2024-03-29T15:39:13Zhttps://escholarship.org/oaioai:escholarship.org:ark:/13030/qt9b7863312024-03-26T02:19:31Zqt9b786331Impact of post-incarceration care engagement interventions on HIV transmission among young Black men who have sex with men and their sexual partners: an agent-based network modeling studyHotton, Anna LLee, FrancisSheeler, DanielOzik, JonathanCollier, NicholsonEdali, MertArdestani, Babak MahdaviBrewer, RussellSchrode, Katrina MFujimoto, KayoHarawa, Nina TSchneider, John AKhanna, Aditya S2023-12-01BackgroundUnderstanding the impact of incarceration on HIV transmission among Black men who have sex with men is important given their disproportionate representation among people experiencing incarceration and the potential impact of incarceration on social and sexual networks, employment, housing, and medical care. We developed an agent-based network model (ABNM) of 10,000 agents representing young Black men who have sex with men in the city of Chicago to examine the impact of varying degrees of post-incarceration care disruption and care engagement interventions following release from jail on HIV incidence.MethodsExponential random graph models were used to model network formation and dissolution dynamics, and network dynamics and HIV care continuum engagement were varied according to incarceration status. Hypothetical interventions to improve post-release engagement in HIV care for individuals with incarceration (e.g., enhanced case management, linkage to housing and employment services) were compared to a control scenario with no change in HIV care engagement after release.FindingHIV incidence at 10 years was 4.98 [95% simulation interval (SI): 4.87, 5.09 per 100 person-years (py)] in the model population overall; 5.58 (95% SI 5.38, 5.76 per 100 py) among those with history of incarceration, and 12.86 (95% SI 11.89, 13.73 per 100 py) among partners of agents recently released from incarceration. Sustained post-release HIV care for agents with HIV and experiencing recent incarceration resulted in a 46% reduction in HIV incidence among post-incarceration partners [incidence rate (IR) per 100 py = 5.72 (95% SI 5.19, 6.27) vs. 10.61 (95% SI 10.09, 11.24); incidence rate ratio (IRR) = 0.54; (95% SI 0.48, 0.60)] and a 19% reduction in HIV incidence in the population overall [(IR per 100 py = 3.89 (95% SI 3.81-3.99) vs. 4.83 (95% SI 4.73, 4.92); IRR = 0.81 (95% SI 0.78, 0.83)] compared to a scenario with no change in HIV care engagement from pre-to post-release.InterpretationDeveloping effective and scalable interventions to increase HIV care engagement among individuals experiencing recent incarceration and their sexual partners is needed to reduce HIV transmission among Black men who have sex with men.FundingThis work was supported by the following grants from the National Institutes of Health: R01DA039934; P20 GM 130414; P30 AI 042853; P30MH058107; T32 DA 043469; U2C DA050098 and the California HIV/AIDS Research Program: OS17-LA-003; H21PC3466.Public HealthHealth SciencesHuman SocietyClinical ResearchHIV/AIDSPreventionMental HealthInfectionGood Health and Well BeingAgent-based modelingHIVIncarcerationSexual minoritiesCC-BYeScholarship, University of Californiahttps://escholarship.org/uc/item/9b786331articleoai:escholarship.org:ark:/13030/qt5mv5p2gj2024-03-25T03:22:05Zqt5mv5p2gjMethamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trialGoodman-Meza, DavidShoptaw, SteveWeiss, Robert ENakazono, TerryHarawa, Nina TTakada, SaeGarland, Wendy HCunningham, William E2019-09-01BackgroundPeople living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants.MethodsWe analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction.ResultsAt baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p < 0.001).ConclusionHigh-risk drug use, dominated by methamphetamine use, independently correlated with decreased VS among recently incarcerated PLWH. Improving HIV care continuum outcomes among populations leaving jail requires attention to efforts to address high-risk drug use.Pharmacology and Pharmaceutical SciencesBiomedical and Clinical SciencesMethamphetaminePreventionBrain DisordersSubstance MisuseClinical Trials and Supportive ActivitiesHIV/AIDSClinical ResearchDrug Abuse (NIDA only)Good Health and Well BeingAdultAnalgesicsOpioidAnti-HIV AgentsCocaineContinuity of Patient CareFemaleHIV InfectionsHumansLinear ModelsLos AngelesMaleMiddle AgedPatient Acceptance of Health CarePrisonersPrisonsSubstance-Related DisordersSubstance useStimulantHIV viral suppressionJailMedical and Health SciencesPsychology and Cognitive SciencesSubstance AbuseBiochemistry and cell biologyPharmacology and pharmaceutical sciencesEpidemiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5mv5p2gjarticleoai:escholarship.org:ark:/13030/qt48z070mt2024-03-24T23:23:48Zqt48z070mtSoluble Urokinase Plasminogen Activator Receptor Is Predictive of Non-AIDS Events During Antiretroviral Therapy–mediated Viral SuppressionHoenigl, MartinMoser, Carlee BFunderburg, NicholasBosch, RonaldKantor, AmyZhang, YonglongEugen-Olsen, JesperFinkelman, MalcolmReiser, JochenLanday, AlanMoisi, DanielaLederman, Michael MGianella, Sara2019-08-01BackgroundDespite effective antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains associated with higher morbidity and mortality, driven, in part, by increased inflammation. Our objective was to identify associations between levels of plasma biomarkers of chronic inflammation, microbial translocation, and monocyte activation, with occurrence of non-AIDS events.MethodsParticipants (141 cases, 310 matched controls) were selected from a longitudinal observational trial; all were virally suppressed on ART at year 1 and thereafter. Soluble urokinase plasminogen activator receptor (suPAR), lipopolysaccharide binding protein (LBP), beta-D-glucan (BDG), intestinal fatty-acid binding protein, oxidized low-density lipoproteins, and soluble CD163 were measured pre-ART, after 1-year of ART, and pre-event. At each time point, conditional logistic regression analysis assessed associations of the biomarkers with events and adjusted for relevant covariates to calculate odds ratios (ORs) according to 1 interquartile range (IQR) difference.ResultsAt all time points, higher levels of suPAR were associated with increased risk of non-AIDS events (OR per 1 IQR was 1.7 before ART-initiation, OR per 1 IQR was 2.0 after 1 year of suppressive ART, and OR 2.1 pre-event). Higher levels of BDG and LBP at year 1 and pre-event (but not at baseline) were associated with increased risk of non-AIDS events. No associations were observed for other biomarkers.ConclusionsElevated levels of suPAR were strongly, consistently, and independently predictive of non-AIDS events at every measured time point. Interventions that target the suPAR pathway should be investigated to explore its role in the pathogenesis of non-AIDS-related outcomes in HIV infection.Medical MicrobiologyBiomedical and Clinical SciencesClinical ResearchInfectious DiseasesHIV/AIDS2.1 Biological and endogenous factorsAetiologyInfectionGood Health and Well BeingAdultAgedBiomarkersFemaleHIV InfectionsHumansInflammationMaleMiddle AgedReceptorsUrokinase Plasminogen ActivatorViral LoadYoung Adultnon-AIDS mortalityviral suppressionsuPARlipopolysaccharide binding proteinbeta-D-glucanAdult Clinical Trials Group NWCS 411 study teamBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/48z070mtarticleClinical Infectious Diseases, vol 69, iss 4676 - 686oai:escholarship.org:ark:/13030/qt8sb792012024-03-24T23:10:29Zqt8sb79201Ethical considerations for HIV cure-related research at the end of lifeDubé, KarineGianella, SaraConcha-Garcia, SusanLittle, Susan JKaytes, AndyTaylor, JeffMathur, KushagraJavadi, SogolNathan, AnshulaPatel, HurschLuter, StuartPhilpott-Jones, SeanBrown, BrandonSmith, Davey2018-12-01BackgroundThe U.S. National Institute of Allergies and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH) have a new research priority: inclusion of terminally ill persons living with HIV (PLWHIV) in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego (UCSD) for PLWHIV who have a terminal illness, with a prognosis of less than 6 months.DiscussionAs end-of-life (EOL) HIV cure research is relatively new, the scientific community has a timely opportunity to examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders (biomedical researchers, PLWHIV, bioethicists, and socio-behavioral scientists) and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders.ConclusionEOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable.Health Services and SystemsHealth SciencesPhilosophy and Religious StudiesApplied EthicsBasic Behavioral and Social ScienceHIV/AIDSBehavioral and Social ScienceInfectious DiseasesClinical ResearchHealth and social care services research8.3 Policyethicsand research governanceGeneric health relevanceInfectionGood Health and Well BeingAltruismAutopsyBiomedical ResearchHIV InfectionsHumansInformed ConsentPersonal AutonomyTerminal CareHIV cure researchEnd-of-lifeLast giftRapid research autopsyEthical considerationsAltruism End-of-life (EOL) Ethical considerations HIV cure research Last gift Rapid research autopsyPublic healthApplied ethicsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8sb79201articleBMC Medical Ethics, vol 19, iss 183oai:escholarship.org:ark:/13030/qt0cn142c82024-03-24T21:55:05Zqt0cn142c8The Control of HIV After Antiretroviral Medication Pause (CHAMP) Study: Posttreatment Controllers Identified From 14 Clinical StudiesNamazi, GolnazFajnzylber, Jesse MAga, EvgeniaBosch, Ronald JAcosta, Edward PSharaf, RadwaHartogensis, WendyJacobson, Jeffrey MConnick, ElizabethVolberding, PaulSkiest, DanielMargolis, DavidSneller, Michael CLittle, Susan JGianella, SaraSmith, Davey MKuritzkes, Daniel RGulick, Roy MMellors, John WMehraj, VikramGandhi, Rajesh TMitsuyasu, RonaldSchooley, Robert THenry, KeithTebas, PabloDeeks, Steven GChun, Tae-WookCollier, Ann CRouty, Jean-PierreHecht, Frederick MWalker, Bruce DLi, Jonathan Z2018-11-05BackgroundHIV posttreatment controllers are rare individuals who start antiretroviral therapy (ART), but maintain HIV suppression after treatment interruption. The frequency of posttreatment control and posttreatment interruption viral dynamics have not been well characterized.MethodsPosttreatment controllers were identified from 14 studies and defined as individuals who underwent treatment interruption with viral loads ≤400 copies/mL at two-thirds or more of time points for ≥24 weeks. Viral load and CD4+ cell dynamics were compared between posttreatment controllers and noncontrollers.ResultsOf the 67 posttreatment controllers identified, 38 initiated ART during early HIV infection. Posttreatment controllers were more frequently identified in those treated during early versus chronic infection (13% vs 4%, P < .001). In posttreatment controllers with weekly viral load monitoring, 45% had a peak posttreatment interruption viral load of ≥1000 copies/mL and 33% had a peak viral load ≥10000 copies/mL. Of posttreatment controllers, 55% maintained HIV control for 2 years, with approximately 20% maintaining control for ≥5 years.ConclusionsPosttreatment control was more commonly identified amongst early treated individuals, frequently characterized by early transient viral rebound and heterogeneous durability of HIV remission. These results may provide mechanistic insights and have implications for the design of trials aimed at achieving HIV remission.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyHIV/AIDSInfectious DiseasesClinical ResearchEvaluation of treatments and therapeutic interventions6.1 PharmaceuticalsInfectionGood Health and Well BeingAdultAnti-HIV AgentsCD4 Lymphocyte CountDrug Administration ScheduleFemaleHIV InfectionsHIV-1HumansMaleMiddle AgedViral LoadBiological SciencesMedical and Health SciencesMicrobiologyBiological sciencesBiomedical and clinical sciencesHealth sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0cn142c8articleThe Journal of Infectious Diseases, vol 218, iss 121954 - 1963oai:escholarship.org:ark:/13030/qt5k1381212024-03-24T21:53:05Zqt5k138121Willingness to participate in HIV research at the end of life (EOL)Prakash, KatyaGianella, SaraDubé, KarineTaylor, JeffLee, GaYoungSmith, Davey MMargolis, Leonid2018-01-01IntroductionAnimal models have been vital for scientific discovery but have limitations, especially in infectious disease research. It is essential to develop a means to study these diseases in human models. We hypothesized that altruistic people would willingly participate in research near the end-of-life (EOL), for the benefit of science and to provide one last gift to society.MethodologyTwo surveys were administered to 377 self-reported HIV-negative and 96 HIV-positive individuals. Hypothetical questions assessed their willingness to participate in altruistic research in the last 6 months of life, which might result in a shortened lifespan or physical discomforts. The self-reported HIV-negative group was also asked about willingness to be exposed to infectious pathogens for the sake of research.ResultsAlmost all responders expressed willingness to participate in research at the EOL, regardless of HIV-status. The majority of participants were willing to endure physical discomfort for the sake of research. 'Blood draws' was identified as the most tolerable physical discomfort (>70% in both groups). In both groups, >60% were willing to shorten their lifespans for the sake of research. A third of the self-reported HIV-negative group expressed willingness to be exposed to at least one infectious agent to participate in EOL research.ConclusionsOur exploratory study demonstrates that people would welcome the opportunity to participate in altruistic research near the EOL. Such research could greatly impact the way infectious disease research is conducted. This study is limited however by its hypothetical nature. Further research is necessary to confirm this interest in those with terminal illness before any further clinical research effort at the EOL can be performed.Biomedical and Clinical SciencesClinical SciencesHIV/AIDSInfectious DiseasesClinical ResearchInfectionGood Health and Well BeingAdolescentAdultAgedAged80 and overFemaleHIV InfectionsHealth KnowledgeAttitudesPracticeHumansMaleMiddle AgedPatient ParticipationResearchSurveys and QuestionnairesTerminal CareYoung AdultAdolescent Adult Aged Aged80 and over Female HIV Infections/*epidemiology/immunology/virology *Health KnowledgeAttitudesPractice Humans Male Middle Aged *Patient Participation *Research Surveys and Questionnaires *Terminal Care Young AdultGeneral Science & TechnologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5k138121articlePLOS ONE, vol 13, iss 7e0199670oai:escholarship.org:ark:/13030/qt4m31k94j2024-03-24T20:48:19Zqt4m31k94jWhat does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIVSaberi, ParyaMing, KristinDawson-Rose, Carol2018-01-01PurposeGiven the consistent associations between younger age and numerous suboptimal clinical outcomes, there is a critical need for more research in youth living with human immunodeficiency virus (YLWH) and tailoring of health care delivery to the unique and complex needs of this population. The objective of this study was to examine the facilitators of and barriers to engagement in care among YLHW at the system and provider/staff level, as well as the barriers to using technology-based forms of communication with YLWH to improve retention and engagement in care.Patients and methodsWe conducted in-depth qualitative interviews with health care providers and staff members at the clinics and organizations serving YLWH in the San Francisco Bay Area.ResultsWe interviewed 17 health care providers and staff members with a mean of 8 years of experience in providing clinical care to YLWH. Interviewees noted various facilitators of and barriers to engagement in care among YLWH, including the environment of the clinic (e.g., clinic location and service setting), provision of youth-friendly services (e.g., flexible hours and use of technology), and youth-friendly providers/staff (e.g., nonjudgmental approach). With regard to barriers to using technology in organizations and clinics, interviewees discussed the challenges at the system level (e.g., availability of technology, clinic capacity, and Health Insurance Portability and Accountability Act compliance), provider/staff level (e.g., time constraints and familiarity with technology), and youth level (e.g., changing of cellular telephones and relationship with provider/staff).ConclusionGiven the need for improved clinical outcomes among YLWH, our results can provide guidance for clinics and institutions providing care for this population to enhance the youth-friendliness of their services and examine their guidelines around the use of technology.PaediatricsBiomedical and Clinical SciencesClinical ResearchHealth ServicesBehavioral and Social SciencePreventionPediatricPediatric Research Initiative8.1 Organisation and delivery of servicesHealth and social care services researchGeneric health relevanceGood Health and Well BeingHIVyouthyoung adultshealth care providertechnologybarriersClinical SciencesPaediatrics and Reproductive Medicineapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4m31k94jarticleoai:escholarship.org:ark:/13030/qt9xr0r34m2024-03-24T20:04:21Zqt9xr0r34mAssessing the costs and estimating scale-up of testing pregnant women for curable sexually transmitted infections in BotswanaWynn, AdrianeMoucheraud, CorrinaKlausner, JeffreyLeibowitz, Arleen2018-01-01Information and Computing SciencesMedical and Health SciencesHealth Policy & ServicesBiomedical and clinical sciencesPsychologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9xr0r34marticleoai:escholarship.org:ark:/13030/qt1cn775wg2024-03-24T17:28:51Zqt1cn775wgThe Importance of Human Immunodeficiency Virus Research for Transgender and Gender-Nonbinary IndividualsGianella, SaraHaw, J SonyaBlumenthal, JillSullivan, BrookeSmith, Davey2018-04-17Transgender and gender-nonbinary (trans/GNB) individuals are disproportionally affected by human immunodeficiency virus (HIV), yet they are not adequately represented in HIV research and often underserved in clinical care. By building on community strengths and addressing structural, psychological and biological challenges, we can improve the engagement of trans/GNB people in research and ultimately improve prevention, testing, and care for this population. Here, we review the current state of the science related to HIV for trans/GNB people and discuss next steps to expand research that aims to improve the lives and well-being of trans/GNB persons.Medical MicrobiologyBiomedical and Clinical SciencesSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSInfectious DiseasesHealth and social care services research8.1 Organisation and delivery of servicesInfectionGood Health and Well BeingBiomedical ResearchFemaleHIVHIV InfectionsHealth Services AccessibilityHumansMalePatient SelectionSocial StigmaTransgender PersonsHIV researchtransgendergender non binaryinclusionBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1cn775wgarticleClinical Infectious Diseases, vol 66, iss 91460 - 1466oai:escholarship.org:ark:/13030/qt2dz5q4q82024-03-24T17:26:15Zqt2dz5q4q8Size, Composition, and Evolution of HIV DNA Populations during Early Antiretroviral Therapy and Intensification with MaravirocChaillon, AntoineGianella, SaraLada, Steven MPerez-Santiago, JosuéJordan, ParrisIgnacio, CarolineKarris, MaileRichman, Douglas DMehta, Sanjay RLittle, Susan JWertheim, Joel OSmith, Davey MSilvestri, Guido2018-02-01Residual viremia is common during antiretroviral therapy (ART) and could be caused by ongoing low-level virus replication or by release of viral particles from infected cells. ART intensification should impact ongoing viral propagation but not virion release. Eighteen acutely infected men were enrolled in a randomized controlled trial and monitored for a median of 107 weeks. Participants started ART with (n = 9) or without (n = 9) intensification with maraviroc (MVC) within 90 days of infection. Levels of HIV DNA and cell-free RNA were quantified by droplet digital PCR. Deep sequencing of C2-V3 env, gag, and pol (454 Roche) was performed on longitudinally collected plasma and peripheral blood mononuclear cell (PBMC) samples while on ART. Sequence data were analyzed for evidence of evolution by (i) molecular diversity analysis, (ii) nonparametric test for panmixia, and (iii) tip date randomization within a Bayesian framework. There was a longitudinal decay of HIV DNA after initiation of ART with no difference between MVC intensification groups (-0.08 ± 0.01 versus -0.09 ± 0.01 log10 copies/week in MVC+ versus MVC- groups; P = 0.62). All participants had low-level residual viremia (median, 2.8 RNA copies/ml). Across participants, medians of 56 (interquartile range [IQR], 36 to 74), 29 (IQR, 25 to 35), and 40 (IQR, 31 to 54) haplotypes were generated for env, gag, and pol regions, respectively. There was no clear evidence of viral evolution during ART and no difference in viral diversity or population structure from individuals with or without MVC intensification. Further efforts focusing on elucidating the mechanism(s) of viral persistence in various compartments using recent sequencing technologies are still needed, and potential low-level viral replication should always be considered in cure strategies.IMPORTANCE Residual viremia is common among HIV-infected people on ART. It remains controversial if this viremia is a consequence of propagating infection. We hypothesized that molecular evolution would be detectable during viral propagation and that therapy intensified with the entry inhibitor maraviroc would demonstrate less evolution. We performed a randomized double-blinded treatment trial with 18 acutely infected men (standard ART versus standard ART plus maraviroc). From longitudinally collected blood plasma and cells, levels of HIV DNA and cell-free HIV RNA were quantified by droplet digital PCR, and HIV DNA (env, gag, and pol coding regions) was deep sequenced (454 Roche). Investigating people who started ART during the earliest stages of their HIV infection, when viral diversity is low, provides an opportunity to detect evidence of viral evolution. Despite using a battery of analytical techniques, no clear and consistent evidence of viral propagation for over 90 weeks of observation could be discerned.