) in reducing sexually transmitted infections (STI) among men who have sex with men attending an HIV pre-exposure prophylaxis (HIV PrEP) clinic in Philadelphia. METHODS: Data from eligible HIV PrEP patients who did and did not receive doxy PEP from September 1, 2019-December 31, 2023 were analyzed. We used a cohort study design and Cox models to estimate associations between doxy PEP receipt and incident gonorrhea (GC), chlamydia (CT), and/or syphilis. We also used a crossover design and Poisson models to estimate incidence rate ratios (IRR) for any STI and each STI separately among individuals in the year before and after doxy PEP initiation. RESULTS: Among the 508 eligible men, most were young men of color and 416 (82%) opted to receive doxy PEP. Receiving doxy PEP was associated with a reduction in any incident STI (hazard ratio [HR] 0.61, 95% confidence interval 0.40-0.93) and any incident CT (HR 0.40, 95% CI 0.21-0.78). Participants experienced a 62% relative reduction in STI rates while taking doxy PEP (IRR 0.38 (95% CI 0.29-0.50), including a reduction in CT (IRR 0.28, 95% CI 0.20-0.39) and GC (IRR 0.49, 95% CI 0.37-0.65). CONCLUSIONS: We observed a significant reduction in any STI and CT in both analytic arms, suggesting that doxy PEP is effective in real-world settings. Enhancing doxy PEP implementation would likely reduce community STI transmission.

BACKGROUND: Achieving low incidence is one of WHO's key targets for the elimination of hepatitis C virus (HCV) infection. As progress in Georgia's hepatitis C elimination programme moves the country closer to reaching this target, tracking new cases of hepatitis C has become a priority. We aimed to estimate temporal trends in hepatitis C incidence among people who were tested more than once for hepatitis C in Georgia. METHODS: We conducted a retrospective cohort study in adults (aged ≥18 years) tested at least twice for antibodies against HCV (anti-HCV), with the first test being non-reactive, in Georgia from Jan 1, 2017, to Dec 31, 2023. Data were extracted from Georgian national hepatitis C screening and treatment databases on Jan 8, 2024. We calculated the incidence of anti-HCV seroconversion and current chronic HCV infections per 100 000 person-years and 95% CIs overall for 2017-23 and by year for 2017-22. For people who seroconverted but did not undergo testing to confirm current infection, we used multiple imputations to impute the status of current chronic HCV infection. To estimate the magnitude of change, we calculated incidence rate ratios (IRRs) with 95% CIs. FINDINGS: Among 1 264 181 adults with repeat anti-HCV testing during the study period, 519 936 (41·1%) were men and 744 245 (58·9%) were women. In total, 18 846 (1·5%) seroconverted to anti-HCV-reactive after a median follow-up time of 1025 days (IQR 503-1553). The overall incidence rate of anti-HCV seroconversion was 514 cases per 100 000 person-years (95% CI 506-521). The overall estimated incidence rate of current chronic HCV infection was 293 cases per 100 000 person-years (288-299). The annual incidence rate of anti-HCV seroconversion was 3·7 times lower in 2022 than in 2017, declining from 1399 cases per 100 000 person-years (1346-1454) to 377 cases per 100 000 person-years (361-394; IRR 0·27 [95% CI 0·25-0·29]). The annual incidence rate of chronic HCV infection was 4·6 times lower in 2022 than in 2017, declining from 935 cases per 100 000 person-years (892-981) to 205 cases per 100 000 person-years (193-217; IRR 0·22 [95% CI 0·20-0·24]). INTERPRETATION: We found a high but decreasing incidence rate of hepatitis C in Georgia among people tested more than once. The country should scale up preventive interventions to reduce incidence further and reach elimination targets. FUNDING: None. TRANSLATION: For the Georgian translation of the abstract see Supplementary Materials section.

BACKGROUND: Viral load suppression among people living with HIV is a key strategy for reducing HIV transmission. A global target for HIV elimination aims to have 95% of people living with HIV diagnosed, 95% of people diagnosed on antiretroviral therapy (ART), and 95% viral load suppression for those on ART. We aimed to assess viral load non-suppression rates and associated factors among people living with HIV on ART in the Sughd region of Tajikistan. METHODS: We conducted a retrospective cohort study of adults (≥ 18 years old) who were newly diagnosed with HIV in 2013–2022 and had received ART for ≥ 6 months in the Sughd Region. Data were collected from the national electronic HIV case surveillance system and cross-referenced with paper medical and laboratory records. We conducted multivariable Quasi-Poisson regression to identify factors associated with viral load non-suppression (defined as ≥ 1000 copies/mL on their latest viral load test). RESULTS: Among the 1,871 people newly diagnosed with HIV who received ART for ≥ 6 months from 2013 to 2022, 11% were not virally suppressed. Over half (57%) were male, 38% were migrants, 73% were married, and the median age was 31 years (range 18–74). One-third (32%) had advanced HIV disease at diagnosis, 58% had been on ART for < 5 years, 94% were on a dolutegravir-containing regimen (DTG), and 9% died. Viral load non-suppression was 23% among people with stage IV at diagnosis and 43% among those not on DTG. Higher risk of viral load non-suppression was observed among male migrants and male nonmigrants compared to female nonmigrants (adjusted relative risk [aRR] and 95% confidence interval = 1.61 [1.13–2.31] and aRR = 1.48 [1.03–2.14], respectively), those who never-married vs. married (aRR = 1.56 [1.05–2.25]), those on ART for < 5 years vs. longer (aRR = 1.56 [1.05–2.29]), those initiating ART in 2013–2018 compared to 2019–2020 (aRR = 1.92 [1.28–2.88]), and those not on DTG (aRR = 3.86 [2.63–5.69]). CONCLUSIONS: Viral load suppression among people living with HIV in the Sughd Region remains below the global 95% target. Viral load suppression may improve with increased treatment support for people with late diagnosis or those newly initiating ART, with a special focus on men and migrants.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM's unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.

