Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Implications of measles inclusion by commercial syndromic polymerase chain reaction panels - United States, May 2022-April 2023
Thomas CM , Hartley A , Schmitz A , Reid HD , Sullivan S , Huebner E , Robinson M , Mathis A , Fill MA , Levinson KJ , Jones TF , Schaffner W , Newhouse CN , Dunn JR . MMWR Morb Mortal Wkly Rep 2024 73 (12) 260-264 Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary. |
COVID-19 vaccines and adverse events of special interest: A multinational Global Vaccine Data Network (GVDN) cohort study of 99 million vaccinated individuals
Faksova K , Walsh D , Jiang Y , Griffin J , Phillips A , Gentile A , Kwong JC , Macartney K , Naus M , Grange Z , Escolano S , Sepulveda G , Shetty A , Pillsbury A , Sullivan C , Naveed Z , Janjua NZ , Giglio N , Perälä J , Nasreen S , Gidding H , Hovi P , Vo T , Cui F , Deng L , Cullen L , Artama M , Weintraub E , Lu H , Clothier HJ , Batty K , Paynter J , Petousis-Harris H , Buttery J , Black S , Hviid A . Vaccine 2024 BACKGROUND: The Global COVID Vaccine Safety (GCoVS) Project, established in 2021 under the multinational Global Vaccine Data Network™ (GVDN®), facilitates comprehensive assessment of vaccine safety. This study aimed to evaluate the risk of adverse events of special interest (AESI) following COVID-19 vaccination from 10 sites across eight countries. METHODS: Using a common protocol, this observational cohort study compared observed with expected rates of 13 selected AESI across neurological, haematological, and cardiac outcomes. Expected rates were obtained by participating sites using pre-COVID-19 vaccination healthcare data stratified by age and sex. Observed rates were reported from the same healthcare datasets since COVID-19 vaccination program rollout. AESI occurring up to 42 days following vaccination with mRNA (BNT162b2 and mRNA-1273) and adenovirus-vector (ChAdOx1) vaccines were included in the primary analysis. Risks were assessed using observed versus expected (OE) ratios with 95 % confidence intervals. Prioritised potential safety signals were those with lower bound of the 95 % confidence interval (LBCI) greater than 1.5. RESULTS: Participants included 99,068,901 vaccinated individuals. In total, 183,559,462 doses of BNT162b2, 36,178,442 doses of mRNA-1273, and 23,093,399 doses of ChAdOx1 were administered across participating sites in the study period. Risk periods following homologous vaccination schedules contributed 23,168,335 person-years of follow-up. OE ratios with LBCI > 1.5 were observed for Guillain-Barré syndrome (2.49, 95 % CI: 2.15, 2.87) and cerebral venous sinus thrombosis (3.23, 95 % CI: 2.51, 4.09) following the first dose of ChAdOx1 vaccine. Acute disseminated encephalomyelitis showed an OE ratio of 3.78 (95 % CI: 1.52, 7.78) following the first dose of mRNA-1273 vaccine. The OE ratios for myocarditis and pericarditis following BNT162b2, mRNA-1273, and ChAdOx1 were significantly increased with LBCIs > 1.5. CONCLUSION: This multi-country analysis confirmed pre-established safety signals for myocarditis, pericarditis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis. Other potential safety signals that require further investigation were identified. |
Evaluation of CHROMagar Candida Plus for the detection of C. auris with a panel of 206 fungal isolates and 83 colonization screening skin-swabs
Bentz ML , Le N , Min B , Nunnally NS , Sullivan V , Tran M , Lockhart SR , Litvintseva A , Berkow EL , Sexton DJ . Microbiol Spectr 2024 e0356423 CHROMagar Candida Plus is a new formulation of chromogenic media designed for the detection and differentiation of major clinical Candida species, including Candida auris. The objective of this study is to evaluate CHROMagar Candida Plus when used according to manufacturer's instructions with a panel of 206 fungal isolates and 83 skin-swab specimens originally collected for C. auris colonization screening. Of the 68 C. auris isolates tested, 66/68 displayed the expected light-blue colony morphology and blue halo within 48 h. None of the remaining 138 non-auris isolates appeared similar to C. auris. CHROMagarCandida Plus was, therefore, inclusive to 97% of 68 C. auris isolates tested and supported visual exclusion of 100% of the 138 non-C. auris isolates tested. For the 83 colonization screening specimens, direct plating onto CHROMagarCandida Plus was 60% sensitive and 100% specific when compared to the enrichment broth gold-standard reference method. In sum, these findings demonstrate the utility of this media when working with isolates but also notable limitations when working with primary skin-swabs specimens when competing yeast species are present.IMPORTANCECandida auris is an emerging fungal pathogen of public health concern. As it continues to spread, it is important to publish evaluations of new diagnostic tools. In this study, we share our experience with a new chromogenic media which can help distinguish C. auris from related species. |
Surveillance for rubella virus in samples obtained from non-immunodeficient individuals
Patel S , Russo P , M HR , Maurer K , Hao L , Beard RS , Perelygina L , Sullivan KE . Pediatr Allergy Immunol 2024 35 (1) e14082 |
Fostering governance and information partnerships for chronic disease surveillance: The Multi-State EHR-Based Network for Disease Surveillance
Kraus EM , Saintus L , Martinez AK , Brand B , Begley E , Merritt RK , Hamilton A , Rubin R , Sullivan A , Karras BT , Grannis S , Brooks IM , Mui JY , Carton TW , Hohman KH , Klompas M , Dixon BE . J Public Health Manag Pract 2024 30 (2) 244-254 CONTEXT: Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex. PROGRAM: Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance. IMPLEMENTATION: MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures. RESULTS: The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document. DISCUSSION: The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance. |
An evaluation of messages to promote parental intent to vaccinate children aged <12 years against COVID-19