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyHIV/AIDSClinical ResearchClinical Trials and Supportive ActivitiesInfectious Diseases6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsInfectionGood Health and Well BeingAdultAntiretroviral TherapyHighly ActiveBayes TheoremCCR5 Receptor AntagonistsCaliforniaCyclohexanesDNAViralDouble-Blind MethodFemaleHIV InfectionsHIV-1HumansMaleMaravirocRNAViralTriazolesViral LoadViremiaVirus ReplicationYoung AdultART intensificationevolutionHIVmaravirocreservoirAdult Antiretroviral TherapyHighly Active Bayes Theorem CCR5 Receptor Antagonists/*therapeutic use California Cyclohexanes/*therapeutic use DNAViral/blood Double-Blind Method Female HIV Infections/*drug therapy/virology HIV-1/genetics/physiology Humans Male Maraviroc RNAViral/blood Triazoles/*therapeutic use Viral Load Viremia/*drug therapy Virus Replication/*drug effects Young Adult *ART intensification *Hiv *evolution *maraviroc *reservoirBiological SciencesAgricultural and Veterinary SciencesMedical and Health SciencesVirologyAgriculturalveterinary and food sciencesBiological sciencesBiomedical and clinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2dz5q4q8articleJournal of Virology, vol 92, iss 3e01589 - e01517oai:escholarship.org:ark:/13030/qt24t0c28z2024-03-24T15:59:12Zqt24t0c28zNo Substantial Evidence for Sexual Transmission of Minority HIV Drug Resistance Mutations in Men Who Have Sex with MenChaillon, AntoineNakazawa, MasatoWertheim, Joel OLittle, Susan JSmith, Davey MMehta, Sanjay RGianella, SaraSilvestri, Guido2017-11-01During primary HIV infection, the presence of minority drug resistance mutations (DRM) may be a consequence of sexual transmission, de novo mutations, or technical errors in identification. Baseline blood samples were collected from 24 HIV-infected antiretroviral-naive, genetically and epidemiologically linked source and recipient partners shortly after the recipient's estimated date of infection. An additional 32 longitudinal samples were available from 11 recipients. Deep sequencing of HIV reverse transcriptase (RT) was performed (Roche/454), and the sequences were screened for nucleoside and nonnucleoside RT inhibitor DRM. The likelihood of sexual transmission and persistence of DRM was assessed using Bayesian-based statistical modeling. While the majority of DRM (>20%) were consistently transmitted from source to recipient, the probability of detecting a minority DRM in the recipient was not increased when the same minority DRM was detected in the source (Bayes factor [BF] = 6.37). Longitudinal analyses revealed an exponential decay of DRM (BF = 0.05) while genetic diversity increased. Our analysis revealed no substantial evidence for sexual transmission of minority DRM (BF = 0.02). The presence of minority DRM during early infection, followed by a rapid decay, is consistent with the "mutation-selection balance" hypothesis, in which deleterious mutations are more efficiently purged later during HIV infection when the larger effective population size allows more efficient selection. Future studies using more recent sequencing technologies that are less prone to single-base errors should confirm these results by applying a similar Bayesian framework in other clinical settings.IMPORTANCE The advent of sensitive sequencing platforms has led to an increased identification of minority drug resistance mutations (DRM), including among antiretroviral therapy-naive HIV-infected individuals. While transmission of DRM may impact future therapy options for newly infected individuals, the clinical significance of the detection of minority DRM remains controversial. In the present study, we applied deep-sequencing techniques within a Bayesian hierarchical framework to a cohort of 24 transmission pairs to investigate whether minority DRM detected shortly after transmission were the consequence of (i) sexual transmission from the source, (ii) de novo emergence shortly after infection followed by viral selection and evolution, or (iii) technical errors/limitations of deep-sequencing methods. We found no clear evidence to support the sexual transmission of minority resistant variants, and our results suggested that minor resistant variants may emerge de novo shortly after transmission, when the small effective population size limits efficient purge by natural selection.Medical MicrobiologyBiomedical and Clinical SciencesClinical ResearchGeneticsAntimicrobial ResistanceHIV/AIDSInfectious DiseasesInfectionAdultAnti-HIV AgentsBiomarkersDrug ResistanceViralHIV InfectionsHIV-1High-Throughput Nucleotide SequencingHomosexualityMaleHumansMaleMiddle AgedMutationPhylogenyYoung Adultminority drug resistance mutationdeep sequencingBayesian hierarchical frameworktransmissionhuman immunodeficiency virusAdult Anti-HIV Agents/*pharmacology Biomarkers/*analysis Drug ResistanceViral/*genetics HIV Infections/drug therapy/*genetics/virology HIV-1/drug effects/*genetics High-Throughput Nucleotide Sequencing HomosexualityMale/*genetics Humans Male Middle Aged *Mutation Phylogeny Young Adult *Bayesian hierarchical framework *deep sequencing *human immunodeficiency virus *minority drug resistance mutation *transmissionBiological SciencesAgricultural and Veterinary SciencesMedical and Health SciencesVirologyAgriculturalveterinary and food sciencesBiological sciencesBiomedical and clinical sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/24t0c28zarticleJournal of Virology, vol 91, iss 21e00769 - e00717oai:escholarship.org:ark:/13030/qt9d11v4g02024-03-24T15:23:12Zqt9d11v4g0Effect of cytomegalovirus and Epstein–Barr virus replication on intestinal mucosal gene expression and microbiome composition of HIV-infected and uninfected individualsGianella, SaraChaillon, AntoineMutlu, Ece AEngen, Phillip AVoigt, Robin MKeshavarzian, AliLosurdo, JohnChakradeo, PrachiLada, Steven MNakazawa, MasatoLanday, Alan L2017-09-24HIV-infection is associated with dramatic changes in the intestinal mucosa. The impact of other viral pathogens is unclear.Eighty biopsies from left and right colon (n=63) and terminal ileum (n = 17) were collected from 19 HIV-infected and 22 HIV-uninfected subjects. Levels of cytomegalovirus (CMV) and Epstein Barr Virus (EBV) DNA were measured by droplet-digital (dd)PCR. Mucosal gene expression was measured via multiplex-assay. Microbiome analysis was performed using bacterial 16S-rDNA-pyrosequencing. The effect of CMV and EBV replication on the microbiome composition and mRNA-expression of selected cytokines (IL-6,IFN-γ,IL-1β, CCL2,IL-8 IFN-β1) was evaluated.Overall, CMV and EBV were detected in at least one intestinal site in 60.5% and 78.9% of subjects, respectively. HIV-infected individuals demonstrated less detectable CMV (p = 0.04); CMV was more frequently detected in terminal ileum than colon (p = 0.04). Detectable EBV was more frequent among HIV-infected (p = 0.05) without differences by intestinal site. The number of operational taxonomic units did not differ by CMV or EBV detection status. Among HIV-infected subjects, higher CMV was only associated with lower relative abundance of Actinobacteria in the ileum (p = 0.03). Presence of CMV was associated with up-regulated expression of all selected cytokines in the ileum (p < 0.02) and higher expression of IL-8 and IFN-β1 in the colon (P < 0.05) of HIV-uninfected subjects, but not among HIV-infected. EBV had no effect on cytokine expression or microbiome composition whatsoever.These results illustrate a complex interplay between HIV-infection, intestinal CMV replication and mucosal gut environment, and highlight a possible modulatory effect of CMV on the microbial and immune homeostasis.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyInfectious DiseasesHuman GenomeClinical ResearchHIV/AIDSGeneticsDigestive DiseasesAetiology2.1 Biological and endogenous factorsInfectionBiopsyColonCytokinesCytomegalovirus InfectionsDNABacterialDNARibosomalDNAViralEpstein-Barr Virus InfectionsFemaleGastrointestinal MicrobiomeGene Expression ProfilingGene Expression RegulationHIV InfectionsHumansIleumIntestinal MucosaMaleMicrobiotaMiddle AgedPolymerase Chain ReactionRNARibosomal16SSequence AnalysisDNAViral Loadcytomegalovirus and Epstein-Barr virus replicationHIV infectionintestinal microbiomemucosal cytokine expressionBiopsy Colon/pathology Cytokines/analysis Cytomegalovirus Infections/*pathology/virology DNABacterial/chemistry/genetics DNARibosomal/chemistry/genetics DNAViral/analysis Epstein-Barr Virus Infections/*pathology/virology Female *Gastrointestinal Microbiome Gene Expression Profiling *Gene Expression Regulation HIV Infections/complications Humans Ileum/pathology Intestinal Mucosa/*pathology Male *Microbiota Middle Aged Polymerase Chain Reaction RNARibosomal16S/genetics Sequence AnalysisDNA Viral LoadBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9d11v4g0articleAIDS, vol 31, iss 152059 - 2067oai:escholarship.org:ark:/13030/qt2n55w7gz2024-03-17T10:03:31Zqt2n55w7gzManaging HIV During the COVID-19 Pandemic: A Study of Help-Seeking Behaviors on a Social Media ForumAyers, John WZhu, ZechariahHarrigian, KeithWightman, Gwenyth PDredze, MarkStrathdee, Steffanie ASmith, Davey M2023-07-21Although numerous editorials claim the COVID-19 pandemic has disproportionately impacted vulnerable populations, particularly those affected by HIV, these claims have received limited empirical evaluation. We analyzed posts to Reddit's r/HIVAIDS from January 3, 2012 through April 30, 2022 to (a) assess changes in the volume of posts during the pandemic and (b) determine the needs of HIV affected communities. There were cumulatively 100% (95%CI: 75-126) more posts than expected since the US declared a pandemic emergency. The most prevalent themes in these posts were for obtaining an HIV + diagnosis (representing 34% (95%CI:29-40) of all posts), seeking HIV treatment (20%; 95%CI:16-25), finding psychosocial support (16%; 95%CI:12-20), and tracking disease progression (8%; 95%CI:5-11). Discussions about PrEP and PEP were the least common, representing less than 6% of all posts each. Social media has increasingly become an important health resource for vulnerable populations seeking information, advice, and support. Public health organizations should recognize how the lay public uses social media and collaborate with social media companies to ensure that the needs of help-seekers on these platforms are met.Public HealthHealth SciencesClinical ResearchHIV/AIDSInfectionGood Health and Well BeingHIVSocial mediaSurveillanceCOVID-19Public Health and Health ServicesSocial WorkPublic healthCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2n55w7gzarticleAIDS and Behavior, vol 28, iss 41 - 7oai:escholarship.org:ark:/13030/qt2cm747dq2024-03-12T06:15:25Zqt2cm747dqMonitoring HIV testing and pre-exposure prophylaxis information seeking by combining digital and traditional dataJohnson, Derek CNobles, Alicia LCaputi, Theodore LLiu, MichaelLeas, Eric CStrathdee, Steffanie ASmith, Davey MAyers, John W2021-12-01BackgroundPublic health is increasingly turning to non-traditional digital data to inform HIV prevention and control strategies. We demonstrate a parsimonious method using both traditional survey and internet search histories to provide new insights into HIV testing and pre-exposure prophylaxis (PrEP) information seeking that can be easily extended to other settings.MethodWe modeled how US internet search volumes from 2019 for HIV testing and PrEP compared against expected search volumes for HIV testing and PrEP using state HIV prevalence and socioeconomic characteristics as predictors. States with search volumes outside the upper and lower bound confidence interval were labeled as either over or under performing. State performance was evaluated by (a) Centers for Disease Control and Prevention designation as a hotspot for new HIV diagnoses (b) expanding Medicaid coverage.ResultsTen states over-performed in models assessing information seeking for HIV testing, while eleven states under-performed. Thirteen states over-performed in models assessing internet searches for PrEP information, while thirteen states under-performed. States that expanded Medicaid coverage were more likely to over perform in PrEP models than states that did not expand Medicaid coverage. While states that were hotspots for new HIV diagnoses were more likely to over perform on HIV testing searches.ConclusionOur study derived a method of measuring HIV and PrEP information seeking that is comparable across states. Several states exhibited information seeking for PrEP and HIV testing that deviated from model assessments. Statewide search volume for PrEP information was affected by a state's decision to expand Medicaid coverage. Our research provides health officials with an innovative way to monitor statewide interest in PrEP and HIV testing using a metric for information-seeking that is comparable across states.Public HealthHealth SciencesPreventionPediatricClinical ResearchBehavioral and Social SciencePediatric AIDSMental HealthHIV/AIDSGood Health and Well BeingHIV InfectionsHIV TestingHumansInformation Seeking BehaviorInternetMedicaidPre-Exposure ProphylaxisPrevalenceUnited StatesGoogle trendsHIVPrEPHIV testingMicrobiologyClinical SciencesMedical MicrobiologyClinical sciencesMedical microbiologyPublic healthpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2cm747dqarticleBMC Infectious Diseases, vol 21, iss 1215oai:escholarship.org:ark:/13030/qt47w070cq2024-03-12T03:57:17Zqt47w070cq#HIV: Alignment of HIV-Related Visual Content on Instagram with Public Health Priorities in the USNobles, Alicia LLeas, Eric CLatkin, Carl ADredze, MarkStrathdee, Steffanie AAyers, John W2020-07-01Instagram, with more than 1 billion monthly users, is the go-to social media platform to chronicle one's life via images, but how are people using the platform to present visual content about HIV? We analyzed public Instagram posts containing the hashtag "#HIV" (because they are self-tagged as related to HIV) between January 2017 and July 2018. We described the prevalence of co-occurring hashtags and explored thematic concepts in the images using automated image recognition and topic modeling. Twenty-eight percent of all #HIV posts included hashtags focused on awareness, followed by LGBTQ (24.5%) and living with HIV (17.9%). However, specific strategies were rarely cited, including testing (10.8%), treatment (10.3%), PrEP (6.2%) and condoms (4.1%). Image analyses revealed 44.5% of posts included infographics followed by people (21.3%) thereby humanizing HIV and stigmatized populations and promoting community mobilization. Novel content such as the handwriting image-theme (3.8%) where posters shared their HIV test results appeared. We discuss how this visual content aligns with public health priorities to reduce HIV in the US and the novel, organic messages that public health could help amplify.Public HealthHealth SciencesHIV/AIDSInfectious DiseasesBehavioral and Social ScienceInfectionGood Health and Well BeingDatasets as TopicHIV InfectionsHealth PrioritiesHumansPrevalenceSocial MediaTelemedicineHIVDigital healthHealth surveillanceSocial mediaBig dataPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/47w070cqarticleAIDS and Behavior, vol 24, iss 72045 - 2053oai:escholarship.org:ark:/13030/qt5t17x8kx2024-03-02T18:25:51Zqt5t17x8kxCharacteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partnersHassan, AdibaWertheim, Joel OBlumenthal, Jill SEllorin, EricDube, Michael PCorado, KatyaMoore, David JMorris, Sheldon R2019-12-01Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.Biomedical and Clinical SciencesClinical SciencesClinical Trials and Supportive ActivitiesPediatricSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchSexually Transmitted InfectionsPediatric AIDSInfectious DiseasesHIV/AIDSPreventionBehavioral and Social ScienceInfectionGood Health and Well BeingAdultAnti-HIV AgentsFollow-Up StudiesHIV InfectionsHomosexualityMaleHumansIncidenceMaleMedication AdherencePrimary PreventionRetrospective StudiesRisk FactorsSexual BehaviorSexual PartnersTransgender PersonsUnited Statesfemale to maleHIV risk factorsmale to femalemen who have sex with menPrEPtransgenderArthritis & RheumatologyBiomedical and clinical sciencesClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5t17x8kxarticleMedicine, vol 98, iss 50e18232oai:escholarship.org:ark:/13030/qt8tn2204p2024-03-01T23:18:34Zqt8tn2204pDeterminants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods StudyAndrzejewski, JackPines, Heather AMorris, SheldonBurke, LeahBolan, RobertSevelius, JaeMoore, David JBlumenthal, Jill2024-01-01Transgender women (TW) face inequities in HIV and unique barriers to PrEP, an effective biomedical intervention to prevent HIV acquisition. To improve PrEP retention among TW, we examined factors related to retention using a two-phase, sequential explanatory mixed methods approach. In Phase I, we used data from a trial of 170 TW who were provided oral PrEP to examine predictors of 24-week retention. In Phase II, we conducted 15 in-depth interviews with PrEP-experienced TW and used thematic analysis to explain Phase I findings. In Phase I, more participants who were not retained at 24 weeks reported sex work engagement (18% versus 7%) and substantial/severe drug use (18% versus 8%). In Phase II, participants reported drug use as a barrier to PrEP, often in the context of sex work, and we identified two subcategories of sex work. TW engaged in "non-survival sex work" had little difficulty staying on PrEP, while those engaged in "survival sex work" struggled to stay on PrEP. In Phase I, fewer participants not retained at 24 weeks reported gender-affirming hormone therapy (GAHT) use (56% versus 71%). In Phase II, participants prioritized medical gender affirmation services over PrEP but also described the bidirectional benefits of accessing GAHT and PrEP. TW who engaged in "survival sex work" experience barriers to PrEP retention (e.g., unstable housing, drug use) and may require additional support to stay in PrEP care.Biomedical and Clinical SciencesClinical SciencesHealth SciencesClinical Trials and Supportive ActivitiesClinical ResearchInfectious DiseasesHIV/AIDSPreventionPediatric AIDSMental HealthPediatricBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)Good Health and Well BeingHumansHIV InfectionsAnti-HIV AgentsTranssexualismFemalePre-Exposure ProphylaxisTransgender PersonsHIVPrEPgender affirmationsex worksubstance usetransgender womenToxicologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8tn2204particleInternational Journal of Environmental Research and Public Health, vol 21, iss 2133oai:escholarship.org:ark:/13030/qt7qx6p2sc2024-02-26T05:26:51Zqt7qx6p2scHarnessing digital data and data science to achieve 90-90-90 goals to end the HIV epidemic.Strathdee, Steffanie ANobles, Alicia LAyers, John W2019-11-01Purpose of reviewEffective public health interventions depend on timely, accurate surveillance. Harnessing digital data (including internet searches, social media, and online media) and data science is an emerging approach to complement traditional surveillance in public health but has been underutilized in HIV prevention and treatment.Recent findingsWe highlight recent examples that illustrate how social media data can be applied to HIV surveillance and prevention interventions.SummaryTo achieve 90-90-90 goals to end the HIV epidemic, we encourage traditional public health researchers to partner with data scientists to supplement HIV surveillance programs with social media analytics to refine estimates of HIV infections and key populations at risk and to identify subgroups and regions where prevention and treatment efforts need to be bolstered. We also encourage interdisciplinary teams to design interventions to promote HIV prevention and linkage to care by leveraging digital media, such as search engines and social media, that have the potential to reach millions of people instantaneously.Biomedical and Clinical SciencesPublic HealthHealth SciencesPreventionHIV/AIDSInfectious DiseasesClinical ResearchBehavioral and Social SciencePrevention of disease and conditionsand promotion of well-being3.1 Primary prevention interventions to modify behaviours or promote wellbeingInfectionGood Health and Well BeingData ScienceHIV InfectionsHumansInternetSocial Mediadigital mediaHIVmachine learningsocial mediasurveillancePublic Health and Health ServicesVirologyClinical sciencesMedical microbiologyEpidemiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7qx6p2scarticleCurrent Opinion in HIV and AIDS, vol 14, iss 6481 - 485oai:escholarship.org:ark:/13030/qt5g59f6sr2024-02-19T22:15:17Zqt5g59f6srIntegrating Virus Monitoring Strategies for Safe Non-Potable Water ReuseJiang, Sunny CBischel, Heather NGoel, RameshRosso, DiegoSherchan, Samendra PWhiteson, Katrine LYan, TaoSolo-Gabriele, Helena M2022-04-02Wastewater reclamation and reuse have the potential to supplement water supplies, offering resiliency in times of drought and helping meet increased water demands associated with population growth. Non-potable water reuse represents the largest potential reuse market. Yet economic constraints for new water reuse infrastructure and safety concerns due to microbial water quality, and especially viral pathogen exposure, limit widespread implementation of water reuse. Cost-effective, real-time methods to measure or indicate viral quality of recycled water would do much to instill greater confidence in the practice. This manuscript discusses advancements in monitoring and modeling of viral health risks in the context of water reuse. First, we describe the current wastewater reclamation processes and treatment technologies with an emphasis on virus removal. Second, we review technologies for the measurement of viruses, both culture- and molecular-based, along with their advantages and disadvantages. We introduce promising viral surrogates and specific pathogenic viruses that can serve as indicators of viral risk for water reuse. We suggest metagenomic analyses for viral screening and flow cytometry for quantification of virus-like particles as new approaches to complement more traditional methods. Third, we describe modeling to assess health risks through quantitative microbial risk assessments (QMRAs), the most common strategy to couple data on virus concentrations with human exposure scenarios. We then explore the potential of artificial neural networks (ANNs) to incorporate suites of data from wastewater treatment processes, water quality parameters, and viral surrogates. We recommend ANNs as a means to utilize existing water quality data, alongside new complementary measures of viral quality, to achieve cost-effective strategies to assess risks associated with infectious human viruses in recycled water. Given the review, we conclude that technologies are ready for identifying and implementing viral surrogates for health risk reduction in the next decade. Incorporating modeling with monitoring data would likely result in more robust assessment of water reuse risk.EngineeringEnvironmental EngineeringInfectious DiseasesBioengineering2.2 Factors relating to the physical environmentAetiologyInfectionClean Water and SanitationGood Health and Well BeingviruseswastewaterreusesurrogatesmodelingModelingReuseSurrogatesVirusesWastewaterapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5g59f6srarticleWater, vol 14, iss 81187oai:escholarship.org:ark:/13030/qt6xf8b7r82024-02-19T18:00:34Zqt6xf8b7r8Efficacy of Daily Text Messaging to Support Adherence to HIV Pre-Exposure Prophylaxis (PrEP) among Stimulant-Using Men Who Have Sex with MenSerrano, Vanessa BMoore, David JMorris, SheldonTang, BinLiao, AntonyHoenigl, MartinMontoya, Jessica L2023-02-23Background: Men who have sex with men (MSM) who use stimulants are at increased risk for HIV infection. Adherence to pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection. We evaluated the efficacy of the individualized Texting for Adherence Building (iTAB) intervention for PrEP adherence compared to standard of care (SoC) among 119 MSM who use stimulants (cocaine, methamphetamine and/or other amphetamine) from the California Collaborative Treatment Group 595 randomized control trial.Method: Three ordered levels of PrEP adherence (non-adherence, adequate adherence, and near-perfect adherence) were compared between intervention arms across study visits (weeks 12 and 48) using ordinal logistic regressions.Results: The effect of intervention arm was not significant in the final model; however, there was a 38% decrease in odds (OR = 0.62, p=.023) of having near-perfect adherence (versus non-adherence or adequate adherence) at week 48 compared to week 12, indicating a significant effect of time. In a follow-up analysis examining week 48 only, logistic regression examining PrEP adherence showed that receiving iTAB (compared to SoC) trended toward higher odds of near-perfect adherence relative to adequate adherence (OR = 2.48, p=.061). Higher HIV knowledge resulted in higher odds (OR = 1.72, p=.020) of near-perfect adherence (versus non-adherence or adequate adherence).Conclusion: HIV knowledge may influence PrEP adherence, and most notably, the iTAB intervention may support near-perfect adherence relative to adequate adherence.Public HealthHealth SciencesClinical ResearchPreventionSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceClinical Trials and Supportive ActivitiesInfectious DiseasesHIV/AIDSInfectionGood Health and Well BeingHumansMaleCentral Nervous System StimulantsHIV InfectionsHomosexualityMaleMedication AdherencePre-Exposure ProphylaxisSexual and Gender MinoritiesText MessagingPrEPmen who have sex with menstimulantssubstance usetext-based interventionPublic Health and Health ServicesPsychologySubstance AbusePublic healthApplied and developmental psychologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6xf8b7r8articleSubstance Use & Misuse, vol 58, iss 3465 - 469oai:escholarship.org:ark:/13030/qt233708152024-02-19T17:42:07Zqt23370815“PrEP”ing for a PrEP demonstration project: understanding PrEP knowledge and attitudes among cisgender womenPasipanodya, Elizabeth CStockman, JamilaPhuntsog, ThuptenMorris, SheldonPsaros, ChristinaLandovitz, RaphaelAmico, K RivetMoore, David JBlumenthal, Jill2021-12-01BackgroundPrior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women's experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California.MethodsThree focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis.ResultsTwenty-two women participated in focus groups, with median age 44 (IQR 30-53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers.ConclusionsAlthough PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.Health Services and SystemsBiomedical and Clinical SciencesPublic HealthHealth SciencesMental HealthClinical ResearchBehavioral and Social SciencePreventionSexual and Gender Minorities (SGM/LGBT*)PediatricHIV/AIDSPediatric AIDSInfectious DiseasesManagement of diseases and conditions7.1 Individual care needsInfectionGood Health and Well BeingAdultBlack or African AmericanAnti-HIV AgentsFemaleHIV InfectionsHealth KnowledgeAttitudesPracticeHumansPre-Exposure ProphylaxisPre-exposure prophylaxisCisgender womenHIV preventionPrEP attitudesNursingPaediatrics and Reproductive MedicinePublic Health and Health ServicesObstetrics & Reproductive MedicineReproductive medicineMidwiferyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/23370815articleBMC Women's Health, vol 21, iss 1220oai:escholarship.org:ark:/13030/qt84c8301t2024-02-13T19:59:05Zqt84c8301tGrowing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in CaliforniaFriedman, JosephHansen, HelenaBluthenthal, Ricky NHarawa, NinaJordan, AyanaBeletsky, Leo2021-12-01As overdose mortality is spiking during the COVID-19 pandemic, few race/ethnicity-stratified trends are available. This is of particular concern as overdose mortality was increasing most rapidly in Black and Latinx communities prior to the pandemic. We used quarterly, age-standardized overdose mortality rates from California to assess trends by race/ethnicity and drug involved over time. Rates from 2020 Q2-Q4 were compared to expected trends based on ARIMA forecasting models fit using data from 2006 to 2020 Q1. In 2020 Q2-Q4 overdose death rates rose by 49.8% from 2019, exceeding an expected increase of 11.5% (95%CI: 0.5%-22.5%). Rates significantly exceeded forecasted trends for all racial/ethnic groups. Black/African American individuals saw an increase of 52.4% from 2019, compared to 42.6% among their White counterparts. The absolute Black-White overdose mortality gap rose from 0.7 higher per 100,000 for Black individuals in 2018 to 4.8 in 2019, and further increased to 9.9 during the pandemic. Black overdose mortality in California was therefore 34.3% higher than that of White individuals in 2020 Q2-Q4. This reflects growing methamphetamine-, cocaine-, and fentanyl-involved deaths among Black communities. Growing racial disparities in overdose must be understood in the context of the unequal social and economic fallout from the COVID-19 pandemic, during which time Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality. Increased investments are required to ameliorate racial/ethnic disparities in substance use treatment, harm reduction, and the structural drivers of overdose, as part of the COVID-19 response and post-pandemic recovery efforts.Public HealthHealth SciencesSubstance MisusePreventionGood Health and Well BeingCOVID-19CaliforniaEthnicityHumansPandemicsSARS-CoV-2Substance useOverdoseRacialethnic disparitiesCOVID-19 pandemicFentanylMethamphetamineRacial/ethnic disparitiesHuman Movement and Sports SciencesPublic Health and Health ServicesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/84c8301tarticleoai:escholarship.org:ark:/13030/qt26f4w75c2024-02-13T19:56:09Zqt26f4w75cShift in racial communities impacted by COVID-19 in CaliforniaCuomo, Raphael E2021-04-01IntroductionSince the first case of COVID-19 was recorded in California, the geospatial distribution of disease cases has fluctuated over time. Given documented racial