INTRODUCTION: We examined the association of pre-exposure prophylaxis (PrEP) programme retention with the use of daily, event-driven (ED) or regimen switching reported during follow-up at any point prior to discontinuation among men who have sex with men (MSM) in Hanoi, Vietnam. METHODS: Between April 2020 and February 2023, we collected data from PrEP clients at Hanoi Medical University Sexual Health Promotion clinic who were prescribed either ED or daily PrEP at the initial visit; at subsequent visits, clients reported the regimen used since the prior visit. We defined three categories of PrEP use: ED-PrEP exclusively, daily PrEP exclusively and switching regimens. The primary outcome was time to discontinuation in the PrEP programme during the study period, defined as missing a scheduled visit by > 30 days. We performed survival analysis using Kaplan-Meier curves. RESULTS: In total, 2107 people were included: 61.1% (n = 1288) reported exclusive use of daily PrEP, 10.4% (n = 220) reported exclusive use of ED-PrEP and 28.4% (n = 599) reported switching PrEP regimens. Among switchers, 29.40% (n = 176) switched more than once. Furthermore, 82.5% switched from daily to ED-PrEP and 17.5% switched from ED to daily PrEP. The median time to discontinuation in the PrEP programme was 105 days (IQR: 52-182) among those reporting exclusive use of ED-PrEP, 104 days (IQR: 56-274) among those reporting exclusive use of daily PrEP and 163 days (IQR: 101-308) among those who switched. Among switchers, those who switched more than once had a median time to discontinuation in the PrEP programme of 231 days (IQR: 137-380) in comparison to 133 days (IQR: 90-274) for those who switched once. CONCLUSIONS: We provide real-world data from MSM in an HIV PrEP programme in Vietnam that those who switched had longer periods of retention during the study period. Our findings suggest that offering flexible PrEP regimen options may improve engagement and long-term adherence among this population.

INTRODUCTION: In Mozambique, post-exposure prophylaxis (PEP) to prevent HIV is offered as part of the essential package of post-violence care services at 1450 health facilities. However, HIV PEP access and adherence continue to be a challenge. Healthcare providers were interviewed to identify and synthesize their recommendations for improving PEP access and adherence. METHODS: We conducted semi-structured, in-depth interviews with 20 adolescent and adult healthcare providers (3 men and 17 women) who had a range of 2-15 years of experience from 20 health facilities across seven provinces during March-August 2023. Data were analysed using inductive and theoretical thematic analysis. We analysed how frequently health providers mentioned specific recommendations. RESULTS: Regarding PEP access, healthcare providers recommended community education as the most effective strategy (10 mentions). In particular, providers cited the importance of palestras [community health talks]. Providers also commonly highlighted the need to have PEP kits prepared (7 mentions) and PEP readily available at health facilities (6 mentions). Regarding PEP adherence, providers recommended client counselling/education (13 mentions) to ensure clients understand the importance of taking PEP, how to properly take PEP and the potential side effects, which can often deter clients from adhering. Additionally, providers highlighted chamadas preventivas [follow-up telephone calls] within 2 weeks or so after the initial visit (9 mentions) as the best means to ensure clients complete the full, 28-day regimen and return for retesting after 3 months. Healthcare providers explained that follow-up telephone calls, despite the client living far from the health facility, can create a bond that supports clients. Providers recommended the institutionalization of follow-up telephone calls for consistent implementation in all healthcare facilities that offer PEP. CONCLUSIONS: Interviewed healthcare providers offered valuable insights and recommendations to improve PEP access and adherence, which could be considered for implementation in Mozambique and other sub-Saharan African countries.