Chan IL , Schwarz K , Weinstein N , Mansergh G , Nahhas RW , Gelaude D , Alexander R , Rodriguez L , Strauss W , Repetski T , Sullivan N , Long E , Evener SL , Garbarino A , Kollar LMM . Public Health Rep 2024 333549231218725 OBJECTIVES: Effective health communication can increase intent to vaccinate. We compared 8 messages that may influence parents' intent to vaccinate their children against COVID-19. METHODS: In a cross-sectional survey of adults in the United States administered online in August 2021, 1837 parents and legal guardians were exposed to 8 messages (individual choice, gain/practical benefits, nonexpert, health care provider recommendation, altruism/community good, safety/effectiveness, safety, and effectiveness) to determine message reception and influence on intent to vaccinate their children. Parents responded to 10 questions using a Likert scale. We computed odds ratios (ORs) for each message, with an OR >1.0 indicating greater observed odds of participant agreement with the follow-up statement as compared with a reference message. We compared outcomes individually across messages with ordinal logistic regression fit using generalized estimating equations. RESULTS: The individual choice message had the highest odds of agreement for understanding intent (OR = 2.10; 95% CI, 1.94-2.27), followed by the health care provider recommendation message (OR = 1.58; 95% CI, 1.46-1.71). The individual choice message had the highest odds of memorability, relatability, and trustworthiness. The altruism/community good message was at or near second best. The altruism/community good message had the highest or near-highest odds of increasing parents' intent to vaccinate their children, asking friends and family for their thoughts, and searching for additional information. The message that most motivated parents to vaccinate their children depended on parental intent to vaccinate prior to being exposed to the tested messages. CONCLUSIONS: Messages with themes of individual choice, health care provider recommendation, and altruism/community good may be used in future message campaigns. Further research is needed to refine message concepts related to altruism/community good. |
Evaluation of the VioOne HIV profile supplemental assay
Franz BJ , Register H , Sullivan V , Warber K , Granade TC , Cornaby C , Magee ME , Denny TN , Lockwood D , Schmitz JL . J Clin Microbiol 2024 e0083623 We evaluated the reproducibility, sensitivity, and specificity data for two versions of the VioOne HIV Profile Supplemental Assay and compared these results back to similar results for the Geenius HIV 1/2 Supplemental Assay that are publicly available. Our study concluded that the VioOne HIV Profile Supplemental Assay compared favorably with the Geenius HIV 1/2 Supplemental Assay, thus providing an additional option for clinical laboratories to improve and expand their HIV testing capabilities. |
Rubella virus chronic inflammatory disease and other unusual viral phenotypes in inborn errors of immunity
Kilich G , Perelygina L , Sullivan KE . Immunol Rev 2023 Infectious susceptibility is a component of many inborn errors of immunity. Nevertheless, antibiotic use is often used as a surrogate in history taking for infectious susceptibility, thereby disadvantaging patients who present with viral infections as their phenotype. Further complicating clinical evaluations are unusual manifestations of viral infections which may be less familiar that the typical respiratory viral infections. This review covers several unusual viral phenotypes arising in patients with inborn errors of immunity and other settings of immune compromise. In some cases, chronic infections lead to oncogenesis or tumor-like growths and the conditions and mechanisms of viral-induced oncogenesis will be described. This review covers enterovirus, rubella, measles, papillomavirus, and parvovirus B19. It does not cover EBV and hemophagocytic lymphohistiocytosis nor lymphomagenesis related to EBV. EBV susceptibility has been recently reviewed. Our goal is to increase awareness of the unusual manifestations of viral infections in patients with IEI and to describe treatment modalities utilized in this setting. Coincidentally, each of the discussed viral infections can have a cutaneous component and figures will serve as a reminder of the physical features of these viruses. Given the high morbidity and mortality, early recognition can only improve outcomes. |
A conceptual framework for nomenclatural stability and validity of medically important fungi: a proposed global consensus guideline for fungal name changes supported by ABP, ASM, CLSI, ECMM, ESCMID-EFISG, EUCAST-AFST, FDLC, IDSA, ISHAM, MMSA, and MSGERC
de Hoog S , Walsh TJ , Ahmed SA , Alastruey-Izquierdo A , Alexander BD , Arendrup MC , Babady E , Bai FY , Balada-Llasat JM , Borman A , Chowdhary A , Clark A , Colgrove RC , Cornely OA , Dingle TC , Dufresne PJ , Fuller J , Gangneux JP , Gibas C , Glasgow H , Gräser Y , Guillot J , Groll AH , Haase G , Hanson K , Harrington A , Hawksworth DL , Hayden RT , Hoenigl M , Hubka V , Johnson K , Kus JV , Li R , Meis JF , Lackner M , Lanternier F , Leal SM Jr , Lee F , Lockhart SR , Luethy P , Martin I , Kwon-Chung KJ , Meyer W , Nguyen MH , Ostrosky-Zeichner L , Palavecino E , Pancholi P , Pappas PG , Procop GW , Redhead SA , Rhoads DD , Riedel S , Stevens B , Sullivan KO , Vergidis P , Roilides E , Seyedmousavi A , Tao L , Vicente VA , Vitale RG , Wang QM , Wengenack NL , Westblade L , Wiederhold N , White L , Wojewoda CM , Zhang SX . J Clin Microbiol 2023 61 (11) e0087323 The rapid pace of name changes of medically important fungi is creating challenges for clinical laboratories and clinicians involved in patient care. We describe two sources of name change which have different drivers, at the species versus the genus level. Some suggestions are made here to reduce the number of name changes. We urge taxonomists to provide diagnostic markers of taxonomic novelties. Given the instability of phylogenetic trees due to variable taxon sampling, we advocate to maintain genera at the largest possible size. Reporting of identified species in complexes or series should where possible comprise both the name of the overarching species and that of the molecular sibling, often cryptic species. Because the use of different names for the same species will be unavoidable for many years to come, an open access online database of the names of all medically important fungi, with proper nomenclatural designation and synonymy, is essential. We further recommend that while taxonomic discovery continues, the adaptation of new name changes by clinical laboratories and clinicians be reviewed routinely by a standing committee for validation and stability over time, with reference to an open access database, wherein reasons for changes are listed in a transparent way. |
Filoviruses: Scientific gaps and prototype pathogen recommendation