disparities in other parts of the country, longitudinal convergence of COVID-19 rates around race groups warrants assessment.MethodsCounty-level cases for COVID-19 were collected from the Johns Hopkins University, and racial distributions were collected from the American Community Survey. Pearson's correlation coefficients were computed for each day since COVID-19 was first reported in California, and the longitudinal distribution of each race-specific set of correlation coefficients was assessed for stationarity, linear trend and exponential trend.ResultsEarlier in the outbreak, the distribution of COVID-19 was most highly correlated with Asian American communities; after approximately 100 days, the distribution of COVID-19 most closely resembled that of African American communities. For every day in this dataset, the county-level distribution of COVID-19 was negatively correlated with the distribution of White American communities in California.DiscussionThe geospatial distribution of COVID-19 in California has increasingly resembled that of African American communities within the state. Further study should be conducted to characterise potentially disproportionate impacts of the COVID-19 pandemic across race groups.EpidemiologyPublic HealthHealth SciencesGISEpidemicsInequalitiesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/26f4w75carticleJournal of Epidemiology & Community Health, vol 75, iss 4390 - 393oai:escholarship.org:ark:/13030/qt36z6264b2024-02-08T23:14:23Zqt36z6264bPre-Exposure Prophylaxis Perspectives, Sociodemographic Characteristics, and HIV Risk Profiles of Cisgender Women Seeking and Initiating PrEP in a US Demonstration ProjectBlumenthal, JillLandovitz, RaphaelJain, SoniaHe, FengKofron, RyanEllorin, EricNtim, Gifty MStockman, Jamila KCorado, KatyaAmico, K RivetMoore, David JMorris, Sheldon2021-12-01Little information is known about the cisgender women who seek and initiate pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Adherence Enhancement Guided by Individualized Texting and Drug Levels was a 48-week single-arm open-label demonstration study of daily oral tenofovir disoproxil fumaratel emtricitabine (TDF/FTC) in cisgender women ≥ 18 years old at risk for HIV. Participants were surveyed at screening and enrollment about sociodemographics, HIV risk perception and behaviors, and PrEP perspectives and aggregated into three risk groups according to HIV sexual risk behavior: being in a serodiscordant partnership (SD), engaging in sex work (SW), and having partners with unknown HIV status at risk for HIV (UP). One hundred sixty-seven women presented for screening with n = 31 screen failures. Of the 162 women completing enrollment, mean age was 40 (standard deviation 11), with 41% non-Hispanic Black, 22% non-Hispanic White, and 19% Latina. Compared with those who screened ineligible, enrolled participants were more likely to have heard of PrEP, had higher HIV risk perception, and reported higher perceived PrEP efficacy. Sixty-four women (47%) were categorized as SD, 21 (15%) as SW, and 51 (38%) as UP. The SW were more likely to report higher levels of drinking and drug use (p = 0.002) and history of intimate partner violence in the past year (p < 0.001) compared with SD and UP. Among cisgender women enrolled, there were significant differences between the three risk groups by demographics, HIV risk behavior, and PrEP perspectives, suggesting that interventions to successfully implement PrEP in US women may need to be tailored by HIV risk group. Clinical Trial Registration number: NCT02584140.Biomedical and Clinical SciencesPublic HealthHealth SciencesBehavioral and Social ScienceClinical Trials and Supportive ActivitiesHIV/AIDSPreventionPediatric AIDSPediatricClinical ResearchInfectious Diseases6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsInfectionGood Health and Well BeingAdolescentAdultAnti-HIV AgentsEmtricitabineFemaleHIV InfectionsHumansMedication AdherencePre-Exposure ProphylaxisUnited Statespre-exposure prophylaxiscisgender womenHIV preventionrisk behaviorsPublic Health and Health ServicesVirologyClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/36z6264barticleAIDS Patient Care and STDs, vol 35, iss 12481 - 487oai:escholarship.org:ark:/13030/qt58t2r8pc2024-02-08T08:11:10Zqt58t2r8pcHIV transmission networks among transgender women in Los Angeles County, CA, USA: a phylogenetic analysis of surveillance dataRagonnet-Cronin, ManonHu, Yunyin WMorris, Sheldon RSheng, ZhijuanPoortinga, KathleenWertheim, Joel O2019-03-01BackgroundTransgender women are among the groups at highest risk for HIV infection, with a prevalence of 27·7% in the USA; and despite this known high risk, undiagnosed infection is common in this population. We set out to identify transgender women and their partners in a molecular transmission network to prioritise public health activities.MethodsSince 2006, HIV protease and reverse transcriptase gene (pol) sequences from drug resistance testing have been reported to the Los Angeles County Department of Public Health and linked to demographic data, gender, and HIV transmission risk factor data for each case in the enhanced HIV/AIDS Reporting System. We reconstructed a molecular transmission network by use of HIV-TRAnsmission Cluster Engine (with a pairwise genetic distance threshold of 0·015 substitutions per site) from the earliest pol sequences from 22 398 unique individuals, including 412 (2%) self-identified transgender women. We examined the possible predictors of clustering with multivariate logistic regression. We characterised the genetically linked partners of transgender women and calculated assortativity (the tendency for people to link to other people with the same attributes) for each transmission risk group.Findings8133 (36·3%) of 22 398 individuals clustered in the network across 1722 molecular transmission clusters. Transgender women who indicated a sexual risk factor clustered at the highest frequency in the network, with 147 (43%) of 345 being linked to at least one other person (adjusted odds ratio [aOR] 2·0, p=0·0002). Transgender women were assortative in the network (assortativity 0·06, p<0·001), indicating that they tended to link to other transgender women. Transgender women were more likely than expected to link to other transgender women (OR 4·65, p<0·001) and cisgender men who did not identify as men who have sex with men (MSM; OR 1·53, p<0·001). Transgender women were less likely than expected to link to MSM (OR 0·75, p<0·001), despite the high prevalence of HIV among MSM. Transgender women were distributed across 126 clusters, and cisgender individuals linked to one transgender woman were 9·2 times more likely to link to a second transgender woman than other individuals in the surveillance database. Reconstruction of the transmission network is limited by sample availability, but sequences were available for more than 40% of diagnoses.InterpretationClustering of transgender women and the observed tendency for linkage with cisgender men who did not identify as MSM, shows the potential to use molecular epidemiology both to identify clusters that are likely to include undiagnosed transgender women with HIV and to improve the targeting of public health prevention and treatment services to transgender women.FundingCalifornia HIV and AIDS Research Program and National Institutes of Health-National Institute of Allergy and Infectious Diseases.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesSexual and Gender Minorities (SGM/LGBT*)PediatricGeneticsHIV/AIDSInfectious DiseasesPediatric AIDSClinical ResearchPrevention2.4 Surveillance and distributionAetiology2.3 Psychologicalsocial and economic factorsInfectionGood Health and Well BeingAdolescentAdultAgedAged80 and overChildCluster AnalysisDisease TransmissionInfectiousFemaleGenotypeHIVHIV InfectionsHIV ProteaseHumansLos AngelesMaleMiddle AgedMolecular EpidemiologySequence AnalysisDNATransgender PersonsYoung Adultpol Gene ProductsHuman Immunodeficiency VirusMedical and Health SciencesBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/58t2r8pcarticleThe Lancet HIV, vol 6, iss 3e164 - e172oai:escholarship.org:ark:/13030/qt4sf419812024-02-07T21:48:26Zqt4sf41981Self-initiated continuation of and adherence to HIV pre-exposure prophylaxis (PrEP) after PrEP demonstration project roll-off in men who have sex with men: associations with risky decision making, impulsivity/disinhibition, and sensation seekingHoenigl, MartinMorgan, ErinFranklin, DonaldAnderson, Peter LPasipanodya, ElizabethDawson, MatthewHanashiro, MarvinEllorin, Eric EBlumenthal, JillHeaton, RobertMoore, David JMorris, Sheldon R2019-06-01The objective of this study was to examine differences in the levels of risky decision making and other frontal system behavior constructs in relation to self-initiated continuance of HIV pre-exposure prophylaxis (PrEP) and PrEP adherence outcomes among men who have sex with men (MSM) following completion of a clinical PrEP trial. At the last PrEP trial visit, study provided PrEP was discontinued and participants were navigated to the community for PrEP continuation. In this cross-sectional analysis, 84/187 (45%) MSM who completed a prospective observational post-PrEP trial follow-up visit at the University of California San Diego were included. PrEP adherence was measured using dried blood spot tenofovir diphosphate (TFV-DP) levels. Risky decision making was assessed using the Iowa Gambling Task (IGT) and the Balloon Analogue Risk Task (BART), while impulsivity/disinhibition, sensation seeking, and substance use were assessed via standardized self-report questionnaires. A total of 58/84 (69%) of MSM who completed the 12-month post-study visit continued PrEP. Of those, n = 46 (79%) reached TFV-DP levels associated with adequate adherence. Individuals who elected to continue PrEP 12 months post-trial had riskier decision making on BART, but less impulsivity/disinhibition compared to individuals who did not continue PrEP. Neither risky decision making nor impulsivity/disinhibition/sensation seeking nor substance use correlated with PrEP adherence. Our findings suggest that those with risky decision making may have greater insight into their HIV risks, and therefore be more likely to continue to use PrEP. However, elevated impulsivity/disinhibition, indicative of greater neurobehavioral alterations, was negatively associated with PrEP continuance and is a potential target for future interventions to help people link to PrEP.Medical MicrobiologyBiomedical and Clinical SciencesNeurosciencesClinical SciencesClinical Trials and Supportive ActivitiesMental HealthSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceHIV/AIDSInfectious DiseasesClinical ResearchPreventionAetiology2.3 Psychologicalsocial and economic factorsMental healthGood Health and Well BeingAdultAgedAnti-HIV AgentsDecision MakingHIV InfectionsHomosexualityMaleHumansImpulsive BehaviorMaleMedication AdherenceMiddle AgedPre-Exposure ProphylaxisRisk-TakingSexual and Gender MinoritiesTenofovirSensation seekingStimulant substance useSeroconversionDried blood spotAdherenceCalifornia Collaborative Treatment Group (CCTG) 601 TeamVirologyClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4sf41981articleJournal of NeuroVirology, vol 25, iss 3324 - 330oai:escholarship.org:ark:/13030/qt8b12z6p22024-02-07T21:48:12Zqt8b12z6p2Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men.Hoenigl, MartinHassan, AdibaMoore, David JAnderson, Peter LCorado, KatyaDubé, Michael PEllorin, Eric EBlumenthal, JillMorris, Sheldon R2019-06-01BackgroundEfficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent.MethodsThis was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit.ResultsOf 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3-757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR.ConclusionMore than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.Biomedical and Clinical SciencesClinical SciencesClinical Trials and Supportive ActivitiesBehavioral and Social ScienceHIV/AIDSClinical ResearchPreventionGood Health and Well BeingAdenineAdultFollow-Up StudiesHIV InfectionsHomosexualityMaleHumansLogistic ModelsMaleMedication AdherenceMiddle AgedOrganophosphatesPre-Exposure ProphylaxisRegression AnalysisRisk-TakingSexual and Gender Minoritiesadherencecontinuumreal-life cohortsubstance userisk behaviorCalifornia Collaborative Treatment Group (CCTG) 601 TeamPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8b12z6p2articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 81, iss 2166 - 174oai:escholarship.org:ark:/13030/qt911243tv2024-02-07T02:36:35Zqt911243tvChallenges in Quantifying Cytosine Methylation in the HIV ProvirusLaMere, Sarah AChaillon, AntoineHuynh, ChristinaSmith, Davey MGianella, SaraMoscona, Anne2019-02-26DNA methylation is an epigenetic mechanism most commonly associated with transcriptional repression. While it is clear that DNA methylation can silence HIV proviral expression in in vitro latency models, its correlation with HIV persistence and expression in vivo is ambiguous, particularly in persons living with HIV (PLWH) receiving antiretroviral therapy (ART). Several factors potentially contribute to discrepancies between results in the literature, including differences in integration sites, functional proviral load, sampling bias, and stochastic PCR amplification. Recent studies into genomic features of cytosine methylation sites in mammalian genes offer potentially significant insights into this mechanism. Here, we discuss the importance of these factors in the context of the HIV.Biological SciencesBiomedical and Clinical SciencesGeneticsImmunologyMedical MicrobiologyMental HealthHIV/AIDSHuman GenomeInfectious DiseasesInfectionCytosineDNA MethylationDNAViralEpigenesisGeneticGene Expression RegulationViralHIVProvirusesVirus LatencyHIV latencycytosine methylationepigenetic silencingnon-CpG methylationMicrobiologyBiochemistry and cell biologyMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/911243tvarticlemBio, vol 10, iss 1e02268 - e02218oai:escholarship.org:ark:/13030/qt4m23t0xq2024-02-07T01:32:50Zqt4m23t0xqRacial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015Jones, Audrey LCochran, Susan DLeibowitz, ArleenWells, Kenneth BKominski, GeraldMays, Vickie M2018-01-01BackgroundBlack and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care.MethodsData were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14-19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010-2015.ResultsOf the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites.ConclusionRacial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.Health Services and SystemsHealth SciencesClinical ResearchMental HealthHealth ServicesBehavioral and Social SciencePreventionBurden of IllnessBasic Behavioral and Social ScienceMental healthGood Health and Well Beinghealthcare disparitiesmental health servicesprimary health careAfrican AmericansHispanic AmericansBiomedical and clinical sciencesHealth sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4m23t0xqarticleHealthcare, vol 6, iss 229oai:escholarship.org:ark:/13030/qt3pp7769q2024-02-06T22:49:07Zqt3pp7769qStructure of SARS-CoV-2 ORF8, a rapidly evolving immune evasion proteinFlower, Thomas GBuffalo, Cosmo ZHooy, Richard MAllaire, MarcRen, XuefengHurley, James H2021-01-12The molecular basis for the severity and rapid spread of the COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is largely unknown. ORF8 is a rapidly evolving accessory protein that has been proposed to interfere with immune responses. The crystal structure of SARS-CoV-2 ORF8 was determined at 2.04-Å resolution by X-ray crystallography. The structure reveals a ∼60-residue core similar to SARS-CoV-2 ORF7a, with the addition of two dimerization interfaces unique to SARS-CoV-2 ORF8. A covalent disulfide-linked dimer is formed through an N-terminal sequence specific to SARS-CoV-2, while a separate noncovalent interface is formed by another SARS-CoV-2-specific sequence, 73YIDI76 Together, the presence of these interfaces shows how SARS-CoV-2 ORF8 can form unique large-scale assemblies not possible for SARS-CoV, potentially mediating unique immune suppression and evasion activities.Biological SciencesBioinformatics and Computational BiologyPreventionPneumonia & InfluenzaLungPneumoniaInfectious DiseasesVaccine RelatedEmerging Infectious DiseasesBiodefenseAetiology2.1 Biological and endogenous factorsGood Health and Well BeingEvolutionMolecularImmune EvasionMolecular StructureSARS-CoV-2Viral ProteinsX-ray crystallographyCOVID-19application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3pp7769qarticleProceedings of the National Academy of Sciences of the United States of America, vol 118, iss 2e2021785118oai:escholarship.org:ark:/13030/qt8td6s5g72024-02-06T21:22:06Zqt8td6s5g7Grindr Users Take More Risks, but Are More Open to Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis: Could This Dating App Provide a Platform for HIV Prevention Outreach?Hoenigl, MartinLittle, Susan JGrelotti, DavidSkaathun, BrittWagner, Gabriel AWeibel, NadirStockman, Jamila KSmith, Davey M2020-10-23BackgroundTechnology has changed the way that men who have sex with men (MSM) seek sex. More than 60% of MSM in the United States use the internet and/or smartphone-based geospatial networking apps to find sex partners. We correlated use of the most popular app (Grindr) with sexual risk and prevention behavior among MSM.MethodsA nested cohort study was conducted between September 2018 and June 2019 among MSM receiving community-based human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening in central San Diego. During the testing encounter, participants were surveyed for demographics, substance use, risk behavior (previous 3 months), HIV pre-exposure prophylaxis (PrEP) use, and Grindr usage. Participants who tested negative for HIV and who were not on PrEP were offered immediate PrEP.ResultsThe study included 1256 MSM, 1090 of whom (86.8%) were not taking PrEP. Overall, 580 of 1256 (46%) participants indicated that they used Grindr in the previous 7 days. Grindr users reported significantly higher risk behavior (greater number of male partners and condomless sex) and were more likely to test positive for chlamydia or gonorrhea (8.6% vs 4.7% of nonusers; P = .005). Grindr users were also more likely to be on PrEP (18.7% vs 8.7% of nonusers; P < .001) and had fewer newly diagnosed HIV infections (9 vs 26 among nonusers; P = .014). Grindr users were also nearly twice as likely as nonusers to initiate PrEP (24.6% vs 14%; P < .001).ConclusionsGiven the higher risk behavior and greater acceptance of PrEP among MSM who used Grindr, Grindr may provide a useful platform to promote HIV and STI testing and increase PrEP uptake.Biomedical and Clinical SciencesClinical SciencesBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)Sexually Transmitted InfectionsPreventionHIV/AIDSClinical ResearchInfectious DiseasesInfectionGood Health and Well BeingCohort StudiesHIVHIV InfectionsHomosexualityMaleHumansMaleMobile ApplicationsPre-Exposure ProphylaxisSexual and Gender MinoritiesUnited StatesHIV riskdating apppre-exposure prophylaxissubstance userisk behaviorBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8td6s5g7articleClinical Infectious Diseases, vol 71, iss 7e135 - e140oai:escholarship.org:ark:/13030/qt85s902842024-02-06T21:14:05Zqt85s90284Recent HIV Risk Behavior and Partnership Type Predict HIV Pre-Exposure Prophylaxis Adherence in Men Who Have Sex with MenBlumenthal, JillMoore, David JJain, SoniaSun, XiaoyingEllorin, EricCorado, KatyaHoenigl, MartinDube, MichaelHaubrich, RichardMorris, Sheldon R2019-05-01Men who have sex with men (MSM) reporting higher HIV risk behavior over time are often more adherent to pre-exposure prophylaxis (PrEP), but it is unclear if recent risk behavior and partnership type affect long-term PrEP adherence. HIV-negative MSM and transgender women completing the 48-week randomized study TAPIR (Daily Text Messages to Support Adherence to PrEP in At-Risk for HIV Individuals) were included. At baseline and weeks 24 and 48, a modified Calculated Risk (mCalcR) Score estimated the likelihood of HIV seroconversion over 1 year based on reported condomless anal sex acts in the last month and current sexually transmitted infection. mCalcR scores were categorized as low, moderate, and high/very high risk. Partnership type was classified as no partner/single HIV-negative partner (no/single-), single HIV-positive partner (single+), or multiple partners of any serostatus (multi) in the past 3 months. PrEP adherence was measured by intracellular tenofovir-diphosphate (TFV-DP) levels. Among 313 individuals, there was no difference in mCalcR category from baseline to week 48. There was a significant change in partnership type, with no/single partnerships increasing from 0.5% to 9%. Participants with moderate and high/very risk had higher TFV-DP levels than the low-risk group. No/single participants had lower TFV-DP levels than those reporting single+ or multi. Although there was a shift toward lower-risk partnerships, HIV risk category remained stable over time. Individuals with riskier behaviors and partnerships had higher PrEP drug levels, suggesting continued motivation for and adherence to PrEP.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesClinical Trials and Supportive ActivitiesMental HealthSexually Transmitted InfectionsSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceHIV/AIDSInfectious DiseasesClinical ResearchPreventionInfectionGood Health and Well BeingAdultAnti-HIV AgentsFemaleHIV InfectionsHomosexualityMaleHumansMaleMedication AdherenceMiddle AgedPre-Exposure ProphylaxisRisk-TakingSexual PartnersTenofovirYoung AdultHIV preventionpre-exposure prophylaxisHIV riskpartnershipsmen who have sex with menmedication adherencePublic Health and Health ServicesVirologyClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/85s90284articleAIDS Patient Care and STDs, vol 33, iss 5220 - 226oai:escholarship.org:ark:/13030/qt2x6068bv2024-02-06T21:12:28Zqt2x6068bvPerceived Versus Calculated HIV RiskBlumenthal, JillJain, SoniaMulvihill, EvanSun, ShellyHanashiro, MarvinEllorin, EricGraber, SaraHaubrich, RichardMorris, Sheldon2019-02-01BackgroundInaccurate HIV risk perception by men who have sex with men is a barrier to HIV prevention. Providing information about objective HIV risk could improve pre-exposure prophylaxis (PrEP) uptake.MethodsPrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of men who have sex with men to determine whether an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors, and HIV self-perceived risk (SPR). The survey generated a calculated HIV risk (CalcR) score, estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine whether they initiated PrEP.ResultsOf 171 participants (median age 32 years; 37% Hispanic or non-Hispanic Black; median 5 sexual partners in the past 6 months), 81% had heard of PrEP, and 57% believed they were good PrEP candidates. SPR had poor agreement with CalcR (kappa = 0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, P > 0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (P = 0.06) but no difference between arms (P = 0.29).ConclusionProviding an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP, given enthusiasm for PrEP on the testing day to facilitate greater uptake.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesBehavioral and Social ScienceMental HealthSexual and Gender Minorities (SGM/LGBT*)Clinical Trials and Supportive ActivitiesHIV/AIDSPreventionPediatric AIDSPediatricClinical ResearchInfectious DiseasesInfectionGood Health and Well BeingAdultAnti-HIV AgentsHIV InfectionsHealth KnowledgeAttitudesPracticeHomosexualityMaleHumansMaleMedication AdherencePatient Acceptance of Health CarePre-Exposure ProphylaxisRisk-TakingSexual BehaviorUnited Statespre-exposure prophylaxisHIV risk perceptionmen who have sex with menPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2x6068bvarticleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 80, iss 2e23 - e29oai:escholarship.org:ark:/13030/qt6k41665t2024-02-03T14:14:25Zqt6k41665tSex-based differences in neurocognitive functioning in HIV-infected young adultsBurlacu, RuxandraUmlauf, AnyaLuca, AncaGianella, SaraRadoi, RoxanaRuta, Simona MMarcotte, Thomas DEne, LuminitaAchim, Cristian L2018-01-14IntroductionSex differences in cognition of HIV positive (HIV) patients are controversial. We aimed to investigate the relationship between cognition, HIV status, and sex, in a highly homogenous cohort of young Romanians parenterally infected during early childhood.MethodsIn total, 250 HIV participants were compared with age-matched HIV negative (HIV) controls (n = 72) in a cross-sectional study. After standardized neurocognitive, psychological testing and medical evaluation, linear regression was used to assess the effect of sex and HIV on neurocognitive outcomes.ResultsStudy participants were on average 23 years old with balanced sex distribution (% women = 52% vs. 43%). HIV were more educated (12.7 vs. 11.6 years, P = 0.002).HIV status was associated with a lower global performance (β = -0.22, P < 0.001), after controlling for age and education. HIV women had better previous and current HIV-associated markers. The effect of HIV on global cognition did not differ between sexes in most cognitive domains (β = 0.07, P = 0.14). An interaction between sex, HIV status, and cognitive functioning was found in the psychomotor domain. HIV women had worse motor skills than HIV women (β = -0.32, P < 0.001) suggesting a specific effect of HIV on motor functioning in women only. Moreover, current CD4 less than 200 cells/μl (P = 0.013) and longer time lived with CD4 less than 200 cells/μl (P = 0.023) were negatively correlated with the motor scaled score in women (β = -0.22, P = 0.034).ConclusionDespite less advanced disease in women, long-term HIV infection has an equally detrimental effect on cognitive performances of both sexes, in all cognitive domains, except the psychomotor domain where women are preferentially affected.Biomedical and Clinical SciencesClinical SciencesHealth SciencesBehavioral and Social ScienceInfectious DiseasesPediatricNeurosciencesHIV/AIDSClinical ResearchInfectionAdultCross-Sectional StudiesFemaleHIV InfectionsHumansMaleNeurocognitive DisordersRomaniaSex FactorsYoung AdultHIV infectionHIV womenneurocognitive impairmentsex differencesyoung adultsAdult Cross-Sectional Studies Female HIV Infections/*complications Humans Male Neurocognitive Disorders/*epidemiology Romania/epidemiology *Sex Factors Young AdultBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6k41665tarticleAIDS, vol 32, iss 2217 - 225oai:escholarship.org:ark:/13030/qt0mf0k6z72024-02-03T01:40:02Zqt0mf0k6z7Higher Anti-Cytomegalovirus Immunoglobulin G Concentrations Are Associated With Worse Neurocognitive Performance During Suppressive Antiretroviral TherapyLetendre, ScottBharti, AjayPerez-Valero, IgnacioHanson, BarbaraFranklin, DonaldWoods, Steven PaulGianella, Sarade Oliveira, Michelli FariaHeaton, Robert KGrant, IgorLanday, Alan LLurain, Nell2018-08-16BackgroundCytomegalovirus (CMV) has been linked to higher risk of cardiovascular disease and mortality. We aimed to determine if CMV is associated with neurocognitive performance in adults infected with human immunodeficiency virus (HIV).MethodsIn this cross-sectional analysis, anti-CMV immunoglobulin G (IgG) concentrations in blood and CMV DNA copies in blood and cerebrospinal fluid (CSF) were measured in stored specimens of 80 HIV-infected adults who were previously assessed with a comprehensive neurocognitive test battery. Thirty-eight were taking suppressive antiretroviral therapy (ART) and 42 were not taking ART. A panel of 7 soluble biomarkers was measured by immunoassay in CSF.ResultsAnti-CMV IgG concentrations ranged from 5.2 to 46.1 IU/mL. CMV DNA was detected in 7 (8.8%) plasma specimens but in no CSF specimens. Higher anti-CMV IgG levels were associated with older age (P = .0017), lower nadir CD4+ T-cell count (P < .001), AIDS (P < .001), and higher soluble CD163 (P = .009). Higher anti-CMV IgG levels trended toward an association with worse neurocognitive performance overall (P = .059). This correlation was only present in those taking suppressive ART (P = .0049). Worse neurocognitive performance remained associated with higher anti-CMV IgG levels after accounting for other covariates in multivariate models (model P = .0038). Detectable plasma CMV DNA was associated with AIDS (P = .05) but not with neurocognitive performance.ConclusionsCMV may influence neurocognitive performance in HIV-infected adults taking suppressive ART. Future clinical trials of anti-CMV therapy should help to determine whether the observed relationships are causal.