BACKGROUND: Patients reporting sexual contact with a person(s) with chlamydia (CT) and/or gonorrhea (NG) are at increased risk of acquiring these sexually transmitted infections (STIs). Presumptive antimicrobial therapy is recommended for sexual contacts, but concerns have been raised about unnecessary antibiotic use. METHODS: We reviewed visits of patients who reported sexual contact to a partner with CT or NG ("contacts") from 1/2021-10/2023 in 10 STI clinics. We calculated CT and NG positivity, stratified by 3 patient groups (women, men who have sex with men [MSM], and men who have sex with women only [MSW]) and symptomatic status. RESULTS: Overall, 11,072 (6.8%) CT and/or NG contacts were identified (7,660 [4.7%] CT contacts and 4,988 [3.1%] NG contacts). CT positivity among CT contacts was 35%; NG positivity among NG contacts was 31%. CT positivity did not differ by symptomatic status across patient groups. NG positivity was higher for symptomatic vs. asymptomatic MSM (34%, 95% confidence interval [CI] 31-37% vs 28% [CI 26-30%]) and MSW (37%, CI 33-41% vs 23%, CI 20-27%), but not in women (38%, CI 33-43% vs 37%, CI 32-42%). CONCLUSIONS: Substantial CT/NG positivity among sexual contacts to CT or NG was observed. Among CT contacts, CT infection was most often detected in MSW; among NG contacts, NG infection was most often detected in women. However, ~60% did not have either CT or NG. The use of point-of-care tests in this population may optimize antimicrobial use while prioritizing individual clinical care.

We examined alignment between sex of sex partners and sexual orientation (SO) in syphilis case notifications among men during 2022 to inform interpretation of SO data for notifiable conditions in the National Notifiable Diseases Surveillance System. Observed partial alignment underscores the importance of analyzing appropriate variable(s) for a given intervention.

The Kessler 6 (K6) scale has been widely used to screen for serious mental illness (SMI) in general populations. Given that populations with high burden of HIV may be more likely to experience poor mental health outcomes, it is important to validate measures used to assess SMI among these groups. Using data from CDC's National HIV Behavioral Surveillance (NHBS) system in the United States, we examined psychometric characteristics of the K6 scale, including exploratory factor analysis, scale reliability, construct validity, and review of interviewer feedback to explore scale performance in the field. Analyses confirmed a single factor structure and demonstrated that the K6 scale had high internal consistency and construct validity. Although interviewers noted that the effort item was difficult for some participants to understand, psychometric properties were not greatly improved with the deletion of the item. The results of this analysis suggest that the K6 scale is appropriate for use among NHBS populations with a high burden of HIV, including persons who inject drugs, heterosexually active adults at increased risk for HIV infection, women who exchange sex for money or drugs, and gay, bisexual, and other men who have sex with men.

OBJECTIVES: We conducted cognitive interviews on a two-module PrEP training series developed by our study team to assess how clear, appropriate, and useful the videos are for gay, bisexual, and other men who have sex with men (collectively referred to as MSM) who are taking or interested in starting PrEP. METHODS: MSM aged 18-39 were recruited through convenience sampling to participate in cognitive interviews during which study staff screen-shared the PrEP training series and asked open-ended questions on the modules' script content, visuals and graphics, and audio. Audio recordings were transcribed and analyzed for common themes using a codebook guided by Fogg's Functional Triad, a theoretical framework which describes the persuasive functions of technology as a tool, media, and a social actor. RESULTS: Thirty participants completed cognitive interviews between November 2023 and January 2024. Common feedback included that the PrEP training videos were a useful tool for those who were either looking to start or continue PrEP use. Further, participants appreciated that the videos were inclusive of diverse populations who may benefit from PrEP, and noted that they should include important topics such as access to PrEP and plain language to improve comprehension of material. CONCLUSIONS: Our study applied Fogg's Functional Triad to identify ways in which our PrEP training series can facilitate PrEP uptake and adherence and allowed us to understand how this video series may be perceived prior to sharing it with the general public during our mChoice implementation study. PRACTICE IMPLICATIONS: The training series has the potential to promote shared decision making in a healthcare setting. Feedback collected during cognitive interviews demonstrates the need for clear and comprehensive PrEP educational tools made specifically for patients as well as the need for involvement of the priority intervention audience in the creation of the training materials prior to their release to the public.

Preliminary experimentation has suggested that a research-use-only real-time transcription-mediated amplification assay for Treponema pallidum (RUO T. pallidum TMA) yields instances of T. pallidum nucleic acid detection that coincide with non-treponemal serology in men who have sex with men (MSM) at increased risk for sexually transmitted infection. To further characterize the specificity of RUO T. pallidum TMA testing, 3,586 rectal swab specimens reported as "not detected" by the assay generated a mean endpoint FAM fluorescence of 637.5 units. Introduction of Treponema denticola, Treponema phagedenis, and Treponema refringens nucleic acid into matrices generated mean endpoint FAM fluorescence ranging from 620.7 to 633.5 units (P ≥ 0.15 versus control). Introduction of lubricant to a pooled rectal swab matrix did not result in elevated FAM fluorescence (mean endpoint value 628.3 units [95% CI 612.0, 644.6]; P = 0.67). Introduction of talcum powder, urine, seminal fluid, and blood also failed to generate increased FAM fluorescence (P ≥ 0.20). Analytic sensitivity assessment was measured by serial 10-fold dilution of T. pallidum whole organism or in vitro 23S rRNA transcript in specimen transport medium or pooled rectal swab matrix and interrogation by the assay. Probit analysis estimated sensitivity (95% detection) of RUO T. pallidum TMA at 421-5,707 in vitro transcript copies/mL and 9-48 T. pallidum cells/mL, depending on dilution matrix. These results support RUO T. pallidum TMA as a highly sensitive method for T. pallidum detection that is not impacted by potentially cross-reactive organisms or interfering substances and may have adjunctive diagnosis capability for syphilis in MSM. IMPORTANCE: Research-use-only Treponema pallidum transcription-mediated amplification (RUO T. pallidum TMA) has the potential to improve laboratory diagnosis of syphilis, particularly in patients at increased risk for sexually transmitted infection. The high analytic sensitivity and lack of cross-reactivity of the assay can facilitate other laboratories exploring the use of the test in a research setting.