Dupuy LC , Spiropoulou CF , Towner JS , Spengler JR , Sullivan NJ , Montgomery JM . J Infect Dis 2023 228 S446-s459 Viruses in the family Filoviridae, including the commonly known Ebola (EBOV) and Marburg (MARV) viruses, can cause severe hemorrhagic fever in humans and nonhuman primates. Sporadic outbreaks of filovirus disease occur in sub-Saharan Africa with reported case fatality rates ranging from 25% to 90%. The high mortality and increasing frequency and magnitude of recent outbreaks along with the increased potential for spread from rural to urban areas highlight the importance of pandemic preparedness for these viruses. Despite their designation as high-priority pathogens, numerous scientific gaps exist in critical areas. In this review, these gaps and an assessment of potential prototype pathogen candidates are presented for this important virus family. |
Peripheral and placental prevalence of sulfadoxine-pyrimethamine resistance markers in plasmodium falciparum among pregnant women in Southern Province, Rwanda
Alruwaili M , Uwimana A , Sethi R , Murindahabi M , Piercefield E , Umulisa N , Abram A , Eckert E , Munguti K , Mbituyumuremyi A , Gutman JR , Sullivan DJ . Am J Trop Med Hyg 2023 109 (5) 1057-1062 Intermittent preventive therapy during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended in areas of moderate to high malaria transmission intensity. As a result of the increasing prevalence of SP resistance markers, IPTp-SP was withdrawn from Rwanda in 2008. Nonetheless, more recent findings suggest that SP may improve birthweight even in the face of parasite resistance, through alternative mechanisms that are independent of antimalarial effects. The prevalence of single nucleotide polymorphisms in Plasmodium falciparum dihydropteroate synthase (pfdhps) and dihydrofolate reductase (pfdhfr) genes associated with SP resistance among 148 pregnant women from 2016 to 2018 within Rwanda's Southern Province (Huye and Kamonyi districts) was measured using a ligase detection reaction-fluorescent microsphere assay. The frequency of pfdhps K540E, A581G, and the quintuple (pfdhfr N51I + C59R + S108N/pfdhps A437G + K540E) and sextuple (pfdhfr N51I + C59R + S108N/pfdhps A437G + K540E + A581G) mutant genotypes was 90%, 38%, 75%, and 28%, respectively. No significant genotype difference was seen between the two districts, which are approximately 50 km apart. Observed agreements for matched peripheral to placental blood were reported and found to be 207 of 208 (99%) for pfdhfr and 239 of 260 (92%) for pfdhps. The peripheral blood sample did not miss any pfdhfr drug-resistant mutants or pfdhps except at the S436 loci. At this level of the sextuple mutant, the antimalarial efficacy of SP for preventing low birthweight is reduced, although overall SP still exerts a nonmalarial benefit during pregnancy. This study further reveals the need to intensify preventive measures to sustain malaria control in Rwanda to keep the overall incidence of malaria during pregnancy low. |
Persistence of mumps antibodies after 2 doses of measles-mumps-rubella vaccine
LeBaron CW , Forghani B , Beck C , Brown C , Bi D , Cossen C , Sullivan BJ . J Infect Dis 2009 199 (4) 552-60 BACKGROUND: Since 1990, most US schoolchildren have received a second dose of measles-mumps-rubella vaccine (MMR2) at kindergarten entry. The objective of the present study was to evaluate the short- and long-term mumps immunogenicity of MMR2. METHODS: At enrollment in 1994-1995, children (n=308) in a rural Wisconsin health maintenance organization received MMR2 at age 4-6 years. A comparison group of older children (n=308) was vaccinated at age 9-11 years. Serum samples were collected over 12 years. Mumps antibody levels were evaluated by plaque-reduction neutralization (lowest detectable titer, 10). RESULTS: Before MMR2, the geometric mean titer (GMT) for the younger group was 33; no subject was seronegative, but 16% had the lowest detectable titer. In response to MMR2, the GMT tripled to 97, and the proportion with low titers diminished to 3%. Four-fold boosts occurred among 54%, but only 3% were positive for immunoglobulin M. Twelve years after MMR2, the GMT declined to 46, the proportion with titers<or=10 was not significantly different from the pre-MMR2 proportion, and 5% were seronegative. The older group showed similar patterns, and at age 17 years both groups had comparable antibody levels. CONCLUSIONS: The mumps antibody response to MMR2 was vigorous, but over a 12-year period titers declined to levels similar to pre-MMR2 titers. No advantage was apparent in delaying MMR2 from kindergarten to middle school. |
Outbreak of locally acquired mosquito-transmitted (autochthonous) malaria - Florida and Texas, May-July 2023
Blackburn D , Drennon M , Broussard K , Morrison AM , Stanek D , Sarney E , Ferracci C , Huard S , Brennan W , Eaton J , Nealeigh S , Barber N , Zimler RA , Adams JN , Blackmore C , Gordillo M , Mercado R , Vore H , Scanlan K , Motie I , Stanfield L , Farooq A , Widel K , Tomson K , Kerr N , Nasir J , Cone M , Rice C , Larkin T , Hernandez E , Bencie J , Lesser CR , Dersch M , Ramirez-Lachmann S , Clark M , Rollo S , Bashadi A , Tyler R , Bolling B , Moore B , Sullivan B , Fonken E , Castillo R , Gonzalez Y , Olivares G , Mace KE , Sayre D , Lenhart A , Sutcliffe A , Dotson E , Corredor C , Rogers E , Raphael BH , Sapp SGH , Qvarnstrom Y , Ridpath AD , McElroy PD . MMWR Morb Mortal Wkly Rep 2023 72 (36) 973-978 Eight cases of locally acquired, mosquito-transmitted (i.e., autochthonous) Plasmodium vivax malaria, which has not been reported in the United States since 2003, were reported to CDC from state health departments in Florida and Texas during May 18-July 17, 2023. As of August 4, 2023, case surveillance, mosquito surveillance and control activities, and public outreach and education activities continue in both states. U.S. clinicians need to consider a malaria diagnosis in patients with unexplained fever, especially in areas where autochthonous malaria has been recently reported, although the risk for autochthonous malaria in the United States remains very low. Prompt diagnosis and treatment of malaria can prevent severe disease or death and limit ongoing transmission to local Anopheles mosquitoes and other persons. Preventing mosquito bites and controlling mosquitoes at home can prevent mosquitoborne diseases, including malaria. Before traveling internationally to areas with endemic malaria, travelers should consult with a health care provider regarding recommended malaria prevention measures, including potentially taking malaria prophylaxis. Malaria is a nationally notifiable disease; continued reporting of malaria cases to jurisdictional health departments and CDC will also help ensure robust surveillance to detect and prevent autochthonous malaria in the United States. |