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyHIV/AIDSClinical ResearchInfectious DiseasesNeurosciencesAetiology2.1 Biological and endogenous factorsInfectionGood Health and Well BeingAdultAge FactorsAnti-HIV AgentsAntibodiesViralAntiretroviral TherapyHighly ActiveBiomarkersCohort StudiesCross-Sectional StudiesCytomegalovirusCytomegalovirus InfectionsDNAViralFemaleHIV InfectionsHumansImmunoglobulin GMaleMental Status and Dementia TestsNeurocognitive DisordersViral LoadHIVcytomegalovirusneurocognitive disorderscerebrospinal fluidCNS HIV AntiRetroviral Therapy Effects Research (CHARTER) GroupBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0mf0k6z7articleClinical Infectious Diseases, vol 67, iss 5770 - 777oai:escholarship.org:ark:/13030/qt0tb966j72024-02-03T01:39:38Zqt0tb966j7A compartmentalized type I interferon response in the gut during chronic HIV-1 infection is associated with immunopathogenesisDillon, Stephanie MGuo, KejunAustin, Gregory LGianella, SaraEngen, Phillip AMutlu, Ece ALosurdo, JohnSwanson, GarthChakradeo, PrachiKeshavarzian, AliLanday, Alan LSantiago, Mario LWilson, Cara C2018-07-31Objective(s)Type I interferon (IFN-I) responses confer both protective and pathogenic effects in persistent virus infections. IFN-I diversity, stage of infection and tissue compartment may account for this dichotomy. The gut is a major site of early HIV-1 replication and microbial translocation, but the nature of the IFN-I response in this compartment remains unclear.DesignSamples were obtained from two IRB-approved cross-sectional studies. The first study included individuals with chronic, untreated HIV-1 infection (n = 24) and age/sex-balanced uninfected controls (n = 14). The second study included antiretroviral-treated, HIV-1-infected individuals (n = 15) and uninfected controls (n = 15).MethodsThe expression of 12 IFNα subtypes, IFNβ and antiviral IFN-stimulated genes (ISGs) were quantified in peripheral blood mononuclear cells (PBMCs) and colon biopsies using real-time PCR and next-generation sequencing. In untreated HIV-1-infected individuals, associations between IFN-I responses and gut HIV-1 RNA levels as well as previously established measures of colonic and systemic immunological indices were determined.ResultsIFNα1, IFNα2, IFNα4, IFNα5 and IFNα8 were upregulated in PBMCs during untreated chronic HIV-1 infection, but IFNβ was undetectable. By contrast, IFNβ was upregulated and all IFNα subtypes were downregulated in gut tissue. Gut ISG levels positively correlated with gut HIV-1 RNA and immune activation, microbial translocation and inflammation markers. Gut IFN-I responses were not significantly different between HIV-1-infected individuals on antiretroviral treatment and uninfected controls.ConclusionThe IFN-I response is compartmentalized during chronic untreated HIV-1 infection, with IFNβ being more predominant in the gut. Gut IFN-I responses are associated with immunopathogenesis, and viral replication is likely a major driver of this response.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyGeneticsDigestive DiseasesInfectious DiseasesClinical ResearchHIV/AIDSDevelopment of treatments and therapeutic interventionsAetiology2.1 Biological and endogenous factors5.1 PharmaceuticalsInfectionGood Health and Well BeingAdultBiopsyColonCross-Sectional StudiesFemaleGene Expression ProfilingHIV InfectionsHumansImmunologic FactorsInterferon Type IIntestinal MucosaLeukocytesMononuclearMaleMiddle AgedYoung AdultgutHIV-1 infectioninterferon-stimulated genesinflammationmucosal immunologytype I interferonBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0tb966j7articleAIDS, vol 32, iss 121599 - 1611oai:escholarship.org:ark:/13030/qt6wf324fk2024-02-02T06:04:47Zqt6wf324fkA Simple Symptom Score for Acute Human Immunodeficiency Virus Infection in a San Diego Community-Based Screening Program.Lin, Timothy CGianella, SaraTenenbaum, TaraLittle, Susan JHoenigl, Martin2018-06-18BackgroundTreatment of acute human immunodeficiency virus (HIV) infection (AHI) decreases transmission and preserves immune function, but AHI diagnosis remains resource intensive. Risk-based scores predictive for AHI have been described for high-risk groups; however, symptom-based scores could be more generalizable across populations.MethodsAdults who tested either positive for AHI (antibody-negative, HIV nucleic acid test [NAT] positive) or HIV NAT negative with the community-based San Diego Early Test HIV screening program were retrospectively randomized 2:1 into a derivation and validation set. In the former, symptoms significant for AHI in a multivariate logistic regression model were assigned a score value (the odds ratio [OR] rounded to the nearest integer). The score was assessed in the validation set using receiver operating characteristics and areas under the curve (AUC). An optimal cutoff score was found using the Youden index.ResultsOf 998 participants (including 261 non-men who have sex with men [MSM]), 113 had AHI (including 4 non-MSM). Compared to HIV-negative cases, AHI cases reported more symptoms (median, 4 vs 0; P < .01). Fever, myalgia, and weight loss were significantly associated with AHI in the multivariate model and corresponded to 11, 8, and 4 score points, respectively. The summed score yielded an AUC of 0.85 (95% confidence interval [CI], .77-.93). A score of ≥11 was 72% sensitive and 96% specific (diagnostic OR, 70.27).ConclusionsA 3-symptom score accurately predicted AHI in a community-based screening program and may inform allocation of resources in settings that do not routinely screen for AHI.Biomedical and Clinical SciencesClinical SciencesClinical ResearchHIV/AIDSPreventionInfectionAcute DiseaseAdultAlgorithmsCaliforniaCross-Sectional StudiesFemaleFeverHIV InfectionsHIV-1HomosexualityMaleHumansLogistic ModelsMaleMass ScreeningMyalgiaPublic HealthROC CurveRandom AllocationRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexSexual and Gender MinoritiesWeight Lossacute HIV infectionHIV screeningacute retroviral syndromesymptom complexsymptom specificityBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6wf324fkarticleClinical Infectious Diseases, vol 67, iss 1105 - 111oai:escholarship.org:ark:/13030/qt2b87j9432024-01-28T00:46:17Zqt2b87j943Strategies to Increase HIV Testing Among MSM: A Synthesis of the LiteratureCampbell, Chadwick KLippman, Sheri AMoss, NicholasLightfoot, Marguerita2018-08-01More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.Public HealthHealth SciencesPediatric AIDSPediatricHIV/AIDSPreventionClinical ResearchBehavioral and Social ScienceMental HealthSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesInfectionGood Health and Well BeingAIDS SerodiagnosisAdultDecision Support TechniquesHIV InfectionsHealth BehaviorHomosexualityMaleHumansMalePatient ComplianceHIVHIV testingMSMHIV self-testingPartner referralsCommunity-based testingPublic Health and Health ServicesSocial WorkPublic healthpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2b87j943articleAIDS and Behavior, vol 22, iss 82387 - 2412oai:escholarship.org:ark:/13030/qt2006t7992024-01-18T23:29:43Zqt2006t799Use of technology for delivery of mental health and substance use services to youth living with HIV: a mixed-methods perspectiveSaberi, ParyaRose, Carol DawsonWootton, Angie RMing, KristinLegnitto, DominiqueJeske, MelaniePollack, Lance MJohnson, Mallory OGruber, Valerie ANeilands, Torsten B2020-08-02Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.Health Services and SystemsPublic HealthHealth SciencesClinical ResearchBrain DisordersPediatric AIDSSubstance MisuseHIV/AIDSMental HealthHealth ServicesBehavioral and Social SciencePediatric Research InitiativePediatricPreventionDrug Abuse (NIDA only)Management of diseases and conditionsHealth and social care services research7.1 Individual care needs8.1 Organisation and delivery of servicesMental healthGood Health and Well BeingAdolescentAdultAnti-HIV AgentsAnti-Retroviral AgentsAntiretroviral TherapyHighly ActiveChildFemaleHIV InfectionsHumansMaleMedication AdherenceMental DisordersMental Health ServicesSan FranciscoSubstance-Related DisordersTelemedicineYoung AdultTechnologymental healthyouthHIVtelehealthPublic Health and Health ServicesPsychologyPublic healthSociologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2006t799articleAIDS Care, vol 32, iss 8931 - 939oai:escholarship.org:ark:/13030/qt54x345012024-01-12T03:55:08Zqt54x34501Automated image analysis of instagram posts: Implications for risk perception and communication in public health using a case study of #HIVNobles, Alicia LLeas, Eric CNoar, SethDredze, MarkLatkin, Carl AStrathdee, Steffanie AAyers, John WGruebner, Oliver2020-01-01People's perceptions about health risks, including their risk of acquiring HIV, are impacted in part by who they see portrayed as at risk in the media. Viewers in these cases are asking themselves "do those portrayed as at risk look like me?" An accurate perception of risk is critical for high-risk populations, who already suffer from a range of health disparities. Yet, to date no study has evaluated the demographic representation of health-related content from social media. The objective of this case study was to apply automated image recognition software to examine the demographic profile of faces in Instagram posts containing the hashtag #HIV (obtained from January 2017 through July 2018) and compare this to the demographic breakdown of those most at risk of a new HIV diagnosis (estimates of incidence of new HIV diagnoses from the 2017 US Centers for Disease Control HIV Surveillance Report). We discovered 26,766 Instagram posts containing #HIV authored in American English with 10,036 (37.5%) containing a detectable human face with a total of 18,227 faces (mean = 1.8, standard deviation [SD] = 1.7). Faces skewed older (47% vs. 11% were 35-39 years old), more female (41% vs. 19%), more white (43% vs. 26%), less black (31% vs 44%), and less Hispanic (13% vs 25%) on Instagram than for new HIV diagnoses. The results were similarly skewed among the subset of #HIV posts mentioning pre-exposure prophylaxis (PrEP). This disparity might lead Instagram users to potentially misjudge their own HIV risk and delay prophylactic behaviors. Social media managers and organic advocates should be encouraged to share images that better reflect at-risk populations so as not to further marginalize these populations and to reduce disparity in risk perception. Replication of our methods for additional diseases, such as cancer, is warranted to discover and address other misrepresentations.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical ResearchPediatricBehavioral and Social SciencePreventionHIV/AIDSInfectionGood Health and Well BeingAdolescentAdultAge FactorsAgedCommunicationEthnicityFemaleHIVHIV InfectionsHealth PromotionHealth Risk BehaviorsHumansImage ProcessingComputer-AssistedMaleMiddle AgedNeural NetworksComputerPerceptionRisk-TakingSex FactorsSocial MediaUnited StatesYoung AdultGeneral Science & Technologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/54x34501articlePLOS ONE, vol 15, iss 5e0231155oai:escholarship.org:ark:/13030/qt8704d0872024-01-12T02:00:13Zqt8704d087Using a Social Network Strategy to Distribute HIV Self-Test Kits to African American and Latino MSMLightfoot, Marguerita ACampbell, Chadwick KMoss, NicholasTreves-Kagan, SarahAgnew, EmilyKang Dufour, Mi-SukScott, HymanSaʼid, Aria MLippman, Sheri A2018-09-01BackgroundMen who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic. Studies suggest that HIV self-testing (HIVST) is highly acceptable among MSM. Social network strategies to increase testing are effective in reaching MSM, particularly MSM of color, who may not otherwise test. We tested a social network-based strategy to distribute HIVST kits to African American MSM (AAMSM) and Latino MSM (LMSM).SettingThis study was conducted in Alameda County, California, a large, urban/suburban county with an HIV epidemic mirroring the national HIV epidemic.MethodsFrom January 2016 to March 2017, 30 AAMSM, LMSM, and transgender women were trained as peer recruiters and asked to distribute 5 self-test kits to MSM social network members and support those who test positive in linking to care. Testers completed an online survey after their test. We compared peer-distributed HIVST testing outcomes to outcomes from Alameda County's targeted, community-based HIV testing programs using χ tests.ResultsPeer-distributed HIVST to 143 social and sexual network members, of whom 110 completed the online survey. Compared with MSM who used the County's sponsored testing programs, individuals reached through the peer-based self-testing strategy were significantly more likely to have never tested for HIV (3.51% vs. 0.41%, P < 0.01) and to report a positive test result (6.14% vs. 1.49%, P < 0.01).ConclusionFindings suggest that a network-based strategy for self-test distribution is a promising intervention to increase testing uptake and reduce undiagnosed infections among AAMSM and LMSM.Biomedical and Clinical SciencesPublic HealthHealth SciencesHIV/AIDSPreventionBehavioral and Social SciencePediatricClinical Trials and Supportive ActivitiesClinical ResearchInfectious DiseasesPediatric AIDSSexual and Gender Minorities (SGM/LGBT*)InfectionAdultBlack or African AmericanHIV InfectionsHispanic or LatinoHomosexualityMaleHumansMaleMiddle AgedPeer GroupReagent KitsDiagnosticSelf CareSocial NetworkingYoung AdultHIV self-testingblack MSMLatino MSMsocial networkssexual networksClinical SciencesPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8704d087articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 79, iss 138 - 45oai:escholarship.org:ark:/13030/qt7gw060f52024-01-08T23:24:37Zqt7gw060f5Scaling up diagnostic-driven management of sexually transmitted infections in pregnancyWynn, AdrianeMoucheraud, CorrinaMorroni, ChelseaRamogola-Masire, DoreenKlausner, Jeffrey DLeibowitz, Arleen2019-08-01Biomedical and Clinical SciencesEpidemiologyClinical SciencesHealth SciencesMedical MicrobiologyCross-Sectional StudiesFemaleHumansPoint-of-Care TestingPregnancyPregnancy ComplicationsInfectiousSexually Transmitted DiseasesPublic Health and Health ServicesMicrobiologyClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7gw060f5articleThe Lancet Infectious Diseases, vol 19, iss 8809 - 810oai:escholarship.org:ark:/13030/qt66s3k6f42024-01-08T17:08:42Zqt66s3k6f4Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender WomenSevelius, Jae MNeilands, Torsten BDilworth, SamanthaCastro, DanielleJohnson, Mallory O2020-05-01Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes.Public HealthHealth SciencesPediatric AIDSClinical Trials and Supportive ActivitiesPediatricHIV/AIDSPreventionClinical ResearchBehavioral and Social ScienceMental HealthSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesManagement of diseases and conditionsPrevention of disease and conditionsand promotion of well-being7.1 Individual care needs3.1 Primary prevention interventions to modify behaviours or promote wellbeingGender EqualityFeasibility StudiesFemaleHIV InfectionsHumansSexual BehaviorTransgender PersonsTranssexualismTransgender womenHIVSexual riskAffirmationInterventionPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/66s3k6f4articleAIDS and Behavior, vol 24, iss 51551 - 1559oai:escholarship.org:ark:/13030/qt88r9s0fk2023-12-31T10:05:15Zqt88r9s0fkComparing Self-Report Pre-Exposure Prophylaxis Adherence Questions to Pharmacologic Measures of Recent and Cumulative Pre-Exposure Prophylaxis ExposureBlumenthal, JillPasipanodya, Elizabeth CJain, SoniaSun, ShellyEllorin, EricMorris, SheldonMoore, David J2019-01-01As pre-exposure prophylaxis (PrEP) effectiveness is strongly linked to adherence, we sought to determine if certain self-report measures could be used to inform objective PrEP adherence. We studied participants from the TAPIR study (a multicenter randomized study of daily text messages to support adherence to PrEP In At-Risk), a 48-week randomized controlled trial of HIV-uninfected men who have sex with men (MSM) randomized to receive text message to support adherence versus standard of care. Self-reported medication adherence was assessed using several validated measures modified for PrEP. Objective PrEP adherence was determined through dried blood spot (DBS) measurement of intracellular tenofovir diphosphate (TFV-DP) and emtricitabine triphosphate (FTC-TP). A summary of adherence was estimated using responses to the seven adherence items at weeks 12 and 48 using confirmatory factor analysis. Correlations between self-report questions and drug concentrations were estimated with Pearson's correlations for continuous outcomes and point-biserial correlations for dichotomous outcomes. Receiver operating characteristic (ROC) analyses were conducted to assess the performance of self-report measures in predicting protective or perfect TFV-DP concentrations. Of the 369 participants who completed week 12 or 48 visits, the mean age was 35 (standard deviation 9 years), with 79% White, 12% Black, and 29% Hispanic. Correlations between self-report measures of adherence (both individual items and the adherence factor) and quantifiable FTC-TP and continuous TFV-DP concentrations showed that all self-report measures were significantly associated with these objective measures. Compared to a summary measure of self-reported adherence, the 4-week percent taken question medication recall was the only self-report item similarly or more strongly associated with recent adherence and long-term protective and perfect adherence at weeks 12 and 48. ROC analysis also showed that 4-week percent taken question had a reasonable AUC (0.798 at week 12 and 0.758 at week 48) in predicting protective TFV-DP concentrations. All single-item self-report questions assessing PrEP adherence were significantly associated with biomarker quantification, with the 4-week percent taken question performing best. Therefore, in the absence of drug concentration measurements, a 4-week self-report percent taken question may be a good single-item measure of PrEP adherence.Biomedical and Clinical SciencesClinical SciencesHIV/AIDSSexual and Gender Minorities (SGM/LGBT*)PreventionClinical ResearchClinical Trials and Supportive ActivitiesBehavioral and Social Scienceadherencemen who have sex with menself-reportpre-exposure (PrEP) prophylaxispharmacologic measuresPharmacology and Pharmaceutical SciencesPharmacology and pharmaceutical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/88r9s0fkarticleoai:escholarship.org:ark:/13030/qt6569q9dq2023-12-31T01:34:17Zqt6569q9dqLongitudinal Viral Dynamics in Semen During Early HIV Infection.Morris, Sheldon RZhao, MitchellSmith, Davey MVargas, Milenka VLittle, Susan JGianella, Sara2017-02-15Multiple viruses co-infect the male genital tract, influencing each other's replication and perhaps affecting HIV pathogenesis and disease progression.This study included 453 longitudinal seminal samples from 195 HIV-infected men from the San Diego Primary Infection Cohort and 67 seminal samples from HIV-negative healthy controls. Seminal HIV RNA and DNA from seven human herpesviruses (HHV) were measured by RT-PCR. Longitudinal shedding rates were determined by Kaplan-Meier survival analysis. Predictors of viral shedding were determined using backwards selection in a multivariable GEE model.HIV-infected participants present significantly increased rates of seminal HHV shedding compared to HIV-negative controls. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are the most commonly detected HHV in semen of HIV-infected participants. Persistent shedding was more common for CMV and EBV when compared to other HHV. With exception of HHV-7, HHV shedding was not significantly influenced by HIV RNA levels, CD4+ counts or antiretroviral therapy. Presence of CMV, EBV and Herpes Simplex Viruses (HSV) were independent predictors of genital HIV RNA shedding after adjusting for plasma HIV RNA and longitudinal measurements.Seminal replication of multiple HHV is common in our HIV primary infection cohort. Genital replication of CMV and EBV was the most common and was significantly associated with seminal HIV RNA shedding. Prevalence of HSV shedding was lower and mostly intermittent but its association with seminal HIV RNA was the strongest. Understanding the complex viral milieu in semen is important for HIV-transmission but might also play a role in HIV pathogenesis and disease progression.Medical MicrobiologyBiomedical and Clinical SciencesImmunologySexually Transmitted InfectionsHIV/AIDSClinical ResearchInfectious DiseasesAetiology2.2 Factors relating to the physical environment2.1 Biological and endogenous factorsInfectionAdultCD4 Lymphocyte CountCase-Control StudiesCoinfectionDNAViralHIV InfectionsHIV-1Herpesviridae InfectionsHomosexualityMaleHumansLongitudinal StudiesMaleRNAViralRisk FactorsSemenViral LoadVirus Sheddinghuman herpesvirusesCMVearly HIV infectiongenital secretionHuman Herpesvirusesearly HIV-infectionAdult CD4 Lymphocyte Count Case-Control Studies Coinfection DNAViral HIV Infections/drug therapy/immunology/*virology *Hiv-1 Herpesviridae Infections/virology HomosexualityMale Humans Longitudinal Studies Male RNAViral Risk Factors Semen/*virology *Viral Load Virus SheddingBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6569q9dqarticleClinical Infectious Diseases, vol 64, iss 4428 - 434oai:escholarship.org:ark:/13030/qt37j9c7f22023-12-22T19:29:40Zqt37j9c7f2Characteristics of a cohort of high-risk men who have sex with men on pre-exposure prophylaxis reporting transgender sexual partnersHassan, AdibaWertheim, Joel OBlumenthal, Jill SEllorin, EricDube, Michael PCorado, KatyaMoore, David JMorris, Sheldon R2019-12-01Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.Biomedical and Clinical SciencesClinical SciencesClinical Trials and Supportive ActivitiesPediatricSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchSexually Transmitted InfectionsPediatric AIDSInfectious DiseasesHIV/AIDSPreventionBehavioral and Social ScienceInfectionGood Health and Well BeingAdultAnti-HIV AgentsFollow-Up StudiesHIV InfectionsHomosexualityMaleHumansIncidenceMaleMedication AdherencePrimary PreventionRetrospective StudiesRisk FactorsSexual BehaviorSexual PartnersTransgender PersonsUnited Statesfemale to maleHIV risk factorsmale to femalemen who have sex with menPrEPtransgenderapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/37j9c7f2articleMedicine, vol 98, iss 50e18232oai:escholarship.org:ark:/13030/qt3jk0n3v12023-12-14T19:49:18Zqt3jk0n3v1Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination Among Men Who Have Sex with Men in Los Angeles CountyNguyen, AnthonyDrabo, Emmanuel FulgenceGarland, Wendy HMoucheraud, CorrinaHolloway, Ian WLeibowitz, ArleenSuen, Sze-chuan2022-08-01Racial and ethnic minority men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Los Angeles County (LAC), an important epicenter in the battle to end HIV. We examine tradeoffs between effectiveness and equality of pre-exposure prophylaxis (PrEP) allocation strategies among different racial and ethnic groups of MSM in LAC and provide a framework for quantitatively evaluating disparities in HIV outcomes. To do this, we developed a microsimulation model of HIV among MSM in LAC using county epidemic surveillance and survey data to capture demographic trends and subgroup-specific partnership patterns, disease progression, patterns of PrEP use, and patterns for viral suppression. We limit analysis to MSM, who bear most of the burden of HIV/AIDS in LAC. We simulated interventions where 3000, 6000, or 9000 PrEP prescriptions are provided annually in addition to current levels, following different allocation scenarios to each racial/ethnic group (Black, Hispanic, or White). We estimated cumulative infections averted and measures of equality, after 15 years (2021-2035), relative to base case (no intervention). By comparing allocation strategies on the health equality impact plane, we find that, of the policies evaluated, targeting PrEP preferentially to Black individuals would result in the largest reductions in incidence and disparities across the equality measures we considered. This result was consistent over a range of PrEP coverage levels, demonstrating that there are "win-win" PrEP allocation strategies that do not require a tradeoff between equality and efficiency.