During the global clade II mpox outbreak, cases have disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Cruise ship travel-associated mpox infections have not been previously described. During January 25-April 18, 2024, CDC was notified of eight mpox cases among cruise travelers on four ships: four among crew members and four among passengers. Seven cases were laboratory-confirmed as clade II Monkeypox virus. All exposure histories indicated male-to-male sexual contact. No patients were hospitalized, and none died. Crew members with mpox received their diagnoses on board and were isolated while infectious. Contacts were identified, monitored, and assessed for mpox postexposure prophylaxis (mpox vaccination). No crew members with mpox had been vaccinated against mpox. Passengers with mpox received their diagnoses after cruising on voyages marketed to gay and bisexual men, with symptom onset dates suggesting voyage exposures. For one cruise ship, two of the three reports of mpox among passengers were received after health departments were notified of potential cruise-associated exposures, and letters were sent to other passengers. Three of the four passengers with mpox had received 2 doses of JYNNEOS vaccine in 2022. Cruise lines should consider educating crew members on symptoms, risks, and preventive measures related to mpox and working with medical personnel to facilitate mpox vaccination as preexposure prophylaxis for eligible crew members. Cruise passengers who are eligible, predominantly MSM, should receive mpox vaccine before cruise travel. For cruise voyages marketed to gay and bisexual men, having mpox vaccine available on board would facilitate timely postexposure prophylaxis, if indicated; mpox prevention messaging and education before and during a voyage are also recommended.

Mpox emerged on the global scale in 2022 and predominately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma related to mpox is a potential harm for individuals experiencing multiple levels of marginalization who may already be discriminated against in family, health care, and other social domains. To understand perceived mpox stigma among cisgender GBMSM in the United States, we conducted a study within the American Men's Internet Survey with 824 cisgender GBMSM >= 15 years from August 5 to 15, 2022. Perceived mpox stigma was most prevalent among non-Hispanic Black individuals (13.9%) compared to non-Hispanic White individuals (6.0%) and particularly among men aged 25-29 (15.1%) compared to men aged 40+ (5.6%). In adjusted logistic regression models, mpox stigma was significantly associated with knowing someone who tested for mpox (adjusted odds ratio (aOR) = 4.3 95% confidence interval, CI [2.1, 9.0]), knowing someone who was vaccinated for mpox (aOR = 2.1; 95% CI [1.2, 3.7]), or having an unexplained rash in the 3 months prior to survey completion (aOR = 3.6; 95% CI [1.9, 7.0]). These initial findings suggested people who were more connected to mpox-affected social networks and also those who had symptoms consistent with mpox were more likely to experience stigma. Taken together, these data suggest the potential harmful impact of mpox-related stigma by affecting those who would most benefit from services. Moreover, these data suggest the importance of real-time stigma measurement and mitigation for both rapidly emergent and chronic infectious diseases to improve equity, reduce fear and misinformation, and optimize the impact of public health responses. (PsycInfo Database Record (c) 2025 APA, all rights reserved) Impact Statement Stigma can have far-reaching consequences. It can exacerbate health disparities, influence social networks, and discourage individuals from seeking preventative health care, including vaccination. This study's findings highlight that, even if not widespread, stigma can concentrate in marginalized groups and drastically affect individuals' lives. By acknowledging and addressing stigma, public health agencies and providers can foster inclusivity, limit fear, promote trust in health care systems, and improve the overall health and resilience of communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