A review of brownfields revitalisation and reuse research in the US over three decades
De Sousa C , Carroll AMM , Whitehead S , Berman L , Coffin S , Heberle L , Hettiarachchi G , Martin S , Sullivan K , Van Der Kloot J . Local Environ 2023 Over the past 30 years, US-based research on contaminated and potentially-contaminated sites, or brownfields, has grown from defining the scope and size of the environmental, health and economic risks posed by abandoned manufacturing sites to exploring and documenting site-specific and area-wide impacts of their cleanup and revitalisation. From early and varied research on environmental and economic policy to equity and public impacts on minority communities, later research considered planning, adding case studies on sustainability and resilience to the scope of research covered. This review paper stems from exchanges of a long-standing network of academic, government agency, and practice professionals working to identify research, policy, and practice gaps. It traces the evolution of US brownfield revitalization research as was informed by, and informed, policy, program and practice. This review summarizes the literature and identifies research gaps and opportunities to further community and agency actions related to investigating, remediating, and redeveloping brownfield sites. It outlines site and area options to build climate resilience, strengthen community action for dismantling structural racism and disinvestment, and reduce the disproportionate risks experienced by communities of colour and areas of low income. The authors propose a new research agenda to address the gaps identified. © 2023 Informa UK Limited, trading as Taylor & Francis Group. |
Nucleoside analogs NM107 and AT-527 are antiviral against rubella virus
Dittmar M , Whig K , Miller J , Kamalia B , Suppiah S , Perelygina L , Sullivan KE , Schultz DC , Cherry S . PNAS Nexus 2023 2 (9) pgad256 Rubella is a highly contagious viral infection that usually causes a mild disease in children and adults. However, infection during pregnancy can result in a fetal or newborn death or congenital rubella syndrome (CRS), a constellation of permanent birth defects including cataracts, heart defects, and sensorineural deafness. The live-attenuated rubella vaccine has been highly effective, with the Americas declared free of endemic rubella transmission in 2015. However, rubella remains a significant problem worldwide and the leading cause of vaccine-preventable birth defects globally. Thus, elimination of rubella and CRS is a goal of the World Health Organization. No specific therapeutics are approved for the rubella virus. Therefore, we set out to identify whether existing small molecules may be repurposed for use against rubella virus infection. Thus, we performed a high-throughput screen for small molecules active against rubella virus in human respiratory cells and identified two nucleoside analogs, NM107 and AT-527, with potent antiviral activity. Furthermore, we found that combining these nucleoside analogs with inhibitors of host nucleoside biosynthesis had synergistic antiviral activity. These studies open the door to new potential approaches to treat rubella infections. |
High PrEP uptake, adherence, persistence and effectiveness outcomes among young Thai men and transgender women who sell sex in Bangkok and Pattaya, Thailand: findings from the open-label combination HIV prevention effectiveness (COPE) study
Weir BW , Wirtz AL , Chemnasiri T , Baral SD , Decker M , Dun C , Hnin Mon SH , Ungsedhapand C , Dunne EF , Woodring J , Pattanasin S , Sukwicha W , Thigpen MC , Varangrat A , Warapornmongkholkul A , O'Connor S , Ngo JP , Qaragholi N , Sisel HI , Truong JM , Janyam S , Linjongrat D , Sriplienchan S , Sirivongrangson P , Rooney JF , Sullivan P , Chua-Intra B , Hickey AC , Beyrer C . Lancet Reg Health Southeast Asia 2023 15 100217 BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection, but no study has evaluated combination prevention interventions with PrEP for transgender women (TGW) and men who have sex with men (MSM) who sell sex. METHODS: The Combination Prevention Effectiveness (COPE) study was a community-based, non-randomized implementation study in Bangkok and Pattaya, Thailand. Participants were HIV-negative MSM and TGW aged 18-26 years who reported exchanging sex with men in the prior 12 months and who met 2014 U.S. Public Health Service PrEP eligibility criteria. The intervention included quarterly HIV testing, semiannual testing for sexually transmitted infections, provision of condoms with lubricant, and the opportunity to initiate or end daily oral PrEP use at any time during study participation. Participants taking PrEP received monthly adherence counseling and short message service reminders. The primary outcome was HIV incidence rate ratio (IRR) on PrEP vs. not on PrEP. Secondary outcomes were PrEP initiation, PrEP use at 12 months, and PrEP adherence. FINDINGS: From October 2017 to August 2019, 846 participants were enrolled: 531 (62.8%) immediately initiated PrEP; 104 (12.3%) subsequently initiated PrEP, and 211 (24.9%) never initiated PrEP. Among those initiating PrEP within 30 days of enrollment; 85.9% were on PrEP at the 12-months. When taking PrEP, participants reported adherent PrEP use at 94.2% of quarterly assessments. Ten HIV seroconversions occurred without PrEP use (incidence rate [IR] = 3.42 per 100 person-years [PY]; 95% CI = 1.64-6.30), while zero cases occurred with PrEP use (IR = 0.0 per 100PY; 95% CI = 0.0-0.62), with IRR = 0.0 (95% CI = 0.0-0.22; p < 0.001). INTERPRETATION: Young Thai MSM and TGW who exchange sex can have high PrEP uptake, persistence and adherence, and low HIV incidence when offered in supportive community-based settings. FUNDING: U.S. National Institute of Allergy and Infectious Diseases; Centers for Disease Control and Prevention. |
Escaping the Fate of Sisyphus: Assessing Resistome Hybridization Baits for Antimicrobial Resistance Gene Capture (preprint)