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical SciencesMental HealthInfectious DiseasesPreventionHIV/AIDSSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceInfectionReduced InequalitiesAnti-HIV AgentsEthnicityHIV InfectionsHomosexualityMaleHumansLos AngelesMaleMinority GroupsPolicyPre-Exposure ProphylaxisSexual and Gender MinoritiesHIVAIDSpre-exposure prophylaxismicrosimulationdisparitiesMSMPublic Health and Health ServicesVirologyClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3jk0n3v1articleAIDS Patient Care and STDs, vol 36, iss 8300 - 312oai:escholarship.org:ark:/13030/qt94k6f00g2023-12-14T17:07:09Zqt94k6f00gUsing Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles CountyDrabo, Emmanuel FMoucheraud, CorrinaNguyen, AnthonyGarland, Wendy HHolloway, Ian WLeibowitz, ArleenSuen, Sze-chuan2022-07-01BackgroundPre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County.SettingMen who have sex with men, residing in Los Angeles County.MethodsWe developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021-2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality).ResultsHIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021-2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14).ConclusionsMicrosimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.Biomedical and Clinical SciencesPublic HealthHealth SciencesInfectious DiseasesPreventionHIV/AIDSClinical ResearchInfectionReduced InequalitiesAnti-HIV AgentsHIV InfectionsHomosexualityMaleHumansLos AngelesMalePre-Exposure ProphylaxisSexual and Gender MinoritiesHIVAIDSPrEPpre-exposure prophylaxisimplementation sciencemicrosimulation modelequityClinical SciencesPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/94k6f00garticleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 90, iss S1s167 - s176oai:escholarship.org:ark:/13030/qt2wc3f2cn2023-12-14T15:24:14Zqt2wc3f2cnLow incidence and prevalence of hepatitis C in two cohorts of HIV pre‐exposure prophylaxis adherence interventions in men who have sex with men in Southern CaliforniaHassan, AdibaSan Agustin, Harold GlennBurke, LeahKofron, RyanCorado, KatyaBolan, RobertLandovitz, Raphael JDubé, Michael PMorris, Sheldon R2022-07-01HIV pre-exposure prophylaxis (PrEP) has been associated with incident hepatitis C virus (HCV) infection in men who have sex with men (MSM) due to decreased condom use. We examined rates of HCV among MSM and transgender women at high-risk of HIV on PrEP in Southern California using data from two trials (NCT01761643 and NCT01781806). Five of 599 participants (0.84%, 95% CI, 0.27-1.93) had HCV antibodies detected at entry. Factors associated with HCV seropositivity included being older (p = .002) and lower education level (p < .001). HCV-positive participants had no reported cases of sexually transmitted infection (rectal, urethral or pharyngeal gonorrhoea and/or chlamydia) at entry while HCV-negative participants had a prevalence of 18% (95% CI, 15%-21%). There were no significant differences in substance use and sexual risk behaviour between HCV-positive and HCV-negative participants 1-3 months prior to entry. Among early PrEP adopters, incident HCV did not occur despite ongoing condomless intercourse. Screening intervals for HCV in MSM on PrEP should be led by a risk behaviour assessment.Biomedical and Clinical SciencesClinical SciencesEmerging Infectious DiseasesHepatitis - CSexually Transmitted InfectionsClinical Trials and Supportive ActivitiesLiver DiseaseBehavioral and Social SciencePreventionInfectious DiseasesChronic Liver Disease and CirrhosisClinical ResearchHIV/AIDSHepatitisSexual and Gender Minorities (SGM/LGBT*)Digestive DiseasesAetiology3.1 Primary prevention interventions to modify behaviours or promote wellbeingPrevention of disease and conditionsand promotion of well-being2.2 Factors relating to the physical environmentInfectionGood Health and Well BeingClinical Trials as TopicFemaleHIV InfectionsHepacivirusHepatitis CHomosexualityMaleHumansIncidenceMalePre-Exposure ProphylaxisPrevalenceSexual BehaviorSexual and Gender Minoritieshepatitis CMSMPrEPMicrobiologyMedical MicrobiologyGastroenterology & HepatologyClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2wc3f2cnarticleJournal of Viral Hepatitis, vol 29, iss 7529 - 535oai:escholarship.org:ark:/13030/qt4sf930332023-12-14T14:29:56Zqt4sf93033Disparities In Uptake Of HIV Pre-Exposure Prophylaxis Among California Medicaid EnrolleesHarawa, Nina TTan, DianeLeibowitz, Arleen A2022-03-01One of the pillars of efforts in the US to curb HIV incidence is pre-exposure prophylaxis (PrEP). We examined racial/ethnic and sex disparities in PrEP uptake among California Medicaid enrollees. Claims data from 2019 identified enrollees and PrEP users in each racial/ethnic, sex, and age group, yielding crude uptake rates. We then predicted age-adjusted uptake rates from multivariable logit regressions and divided PrEP uptake estimates by each group's number of new HIV diagnoses to estimate PrEP-to-need ratios. Predicted uptake was highest for White (0.29 percent) and Black (0.23 percent) males and lowest (0.16 percent) for Hispanic males. Rates for males exceeded those for females; however, Black females had twice the rate of PrEP uptake of White females. Black males and females and Hispanic males had PrEP-to-need ratios that were less than one-third (4.0-6.3) those of Asian and White males and females (14.4-19.9). Low PrEP use rates and disparities in uptake threaten efforts to end the HIV epidemic. Policy makers must craft the rollout of innovations such as PrEP in a manner that narrows HIV disparities instead of widening them.Public HealthHealth SciencesHuman SocietyHIV/AIDSPreventionInfectious DiseasesClinical ResearchGood Health and Well BeingAnti-HIV AgentsCaliforniaFemaleHIV InfectionsHispanic or LatinoHumansMaleMedicaidPre-Exposure ProphylaxisUnited StatesPublic Health and Health ServicesApplied EconomicsHealth Policy & ServicesHealth services and systemsPolicy and administrationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4sf93033articleHealth Affairs, vol 41, iss 3360 - 367oai:escholarship.org:ark:/13030/qt0kd2f0mq2023-12-14T14:22:37Zqt0kd2f0mqSexually transmitted infections among participants in an HIV PrEP adherence trialBristow, Claire CHassan, AdibaMoore, David JDubé, Michael PCorado, KatyaChow, KarenEllorin, EricBlumenthal, JillMorris, Sheldon RTeam, The CCTG2022-03-01BackgroundHIV PrEP effectiveness is highly dependent on adherence. High STI incidence has been reported among PrEP users. We assessed the relationship between STI incidence (CT, NG, and syphilis) and PrEP adherence.MethodsWe performed a subanalysis of a controlled, open-label, two-arm, randomized clinical demonstration project of a text-message based adherence intervention. Participants had 48 weeks of follow-up and had STI testing every 12 or 24 weeks. PrEP adherence was measured at week 48 using intracellular tenofovir-diphosphate drug concentrations. We calculated incidence rate ratios for STIs among those adherent as compared with those not adherent to PrEP.ResultsOf the 381 assessed for CT, NG and syphilis at one or more follow-up visits, there were 16 cases of syphilis or 5.0 per 100 person years (95% CI: 2.6, 7.5); 63 cases of NG or 26.3 per 100 person years (95% CI: 19.8, 32.8); and 81 cases of CT or 36.3 per 100 person years (95% CI: 28.4, 44.2). We found no association between adequate PrEP adherence and STI incidence (aIRR: 0.97 95% CI: 0.67, 1.40).ConclusionsWe found that the incidence of STIs was not significantly different between those adherent to PrEP and those non-adherent. Further research is needed to assess how PrEP use may impact STIs over time.Biomedical and Clinical SciencesClinical SciencesInfectious DiseasesPreventionSexually Transmitted InfectionsClinical ResearchHIV/AIDSClinical Trials and Supportive ActivitiesInfectionGood Health and Well BeingHIV InfectionsHomosexualityMaleHumansMaleMedication AdherencePre-Exposure ProphylaxisSexually Transmitted DiseasesSyphilisSexually transmitted infectionspre-exposure prophylaxismen who have sex with menCCTG TeamMedical MicrobiologyPublic Health and Health ServicesPublic HealthClinical sciencesImmunologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0kd2f0mqarticleInternational Journal of STD & AIDS, vol 33, iss 4397 - 403oai:escholarship.org:ark:/13030/qt9232833z2023-12-14T13:55:34Zqt9232833zHypoxia Is a Dominant Remodeler of the Effector T Cell Surface Proteome Relative to Activation and Regulatory T Cell SuppressionByrnes, James RWeeks, Amy MShifrut, EricCarnevale, JuliaKirkemo, LisaAshworth, AlanMarson, AlexanderWells, James A2022-04-01Immunosuppressive factors in the tumor microenvironment (TME) impair T cell function and limit the antitumor immune response. T cell surface receptors and surface proteins that influence interactions and function in the TME are proven targets for cancer immunotherapy. However, how the entire surface proteome remodels in primary human T cells in response to specific suppressive factors in the TME remains to be broadly and systematically characterized. Here, using a reductionist cell culture approach with primary human T cells and stable isotopic labeling with amino acids in cell culture-based quantitative cell surface capture glycoproteomics, we examined how two immunosuppressive TME factors, regulatory T cells (Tregs) and hypoxia, globally affect the activated CD8+ surface proteome (surfaceome). Surprisingly, coculturing primary CD8+ T cells with Tregs only modestly affected the CD8+ surfaceome but did partially reverse activation-induced surfaceomic changes. In contrast, hypoxia drastically altered the CD8+ surfaceome in a manner consistent with both metabolic reprogramming and induction of an immunosuppressed state. The CD4+ T cell surfaceome similarly responded to hypoxia, revealing a common hypoxia-induced surface receptor program. Our surfaceomics findings suggest that hypoxic environments create a challenge for T cell activation. These studies provide global insight into how Tregs and hypoxia remodel the T cell surfaceome and we believe represent a valuable resource to inform future therapeutic efforts to enhance T cell function.Biomedical and Clinical SciencesOncology and CarcinogenesisImmunologyCancer2.1 Biological and endogenous factorsAetiologyCD8-Positive T-LymphocytesHumansHypoxiaProteomeT-LymphocytesRegulatoryTumor MicroenvironmentT cellscell surface proteomicshypoxiatumor microenvironmentBiochemistry & Molecular Biologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9232833zarticleMolecular & Cellular Proteomics, vol 21, iss 4100217oai:escholarship.org:ark:/13030/qt43k985pp2023-12-14T13:49:52Zqt43k985ppMethod of Calculating Renal Function Estimates Could Inappropriately Exclude Transgender Patients Receiving Gender-Affirming Hormone Therapy from Pre-Exposure Prophylaxis EligibilityPatel, NimishBlumenthal, JillDubé, Michael PHood, AllisonBolan, RobertMorris, Sheldon2022-04-01Purpose: Despite the importance of reliable renal function estimation among the growing transgender population, research describing the variability of existing equations is scarce. Study objectives were to (1) quantify the range of renal function estimates that would be observed if different gender coefficients are used in the estimating equations, (2) compare estimates of renal function (creatinine clearance [CLCR] or estimated glomerular filtration rate [GFR]) between users and nonusers of gender-affirming therapies, and (3) quantify the proportion of subjects who would be deemed ineligible for tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for pre-exposure prophylaxis (PrEP) based on the gender coefficient used. Methods: A retrospective analysis was performed among transgender PrEP users enrolled in a multicenter observational study between June 2017 and October 2021. The primary outcome was estimated kidney function, defined using calculated CLCR or GFR before initiating TDF/FTC for PrEP based on the three most commonly used estimating equations. Results: A total of 258 participants were evaluated. Median differences in renal function ranged from 13 to 25 mL/min based on which gender coefficient and equation was used. Regardless of the method used to compute renal function, there were significant differences between users and nonusers of gender-affirming therapy. There were 17 (6.6%) participants where at least one of the methods would potentially render them ineligible to receive TDF/FTC for PrEP. Conclusions: Renal function estimates vary considerably with different estimating equations in the transgender population and are modified by use of gender-affirming therapy. These variations could result in exclusion from drug therapies such as TDF/FTC for PrEP.Health Services and SystemsPolicy and AdministrationHealth SciencesHuman SocietyClinical ResearchPreventionKidney DiseaseRenal and urogenitalAnti-HIV AgentsHIV InfectionsHormonesHumansKidneyPre-Exposure ProphylaxisRetrospective StudiesTransgender PersonsHIVkidneypre-exposure prophylaxispreventionrenaltransgenderHealth services and systemsPolicy and administrationpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/43k985pparticleLGBT Health, vol 9, iss 3199 - 206oai:escholarship.org:ark:/13030/qt19j6w3pc2023-12-14T12:33:07Zqt19j6w3pcRobust T cell activation requires an eIF3-driven burst in T cell receptor translationDe Silva, DasmanthieFerguson, LucasChin, Grant HSmith, Benjamin EApathy, Ryan ARoth, Theodore LBlaeschke, FranziskaKudla, MarekMarson, AlexanderIngolia, Nicholas TCate, Jamie HD2021-01-01Activation of T cells requires a rapid surge in cellular protein synthesis. However, the role of translation initiation in the early induction of specific genes remains unclear. Here, we show human translation initiation factor eIF3 interacts with select immune system related mRNAs including those encoding the T cell receptor (TCR) subunits TCRA and TCRB. Binding of eIF3 to the TCRA and TCRB mRNA 3'-untranslated regions (3'-UTRs) depends on CD28 coreceptor signaling and regulates a burst in TCR translation required for robust T cell activation. Use of the TCRA or TCRB 3'-UTRs to control expression of an anti-CD19 chimeric antigen receptor (CAR) improves the ability of CAR-T cells to kill tumor cells in vitro. These results identify a new mechanism of eIF3-mediated translation control that can aid T cell engineering for immunotherapy applications.Biochemistry and Cell BiologyBiomedical and Clinical SciencesBiological SciencesImmunologyOncology and CarcinogenesisGenetics5.2 Cellular and gene therapiesDevelopment of treatments and therapeutic interventions1.1 Normal biological development and functioningUnderpinning researchCell LineEukaryotic Initiation Factor-3HumansLymphocyte ActivationReceptorsAntigenT-CellT-LymphocyteseIF3protein synthesisT cell receptorCD28chimeric antigen receptorcellular immunotherapyHumancell biologyhumanimmunologyinflammationBiological sciencesBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/19j6w3pcarticleoai:escholarship.org:ark:/13030/qt096581rq2023-12-14T09:37:04Zqt096581rqInforming California's Plan to Enhance HIV Screening in the Ending the HIV Epidemic Initiative.Leibowitz, ArleenTan, Diane2021-10-01The CDC recommends that everyone have at least one HIV test in their lifetime. However, analyses of California Health Interview Survey data showed that in 2017 only half of Californians had ever received an HIV test. Non-Hispanic Black (64.8%) and Hispanic adults (54.7%) had higher lifetime testing rates than non-Hispanic White adults (48.8%). In multivariable analyses non-Hispanic African American adults had twice and Hispanic adults 1.2 times the odds of lifetime HIV testing as non-Hispanic White adults. The CDC recommends annual HIV testing for higher-risk individuals. Independent of race/ethnicity, heterosexual men with multiple sex partners had lower annual testing rates than other high-risk individuals. Annual testing was unrelated to education level and poverty, but was related to number of doctor visits. HIV screening rates among heterosexual men with multiple partners could be increased by targeting HIV screening to non-medical settings in California's eight Ending the HIV Epidemic counties.Public HealthHealth SciencesPediatric AIDSInfectious DiseasesHIV/AIDSMental HealthPreventionPediatricClinical ResearchBehavioral and Social ScienceInfectionGood Health and Well BeingAdultBlack or African AmericanCaliforniaEpidemicsHIV InfectionsHispanic or LatinoHumansMaleSexual Partnerslifetime HIV testingannual HIV testing for those at elevated riskEnding the HIV EpidemicPrEPPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/096581rqarticleAIDS Education and Prevention, vol 33, iss 5377 - 394oai:escholarship.org:ark:/13030/qt7x58d3fc2023-12-14T03:51:52Zqt7x58d3fcResults from a Pre-exposure Prophylaxis Demonstration Project for At-risk Cisgender Women in the United States.Blumenthal, JillJain, SoniaHe, FengAmico, K RivetKofron, RyanEllorin, EricStockman, Jamila KPsaros, ChristinaNtim, Gifty MChow, KarenAnderson, Peter LHaubrich, RichardCorado, KatyaMoore, David JMorris, SheldonLandovitz, Raphael J2021-10-05BackgroundDaily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is effective for reducing human immunodeficiency virus (HIV) acquisition among cisgender women. We report results from the first US observational open-label demonstration project of pre-exposure prophylaxis (PrEP) among at-risk cisgender women.MethodsAdherence Enhancement Guided by Individualized Texting and Drug Levels was a 48-week, single-arm, open-label demonstration study of daily oral TDF/FTC in cisgender women ≥18 years old at risk for HIV. Adherence was supported using 2-way text messaging and titrated adherence counseling based on rapid-turnaround tenofovir diphosphate concentrations from dried blood spots. Study visits occurred at baseline, weeks 4 and 12, and quarterly through week 48. Outcomes included TDF/FTC adherence, retention, and persistence.ResultsFrom June 2016 to October 2018, 136 cisgender women enrolled (mean age, 40 years (standard deviation, 11); 38% non-Hispanic Black and 19% Latina). At 48 weeks, 84 (62%) participants were retained and 62 (46%) remained on PrEP. More than one-third (12/31) of those on study but off PrEP throughout the study discontinued TDF/FTC because of side effects, and 1 adverse event led to study discontinuation. Of 120 participants with drug concentrations measured, 67 (56%) had at least 1 concentration consistent with 6 doses/week; 22 (18%) had consistent ≥6 doses/week across all study visits attended. There were no incident HIV infections and 4 incident bacterial sexually transmitted infections.ConclusionAdequate PrEP adherence for protective drug concentrations was not achieved for most study participants. More work needs to be done to fully explicate the reasons for nonadherence and low retention in cisgender women.Biomedical and Clinical SciencesClinical SciencesInfectious DiseasesClinical Trials and Supportive ActivitiesPreventionPediatricBehavioral and Social ScienceHIV/AIDSClinical ResearchPediatric AIDS6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsInfectionGood Health and Well BeingAdolescentAdultAnti-HIV AgentsEmtricitabineFemaleHIV InfectionsHumansMedication AdherenceMiddle AgedPre-Exposure ProphylaxisTenofovirUnited Statespre-exposure prophylaxiscisgender womenadherenceretentionBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7x58d3fcarticleClinical Infectious Diseases, vol 73, iss 71149 - 1156oai:escholarship.org:ark:/13030/qt2vq7s0jf2023-12-14T02:05:47Zqt2vq7s0jfBarriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California.Watson, C Wei-MingPasipanodya, ElizabethSavin, Micah JEllorin, Eric ECorado, Katya CFlynn, Risa POpalo, ChloéLampley, ElizabethHenry, Brook LBlumenthal, JillBolan, RobertMorris, SheldonMoore, David J2020-12-01While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.Health Services and SystemsHealth SciencesSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSClinical ResearchMental HealthBehavioral and Social ScienceInfectious DiseasesPediatric7.1 Individual care needs8.1 Organisation and delivery of servicesHealth and social care services researchManagement of diseases and conditionsInfectionGood Health and Well BeingAdultAnti-HIV AgentsAttitude of Health PersonnelDiscriminationPsychologicalFemaleFocus GroupsHIV InfectionsHealth KnowledgeAttitudesPracticeHealth Services AccessibilityHealthcare DisparitiesHumansLos AngelesMalePre-Exposure ProphylaxisQualitative ResearchTransgender PersonsVulnerable PopulationsHIV preventiongender non-conformingpre-exposure prophylaxisqualitativehealth care disparitiesSTDs/STIsPublic Health and Health ServicesSocial WorkPublic HealthPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2vq7s0jfarticleAIDS Education and Prevention, vol 32, iss 6472 - 485oai:escholarship.org:ark:/13030/qt77f5t0qm2023-12-14T01:57:07Zqt77f5t0qmHIV and syphilis testing preferences among men who have sex with men and among transgender women in Lima, PeruBristow, Claire CKojima, NoahLee, Sung-JaeLeon, Segundo RRamos, Lourdes BKonda, Kelika ABrown, BrandonCaceres, Carlos FKlausner, Jeffrey DRendina, H Jonathon2018-01-01BackgroundMen who have sex with men (MSM) and transgender women in Peru are at high risk for acquiring syphilis and HIV infection. The World Health Organization highly recommends screening for HIV and syphilis to reduce morbidity and mortality associated with untreated infections. We aimed to identify factors associated with dual testing preferences for HIV and syphilis infection among MSM and transgender women in Lima, Peru.MethodsWe used conjoint analysis, an innovative method for systematically estimating consumer preferences. We created eight hypothetical test profiles varying across six dichotomous attributes: cost (free vs. $4), potential for false positive syphilis result (no false positive vs. some risk of false positive), time-to-result (20 minutes vs. 1 week), blood draw method (finger prick vs. venipuncture), test type (rapid vs. laboratory), and number of draws (1 vs. 2). We fit a conjoint analysis model for each participant using a simple main effects ANOVA. Attribute importance values were calculated using percentages from relative ranges in the attribute's utility values. Results were summarized across participants and averages were reported.ResultsWe recruited 415 MSM/transgender women over 18 years of age from two STD clinics in Lima, Peru. No potential for syphilis false positive result (no false positive vs. some potential for false positive) had the largest average impact on willingness to use the test and on average accounted for 23.8% of test type preference, followed by cost (free vs. ~USD$4; 21.6%), time to results (20 minutes vs. 1 week; 17.4%), number of blood draws (1 draw vs. 2 draws; 13.8%), method of blood draw (fingerprick vs. venipuncture; 13.7%), and test type (rapid POC vs. laboratory; 9.7%).ConclusionMSM/transgender women in Peru prioritized accuracy, cost, timeliness and number of blood draws for HIV and syphilis testing. Implementing a low cost, accurate, rapid and dual testing strategy for HIV and syphilis could improve screening uptake and accessibility of testing to accelerate time to treatment.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical SciencesSexually Transmitted InfectionsInfant MortalityBehavioral and Social ScienceClinical ResearchPediatricInfectious DiseasesSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSInfectionGood Health and Well BeingAdultFemaleHIV InfectionsHomosexualityMaleHumansMaleMass ScreeningPatient PreferencePeruSurveys and QuestionnairesSyphilisTransgender PersonsYoung AdultGeneral Science & Technologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/77f5t0qmarticlePLOS ONE, vol 13, iss 10e0206204oai:escholarship.org:ark:/13030/qt4pn7q41c2023-12-14T01:41:39Zqt4pn7q41cResponses to addiction help-seeking from Alexa, Siri, Google Assistant, Cortana, and Bixby intelligent virtual assistants.Nobles, Alicia LLeas, Eric CCaputi, Theodore LZhu, Shu-HongStrathdee, Steffanie AAyers, John W2020-01-29We investigated how intelligent virtual assistants (IVA), including Amazon's Alexa, Apple's Siri, Google Assistant, Microsoft's Cortana, and Samsung's Bixby, responded to addiction help-seeking queries. We recorded if IVAs provided a singular response and if so, did they link users to treatment or treatment referral services. Only 4 of the 70 help-seeking queries presented to the five IVAs returned singular responses, with the remainder prompting confusion (e.g., "did I say something wrong?"). When asked "help me quit drugs" Alexa responded with a definition for the word drugs. "Help me quit…smoking" or "tobacco" on Google Assistant returned Dr. QuitNow (a cessation app), while on Siri "help me quit pot" promoted a marijuana retailer. IVAs should be revised to promote free, remote, federally sponsored addiction services, such as SAMSHA's 1-800-662-HELP helpline. This would benefit millions of IVA users now and more to come as IVAs displace existing information-seeking engines.Health services and systemspubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4pn7q41carticleNPJ digital medicine, vol 3, iss 111oai:escholarship.org:ark:/13030/qt6cn9w57h2023-12-13T23:41:51Zqt6cn9w57hApolipoprotein A-I mimetics attenuate macrophage activation in chronic treated HIV.Mu, WilliamSharma, MadhavHeymans, RachelRitou, EleniRezek, ValerieHamid, PhilipKossyvakis, AthanasiosSen Roy, ShubhenduGrijalva, VictorChattopadhyay, ArnabPapesh, JeremyMeriwether, DavidKitchen, Scott GFogelman, Alan MReddy, Srinivasa TKelesidis, Theodoros2021-03-15ObjectivesDespite antiretroviral therapy (ART), there is an unmet need for therapies to mitigate immune activation in HIV infection. The goal of this study is to determine whether the apoA-I mimetics 6F and 4F attenuate macrophage activation in chronic HIV.DesignPreclinical assessment of the in-vivo impact of Tg6F and the ex-vivo impact of apoA-I mimetics on biomarkers of immune activation and gut barrier dysfunction in treated HIV.MethodsWe used two humanized murine models of HIV infection to determine the impact of oral Tg6F with ART (HIV+ART+Tg6F+) on innate immune activation (plasma human sCD14, sCD163) and gut barrier dysfunction [murine I-FABP, endotoxin (LPS), LPS-binding protein (LBP), murine sCD14]. We also used gut explants from 10 uninfected and 10 HIV-infected men on potent ART and no morbidity, to determine the impact of ex-vivo treatment with 4F for 72 h on secretion of sCD14, sCD163, and I-FABP from gut explants.ResultsWhen compared with mice treated with ART alone (HIV+ART+), HIV+ART+Tg6F+ mice attenuated macrophage activation (h-sCD14, h-sCD163), gut barrier dysfunction (m-IFABP, LPS, LBP, and m-sCD14), plasma and gut tissue oxidized lipoproteins. The results were consistent with independent mouse models and ART regimens. Both 4F and 6F attenuated shedding of I-FABP and sCD14 from gut explants from HIV-infected and uninfected participants.ConclusionGiven that gut barrier dysfunction and macrophage activation are contributors to comorbidities like cardiovascular disease in HIV, apoA-I mimetics should be tested as therapy for morbidity in chronic treated HIV.