OBJECTIVE: Longer-acting pre-exposure prophylaxis (LA-PrEP) products have potential to increase PrEP uptake and continuation. This study sought to elicit preferences for LA-PrEP product and delivery program characteristics among populations disproportionately impacted by HIV to identify factors important to adoption and anticipate potential use challenges. DESIGN: Cross-sectional, online discrete choice experiment. METHODS: We recruited 940 men who have sex with men (MSM), people who inject drugs (PWID), and Black heterosexual men and women (BHMW) with PrEP indications. In a series of 10 tasks, participants chose between two hypothetical LA-PrEP options composed of 5 attributes (product type, side effects, clinic type, appointment duration, cost), or neither (their current HIV prevention method). Analysis used random-parameters logit models. RESULTS: Respondents chose an LA-PrEP method over their current HIV prevention option in 96.8% of tasks. Cost was the most important determinant of LA-PrEP choice for all populations (relative importance [RI] of 10]. Side effects and product type were 1/3 to 1/2 as important as cost (RI 3.5-5.1). MSM and PWID most preferred the 12-month implant followed by semiannual dual injections and least preferred the monthly oral pill and 2-month single injection. BHMW most preferred the monthly pill and semiannual injections and least preferred the 12-month implant and 2-month injection. Clinic type and appointment duration had minimal influence (RI 0.1-2.1). CONCLUSIONS: Results suggest high demand for LA-PrEP among populations with disproportionately high HIV incidence. To facilitate use, programs should offer a range of LA-PrEP products, minimize out-of-pocket costs, and counsel on side effects.

Dermatophytosis (also called ringworm or tinea infection) is a common, contagious superficial infection of the skin, hair, or nails caused by dermatophyte molds. Historically, clinicians have considered dermatophytosis as a mild, easy-to-treat condition; however, the epidemiology of dermatophytosis has changed dramatically in the past decade because of the emergence of dermatophyte strains causing increasingly severe and difficult-to-treat infections. We review three recently emerged dermatophytes of public health concern: Trichophyton indotineae, which is causing outbreaks of frequently terbinafine-resistant and difficult-to-treat tinea in South Asia, with cases also reported across six continents; Trichophyton mentagrophytes genotype VII (TMVII), associated with oral and anogenital tinea infections particularly among men who have sex with men in France and the United States; and terbinafine-resistant Trichophyton rubrum, noted as a cause of difficult-to-treat tinea infections, although data are limited. We discuss practical considerations for identifying these pathogens, which relies on DNA sequencing or MALDI-ToF rather than on morphological characteristics. Additionally, we highlight the importance of antifungal susceptibility testing and practical laboratory considerations. Finally, we emphasize the importance of increased adoption of diagnostic testing for suspected dermatophyte infections, as well as the development of rapid, accurate, and affordable dermatophyte testing methods to help improve diagnostic accuracy and judicious antifungal use. Overall, the emergence of severe and antifungal-resistant dermatophyte infections poses a global public health concern. Clinical microbiologists can play a crucial role in addressing this threat by familiarizing themselves with techniques for identifying emerging dermatophyte species and performing antifungal susceptibility testing to guide patient management, monitor trends, and inform future public health interventions. Copyright © 2025

There is limited population-level data on the pre-exposure prophylaxis (PrEP) care continuum in eastern Africa. Here, we assessed the PrEP care continuum following PrEP rollout in a Ugandan community with ~40% HIV seroprevalence. We used cross-sectional population-based data collected between September 3 and December 19, 2018 from a Lake Victoria fishing community in southern Uganda to measure levels of self-reported PrEP awareness, ever-use, and discontinuation following 2017 PrEP rollout via a U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported phased implementation program. Our analysis included HIV-seronegative persons reporting having ever received an HIV test result. We examined associations between demographic, behavioral, and health utilization factors with each outcome using age-adjusted modified Poisson regression. There were 1,401 HIV-seronegative participants, of whom 1,363 (97.3%) reported ever receiving an HIV test result. Median age was 29 years (IQR: 23-36), and 42.3% (n = 577) were women. Most (85.5%; n = 1,166/1363) participants reported PrEP awareness, but few (14.5%; n = 197/1363) reported ever using PrEP. Among 47.7% (375/786) of men and 29.3% (169/577) of women PrEP-eligible at time of survey, 18.9% (n = 71/375) and 27.8% (n = 47/169) reported ever using PrEP, respectively. Over half (52.3%, n = 103/197) of those who had ever used PrEP, self-reported current use. In this Lake Victoria fishing community, there were low levels of PrEP use despite high levels of PrEP awareness and eligibility, particularly among men. Efforts that enhance awareness of HIV risk and increase PrEP accessibility may help increase PrEP use among HIV-seronegative persons in African settings with high HIV burden.

BACKGROUND: Men who have sex with men (MSM) with HIV are disproportionately affected by human papillomavirus (HPV) and related diseases. We assessed HPV vaccine effectiveness (VE) against anal HPV among MSM with HIV. METHODS: During 2018-2023, residual anal specimens from MSM with HIV, aged 18-45 years, attending sexual health clinics in three U.S. cities were collected and tested for HPV. Demographic and vaccination information were obtained from clinic records or immunization registries. Timing of vaccination relative to HIV acquisition was unknown. Log-binomial regression was used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between vaccination (≥1 dose) and quadrivalent vaccine (4vHPV)-type infection, adjusting for city. Models were stratified by age group (18-26, 27-45 years). VE was calculated as (1-aPR) x 100. RESULTS: Among 224 persons aged 18-26 years, 54% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at age <18 (aPR=0.31, 95% CI:0.14-0.72, VE=69%) and ≥2 years before specimen collection (aPR=0.54, 95% CI:0.31-0.92, VE=46%). Among 700 persons aged 27-45 years, 17% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at ages 18-26 (aPR=0.63, 95% CI:0.45-0.89, VE=37%) and ≥2 years before specimen collection (aPR=0.63, 95% CI:0.46-0.86, VE=37%). CONCLUSIONS: While timing of vaccination relative to HIV acquisition was unknown, we found significant VE against prevalent HPV infection in adult MSM with HIV. Within each age group, VE was higher with younger age at vaccination.