Beaudry MS , Thomas JC , Baptista RP , Sullivan AH , Norfolk W , Devault A , Enk J , Kieran TJ , Rhodes OEJr , Perry KA , Rose LJ , Bayona-Vásquez NJ , Oladeinde A , Lipp EK , Sanchez S , Glenn TC . bioRxiv 2021 2021.07.20.452950 Finding, characterizing, and monitoring reservoirs for antimicrobial resistance (AMR) is vital to protecting public health. Hybridization capture baits are an accurate, sensitive, and cost-effective technique used to enrich and characterize DNA sequences of interest, including antimicrobial resistance genes (ARGs), in complex environmental samples. We demonstrate the continued utility of a set of 19,933 hybridization capture baits designed from the Comprehensive Antibiotic Resistance Database (CARD)v1.1.2 and Pathogenicity Island Database (PAIDB)v2.0, targeting 3,565 unique nucleotide sequences that confer resistance. We demonstrate the efficiency of our bait set on a custom-made resistance mock community and complex environmental samples to increase the proportion of on-target reads as much as >200-fold. However, keeping pace with newly discovered ARGs poses a challenge when studying AMR, because novel ARGs are continually being identified and would not be included in bait sets designed prior to discovery. We provide imperative information on how our bait set performs against CARDv3.3.1, as well as a generalizable approach for deciding when and how to update hybridization capture bait sets. This research encapsulates the full life cycle of baits for hybridization capture of the resistome from design and validation (both in silico and in vitro) to utilization and forecasting updates and retirement.Originality-Significance Statement This work is applicable to a wide range of research. It helps to define conditions under which hybridization capture is useful regarding not only antimicrobial resistance specifically, but also more generally how to assess the ongoing utility of existing bait sets - giving objective criteria for when and by what strategies baits should be updated. We also provide a method for quantifying and comparing antimicrobial resistance genes (ARGs) similar to what is used for RNAseq experiments. This approach improves comparison of ARGs across environments. Thus, the work provides an improved foundation for ARG future studies, while cutting across traditional areas of microbiology and extending beyond.Competing Interest StatementThe EHS DNA lab provides oligonucleotide aliquots and library preparation services at cost, including some oligonucleotides and services used in this manuscript (baddna.uga.edu). JE and AD were employed by, and thereby have financial interest in, Daicel Arbor Biosciences, who provided the in-solution capture reagents used in this work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. |
A Decision Analytics Model to Optimize Investment in Interventions Targeting the HIV PrEP Cascade of Care (preprint)
Jenness SM , Knowlton G , Smith DK , Marcus JL , Anderson EJ , Siegler AJ , Jones J , Sullivan PS , Enns E . medRxiv 2021 2020.12.10.20247270 Objectives Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact.Design We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model.Methods The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective.Results From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions.Conclusions Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by Centers for Disease Control and Prevention cooperative agreement number U38 PS004646 and National Institutes of Health grant R01 AI138783. Dr. Marcus is supported in part by National Institutes of Health grant K01 AI122853.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Emory University Institutional Review Board approved the study protocols for the primary empirical data collection yielding model parameters for the current study.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe model code and parameters are all open and availability at the Github repository linked below. https://github.com/EpiModel/PrEP-Optimize |
The PrEP Care Continuum and Racial Disparities in HIV Incidence among Men Who Have Sex with Men (preprint)
Jenness SM , Maloney KM , Smith DK , Hoover KW , Goodreau SM , Rosenberg ES , Weiss KM , Liu AY , Rao DW , Sullivan PS . bioRxiv 2018 249540 Background HIV preexposure prophylaxis (PrEP) could reduce the disparities in HIV incidence among black men who have sex with men (BMSM) compared to white MSM (WMSM), but this may depend on progression through the PrEP care continuum.Methods We expanded our network-based mathematical model of HIV transmission for MSM, which simulates PrEP based on CDC’s clinical practice guidelines, to include race-stratified transitions through the PrEP continuum steps of awareness, access, prescription, adherence, and retention. Continuum parameters were estimated based on published incidence cohorts and PrEP open-label studies. Counterfactuals included a no-PrEP reference scenario, and intervention scenarios in which the BMSM continuum step parameters were modified.Results Implementing PrEP according to the observed BMSM continuum was projected to result in 8.4% of all BMSM on PrEP at year 10, yielding a 23% decline in incidence (HR = 0.77). On an absolute scale, the racial disparity in incidence in this scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the reference scenario. If BMSM continuum parameters were equal to WMSM values, 17.7% of BMSM would be on PrEP, yielding a 47% decline in incidence (HR = 0.53) and a disparity of 3.30 per 100 PYAR (a 46% decline in the disparity).Conclusions PrEP could lower HIV incidence overall and reduce absolute racial disparities between BMSM and WMSM. Interventions addressing the racial gaps in the PrEP continuum will be needed to further decrease these HIV disparities. |
The Role of HIV Partner Services in the Modern Biomedical HIV Prevention Era: A Network Modeling Study (preprint)