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyClinical ResearchInfectious DiseasesHIV/AIDSDevelopment of treatments and therapeutic interventions5.1 PharmaceuticalsInfectionAnimalsApolipoprotein A-IBiomarkersHIV InfectionsLipopolysaccharide ReceptorsMacrophage ActivationMiceapolipoprotein A-I mimetic peptideschronic treated HIVimmune activationBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6cn9w57harticleAIDS, vol 35, iss 4543 - 553oai:escholarship.org:ark:/13030/qt1506p3q92023-12-13T20:45:58Zqt1506p3q9The UCSC SARS-CoV-2 Genome BrowserFernandes, Jason DHinrichs, Angie SClawson, HiramGonzalez, Jairo NavarroLee, Brian TNassar, Luis RRaney, Brian JRosenbloom, Kate RNerli, SantruptiRao, Arjun ASchmelter, DanielFyfe, AlastairMaulding, NathanZweig, Ann SLowe, Todd MAres, ManuelCorbet-Detig, RussKent, W JamesHaussler, DavidHaeussler, Maximilian2020-10-01BACKGROUND:: Researchers are generating molecular data pertaining to the SARS-CoV-2 RNA genome and its proteins at an unprecedented rate during the COVID-19 pandemic. As a result, there is a critical need for rapid and continuously updated access to the latest molecular data in a format in which all data can be quickly cross-referenced and compared. We adapted our genome browser visualization tool to the viral genome for this purpose. Molecular data, curated from published studies or from database submissions, are mapped to the viral genome and grouped together into “annotation tracks” where they can be visualized along the linear map of the viral genome sequence and programmatically downloaded in standard format for analysis. RESULTS:: The UCSC Genome Browser for SARS-CoV-2 (https://genome.ucsc.edu/covid19.html) provides continuously updated access to the mutations in the many thousands of SARS-CoV-2 genomes deposited in GISAID and the international nucleotide sequencing databases, displayed alongside phylogenetic trees. These data are augmented with alignments of bat, pangolin, and other animal and human coronavirus genomes, including per-base evolutionary rate analysis. All available annotations are cross-referenced on the virus genome, including those from major databases (PDB, RFAM, IEDB, UniProt) as well as up-to-date individual results from preprints. Annotated data include predicted and validated immune epitopes, promising antibodies, RT-PCR and sequencing primers, CRISPR guides (from research, diagnostics, vaccines, and therapies), and points of interaction between human and viral genes. As a community resource, any user can add manual annotations which are quality checked and shared publicly on the browser the next day. CONCLUSIONS:: We invite all investigators to contribute additional data and annotations to this resource to accelerate research and development activities globally. Contact us at genome-www@soe.ucsc.edu with data suggestions or requests for support for adding data. Rapid sharing of data will accelerate SARS-CoV-2 research, especially when researchers take time to integrate their data with those from other labs on a widely-used community browser platform with standardized machine-readable data formats, such as the SARS-CoV-2 Genome Browser.Biological SciencesBioinformatics and Computational BiologyVaccine RelatedPreventionHuman GenomePneumoniaBiodefenseEmerging Infectious DiseasesLungBiotechnologyGeneticsBetacoronavirusCOVID-19Coronavirus InfectionsDatabasesGeneticGenomeViralHumansInternetPandemicsPneumoniaViralSARS-CoV-2Medical and Health SciencesDevelopmental BiologyAgricultural biotechnologyBioinformatics and computational biologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1506p3q9articleNature Genetics, vol 52, iss 10991 - 998oai:escholarship.org:ark:/13030/qt8qw107sx2023-12-13T18:46:19Zqt8qw107sx“Being downcast by society… adds to the stress levels and would explain why [we] smoke more.”: Smoking among HIV-positive Black men who have sex with mendel Pino, Homero EDacus, Jagadisa-devasriHarawa, Nina TMcWells, Charles2021-01-02Smoking causes more deaths among people living with HIV than HIV infection itself. Few smoking cessation interventions and studies of sexual minority communities have considered the lived experiences of Black men who have sex with men (BMSM) living with HIV. Before developing interventions for these men, we need to answer: How do experiences of discrimination and stigma influence their perceptions of smoking? This phenomenological study was led by a community-based organization. We conducted six focus groups with 53 BMSM living with HIV in Los Angeles. We used minority stress theory in the analysis and interpretation of the data. We identified two themes: (1) co-occurrence of race and sexual orientation stressors and smoking (e.g., "I feel like I'd be discriminated against sometimes because I'm gay and because I'm Black.") and (2) smoking as a reaction to HIV-positive status (e.g., "I know more people that started smoking after they found out they [had] HIV."). Participants smoked to cope with stressors around race, sexual orientation, and living with HIV. These findings challenge us to ensure that smoking cessation interventions address the personal and social concerns of BMSM living with HIV and help them identify healthier ways to cope with stressors.Gender StudiesHuman SocietySexual and Gender Minorities (SGM/LGBT*)Mental HealthSubstance MisusePreventionTobaccoInfectious DiseasesHIV/AIDSTobacco Smoke and HealthClinical ResearchDrug Abuse (NIDA only)Behavioral and Social SciencePrevention of disease and conditionsand promotion of well-being3.1 Primary prevention interventions to modify behaviours or promote wellbeingRespiratoryInfectionGood Health and Well BeingAfrican AmericanHIVminority stressMSMsmokingSocial WorkPublic HealthSocial workClinical and health psychologyapplication/pdfCC-BYeScholarship, University of Californiahttps://escholarship.org/uc/item/8qw107sxarticleJournal of Gay & Lesbian Social Services, vol 33, iss 116 - 31oai:escholarship.org:ark:/13030/qt0kt8s3tw2023-12-13T18:43:03Zqt0kt8s3twPrEP non-adherence, white coat dosing, and HIV risk among a cohort of MSMBlair, Cheríe SBeymer, Matthew RKofron, Ryan MBolan, Robert KJordan, Wilbert CHaubrich, Richard HWohl, Amy RLandovitz, Raphael J2020-08-01Among a cohort of men who have sex with men in a pre-exposure prophylaxis (PrEP) adherence trial, syphilis requiring treatment was associated with white coat dosing (increased PrEP adherence immediately preceding study visits) when compared with participants with optimal drug concentrations. The findings highlight the need for identifying and reducing barriers to PrEP adherence.Biomedical and Clinical SciencesClinical SciencesMental HealthInfectious DiseasesPreventionSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchPediatric AIDSBehavioral and Social ScienceHIV/AIDSPediatricClinical Trials and Supportive ActivitiesInfectionGood Health and Well BeingMSMPrEP adherencepre-exposure prophylaxissyphiliswhite coat dosingClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0kt8s3twarticleOpen Forum Infectious Diseases, vol 7, iss 8ofaa329-oai:escholarship.org:ark:/13030/qt554734472023-12-13T18:36:04Zqt55473447Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study.Grant, Robert MPellegrini, MarionDefechereux, Patricia AAnderson, Peter LYu, MichelleGlidden, David VO'Neal, JoshuaYager, JennaBhasin, ShalenderSevelius, JaeDeutsch, Madeline B2021-10-05BackgroundSex hormone and preexposure prophylaxis (PrEP) drug interactions among transgender women (TGW), transgender men (TGM), and cisgender men (CGM) are not fully understood.MethodsTGM and TGW on at least 6 months of stable sex hormone therapy containing testosterone or estradiol (respectively) were enrolled in a 4-week study of directly observed dosing of daily oral coformulated emtricitabine and tenofovir disoproxil fumarate (FTC/TDF). TFV-DP in dried blood spots and sex hormones in serum were measured at weekly intervals. TFV-DP was compared with 2- and 4-week samples from Directly Observed Therapy Dried Blood Spots (DOT-DBS) Study (NCT02022657).ResultsFrom May 2017 to June 2018, 24 TGM and 24 TGW were enrolled. Testosterone (total and free) and estradiol concentrations were comparable before and after 4 weeks of PrEP use in TGM and TGW, respectively. Historical controls included 17 cisgender women (CGW) and 15 CGM. TFV-DP concentrations at week 4 were comparable between TGW and TGM (mean difference, -6%; 95% confidence interval [CI], -21% to 12%; P = .47), comparable between TGW and CGM (mean difference, -12%; 95% CI, -27% to 7%; P = .21) and were lower among TGM compared with CGW (mean difference, -23%; 95% CI, -36% to -7%; P = .007). All persons in all groups were projected to reach the TFV-DP threshold that has been associated with high protection from human immunodeficiency virus.ConclusionsCGM, TGM, and TGW had comparable TFV-DP concentrations in dried blood spots after 4 weeks of directly observed daily FTC/TDF PrEP use. Serum hormone concentrations were not affected by FTC/TDF PrEP use.Clinical trials registrationNCT04050371.Biomedical and Clinical SciencesClinical SciencesClinical ResearchInfectious DiseasesSexual and Gender Minorities (SGM/LGBT*)PreventionHIV/AIDSAdenineAnti-HIV AgentsEmtricitabineEstradiolFemaleHIV InfectionsHumansMaleOrganophosphatesPre-Exposure ProphylaxisTransgender PersonsHIVpreexposure prophylaxistransgendersex hormonespharmacokineticsBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/55473447articleClinical Infectious Diseases, vol 73, iss 7e2117 - e2123oai:escholarship.org:ark:/13030/qt8440t2ps2023-12-13T18:01:59Zqt8440t2psMobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled TrialEdwards, Gabriel GReback, Cathy JCunningham, William EHilliard, Charles LMcWells, CharlesMukherjee, SukritWeiss, Robert EHarawa, Nina T2020-01-01BackgroundMen who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one's social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women.ObjectiveThe purpose of this study is to test a new intervention-Mobile-Enhanced Prevention Support (MEPS)-that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services.MethodsA two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism.ResultsEnrollment began in November 2019 and study completion is expected in 2023.ConclusionsThis study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant-peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm.Trial registrationClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396.International registered report identifier (irrid)PRR1-10.2196/18106.Health Services and SystemsPublic HealthHealth SciencesHealth ServicesDrug Abuse (NIDA only)PediatricClinical Trials and Supportive ActivitiesPreventionMental HealthInfectious DiseasesSubstance MisuseSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSClinical ResearchSexually Transmitted InfectionsBehavioral and Social SciencePrevention of disease and conditionsand promotion of well-being3.1 Primary prevention interventions to modify behaviours or promote wellbeingInfectionGood Health and Well BeingHIVMSMtransgender womenpeer navigationjailsubstance use disordereHealthPrEPsexually transmitted infectionshepatitis Cmobile phonesmartphoneClinical SciencesPublic Health and Health ServicesHealth services and systemsPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8440t2psarticleJMIR Research Protocols, vol 9, iss 9e18106oai:escholarship.org:ark:/13030/qt5vg5k1ps2023-12-13T17:55:13Zqt5vg5k1psHIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States.Sevelius, Jae MPoteat, ToniaLuhur, Winston EReisner, Sari LMeyer, Ilan H2020-08-01BackgroundHIV testing and pre-exposure prophylaxis (PrEP) are effective HIV prevention strategies often underused by transgender people.MethodsRecruitment occurred in 2 phases to identify transgender respondents in a probability sample of adults in the United States. Transgender respondents completed a self-administered paper or web-based survey designed to assess transgender population health. Sexually active respondents (HIV-negative and had sex in the 5 years previously, N = 190) and a subsample of those at risk for sexual HIV acquisition (sex with cisgender men or transgender women, n = 120) were included in analyses.ResultsOf the full sample of sexually active respondents, those who were transfeminine were less likely to be familiar with PrEP; most (72%) reported favorable attitudes toward PrEP. Of those at risk for HIV acquisition, 23% had never tested for HIV. Respondents of color were more likely than white respondents to meet Centers for Disease Control and Prevention recommendations for HIV testing. Respondents who met Centers for Disease Control and Prevention recommendations for HIV testing were more likely to report looking online for lesbian, gay, bisexual, and transgender or transgender-specific health information. Few respondents reported currently taking PrEP (3%); those who reported higher levels of nonaffirmation of their gender identity were less likely to currently use PrEP.DiscussionThese findings may indicate some success of HIV testing outreach programs that prioritize people at higher risk for acquiring HIV, focusing on those who are vulnerable to structural marginalization. Ongoing public health efforts are needed to increase HIV testing and PrEP awareness among transgender adults, who are disproportionately impacted by HIV.HumansHIV-1HIV InfectionsAnti-HIV AgentsUnited StatesFemaleMalePre-Exposure ProphylaxisTransgender PersonsHIV TestingClinical SciencesPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5vg5k1psarticleJournal of acquired immune deficiency syndromes (1999), vol 84, iss 5437 - 442oai:escholarship.org:ark:/13030/qt2b65x55k2023-12-13T16:30:33Zqt2b65x55kTailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative studyPasipanodya, Elizabeth CMontoya, Jessica LWatson, Caitlin W-MMarquine, María JHoenigl, MartinGarcia, RogelioKua, JohnGant, VernaTrambley, JoelMoore, David JTaggart, Tamara2020-01-01African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants' comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.Health Services and SystemsPublic HealthHealth SciencesInfectious DiseasesHIV/AIDSPediatric AIDSClinical ResearchBehavioral and Social ScienceMental HealthPreventionPediatricClinical Trials and Supportive ActivitiesManagement of diseases and conditions7.1 Individual care needsInfectionGood Health and Well BeingAdultBlack or African AmericanAnti-HIV AgentsAnti-Retroviral AgentsCell PhoneFemaleFocus GroupsHIV InfectionsHumansMaleMedication AdherenceMiddle AgedQualitative ResearchTelemedicineText MessagingGeneral Science & Technologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2b65x55karticlePLOS ONE, vol 15, iss 6e0233217oai:escholarship.org:ark:/13030/qt8056692p2023-12-13T15:10:49Zqt8056692pPolygenic burden in focal and generalized epilepsiesLeu, CostinStevelink, RemiSmith, Alexander WGoleva, Slavina BKanai, MasahiroFerguson, LisaCampbell, CiaranKamatani, YoichiroOkada, YukinoriSisodiya, Sanjay MCavalleri, Gianpiero LKoeleman, Bobby PCLerche, HolgerJehi, LaraDavis, Lea KNajm, Imad MPalotie, AarnoDaly, Mark JBusch, Robyn MConsortium, Epi25Lal, Dennis2019-11-01Rare genetic variants can cause epilepsy, and genetic testing has been widely adopted for severe, paediatric-onset epilepsies. The phenotypic consequences of common genetic risk burden for epilepsies and their potential future clinical applications have not yet been determined. Using polygenic risk scores (PRS) from a European-ancestry genome-wide association study in generalized and focal epilepsy, we quantified common genetic burden in patients with generalized epilepsy (GE-PRS) or focal epilepsy (FE-PRS) from two independent non-Finnish European cohorts (Epi25 Consortium, n = 5705; Cleveland Clinic Epilepsy Center, n = 620; both compared to 20 435 controls). One Finnish-ancestry population isolate (Finnish-ancestry Epi25, n = 449; compared to 1559 controls), two European-ancestry biobanks (UK Biobank, n = 383 656; Vanderbilt biorepository, n = 49 494), and one Japanese-ancestry biobank (BioBank Japan, n = 168 680) were used for additional replications. Across 8386 patients with epilepsy and 622 212 population controls, we found and replicated significantly higher GE-PRS in patients with generalized epilepsy of European-ancestry compared to patients with focal epilepsy (Epi25: P = 1.64×10-15; Cleveland: P = 2.85×10-4; Finnish-ancestry Epi25: P = 1.80×10-4) or population controls (Epi25: P = 2.35×10-70; Cleveland: P = 1.43×10-7; Finnish-ancestry Epi25: P = 3.11×10-4; UK Biobank and Vanderbilt biorepository meta-analysis: P = 7.99×10-4). FE-PRS were significantly higher in patients with focal epilepsy compared to controls in the non-Finnish, non-biobank cohorts (Epi25: P = 5.74×10-19; Cleveland: P = 1.69×10-6). European ancestry-derived PRS did not predict generalized epilepsy or focal epilepsy in Japanese-ancestry individuals. Finally, we observed a significant 4.6-fold and a 4.5-fold enrichment of patients with generalized epilepsy compared to controls in the top 0.5% highest GE-PRS of the two non-Finnish European cohorts (Epi25: P = 2.60×10-15; Cleveland: P = 1.39×10-2). We conclude that common variant risk associated with epilepsy is significantly enriched in multiple cohorts of patients with epilepsy compared to controls-in particular for generalized epilepsy. As sample sizes and PRS accuracy continue to increase with further common variant discovery, PRS could complement established clinical biomarkers and augment genetic testing for patient classification, comorbidity research, and potentially targeted treatment.Biomedical and Clinical SciencesClinical ResearchNeurosciencesBrain DisordersNeurodegenerativeEpilepsyGeneticsHuman Genome2.1 Biological and endogenous factorsAetiologyGood Health and Well BeingCohort StudiesCost of IllnessDatabasesFactualEpilepsiesPartialEpilepsyGeneralizedFemaleGenetic Predisposition to DiseaseGenetic VariationGenome-Wide Association StudyHumansMaleMultifactorial InheritancePolymorphismSingle NucleotideWhite PeopleEpi25 Consortiumcommon variant riskepilepsygenetic generalized epilepsygeneticsMedical and Health SciencesPsychology and Cognitive SciencesNeurology & NeurosurgeryBiomedical and clinical sciencesHealth sciencesPsychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8056692particleBrain, vol 142, iss 113473 - 3481oai:escholarship.org:ark:/13030/qt27x8c3kw2023-12-13T10:19:52Zqt27x8c3kw‘I want the heart of fierceness to arise within us’: maintaining public space to promote HIV-related health with House Ball Community members in an era of gentrificationWong, Jeffrey OBenjamin, MichaelArnold, Emily A2020-04-02The House Ball Community consists of sexual, gender and ethnic minority youth who form family-like houses and compete in balls. Many rely on community-based organisations as venues for socialising and accessing health-related resources. In recent years, urban gentrification has challenged the economic survival of the organisations that serve this community and its members. Between 2016 and 2017, we conducted 45 in-depth interviews with houses and gay families in the San Francisco Bay Area and regular participant observation at community events, including balls. In addition to forcing community organisations to close or move, rising rents have increased housing instability among Ballroom Community members, with some moving to distal locations. Participants felt nostalgia for organisations that provided HIV-related services and hosted balls in previous years, feeling the loss of space keenly. To maintain community and generate employment, the San Francisco Ballroom Community now offers Vogue classes at private dance studios. This allows participants to recruit new house members, welcoming a broader array of individuals into the community than those who have historically participated. However, accessing culturally appropriate sexual health services remains difficult. Health advocates should recognise that community organisations are necessary for diverse youth to build community and access sexual health services.Human GeographyPublic HealthHealth SciencesHuman SocietyPediatricHIV/AIDSSustainable Cities and CommunitiesGood Health and Well BeingAdolescentAdultCommunity NetworksEthnicityFemaleHIV InfectionsHealth Services AccessibilityHumansInterviews as TopicMaleMinority GroupsSan FranciscoSexual and Gender MinoritiesSocial InteractionSocial SupportHIVgentrificationsexual ethnic and gender minoritiessocial supportHouse Ball CommunitiesPublic Health and Health ServicesSociologyCultural StudiesPublic healthAnthropologyGender studiesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/27x8c3kwarticleCulture Health & Sexuality, vol 22, iss 4444 - 458oai:escholarship.org:ark:/13030/qt7623h8082023-12-13T10:12:35Zqt7623h808Harnessing digital data and data science to achieve 90-90-90 goals to end the HIV epidemic.Strathdee, Steffanie ANobles, Alicia LAyers, John W2019-11-01Purpose of reviewEffective public health interventions depend on timely, accurate surveillance. Harnessing digital data (including internet searches, social media, and online media) and data science is an emerging approach to complement traditional surveillance in public health but has been underutilized in HIV prevention and treatment.Recent findingsWe highlight recent examples that illustrate how social media data can be applied to HIV surveillance and prevention interventions.SummaryTo achieve 90-90-90 goals to end the HIV epidemic, we encourage traditional public health researchers to partner with data scientists to supplement HIV surveillance programs with social media analytics to refine estimates of HIV infections and key populations at risk and to identify subgroups and regions where prevention and treatment efforts need to be bolstered. We also encourage interdisciplinary teams to design interventions to promote HIV prevention and linkage to care by leveraging digital media, such as search engines and social media, that have the potential to reach millions of people instantaneously.Biomedical and Clinical SciencesPublic HealthHealth SciencesPreventionHIV/AIDSInfectious DiseasesClinical ResearchBehavioral and Social SciencePrevention of disease and conditionsand promotion of well-being3.1 Primary prevention interventions to modify behaviours or promote wellbeingInfectionGood Health and Well BeingData ScienceHIV InfectionsHumansInternetSocial Mediadigital mediaHIVmachine learningsocial mediasurveillancePublic Health and Health ServicesVirologyClinical sciencesMedical microbiologyEpidemiologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7623h808articleCurrent Opinion in HIV and AIDS, vol 14, iss 6481 - 485oai:escholarship.org:ark:/13030/qt0s48b9532023-12-13T10:03:32Zqt0s48b953Development of a measure to assess vaccine confidence among men who have sex with menFrew, Paula MHolloway, Ian WGoldbeck, CameronTan, DianeWu, ElizabethJauregui, JuanFenimore, Vincent LRandall, Laura ALutz, Chelsea SMendel, JudithAikin, Ann LNowak, Glen JBednarczyk, Robert A2018-11-02BackgroundRecent serogroup C meningococcal disease outbreaks led to meningococcal vaccine recommendations for Southern California men who have sex with men (MSM). Assessment of vaccine confidence is critical to improving vaccine coverage in the context of disease outbreaks wherein immunization(s) are recommended.MethodsWe surveyed MSM using venue-based sampling and began development of the vaccine confidence index (VCI) with 30 survey items corresponding to trust- and safety-related perceptions. We performed exploratory factor analyses and computed the Cronbach's alpha coefficient to assess internal consistency of the VCI. We created a categorical confidence variable (low, medium, and high confidence) and conducted bivariate and multivariate analyses to evaluate associations with reported confidence and immunization uptake.ResultsTen survey items were included in the final VCI and formed the confidence measure. Participants with low confidence had the lowest levels of reported uptake for both meningococcal vaccines. Confidence differed significantly (p ≤ 0.05) between MSM who indicated they received vaccines recommended within the context of the outbreak and those who did not.ConclusionsOur VCI is sensitive to a number of issues that may influence vaccine confidence. It is useful for assessing MSM trust and acceptance of recommended immunizations and may be used to inform intervention development.Biomedical and Clinical SciencesImmunologySexual and Gender Minorities (SGM/LGBT*)PreventionInfectious DiseasesImmunizationVaccine Related3.4 VaccinesPrevention of disease and conditionsand promotion of well-beingInfectionGood Health and Well BeingAdolescentAdultAgedDisease OutbreaksFactor AnalysisStatisticalHumansMaleMeningococcal InfectionsMeningococcal VaccinesMiddle AgedNeisseria meningitidisSerogroup CPatient Acceptance of Health CareSexual and Gender MinoritiesSurveys and QuestionnairesVaccinationVaccination CoverageYoung AdultImmunization acceptanceMSMimmunization assessmentvaccine confidencevaccine measurementClinical SciencesPublic Health and Health ServicesVirologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0s48b953articleExpert Review of Vaccines, vol 17, iss 111053 - 1061oai:escholarship.org:ark:/13030/qt3v7530102023-12-13T09:18:20Zqt3v753010Harnessing Digital Data and Data Science to Achieve 90-90-90 Goals to End the HIV EpidemicStrathdee, SteffanieNobles, AliciaAyers, John2019-11-01PURPOSE OF REVIEW:
Effective public health interventions depend on timely, accurate surveillance. Harnessing digital data (including internet searches, social media, and online media) and data science is an emerging approach to complement traditional surveillance in public health but has been underutilized in HIV prevention and treatment.
RECENT FINDINGS:
We highlight recent examples that illustrate how social media data can be applied to HIV surveillance and prevention interventions.
SUMMARY:
To achieve 90-90-90 goals to end the HIV epidemic, we encourage traditional public health researchers to partner with data scientists to supplement HIV surveillance programs with social media analytics to refine estimates of HIV infections and key populations at risk and to identify subgroups and regions where prevention and treatment efforts need to be bolstered. We also encourage interdisciplinary teams to design interventions to promote HIV prevention and linkage to care by leveraging digital media, such as search engines and social media, that have the potential to reach millions of people instantaneously.hivsocial mediaPublic Health and Health ServicesVirologyClinical sciencesMedical microbiologyEpidemiologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3v753010articleoai:escholarship.org:ark:/13030/qt07n1m2972023-12-13T08:06:51Zqt07n1m297Overcoming Technological Challenges: Lessons Learned from a Telehealth Counseling StudyWootton, Angie RMcCuistian, CaravellaPackard, Dominique A LegnittoGruber, Valerie ASaberi, Parya2020-10-01Background: Telehealth methods, including video chat counseling, have been growing in popularity within the behavioral health counseling field for over a decade. While video-based counseling methods have been shown to be effective and convenient, they have unique challenges stemming from the technology they use. Technical challenges can negatively impact appointment flow, intervention effectiveness, and the satisfaction of both patients and clinicians. Methodology: The Y2TEC (Youth to Text or Telehealth for Engagement in HIV Care) study is a pilot randomized control trial examining the feasibility and acceptability of a video counseling series provided to young adults (ages 18-29) living with HIV. The study's clinicians provided about 500 video-based counseling sessions through the Zoom videoconferencing platform. The study team then developed recommendations for overcoming technical challenges through a review of the best practice literature, insights from the clinicians and study coordinator, engaging in consultations during supervision meetings, receiving verbal feedback from participants, and reviewing logs of technical challenges. Results: Through our experience, we have found that quality of video-based counseling services can be greatly improved with minor intentional technological modifications in preparation and provision of services. We provide an overview of common challenges and corresponding recommendations to address them. Conclusion: This article can help clinicians improve their quality of telehealth sessions by identifying several common technological challenges that can occur during video chat sessions, exploring the impact of these challenges on session dynamics and providing concise, best practice-based recommendations to mitigate these issues that clinicians face.Health Services and SystemsHealth SciencesBehavioral and Social ScienceClinical Trials and Supportive ActivitiesPreventionMental HealthClinical ResearchManagement of diseases and conditions7.1 Individual care needsGood Health and Well BeingAdolescentAdultCounselingHumansRandomized Controlled Trials as TopicTechnologyTelemedicineText MessagingVideoconferencingYoung Adulttelehealthtelemental healthvideo-based counselingbehavioral telehealthtechnological challengesbest practicestelemedicineLibrary and Information StudiesBiomedical EngineeringPublic Health and Health ServicesMedical InformaticsHealth services and systemsPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/07n1m297articleTelemedicine Journal and e-Health, vol 26, iss 101278 - 1283oai:escholarship.org:ark:/13030/qt7wn7r7bz2023-12-13T02:58:16Zqt7wn7r7bzLife Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into JailTakada, SaeEttner, Susan LHarawa, Nina TGarland, Wendy HShoptaw, Steve JCunningham, William E2020-02-01Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.Public HealthHealth SciencesBehavioral and Social ScienceClinical ResearchSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesPreventionHIV/AIDSMental Health7.1 Individual care needsManagement of diseases and conditionsPeaceJustice and Strong InstitutionsAdultAnti-HIV AgentsAnti-Retroviral AgentsContinuity of Patient CareCriminal LawFemaleHIV InfectionsHumansLos AngelesMaleMass ScreeningMedication AdherenceMiddle AgedPrisonersPrisonsSocial StigmaSocial SupportTransgender PersonsHIVAIDSLife chaosSocial supportHIV-related stigmaIncarcerationPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7wn7r7bzarticleAIDS and Behavior, vol 24, iss 2491 - 505oai:escholarship.org:ark:/13030/qt02k2z3rb2023-12-13T01:08:17Zqt02k2z3rbCurrent and Future PrEP Medications and Modalities: On-demand, Injectables, and TopicalsBeymer, Matthew RHolloway, Ian WPulsipher, CraigLandovitz, Raphael J2019-08-01Purpose of reviewPre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation.Recent findingsInjectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use. On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.Biomedical and Clinical SciencesClinical SciencesImmunologyClinical Trials and Supportive ActivitiesTopical MicrobicidesHIV/AIDSPreventionClinical ResearchEvaluation of treatments and therapeutic interventions6.1 PharmaceuticalsAdministrationTopicalAdultAnti-HIV AgentsAnti-Infective AgentsContraceptive DevicesFemaleEmtricitabineFemaleHIV InfectionsHomosexualityMaleHumansInjectionsMalePre-Exposure ProphylaxisSexual and Gender MinoritiesTenofovirPre-exposure prophylaxisHIVAIDSOn-demandInjectablesMicrobicide gelsVaginal ringsMedical MicrobiologyVirologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/02k2z3rbarticleCurrent HIV/AIDS Reports, vol 16, iss 4349 - 358oai:escholarship.org:ark:/13030/qt4wc246w12023-12-12T23:33:02Zqt4wc246w1Perspectives on Academic Mentorship From Sexual and Gender Minority Students Pursuing Careers in the Health SciencesHolloway, Ian WOchoa, Ayako MiyashitaWu, Elizabeth SCHimmelstein, RebeccaWong, Jeffrey OWilson, Bianca DM2019-01-01High-quality academic mentorship is key to the success of students pursuing careers in the health sciences. Mentorship may take on additional importance for sexual and gender minority (SGM) students, who often face stressors related to stigmatized identities. We conducted an anonymous online survey to assess the mentorship experiences of SGM students pursuing careers in the health sciences and to elicit their perspectives on what makes an effective mentor. Students (N = 166) were pursuing a variety of health-related careers, including medicine (12.7%), nursing (7.8%), public health (21.1%), and social work (19.3%). Overall, students rated the quality of their mentorship experiences as (very) good: 83.8% among participants who reported having had an academic mentor that openly identified as SGM and 79.5% among participants who had a non-SGM identified mentor (ns). Participants recommended individual, dyadic and structural level activities that could be undertaken by academic mentors of SGM students to promote the students' academic success and positive career trajectories. Education on SGM issues, direct conversation about experiences of homophobia and transphobia in academic settings, and advocacy for including SGM content in coursework were among the suggestions provided by participants. (PsycINFO Database Record (c) 2019 APA, all rights reserved).PsychologyClinical and Health PsychologyApplied and Developmental PsychologyPediatricGood Health and Well BeingEducationProfessionalFemaleHumansInternetMaleMentorsSexual and Gender MinoritiesStudentsHealth OccupationsStudentsMedicalStudentsNursingSurveys and Questionnairesmentorshipsexual and gender minoritiesLGBThealth sciencesDevelopmental & Child PsychologyApplied and developmental psychologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4wc246w1articleAmerican Journal of Orthopsychiatry, vol 89, iss 3343 - 353oai:escholarship.org:ark:/13030/qt8w08s3782023-12-12T21:30:25Zqt8w08s378Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los AngelesGoodman-Meza, DavidBeymer, Matthew RKofron, Ryan MAmico, K RivetPsaros, ChristinaBushman, Lane RAnderson, Peter LBolan, RobertJordan, Wilbert CRooney, James FWohl, Amy RLandovitz, Raphael J2019-10-03PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.Public HealthHealth SciencesSexual and Gender Minorities (SGM/LGBT*)PreventionHIV/AIDSClinical ResearchAdenineAdultAnti-Retroviral AgentsCentral Nervous System StimulantsCondomsHIV InfectionsHomosexualityMaleHumansLongitudinal StudiesLos AngelesMaleMedication AdherenceOrganophosphatesPre-Exposure ProphylaxisSexual PartnersTenofovirUnsafe SexPrEPadherenceMSMstimulantcondomless anal sexPublic Health and Health ServicesPsychologyPublic healthSociologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8w08s378articleAIDS Care, vol 31, iss 101228 - 1233oai:escholarship.org:ark:/13030/qt91k2c0772023-12-12T17:24:21Zqt91k2c077Substance Use and Adherence to HIV Preexposure Prophylaxis for Men Who Have Sex with Men1Hoenigl, MartinJain, SoniaMoore, DavidCollins, DeborahSun, XiaoyingAnderson, Peter LCorado, KatyaBlumenthal, Jill SDaar, Eric SMilam, JoelDubé, Michael PMorris, Sheldon2018-12-01The effectiveness of oral HIV preexposure prophylaxis (PrEP) strongly depends on maintaining adherence. We investigated the association between substance use and PrEP adherence, as well as incident sexually transmitted infections (STIs) in a high-risk cohort of 394 participants (391 men who have sex with men and 3 transgender women) who were enrolled in a PrEP demonstration project. We assessed baseline and ongoing substance use over a 48-week period for stimulants and nonstimulant substances and for each substance separately. We measured PrEP adherence by using dried blood spots to obtain levels of tenofovir diphosphate. No differences in these levels were found between substance users and nonsubstance users. Baseline stimulant use was strongly associated (odds ratio 3.4; p<0.001) with incident STIs during the study. Thus, PrEP adherence was not decreased by substance use. Because substance users had increased rates of STIs, indicating higher-risk behavior, they might be excellent candidates for PrEP.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesInfectious DiseasesSubstance MisuseSexual and Gender Minorities (SGM/LGBT*)Drug Abuse (NIDA only)Sexually Transmitted InfectionsClinical ResearchBehavioral and Social ScienceHIV/AIDSPreventionGood Health and Well BeingAlcohol DrinkingCaliforniaFemaleHIV InfectionsHomosexualityMaleHumansMalePre-Exposure ProphylaxisProportional Hazards ModelsPublic Health SurveillanceRandomized Controlled Trials as TopicSexual and Gender MinoritiesSexually Transmitted DiseasesSubstance-Related DisordersCalifornia Collaborative Treatment Group 595 TeamHIVHIV and other retrovirusesMSMPrEPadherenceadherence to HIV preexposure prophylaxisalcoholdried blood spotsinjection drug usemen who have sex with menmethamphetaminepersons who injected drugssexually transmitted infectionssubstance usetransgender womenvirusesMedical MicrobiologyPublic Health and Health ServicesMicrobiologyClinical sciencesEpidemiologyHealth services and systemsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/91k2c077articleEmerging Infectious Diseases, vol 24, iss 122292 - 2302oai:escholarship.org:ark:/13030/qt8zf8s9s52023-12-12T16:38:55Zqt8zf8s9s5Genital HIV-1 Shedding With Dolutegravir (DTG) Plus Lamivudine (3TC) Dual TherapyGianella, SaraMarconi, Vincent CBerzins, BaibaBenson, Constance ASax, PaulFichtenbaum, Carl JWilkin, TimothyVargas, MillieDeng, QianqianOliveira, Michelli FMoser, CarleeTaiwo, Babafemi O2018-12-15Biomedical and Clinical SciencesEpidemiologyPublic HealthClinical SciencesHealth SciencesAnti-HIV AgentsFemaleGenitaliaGenotyping TechniquesHIV InfectionsHIV-1Heterocyclic Compounds3-RingHumansLamivudineMaleOxazinesPiperazinesPyridonesRNAViralTreatment OutcomeVirus SheddingPublic Health and Health ServicesVirologyClinical sciencesPublic healthpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8zf8s9s5articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 79, iss 5e112 - e114oai:escholarship.org:ark:/13030/qt3xj2173f2023-12-12T16:05:59Zqt3xj2173fDaily HIV pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate-emtricitabine reduced Streptococcus and increased Erysipelotrichaceae in rectal microbiotaDubé, Michael PPark, Sung YongRoss, HeatherLove, Tanzy MTMorris, Sheldon RLee, Ha Youn2018-01-01Daily PrEP is highly effective at preventing HIV-1 acquisition, but risks of long-term tenofovir disoproxil fumarate plus emtricitabine (TDF-FTC) include renal decline and bone mineral density decrease in addition to initial gastrointestinal side effects. We investigated the impact of TDF-FTC on the enteric microbiome using rectal swabs collected from healthy MSM before PrEP initiation and after 48 to 72 weeks of adherent PrEP use. The V4 region of the 16S ribosomal RNA gene sequencing showed that Streptococcus was significantly reduced from 12.0% to 1.2% (p = 0.036) and Erysipelotrichaceae family was significantly increased from 0.79% to 3.3% (p = 0.028) after 48-72 weeks of daily PrEP. Catenibacterium mitsuokai, Holdemanella biformis and Turicibacter sanguinis were increased within the Erysipelotrichaceae family and Streptococcus agalactiae, Streptococcus oralis, Streptococcus mitis were reduced. These changes were not associated with host factors including PrEP duration, age, race, tenofovir diphosphate blood level, any drug use and drug abuse, suggesting that the observed microbiome shifts were likely induced by daily PrEP use. Long-term PrEP resulted in increases of Catenibacterium mitsuokai and Holdemanella biformis, which have been associated with gut microbiome dysbiosis. Our observations can aid in characterizing PrEP's side effects, which is likely to improve PrEP adherence, and thus HIV-1 prevention.Biomedical and Clinical SciencesClinical SciencesPreventionHIV/AIDSClinical ResearchInfectionGood Health and Well BeingAdultBiodiversityDrug Administration ScheduleEmtricitabineErysipelothrixFemaleHIV-1HumansMicrobiotaMiddle AgedPre-Exposure ProphylaxisRectumSpecies SpecificityStreptococcusTenofovirapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3xj2173farticleScientific Reports, vol 8, iss 115212oai:escholarship.org:ark:/13030/qt7z3721v12023-12-12T15:53:44Zqt7z3721v1Trajectories and Predictors of Longitudinal Preexposure Prophylaxis Adherence Among Men Who Have Sex With Men.Pasipanodya, Elizabeth CJain, SoniaSun, XiaoyingBlumenthal, JillEllorin, EricCorado, KatyaDube, Michael PDaar, Eric SMorris, Sheldon RMoore, David J2018-10-05BackgroundAdherence is necessary for efficacy of preexposure prophylaxis (PrEP), and text-messaging methods are promising tools for both adherence assessment and support. Although PrEP adherence is variable, little research has examined patterns of variability or factors associated with longitudinal use.MethodsIn the context of a randomized controlled trial of text-messaging versus standard of care for PrEP adherence, 181 men who have sex with men received once-daily tenofovir disoproxil fumarate/emtricitabine and daily adherence texts for 48 weeks. Growth mixture modeling (GMM) was used to identify subgroups of individuals with similar trajectories of text-reported adherence. Between-group differences in pharmacologic measures of adherence (ie, tenofovir diphosphate and emtricitabine triphosphate levels), as well as predictors and study-end attitudes associated with group membership, were examined.ResultsGMM identified 4 trajectories of text-reported adherence. Classes with higher text-reported adherence had higher drug concentrations. Younger age and minority race were associated with lower adherence, and individuals in classes with lower adherence had greater baseline levels of depression, substance use concerns, and sexual risk. Differences in study satisfaction were also associated with adherence.ConclusionsThis study supports the use of text-reported PrEP adherence. Identifying factors associated with less-than-optimal adherence may aid clinicians in anticipating at-risk patients requiring augmented intervention.Clinical trials registrationNCT01761643.Biomedical and Clinical SciencesClinical SciencesClinical Trials and Supportive ActivitiesClinical ResearchPrevention7.1 Individual care needsManagement of diseases and conditionsGood Health and Well BeingAdultHIV InfectionsHomosexualityMaleHumansMaleMedication AdherencePre-Exposure ProphylaxisText MessagingYoung AdultPrEPadherenceHIVMSMgrowth mixture modelingtext messagingCalifornia Collaborative Treatment Group (CCTG) TAPIR Study TeamBiological SciencesMedical and Health SciencesMicrobiologyBiological sciencesBiomedical and clinical sciencesHealth sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7z3721v1articleThe Journal of Infectious Diseases, vol 218, iss 101551 - 1559oai:escholarship.org:ark:/13030/qt6mn0j0zq2023-12-12T15:00:57Zqt6mn0j0zqAssociation between Federally Qualified Health Center usage and emergency department utilization among California’s HIV-infected Medicaid beneficiaries, 2009Chow, Jeremy YComulada, W ScottGildner, Jennifer LDesmond, Katherine ALeibowitz, Arleen A2019-04-03Federally Qualified Health Centers (FQHCs) have long been important sources of care for publicly insured people living with HIV. FQHC users have historically used emergency departments (EDs) at a higher-than-average rate. This paper examines whether this greater use relates to access difficulties in FQHCs or to characteristics of FQHC users. Zero-inflated Poisson models were used to estimate how FQHC use related to the odds of being an ED user and annual number of ED visits, using claims data on 6,284 HIV-infected California Medicaid beneficiaries in 2008-2009. FQHC users averaged significantly greater numbers of annual ED visits than non-FQHC users and those with no outpatient usage (1.89, 1.59, and 1.70, respectively; P = 0.043). FQHC users had higher odds of being ED users (OR = 1.14; 95%CI 1.02-1.27). In multivariable analyses, FQHC clients had higher odds of ED usage controlling for demographic and service characteristics (OR = 1.15; 95%CI 1.02-1.30) but not when medical characteristics were included (OR = 1.08; 95%CI 0.95-1.24). Among ED users, FQHC use was not significantly associated with the number of ED visits in our models (rate ratio (RR) = 1.00; 95%CI 0.87-1.15). The overall difference in mean annual ED visits observed between FQHC and non-FQHC groups was reduced to insignificance (1.75; 95% CI 1.59-1.92 vs 1.70; 95%CI 1.54-1.85) after adjusting for demographic, service, and medical characteristics. Overall, FQHC users had higher ED utilization than non-FQHC users, but the disparity was largely driven by differences in underlying medical characteristics.Public HealthHealth SciencesClinical ResearchHealth ServicesHIV/AIDSEmergency CareInfectionGood Health and Well BeingAdultCaliforniaDemographyEmergency ServiceHospitalFemaleHIV InfectionsHealth Services AccessibilityHumansMaleMedicaidMiddle AgedPrimary Health CareUnited StatesHIVFederally Qualified Health Centeremergency departmentPublic Health and Health ServicesPsychologyPublic healthSociologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6mn0j0zqarticleAIDS Care, vol 31, iss 4519 - 527oai:escholarship.org:ark:/13030/qt6822x1ds2023-12-12T14:19:27Zqt6822x1dsCD4:CD8 ratio and CD8+ cell count for prognosticating mortality in HIV-infected patients on antiretroviral therapyJenks, Jeffrey DanielHoenigl, Martin2018-02-01Medical MicrobiologyBiomedical and Clinical SciencesImmunologyInfectious DiseasesHIV/AIDS6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsInfectionGood Health and Well BeingClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6822x1dsarticleJournal of Laboratory and Precision Medicine, vol 3, iss 28 - 8oai:escholarship.org:ark:/13030/qt8h17g2fz2023-12-12T14:18:09Zqt8h17g2fzQuadrivalent Meningococcal Vaccine Uptake Among Men Who Have Sex With Men During a Meningococcal Outbreak in Los Angeles County, California, 2016-2017Holloway, Ian WWu, Elizabeth SCGildner, JenniferFenimore, Vincent LTan, DianeRandall, LauraFrew, Paula M2018-09-01ObjectiveThe objective of our study was to assess meningococcal ACWY (MenACWY) vaccine uptake among men who have sex with men (MSM) during an ongoing, invasive meningococcal disease outbreak in Southern California. This research was important to inform future vaccination uptake interventions for this high-priority population.MethodsWe conducted venue-based sampling to recruit and enroll MSM living in Los Angeles County, California, from December 2016 through February 2017. We conducted bivariate and multivariable analyses to evaluate associations between MenACWY vaccine uptake and other predetermined factors.ResultsOf 368 participants, 138 (37.5%) reported receiving the MenACWY vaccine. In multivariable analyses, older age (adjusted odds ratio [aOR] = 2.57; 95% confidence interval [CI], 1.31-5.03), previous diagnosis of a sexually transmitted infection (aOR = 2.22; 95% CI, 1.14-4.30), belief that MenACWY vaccine is important (aOR = 3.49; 95% CI, 1.79-6.82), confidence in the MenACWY vaccine (aOR = 5.53; 95% CI, 3.11-9.83), and knowing someone who had been vaccinated (aOR = 5.82; 95% CI, 3.05-11.12) were significantly associated with MenACWY vaccine uptake.ConclusionsOur findings reflect low uptake of the recommended MenACWY vaccine among MSM after a local outbreak, despite public health efforts. In addition to ongoing, widespread campaigns to inform MSM about local outbreaks and vaccination recommendations, MSM may be responsive to direct outreach from peers who have been vaccinated.Public HealthHealth SciencesImmunizationClinical ResearchVaccine RelatedPreventionPrevention of disease and conditionsand promotion of well-being3.4 VaccinesInfectionGood Health and Well BeingAdultDisease OutbreaksHomosexualityMaleHumansLos AngelesMaleMeningococcal InfectionsMeningococcal VaccinesPatient Acceptance of Health Caremeningococcalmeningitisquadrivalent meningococcal vaccineMenACWYMSMvaccine measurementimmunization acceptanceimmunization assessmentNursingPublic Health and Health ServicesPolicy and AdministrationHealth services and systemsPublic healthPolicy and administrationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8h17g2fzarticlePublic Health Reports, vol 133, iss 5559 - 569oai:escholarship.org:ark:/13030/qt9rs438zm2023-12-12T14:13:58Zqt9rs438zmExploring the preferences of a culturally congruent, peer-based HIV prevention intervention for black men who have sex with menDangerfield, Derek THarawa, Nina TMcWells, CharlesHilliard, CharlesBluthenthal, Ricky N2018-01-01Background HIV testing, treatment initiation and treatment adherence have been emphasised for Black men who have sex with men (BMSM). However, many BMSM do not get tested, obtain HIV treatment or adhere to treatment. It is essential to highlight barriers to HIV testing, treatment adherence and the ideal components for an intervention: peer mentors, socioeconomic resources and participant incentives.MethodsFive focus groups (n=24) were conducted among HIV-negative and HIV-positive BMSM aged ≥18 years in Los Angeles, California, USA to explore motivations and barriers to testing and treatment and the components of an ideal, culturally competent HIV testing intervention for BMSM.ResultsBarriers to HIV testing included fear and stigma associated with discovering a HIV-positive status and drug use. Motivations for testing included experiencing symptoms, beginning new relationships, perceptions of risk and peer mentors.ConclusionsFuture HIV prevention and treatment efforts should consider these components to improve health outcomes among BMSM.