BACKGROUND: Many medications can have blood pressure (BP)-elevating effects, which might negatively impact BP control among people with hypertension. This study examines trends in prescription fills for BP-elevating and antihypertensive medications, individually and concurrently, among US individuals. METHODS: Quarterly trends of concurrent and individual fills for BP-elevating and antihypertensive medications were reported using the nationwide sample from IQVIA's Total Patient Tracker database, covering 94% of all retail prescription fills in the United States. We identified 1387 products containing BP-elevating medications and 240 products containing antihypertensive medications. Percentage change from Q1/2017 and average quarterly percent change from the joinpoint regression were used to present trends overall and by sex and age group (0-17, 18-44, 45-64, 65-74, and ≥75 years). RESULTS: From 2017 to 2023, fills remained stable for BP-elevating medications alone and increased for antihypertensive medications alone (9.5% increase; from 10.1% to 11.0%; P<0.001). Concurrent fills for antihypertensive and BP-elevating medications increased by 15.9% (from 5.4% to 6.2%; P<0.001). Fills for BP-elevating medications were higher among adult women compared with men; among women aged 18 to 44 years, this was primarily due to the use of combined oral contraceptives. In Q4/2023, fills for BP-elevating medications were most common among those aged 65 to 74 years (females=30.7%; males=20.4%). CONCLUSIONS: These results provide the first nationwide trends in concurrent prescription fills for BP-elevating and antihypertensive medications, indicating an increasing trend. Our findings might inform clinician decision-making regarding medication selection for patients with hypertension.

BACKGROUND: In 2023, the United States Food and Drug Administration revised its blood donor eligibility policy for men who have sex with men (MSM) from a 3-month deferral to individual assessment. Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP) use remains a reason for deferral, and nondisclosure is a concern. STUDY DESIGN AND METHODS: In a cross-sectional study of sexually active MSM from 8 U.S. cities who were interested in future blood donation, we assessed the performance of an enzyme-linked immunosorbent assay for detecting tenofovir (TFV) in whole blood (WB) and plasma and the correlation with self-reported PrEP use. RESULTS: Of 1548 individuals, 48% reported oral PrEP use. The WB assay identified 95% of PrEP users, while the plasma assay detected 88%. The WB assay performed well up to 14 days after the last reported dose. Receiver operating characteristics curve analysis showed an area under the curve of 0.96 (95% confidence interval [CI]: 0.95-0.97) using WB and 0.88 (95% CI: 0.86-0.90) using plasma. Specificity was 80% for WB and 66% for plasma. Detection rates for TFV disoproxil fumarate/emtricitabine (FTC) formulations were 99% in WB and 98% in plasma, compared to 93% and 86% for the TFV alafenamide/FTC formulation. DISCUSSION: High concordance between self-reported oral PrEP use and TFV detection was observed among PrEP users, suggesting the potential utility of WB as a biomatrix for TFV detection to support screening strategies. Given the expanded eligibility for MSM, who may be PrEP users, to donate blood, further examination of undisclosed PrEP use is important.