Jenness SM , Le Guillou A , Lyles C , Bernstein KT , Krupinsky K , Enns EA , Sullivan PS , Delaney KP . medRxiv 2022 21 (12) 801-807 Background HIV partner services can accelerate the use of antiretroviral-based HIV prevention tools (ART and PrEP), but its population impact on long-term HIV incidence reduction is challenging to quantify with traditional PS metrics of partner identified or HIV-screened. Understanding the role of partner services within the portfolio of HIV prevention interventions, including using it to efficiently deliver antiretrovirals, is needed to achieve HIV prevention targets. Methods We used a stochastic network model of HIV/STI transmission for men who have sex with men (MSM), calibrated to surveillance-based estimates in the Atlanta area, a jurisdiction with high HIV burden and suboptimal partner services uptake. Model scenarios varied successful delivery of partner services cascade steps (newly diagnosed "index" patient and partner identification, partner HIV screening, and linkage or reengagement of partners in PrEP or ART care) individually and jointly. Results At current levels observed in Atlanta, removal of HIV partner services had minimal impact on 10-year cumulative HIV incidence, as did improving a single partner services step while holding the others constant. These changes did not sufficiently impact overall PrEP or ART coverage to reduce HIV transmission. If all index patients and partners were identified, maximizing partner HIV screening, partner PrEP provision, partner ART linkage, and partner ART reengagement would avert 6%, 11%, 5%, and 18% of infections, respectively. Realistic improvements in partner identification and service delivery were estimated to avert 2-8% of infections, depending on the combination of improvements. Conclusions Achieving optimal HIV prevention with partner services depends on pairing improvements in index patient and partner identification with maximal delivery of HIV screening, ART, and PrEP to partners if indicated. Improving the identification steps without improvement to antiretroviral service delivery steps, or vice versa, is projected to result in negligible population HIV prevention benefit. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Notes from the field: Multistate, multiserotype outbreak of salmonella infections linked to cashew brie United States, 2021
Lewis K , Vasser M , Garman K , Higa J , Needham M , Irving DJ , Cavallo S , Sullivan D , Marks , Kirchner M , Madad A , McCormic ZD , Dunn J . MMWR Morb Mortal Wkly Rep 2023 72 (21) 589-90 |
Factors associated with mobile app-based ordering of HIV self-test kits among men who have sex with men in Atlanta, Detroit and New York City: an exploratory secondary analysis of a randomized control trial
Mancuso N , Mansergh G , Stephenson R , Horvath KJ , Hirshfield S , Bauermeister JA , Chiasson MA , Downing MJ Jr , Sullivan PS . J Int AIDS Soc 2023 26 (5) e26100 INTRODUCTION: The United States Centers for Disease Control and Prevention currently recommends HIV screening at least annually among sexually active gay, bisexual and other men who have sex with men (MSM), but only half report being tested in the past year in the United States. As HIV self-test kits are becoming more available around the United States via web and app-based interventions, it is important to understand who is willing and able to order them. This analysis sought to better understand predictors of free HIV self-test kit utilization among MSM in M-cubed, an HIV prevention mobile app intervention trial in Atlanta, Detroit and New York City. METHODS: We conducted an exploratory secondary analysis of self-report and in-app data collected from the intervention arm of the M-Cubed study from 24 January 2018 to 31 October 2019. Behavioural, demographic and other potential predictors of HIV self-test ordering were identified from Social Cognitive Theoretical underpinnings of the app, and from the literature. Significant predictor variables in bivariate analyses were considered for inclusion in the empiric multivariable model. Demographic variables chosen a priori were then added to a final model estimating adjusted prevalence ratios (aPR). RESULTS: Over half of the 417 intervention participants ordered an HIV self-test kit during the study. In bivariate analyses, ordering a kit was associated with HIV testing history, plans to get tested and reported likelihood of getting tested. In the final model, participants were more likely to order a kit if they reported plans to get tested in the next 3 months (aPR = 1.58, 95% CI: 1.18-2.11) or had not tested for HIV in the past 3 months (aPR = 1.38, 95% CI: 1.13-1.70). There was no difference in HIV self-test kit ordering by income, race/ethnicity or age. CONCLUSIONS: HIV testing is an important tool in ending the HIV epidemic and must be accessible and frequent for key populations. This study demonstrates the effectiveness of HIV self-test kits in reaching populations with suboptimal testing rates and shows that self-testing may supplement community-based and clinical testing while helping overcome some of the structural barriers that limit access to annual HIV prevention services for MSM. |
National burden of influenza-associated hospitalizations in Cambodia, 2015 and 2016
Ieng V , Tolosa MX , Tek B , Sar B , Sim K , Seng H , Thyl M , Dara C , Moniborin M , Stewart RJ , Bell LC , Theocharopoulos G , Chin S , Chau D , Iuliano AD , Moen A , Tsuyuoka R , Dueger EL , Sullivan SG , Ly S . Western Pac Surveill Response J 2018 9 44-52 INTRODUCTION: The burden of influenza in Cambodia is not well known, but it would be useful for understanding the impact of seasonal epidemics and pandemics and to design appropriate policies for influenza prevention and control. The severe acute respiratory infection (SARI) surveillance system in Cambodia was used to estimate the national burden of SARI hospitalizations in Cambodia. METHODS: We estimated age-specific influenza-associated SARI hospitalization rates in three sentinel sites in Svay Rieng, Siem Reap and Kampong Cham provinces. We used influenza-associated SARI surveillance data for one year to estimate the numerator and hospital admission surveys to estimate the population denominator for each site. A national influenza-associated SARI hospitalization rate was calculated using the pooled influenza-associated SARI hospitalizations for all sites as a numerator and the pooled catchment population of all sites as denominator. National influenza-associated SARI case counts were estimated by applying hospitalization rates to the national population. RESULTS: The national annual rates of influenza-associated hospitalizations per 100 000 population was highest for the two youngest age groups at 323 for < 1 year and 196 for 1-4 years. We estimated 7547 influenza-associated hospitalizations for Cambodia with almost half of these represented by children younger than 5 years. DISCUSSION: We present national estimates of influenza-associated SARI hospitalization rates for Cambodia based on sentinel surveillance data from three sites. The results of this study indicate that the highest burden of severe influenza infection is borne by the younger age groups. These findings can be used to guide future strategies to reduce influenza morbidity. |
Decreased influenza activity during the COVID-19 pandemic-United States, Australia, Chile, and South Africa, 2020.