IMPORTANCE: The oral microbiome likely plays key roles in human health. Yet, population-representative characterizations are lacking. OBJECTIVE: To characterize the composition, diversity, and correlates of the oral microbiome in US adults. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from the population-representative National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012. Microbiome data were made publicly available in 2024. NHANES participants were aged 18 to 69 years and provided oral rinse samples in 1 of 2 consecutive NHANES cycles (2009-2010 and 2011-2012). EXPOSURES: Demographic, socioeconomic, behavioral, anthropometric, metabolic, and clinical characteristics. MAIN OUTCOMES AND MEASURES: Oral microbiome measures, characterized through 16S ribosomal RNA gene sequencing, included α diversity (observed amplicon sequence variants [ASVs], Faith phylogenetic diversity, Shannon-Weiner Index, and Simpson Index); β diversity (unweighted UniFrac, weighted UniFrac, and Bray-Curtis dissimilarity); and prevalence and relative abundance at phylum level through genus level. Analyses accounted for the NHANES complex sample design. RESULTS: This study included 8237 US adults aged 18 to 69 years, representing 202 314 000 individuals (102 813 000 men [50.8%]; mean [SD] age, 42.3 [14.4] years; 9.3% self-reported as Mexican American, 12.1% as non-Hispanic Black, 64.7% as non-Hispanic White, 5.9% as other Hispanic, and 8.1% as other non-Hispanic individuals). The oral microbiome encompassed 37 bacterial phyla, 99 classes, 212 orders, 446 families, and 1219 genera. Five phyla (Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, and Fusobacteria) and 6 genera (Veillonella, Streptococcus, Prevotella 7, Rothia, Actinomyces, and Gemella) were present in nearly all US adults (weighted prevalence, >99%). These genera were the most abundant, accounting for 65.7% of total abundance. Observed ASVs showed a quadratic pattern with age (peak at 30 years), were similar by sex, significantly lower among non-Hispanic White individuals, and increased with greater body mass index (BMI), alcohol use, and periodontal disease severity. All covariates together accounted for a modest proportion of oral microbiome variability as measured by β diversity: R2 = 8.7% (95% CI, 8.4%-9.1%) for unweighted UniFrac, R2 = 7.2% (95% CI, 6.6%-7.7%) for weighted UniFrac, and R2 = 6.3% (95% CI, 3.1%-6.7%) for Bray-Curtis matrices. By contrast, relative abundance of a few genera explained a high percentage of variability in β diversity for weighted UniFrac: Aggregatibacter (R2 = 22.4%; 95% CI, 22.1%-22.8%), Lactococcus (R2 = 21.6%; 95% CI, 20.9%-22.3%), and Haemophilus (R2 = 18.4%; 95% CI, 18.1%-18.8%). Prevalence and relative abundance of numerous genera were associated with age, race and ethnicity, smoking, BMI categories, alcohol use, and periodontal disease severity. CONCLUSIONS AND RELEVANCE: This cross-sectional study of the oral microbiome in US adults showed that a few genera were universally present and a different set of genera explained a high percentage of oral microbiome diversity across the population. This comprehensive characterization provides a contemporary reference standard for future studies.

Young Black and Latino men who have sex with men are disproportionately affected by the U.S. HIV Epidemic, yet pre-exposure prophylaxis (PrEP) uptake remains low. To understand barriers and facilitators to PrEP uptake and persistence, we used a concurrent mixed methods design (quantitative: online surveys, n = 19; qualitative: individual interviews, n = 15) from providers (e.g., nurse practitioners, clinicians, and social workers) at 4 clinics providing PrEP services in Birmingham, Alabama and New York City. Although all providers were comfortable prescribing daily oral PrEP, they had concerns about on-demand PrEP (e.g., complex dosing schedule) and injectable PrEP (e.g., insurance barriers). Provider training is needed to address barriers to providing PrEP modalities beyond daily oral PrEP and increase uptake among young Black and Latino men who have sex with men. Additionally, in order to increase uptake of injectable PrEP, rising PrEP costs due to changes in the 340B Drug Pricing Program will need to be addressed.

BACKGROUND: Caregiver barriers to accessing immunizations are a key factor influencing childhood vaccination. In preparation for the rollout of the second dose measles-containing vaccine (MCV2) in Uganda in October 2022, we aimed to identify possible barriers specific to female caregivers that could influence MCV2 implementation and suggest initiatives to facilitate MCV2 uptake. METHODS: In September 2022, we conducted a rapid community assessment in 18 districts in Uganda. We conducted key informant interviews with 17 district health managers and 18 community leaders, and 18 focus group discussions, one in each district, with caregivers of immunization-eligible children. We conducted a rapid analysis based of debriefing notes and in-depth thematic analysis of translated transcripts. Data were analyzed using NVivo version 12, wherein we used the framework analysis approach to define and structure codes deductively and inductively to identify themes. We mapped themes onto the socio-ecological model to examine factors that influence immunization at individual, household, community, and health system level. RESULTS: We found that individual, household, and health system factors influenced childhood vaccination and could be potential barriers to MCV2 uptake. At the individual level, female caregiver's heavy workload and limited decision-making power hindered their ability to take children for vaccination, with mothers often relying on fathers and depended on men for transport costs to immunization centers. At the household level, participants mothers were primarily responsible for taking children to vaccination centers, while fathers were less involved in child health. Health workers often gave preferential treatment to fathers over mothers at the health facility when they brought the child in for vaccination Participants suggested that approaches that ensure the involvement of fathers, other family members and mother-to-mother peer groups could address the barriers specific to female caregivers. CONCLUSION: Role differentiation between female and male caregivers affect childhood vaccination practices within communities in Uganda, potentially exacerbating challenges in accessing vaccines for children in the second year of life. Integrating interventions responsive to specific caregiver needs and that improve family participation may improve childhood vaccination in Uganda.