Olsen SJ , Azziz-Baumgartner E , Budd AP , Brammer L , Sullivan S , Pineda RF , Cohen C , Fry AM . Am J Transplant 2020 20 (12) 3681-3685 Transplant recipients are among the groups for whom the updated recommendations for 2020–2021 influenza vaccination should generally be considered essential, notably in the face of the COVID-19 pandemic. |
Adeno-associated virus type 2 in US children with acute severe hepatitis.
Servellita V , Gonzalez AS , Lamson DM , Foresythe A , Huh HJ , Bazinet AL , Bergman NH , Bull RL , Garcia KY , Goodrich JS , Lovett SP , Parker K , Radune D , Hatada A , Pan CY , Rizzo K , Bertumen JB , Morales C , Oluniyi PE , Nguyen J , Tan J , Stryke D , Jaber R , Leslie MT , Lyons Z , Hedman HD , Parashar U , Sullivan M , Wroblewski K , Oberste MS , Tate JE , Baker JM , Sugerman D , Potts C , Lu X , Chhabra P , Pediatric Hepatitis of Unknown Etiology Working Group , Ingram LA , Shiau H , Britt W , Sanchez LHG , Ciric C , Rostad CA , Vinjé J , Kirking HL , Wadford DA , Raborn RT , St George K , Chiu CY . Nature 2023 As of August 2022, clusters of acute severe hepatitis of unknown etiology in children have been reported from 35 countries, including the United States(1,2). Previous studies have found human adenoviruses (HAdVs) in the blood from cases in Europe and the United States(3-7), although it is unclear whether this virus is causative. Here we used PCR testing, viral enrichment based sequencing, and agnostic metagenomic sequencing to analyze samples from 16 HAdV-positive cases from October 1, 2021 to May 22, 2022, in parallel with 113 controls. In blood from 14 cases, adeno-associated virus 2 (AAV2) sequences were detected in 93% (13 of 14), compared to 4 (3.5%) of 113 controls (P<0.001) and to 0 of 30 patients with hepatitis of defined etiology (P<0.001). In controls, HAdV-41 was detected in blood from 9 (39.1%) of the 23 patients with acute gastroenteritis (without hepatitis), including 8 of 9 patients with positive stool HAdV testing, but co-infection with AAV2 was observed in only 3 (13.0%) of these 23 patients versus 93% of cases (P<0.001). Co-infections by Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and/or enterovirus A71 (EV-A71) were also detected in 12 (85.7%) of 14 cases, with higher herpesvirus detection in cases versus controls (P<0.001). Our findings suggest that the severity of the disease is related to co-infections involving AAV2 and one or more helper viruses. |
Characteristics of mpox vaccine recipients among a sample of men who have sex with men with presumed exposure to mpox
Abara WE , Sullivan P , Carpino T , Sanchez T , Atkins K , Delaney K , Edwards OW , Marissa H , Baral S , Ogale Y , Galloway E , Lansky A . Sex Transm Dis 2023 50 (7) 458-461 Mpox vaccination is recommended for persons exposed to or at risk for mpox. About 25% of an online sample of MSM with presumed mpox exposure were vaccinated (≥1 dose). Vaccination was higher among younger MSM and MSM concerned about mpox or reporting sexual risk behaviors. Incorporating mpox vaccination into routine sexual health care and increasing 2-dose vaccination uptake is essential to preventing mpox acquisition, improving MSM sexual health, and averting future mpox outbreaks. |
Effectiveness of intermittent screening and treatment of malaria in pregnancy on maternal and birth outcomes in selected districts in Rwanda: A cluster randomized controlled trial
Uwimana A , Sethi R , Murindahabi M , Ntirandeka C , Piercefield E , Umulisa N , Abram A , Eckert E , Munguti K , Sullivan D , Uyizeye D , Mbituyumuremyi A , Gutman JR . Clin Infect Dis 2023 77 (1) 127-134 BACKGROUND: Malaria during pregnancy can cause serious consequences including maternal anemia and low birthweight (LBW). Routine antenatal care (ANC) in Rwanda includes malaria symptom screening at each ANC visit. This cluster randomized controlled trial investigated whether adding intermittent screening with a malaria rapid diagnostic test (RDT) at each routine ANC visit and treatment of positives during pregnancy (ISTp) is more effective than routine ANC for reducing malaria prevalence at delivery. METHODS: Between September 2016- June 2018, pregnant women initiating ANC at 14 health centers in Rwanda were enrolled into ISTp or control arms. All women received an insecticide-treated bed net at enrolment. Hemoglobin concentration, placental and peripheral parasitemia, newborn outcome, birthweight, and prematurity were assessed at delivery. RESULTS: 975 were enrolled in ISTp and 811 in the control. Routine ANC plus ISTp did not significantly reduce PCR-confirmed placental malaria compared to control (adjusted relative risk [aRR] 0.94, 95% confidence interval [CI] 0.59-1.50, p=0.799). ISTp had no impact on anemia (aRR 1.08, 95% CI 0.57-2.04, p=0.821). The mean birthweight of singleton newborns was not significantly different between arms (3054gm vs 3096gm, p=0.395), however women in the ISTp arm had a higher proportion of LBW (aRR = 1.59, 95% CI 1.02-2.49, p=0.042). CONCLUSIONS: This is the only study to compare ISTp to symptomatic screening at ANC in a setting where intermittent preventive treatment is not routinely provided. ISTp did not reduce the prevalence of malaria or anemia at delivery and was associated with an increased risk of LBW. CLINICAL TRIALS REGISTRATION: NCT03508349. |
Four principles to establish a universal virus taxonomy.
Simmonds P , Adriaenssens EM , Zerbini FM , Abrescia NGA , Aiewsakun P , Alfenas-Zerbini P , Bao Y , Barylski J , Drosten C , Duffy S , Duprex WP , Dutilh BE , Elena SF , García ML , Junglen S , Katzourakis A , Koonin EV , Krupovic M , Kuhn JH , Lambert AJ , Lefkowitz EJ , Ĺobocka M , Lood C , Mahony J , Meier-Kolthoff JP , Mushegian AR , Oksanen HM , Poranen MM , Reyes-Muñoz A , Robertson DL , Roux S , Rubino L , Sabanadzovic S , Siddell S , Skern T , Smith DB , Sullivan MB , Suzuki N , Turner D , Van Doorslaer K , Vandamme AM , Varsani A , Vasilakis N . PLoS Biol 2023 21 (2) e3001922 A universal taxonomy of viruses is essential for a comprehensive view of the virus world and for communicating the complicated evolutionary relationships among viruses. However, there are major differences in the conceptualisation and approaches to virus classification and nomenclature among virologists, clinicians, agronomists, and other interested parties. Here, we provide recommendations to guide the construction of a coherent and comprehensive virus taxonomy, based on expert scientific consensus. Firstly, assignments of viruses should be congruent with the best attainable reconstruction of their evolutionary histories, i.e., taxa should be monophyletic. This fundamental principle for classification of viruses is currently included in the International Committee on Taxonomy of Viruses (ICTV) code only for the rank of species. Secondly, phenotypic and ecological properties of viruses may inform, but not override, evolutionary relatedness in the placement of ranks. Thirdly, alternative classifications that consider phenotypic attributes, such as being vector-borne (e.g., "arboviruses"), infecting a certain type of host (e.g., "mycoviruses," "bacteriophages") or displaying specific pathogenicity (e.g., "human immunodeficiency viruses"), may serve important clinical and regulatory purposes but often create polyphyletic categories that do not reflect evolutionary relationships. Nevertheless, such classifications ought to be maintained if they serve the needs of specific communities or play a practical clinical or regulatory role. However, they should not be considered or called taxonomies. Finally, while an evolution-based framework enables viruses discovered by metagenomics to be incorporated into the ICTV taxonomy, there are essential requirements for quality control of the sequence data used for these assignments. Combined, these four principles will enable future development and expansion of virus taxonomy as the true evolutionary diversity of viruses becomes apparent. |
Video selection and assessment for an app-based HIV prevention messaging intervention: formative research
Downing MJ Jr , Wiatrek SE , Zahn RJ , Mansergh G , Olansky E , Gelaude D , Sullivan PS , Stephenson R , Siegler AJ , Bauermeister J , Horvath KJ , Chiasson MA , Yoon IS , Houang ST , Hernandez AJ , Hirshfield S . Mhealth 2023 9 2 BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individual's serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video- and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. METHODS: The selection of videos included balancing of specific criteria [e.g., accuracy of scientific information, video length, prevention domains: HIV/STI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use] to ensure that they were intended for our GBMSM audiences: HIV-negative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta. RESULTS: Following a qualitative content analysis, the study team identified five themes across the interviews: participant reactions to the video messages, message comprehension, PrEP concerns, targeting of video messaging, and prompted action. CONCLUSIONS: Study results informed a final selection of 12 video messages for inclusion in a randomized controlled trial of M-Cubed. Findings may serve as a guide for researchers who plan to develop HIV prevention interventions that utilize publicly available videos to promote behavioral change. Further, the findings presented here suggest the importance of developing videos with broad age and gender diversity for use in interventions such as M-Cubed, and in other health promotion settings. |
Estimation of HIV-1 incidence using a testing history-based method; analysis from the population-based HIV impact assessment survey data in 12 African countries
Gurley SA , Stupp PW , Fellows IE , Parekh BS , Young PW , Shiraishi RW , Sullivan PS , Voetsch AC . J Acquir Immune Defic Syndr 2023 92 (3) 189-196 BACKGROUND: Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described. METHODS: We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation. RESULTS: The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method. CONCLUSIONS: The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data. |
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