BACKGROUND: Limited estimates exist on population-level impact of partner notification (PN) for gonorrhea with uncertainty in the influence of local epidemiology on PN effectiveness. An ecological study in New York found a 6% reduction in diagnoses with a 10% increase in PN coverage. We estimated gonorrhea incidence reductions via partner notification across different epidemiological conditions to compare effects to the prior finding and understand key determinants of variation. METHODS: We developed a stochastic network model of men who have sex with men and calibrated gonorrhea transmission dynamics to varied epidemiological conditions. Population level impact of increasing partner notification was summarized by incidence rate ratios (IRRs), and relative importance of explanatory variables (including network density, baseline burden, natural history parameters) was assessed via linear regression modeling of IRR, and bootstrapping to evaluate uncertainty in estimation. RESULTS: We estimated IRR of 0.97 (95% range 0.93--0.99) for a 10% relative increase in partner notification coverage, comparable to the IRR of 0.94 (0.91--0.97) identified in the empirical study. Partner notification retained effectiveness under diverse epidemiological conditions. In a univariate sensitivity analysis, the strongest influence on IRR came from parameters governing index case testing probability with IRR 0.93 when testing was at its highest. Other factors such as network density, baseline incidence, and various natural history parameters had relatively minor effects on the IRR. We observed larger individual-level benefits from partner notification for individuals with higher number of partners. CONCLUSIONS: Our findings support prior population-level estimates of the impact of partner notification on gonorrhea incidence.

BACKGROUND: In sub-Saharan Africa, mHealth interventions and phone-based data collection are increasingly popular but little is known about who can be reached by these programmes. We used national probability surveys to examine characteristics of youth (15-24 years) mobile phone owners in seven Southern African countries: Botswana, Eswatini, Lesotho, Malawi, Mozambique, Zambia, and Zimbabwe. METHODS: Population-based HIV Impact Assessment surveys are cross-sectional, nationally representative household-based surveys conducted between November 2019 and February 2022. Data were analysed using multivariable logistic regression. RESULTS: Eighty-four percent of youth in Eswatini, 83% in Botswana, 76% in Lesotho, 61% in Zimbabwe, 47% in Mozambique, 46% in Zambia and 32% in Malawi were mobile phone owners. In all countries, odds of phone ownership were higher amongst persons ages 20-24 (compared to 15-19) and those with secondary education or higher. In the three countries with ownership less than 50%, women had lower odds of owning a phone than men, and all wealth quintiles had higher odds of ownership than the lowest wealth quintile. CONCLUSIONS: Mobile phone ownership was consistently higher among certain demographic groups. Public health practitioners employing mobile phones for youth health programmes in Sub-Saharan Africa may not reach the general youth population.

We conducted formative interviews and design workshops to tailor evidence-based tools addressing informational needs around pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) of color. Clients (n = 18) and providers (n = 19) were interviewed to explore needs and preferences for PrEP-related decision-making tools. Next, we developed an analysis matrix to design personas to tailor materials to real-world contexts. Existing PrEP educational materials were then revised using participant feedback elicited through the personas. We presented personas, findings, and revised materials to clients (n = 9) and providers (n = 9) in iterative design workshops and solicited further feedback. Revisions to materials for providers included tips for destigmatizing PrEP counseling and routine care, sexual practices, and structural barriers that YMSM of color often navigate. Our evidence-based approach has the potential to enhance shared decision-making and destigmatize HIV prevention counseling in our larger trial, thus promoting both PrEP uptake and persistence among YMSM of color. © 2025 National Communication Association.

Purpose: Research suggests that sexual minority women (SMW) face elevated HIV risk compared with their heterosexual counterparts. This study examined the association between sexual minority status-defined by identity and behavior-and HIV-related vulnerabilities among heterosexually active low-income women. Methods: This analysis used National HIV Behavioral Surveillance data (n = 5542) collected in 2019 from heterosexually active low-income women in 23 U.S. urban areas. We examined sexual minority identity and behavior and a set of substance use, sexual behavior, health and health care, and social determinants of health indicators commonly associated with heightened HIV transmission risk. Log-linked Poisson regression models generated adjusted prevalence ratios and 95% confidence intervals. Results: Among women who reported sexual minority identity (22.2%; n = 1231), 34.6% (n = 426) reported past-year sex with only men. Of women who reported past-year sex with both women and men (17.8%; n = 985), 18.3% (n = 180) identified as heterosexual. In adjusted models, SMW had significantly higher prevalence of nearly every HIV risk-associated factor examined than their heterosexual counterparts. Risk profiles by identity and behavior were similar. Notably, SMW defined by behavior had similar or higher prevalence of nearly every risk factor than those defined by identity. Conclusions: This study demonstrates disproportionate HIV-related vulnerabilities among SMW compared with their heterosexual counterparts. The findings underscore the importance of measuring multiple dimensions of sexual orientation (identity and behavior), as SMW and their associated risks show important nuances. Implications include tailoring HIV prevention and health promotion interventions to meet the needs of low-income SMW.

Over 10 years, the reported incidence of primary and secondary syphilis increased among women at 6 times the rate compared with men (636% vs. 103%). Untreated syphilis can lead to life-altering complications including permanent vision and hearing loss, congenital syphilis, and increased HIV acquisition. Syphilis diagnosis and staging require current and prior laboratory results, physical examination, and history. The preferred treatment for syphilis is long-acting penicillin G benzathine. Partner testing and treatment are critical to prevent re-infection and further community transmission. Innovative strategies are needed to prevent and treat syphilis among women, especially those without regular access to health care.