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical SciencesHIV/AIDSPediatric AIDSClinical ResearchPreventionInfectious DiseasesMental HealthPediatricClinical Trials and Supportive ActivitiesBehavioral and Social ScienceManagement of diseases and conditions7.1 Individual care needsInfectionGood Health and Well BeingAdultBlack or African AmericanCounselingCulturally Competent CareFocus GroupsHIV InfectionsHumansLos AngelesMaleMass ScreeningMiddle AgedPeer GroupSexual and Gender MinoritiesBlack men who have sex with mencultureinterventionpreferencesMedical and Health SciencesStudies in Human SocietyBiomedical and clinical sciencesHealth sciencesHuman societyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9rs438zmarticleSexual Health, vol 15, iss 5424 - 430oai:escholarship.org:ark:/13030/qt4fb189k02023-12-12T13:56:51Zqt4fb189k0Acceptability of Injectable and On-Demand Pre-Exposure Prophylaxis Among an Online Sample of Young Men Who Have Sex with Men in CaliforniaBeymer, Matthew RGildner, Jennifer LHolloway, Ian WLandovitz, Raphael J2018-09-01PurposePre-exposure prophylaxis (PrEP) is an effective strategy to prevent HIV. However, low uptake of daily oral PrEP since Food and Drug Administration approval and low medication adherence among users have stimulated the investigation of other modalities for delivery, such as injectable PrEP and on-demand PrEP. The objective of this study was to determine the demographic and behavioral predictors of willingness to try alternative PrEP delivery mechanisms among young men who have sex with men (YMSM) who stated that they were unwilling to try daily oral PrEP.MethodsYMSM in California were recruited through geosocial networking applications; we analyzed a subsample who stated that they were either ambivalent about trying or unwilling to try daily oral PrEP (n = 265). We used chi-square and Fisher's exact tests to determine characteristics associated with willingness to try injectable PrEP, willingness to try on-demand PrEP, and willingness to try either alternative form.ResultsFor individuals who stated that they would not be willing to try daily oral PrEP, ∼85% were willing to try on-demand and/or injectable PrEP. Individuals who reported some college or more reported greater willingness to try injectable PrEP (adjusted odds ratio [aOR]: 2.92; 95% confidence interval [CI]: 1.32-6.46), on-demand PrEP (aOR: 2.28; 95% CI: 1.06-4.90), or either method (aOR: 5.54; 95% CI: 1.78-17.22).ConclusionFuture research should determine how to enhance uptake of emerging forms of PrEP among the individuals most at risk for HIV.Public HealthHealth SciencesHIV/AIDSPreventionGood Health and Well BeingAdolescentAdultAnti-HIV AgentsCaliforniaHIV InfectionsHomosexualityMaleHumansInjectionsInternetMalePatient Acceptance of Health CarePre-Exposure ProphylaxisSurveys and QuestionnairesYoung Adultgaybisexual menHIV pre-exposure prophylaxisHIV preventionmen who have sex with mengay/bisexual menHealth services and systemsPolicy and administrationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4fb189k0articleLGBT Health, vol 5, iss 6341 - 349oai:escholarship.org:ark:/13030/qt4079w4c32023-12-12T13:17:17Zqt4079w4c3Influenza Vaccination Can Broadly Activate the HIV Reservoir During Antiretroviral TherapyChristensen-Quick, AaronChaillon, AntoineYek, ChristinaZanini, FabioJordan, ParrisIgnacio, CarolineCaballero, GemmaGianella, SaraSmith, Davey2018-11-01Biomedical and Clinical SciencesEpidemiologyPublic HealthClinical SciencesHealth SciencesAdolescentAdultAnti-Retroviral AgentsFemaleHIVHIV InfectionsHumansInfluenza VaccinesInfluenzaHumanMaleMiddle AgedVirus ActivationYoung AdultPublic Health and Health ServicesVirologyClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4079w4c3articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 79, iss 3e104 - e107oai:escholarship.org:ark:/13030/qt69t176kr2023-12-12T12:12:30Zqt69t176krFactors Associated with Immunization Opinion Leadership among Men Who Have Sex with Men in Los Angeles, CaliforniaHolloway, Ian WBednarczyk, RobertFenimore, Vincent LGoldbeck, CameronWu, ElizabethHimmelstein, RebeccaTan, DianeRandall, LauraLutz, Chelsea SFrew, Paula M2018-05-01We sought to identify the characteristics of men who have sex with men (MSM) who are opinion leaders on immunization issues and to identify potential opportunities to leverage their influence for vaccine promotion within MSM communities. Using venue-based sampling, we recruited and enrolled MSM living in Los Angeles (N = 520) from December 2016 to February 2017 and evaluated characteristic differences in sociodemographic characteristics, health behaviors, and technology use among those classified as opinion leaders versus those who were not. We also asked respondents about their past receipt of meningococcal serogroups A, C, W, and Y (MenACWY) and meningococcal B (MenB) vaccines, as well as their opinions on the importance of 13 additional vaccines. Multivariable results revealed that non-Hispanic black (aOR = 2.64; 95% CI: 1.17⁻5.95) and other race/ethnicity (aOR = 2.98; 95% CI: 1.41⁻6.29) respondents, as well as those with a history of an STI other than HIV (aOR = 1.95; 95% CI: 1.10⁻3.48), were more likely to be opinion leaders. MenACWY (aOR = 1.92; 95% CI: 1.13⁻3.25) and MenB (aOR = 3.09; 95% CI: 1.77⁻5.41) vaccine uptake, and perceived importance for these and seven additional vaccines, were also associated with being an opinion leader. The results suggest that the co-promotion of vaccination and other health promotion initiatives via opinion leaders could be a useful strategy for increasing vaccination among MSM.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical SciencesPreventionVaccine RelatedClinical ResearchHIV/AIDSImmunization3.4 VaccinesPrevention of disease and conditionsand promotion of well-beingInfectionGood Health and Well BeingAdultHealth KnowledgeAttitudesPracticeHealth PromotionHomosexualityMaleHumansLeadershipLos AngelesMalePatient Acceptance of Health CareSexually Transmitted DiseasesVaccinationopinion leadershipMSMpeer health navigationvaccine measurementimmunization acceptanceimmunization assessmentvaccine promotionToxicologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/69t176krarticleInternational Journal of Environmental Research and Public Health, vol 15, iss 5939oai:escholarship.org:ark:/13030/qt4160k5vm2023-12-12T12:07:03Zqt4160k5vmEffect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxisHassan, AdibaBlumenthal, Jill SDube, Michael PEllorin, EricCorado, KatyaMoore, David JMorris, Sheldon R2018-11-01ObjectivesRectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT).MethodsFrom 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson's χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted.ResultsOf 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p<0.001), male partners (med:6, p<0.001) and substance use (any of methamphetamine/hallucinogens/dissociative/poppers) (p<0.001) were associated with increased odds of RI. Controlling for potential confounders, odds of prevalent RI were 3.59 (p<0.001, 95% CI 1.90 to 6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78 to 8.39) when douching weekly or more compared with not douching. MSM with more than six male partners had 5.34 (p=0.002, 95% CI 1.87 to 15.31) increased odds of RI when douching weekly or more compared with not douching.ConclusionRectal hygiene with RD is a common practice (66%) among HIV-uninfected MSM on PrEP in this study, which increases the odds of acquiring rectal NG and/or CT independent of sexual risk behaviour, substance use and other factors. This suggests interventional approaches targeting rectal hygiene products and practices could reduce sexually transmitted infections.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesInfectious DiseasesSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceHIV/AIDSSexually Transmitted InfectionsPreventionClinical ResearchInfectionGood Health and Well BeingAdultChlamydiaChlamydia InfectionsCohort StudiesEnemaGonorrheaHIV InfectionsHomosexualityMaleHumansMaleMiddle AgedPre-Exposure ProphylaxisRectal DiseasesRectumRisk-TakingSexual BehaviorSexual PartnersTherapeutic IrrigationYoung Adultchlamydia infectiongonorrhoeasexual behaviourMedical MicrobiologyPublic Health and Health ServicesClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4160k5vmarticleSexually Transmitted Infections, vol 94, iss 7508 - 514oai:escholarship.org:ark:/13030/qt4cs573cq2023-12-12T10:17:00Zqt4cs573cqDifferential Patterns of Risk and Vulnerability Suggest the Need for Novel Prevention Strategies for Black Bisexual Men in the HPTN 061 StudyDyer, Typhanye VKhan, Maria RRegan, RotreaseHarawa, Nina TNelson, LaRon EWilton, LeoWang, LeiPeng, LiliOu, San SanShoptaw, Steve2018-08-15BackgroundBlack men who have sex with men (BMSM) and some who also have sex with women (BMSMW) account for over 70% of new HIV infections in the United States representing an elevated HIV risk in this group, also informing risks of HIV transmission to other BMSM and female sexual partners.SettingsWe examined trajectories of self-reported substance use, HIV-related sexual risk behaviors, and psychosocial vulnerabilities among BMSMW versus BMSM over a 1-year study period.MethodsWe analyzed baseline, 6-, and 12-month follow-up data from the HIV Prevention Trials Network "BROTHERS" Study (HPTN 061; n = 1126). Categorizing participants by sexual partner type across 3 time points: (1) BMSMO: having male and no female partners across assessments and (2) BMSMW: having sex with male and one or more female partners at least at 1 time point. Using generalized estimating equations, we estimated associations between being BMSMW (versus BMSMO) and changes in psychosocial vulnerability, substance use, and HIV-related sexual risk behaviors.ResultsGeneralized estimating equation models controlling for sociodemographics, time-varying effects, and intervention status showed that BMSMW versus BMSMO had 50% increased odds of crack use, 71% increased odds of alcohol use during condomless anal intercourse (CAI), 51% greater odds of using drugs at last CAI, and twice the odds of receiving goods at last CAI.ConclusionsFindings show stable and comparatively elevated illicit drugs, alcohol, and exchange sex during last CAI among BMSMW. Future intervention research should focus on ways to address changes in substance-related HIV-transmission behaviors over time in this population of men.PaediatricsBiomedical and Clinical SciencesPublic HealthHealth SciencesSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSBehavioral and Social ScienceClinical Trials and Supportive ActivitiesDrug Abuse (NIDA only)PreventionSubstance MisuseClinical Research3.1 Primary prevention interventions to modify behaviours or promote wellbeingAetiologyPrevention of disease and conditionsand promotion of well-being2.2 Factors relating to the physical environment2.3 Psychologicalsocial and economic factorsInfectionGood Health and Well BeingBlack or African AmericanBisexualityHIV InfectionsHealth Services Needs and DemandHumansMaleProspective StudiesRisk FactorsUnited Statessubstance useblack MSMblack MSMWHIV sexual riskrepeated measurescohort studiesClinical SciencesPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4cs573cqarticleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 78, iss 5491 - 498oai:escholarship.org:ark:/13030/qt33s6g2kc2023-12-12T07:17:26Zqt33s6g2kcLatent Classes of Sexual Risk Among Black Men Who Have Sex with Men and WomenDangerfield, Derek THarawa, Nina TSmith, Laramie RJeffries, William LBaezconde-Garbanati, LourdesBluthenthal, Ricky2018-10-01Black men who have sex with men and women (BMSMW) are at high risk for HIV and other sexually transmitted infections (STIs). Despite knowing that HIV/STI risk varies by sexual positioning practices, limited data have characterized the risk profiles of BSMW. This study utilized latent class analysis (LCA) to explore BMSMW's sexual risk profiles regarding condomless sexual positioning practices. Participants were BMSMW in intervention studies in Los Angeles, Chicago, and Philadelphia. LCA was used to characterize their sexual risk profiles. Age, study location, HIV status, social support, and internalized homophobia were used as covariates in a multinomial regression model predicting the likelihood of class membership. Among the 546 participants, three latent classes of risk were identified: Seropositive Serosorters, Seronegative/unknown Serosorters, and Main Partners Only. All groups had the greatest probabilities of condomless sex with main partners. Seropositive Serosorters had the highest probabilities of condomless sex with HIV-positive partners. Seronegative/unknown Serosorters had the highest probabilities of condomless sex with HIV-negative or unknown status partners. HIV-positive BMSMW had 87% lower odds of being classified as Seronegative/unknown Serosorters than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.13, 95% CI 0.06, 0.28). HIV-positive BMSMW had 71% lower odds of being classified as Main Partners Only than Seropositive Serosorters than HIV-negative/unknown status BMSMW (AOR = 0.29, 95% CI 0.16, 0.51). Findings highlight opportunities for clinicians to promote condom use and risk reduction among BMSMW with differing sexual risk profiles. Increased understanding of sexual positioning practices among BMSMW might help address HIV/STIs among this group.Clinical and Health PsychologySocial and Personality PsychologyHuman SocietyPsychologyGender StudiesPreventionInfectious DiseasesSexually Transmitted InfectionsHIV/AIDSClinical ResearchReproductive health and childbirthInfectionGood Health and Well BeingAdolescentAdultBlack or African AmericanChicagoFemaleHomophobiaHomosexualityMaleHumansLos AngelesMaleMiddle AgedPhiladelphiaRisk-TakingSafe SexSexual BehaviorSexual PartnersSexual and Gender MinoritiesSexually Transmitted DiseasesSocial SupportYoung AdultBlack MSMWBlack MSMSexual positioningHIV riskSTI riskSexual orientationPublic Health and Health ServicesOther Studies in Human SocietyClinical PsychologyGender studiesClinical and health psychologySocial and personality psychologyapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/33s6g2kcarticleArchives of Sexual Behavior, vol 47, iss 72071 - 2080oai:escholarship.org:ark:/13030/qt29d8v9sz2023-12-12T07:14:29Zqt29d8v9szEfficacy of a Small-Group Intervention for Post-Incarcerated Black Men Who Have Sex with Men and Women (MSMW)Harawa, Nina TGuentzel-Frank, HeatherMcCuller, William JasonWilliams, John KMillet, GregorioBelcher, LisaJoseph, Heather ABluthenthal, Ricky N2018-04-01We conducted a randomized controlled trial of a six-session behavioral intervention designed to reduce frequency of condomless sex and numbers of sex partners among recently incarcerated, bisexual Black men. One hundred participants were assigned to the small-group intervention, Men in Life Environments (MILE), and 112 were assigned to the control condition. Among those assigned to MILE, 69% attended at least one session, 88% of whom attended all sessions. At 3-months' follow-up, large reductions in risk behaviors were reported by both groups. Means for episodes of condomless sex in the previous 3 months declined from 27.7 to 8.0 for the intervention and 25.6 to 6.7 for the control group. Reductions were not greater for the intervention than those of the control group. Regression to the mean, respondent burden, and implementation issues, such as moving from office-based to field-based survey administration at follow-up, may have contributed to the large declines reported by both groups.Public HealthHealth SciencesClinical ResearchBehavioral and Social ScienceClinical Trials and Supportive ActivitiesPreventionAdultBlack or African AmericanBehavior TherapyFemaleHealth PromotionHomosexualityMaleHumansMaleMiddle AgedPrisonersRisk-TakingSafe SexSexual BehaviorSexual and Gender MinoritiesSurveys and QuestionnairesUnited StatesBehavioral interventionHIV risk behaviorBisexualBlack/African American menIncarcerationHuman Movement and Sports SciencesPublic Health and Health ServicesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/29d8v9szarticleJournal of Urban Health, vol 95, iss 2159 - 170oai:escholarship.org:ark:/13030/qt5d1875w02023-12-12T04:36:39Zqt5d1875w0Facilitators and Barriers to Pre-Exposure Prophylaxis Willingness Among Young Men Who Have Sex with Men Who Use Geosocial Networking Applications in CaliforniaHolloway, Ian WTan, DianeGildner, Jennifer LBeougher, Sean CPulsipher, CraigMontoya, Jorge APlant, AaronLeibowitz, Arleen2017-12-01While correlates of pre-exposure prophylaxis (PrEP) uptake have been explored among older men who have sex with men (MSM), less is known about the facilitators and barriers that encourage uptake among younger MSM (YMSM). This study explores the association between willingness to take PrEP and demographic characteristics, sexual risk, and substance use, and attitudinal factors among YMSM in California who use geosocial networking applications (GSN apps). Based on survey data from YMSM recruited through GSN apps (n = 687), PrEP willingness was positively associated with Hispanic ethnicity [adjusted odds ratio (aOR): 1.73; confidence interval (CI): 1.01-2.98; p = 0.046], concerns about drug effects (aOR: 0.46; CI: 0.33-0.65; p < 0.001), medical mistrust (aOR: 0.71; CI: 0.53-0.96; p < 0.001), and concerns about adherence (aOR: 0.65; CI: 0.49-0.89; p = 0.005). PrEP willingness was positively associated with medium (aOR: 1.87; CI: 1.14-3.07; p = 0.014) and high concern (aOR: 1.84; CI: 1.13-3.01; p < 0.001) about contracting HIV and perceived benefits of taking PrEP (aOR: 2.59; CI: 1.78-3.78; p < 0.001). In addition to emphasizing the benefits of using PrEP, campaigns that address concerns regarding adherence and side effects may increase interest in and demand for PrEP among YMSM. More opportunities are needed to educate YMSM about PrEP, including addressing their concerns about this new prevention strategy. Providers should speak openly and honestly to YMSM considering PrEP about what to do if side effects occur and how to handle missed doses. Outreach using GSN apps for PrEP education and screening may be an effective way to reach YMSM.Biomedical and Clinical SciencesPublic HealthHealth SciencesBehavioral and Social SciencePediatricPediatric AIDSPreventionSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchHIV/AIDSGood Health and Well BeingAdultHIV InfectionsHealth KnowledgeAttitudesPracticeHomosexualityMaleHumansMaleMedication AdherencePatient Acceptance of Health CarePerceptionPre-Exposure ProphylaxisSexual BehaviorSocial NetworkingSurveys and QuestionnairesYoung Adultpre-exposure prophylaxisyoung men who have sex with mensocial networkingmedication adherencemedical mistrustPublic Health and Health ServicesVirologyClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5d1875w0articleAIDS Patient Care and STDs, vol 31, iss 12517 - 527oai:escholarship.org:ark:/13030/qt7sd6q09r2023-12-12T04:09:36Zqt7sd6q09rSexually Transmitted Infection Testing of HIV-Positive Medicare and Medicaid Enrollees Falls Short of GuidelinesLandovitz, Raphael JGildner, Jennifer LLeibowitz, Arleen A2018-01-01BackgroundMen who have sex with men with HIV have high sexually transmitted infection (STI) incidence. Thus, the Centers for Disease Control and Prevention (CDC) recommends at least yearly STI screening of HIV-infected individuals.MethodsWe calculated testing rates for syphilis, chlamydia, and gonorrhea among HIV-positive Californians with Medicare or Medicaid insurance in 2010. Logistic regressions estimated how testing for each bacterial STI relates to demographic and provider factors.ResultsFewer than two-thirds of HIV-positive Medicare and fewer than three-quarters of Medicaid enrollees received a syphilis test in 2010. Screenings for chlamydia or gonorrhea were less frequent: approximately 30% of Medicare enrollees were tested for chlamydia or gonorrhea in 2010, but higher proportions of Medicaid enrollees were tested (45%-46%). Only 34% of HIV-positive Medicare enrollees who were tested for syphilis were also screened for chlamydia or gonorrhea on the same day. Nearly half of Medicaid enrollees were tested for all 3 STIs on the same day. Patients whose providers had more HIV experience had higher STI testing rates.ConclusionsTesting rates for chlamydia and gonorrhea infection are low, despite the increase in these infections among people living with HIV and their close association with HIV transmission. Interventions to increase STI testing include the following: prompts in the medical record to routinely conduct syphilis testing on blood drawn for viral load monitoring, opt-out consent for STI testing, and provider education about the clinical importance of STIs among HIV-positive patients. Last, it is crucial to change financial incentives that discourage nucleic acid amplification testing for rectal chlamydia and gonorrhea infections.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesInfectious DiseasesHealth ServicesBehavioral and Social SciencePreventionSexually Transmitted InfectionsHIV/AIDSClinical Research2.2 Factors relating to the physical environmentAetiologyInfectionGood Health and Well BeingAdultCaliforniaDelivery of Health CareFemaleGuideline AdherenceGuidelines as TopicHIV InfectionsHumansIncidenceMaleMass ScreeningMedicaidMedicareMiddle AgedOdds RatioPublic Health SurveillanceSexual PartnersSexually Transmitted DiseasesBacterialUnited StatesViral LoadYoung AdultBiological SciencesMedical and Health SciencesClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7sd6q09rarticleSexually Transmitted Diseases, vol 45, iss 18 - 13oai:escholarship.org:ark:/13030/qt3h51h9qn2023-12-12T03:34:39Zqt3h51h9qnResults from the post-exposure prophylaxis pilot program (P-QUAD) demonstration project in Los Angeles CountyBeymer, Matthew RKofron, Ryan MTseng, Chi-HongBolan, Robert KFlynn, Risa PSayles, Jennifer MPerez, Mario JJordan, Wilbert CLandovitz, Raphael J2018-05-01Post-exposure prophylaxis (PEP) is a promising but under-utilized strategy for HIV prevention in high-risk populations. Between March 2010 and June 2011, two community-based clinics in Los Angeles County provided PEP in a pilot program to 267 unique individuals. Courses were primarily dispensed to men who have sex with men (84%) and consisted overwhelmingly of a three-drug antiretroviral therapy regimen containing two nucleoside reverse transcriptase inhibitors and either an integrase inhibitor (raltegravir) or a boosted protease inhibitor (lopinavir/ritonavir). Approximately 64% of all PEP courses were followed for at least 12 weeks, and seven individuals seroconverted. Of the seven seroconversions, six had subsequent re-exposure. The low rate of PEP failure calls for expanded funding for PEP in other jurisdictions.Biomedical and Clinical SciencesClinical SciencesHIV/AIDSPreventionInfectious DiseasesAdolescentAdultAnti-HIV AgentsFemaleHIV InfectionsHIV-1HomosexualityMaleHumansLopinavirLos AngelesMaleMedication AdherenceMiddle AgedPilot ProjectsPost-Exposure ProphylaxisRaltegravir PotassiumReverse Transcriptase InhibitorsRitonavirYoung AdultAntiretroviral therapyhigh-risk behaviorHIVhomosexualNorth AmericaMedical MicrobiologyPublic Health and Health ServicesPublic HealthClinical sciencesImmunologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3h51h9qnarticleInternational Journal of STD & AIDS, vol 29, iss 6557 - 562oai:escholarship.org:ark:/13030/qt1845m9312023-12-12T01:16:36Zqt1845m931Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug–Drug Interaction ConcernsBraun, Hannan MCandelario, JuryHanlon, Courtney LSegura, Eddy RClark, Jesse LCurrier, Judith SLake, Jordan E2017-10-01PurposeBoth hormone therapy (HT) and antiretroviral therapy (ART) can be lifesaving for transgender women (TW) living with HIV, but each has side effects and potential drug-drug interactions (DDI). We assessed how concerns about HT-ART interactions affect treatment adherence.MethodsThis study used a cross-sectional survey of TW (n = 87) in Los Angeles, CA.ResultsFifty-four percent were living with HIV; 64% used HT. Only 49% of TW living with HIV discussed ART-HT DDI with their provider; 40% reported not taking ART (12%), HT (12%), or both (16%) as directed due to DDI concerns.ConclusionImperfect HT/ART use and limited provider communication suggests a need for improved HT-ART integration.Health Services and SystemsPolicy and AdministrationHealth SciencesHuman SocietyInfectious DiseasesClinical ResearchHIV/AIDSEvaluation of treatments and therapeutic interventions6.1 PharmaceuticalsInfectionAnti-HIV AgentsCross-Sectional StudiesDrug InteractionsFemaleHIV InfectionsHormone Replacement TherapyHumansLos AngelesMaleMedication AdherenceMiddle AgedPilot ProjectsTransgender Personsantiretroviral therapyhealth disparitiesHIVmedication adherencetransgenderHealth services and systemsPolicy and administrationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1845m931articleLGBT Health, vol 4, iss 5371 - 375oai:escholarship.org:ark:/13030/qt7t60w0fc2023-12-11T22:28:33Zqt7t60w0fcAre Partner Race and Intimate Partner Violence Associated with Incident and Newly Diagnosed HIV Infection in African-American Men Who Have Sex with Men?Beymer, Matthew RHarawa, Nina TWeiss, Robert EShover, Chelsea LToynes, Brian RMeanley, StevenBolan, Robert K2017-10-01Black gay, bisexual, and other men who have sex with men (BMSM) experience a disparate rate of HIV infections among MSM. Previous analyses have determined that STI coinfection and undiagnosed HIV infection partly explain the disparity. However, few studies have analyzed the impact of partner-level variables on HIV incidence among BMSM. Data were analyzed for BMSM who attended the Los Angeles LGBT Center from August 2011 to July 2015 (n = 1974) to identify risk factors for HIV infection. A multivariable logistic regression was used to analyze predictors for HIV prevalence among all individuals at first test (n = 1974; entire sample). A multivariable survival analysis was used to analyze predictors for HIV incidence (n = 936; repeat tester subset). Condomless receptive anal intercourse at last sex, number of sexual partners in the last 30 days, and intimate partner violence (IPV) were significant partner-level predictors of HIV prevalence and incidence. Individuals who reported IPV had 2.39 times higher odds (CI 1.35-4.23) and 3.33 times higher hazard (CI 1.47-7.55) of seroconverting in the prevalence and incidence models, respectively. Reporting Black partners only was associated with increased HIV prevalence, but a statistically significant association was not found with incidence. IPV is an important correlate of both HIV prevalence and incidence in BMSM. Further studies should explore how IPV affects HIV risk trajectories among BMSM. Given that individuals with IPV history may struggle to negotiate safer sex, IPV also warrants consideration as a qualifying criterion among BMSM for pre-exposure prophylaxis (PrEP).Public HealthHealth SciencesHIV/AIDSBehavioral and Social ScienceSexually Transmitted InfectionsPreventionSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesViolence Against WomenViolence ResearchMental HealthInfectionAdultBlack or African AmericanHIV InfectionsHomosexualityMaleHumansIntimate Partner ViolenceLogistic ModelsLos AngelesMalePrevalenceRisk FactorsSexual BehaviorSexual and Gender MinoritiesUnited StatesBlack MSMHIVIntimate partner violencePartner-level factorsHuman Movement and Sports SciencesPublic Health and Health ServicesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7t60w0fcarticleJournal of Urban Health, vol 94, iss 5666 - 675oai:escholarship.org:ark:/13030/qt858603nj2023-12-11T22:02:05Zqt858603njDifferentiating non-occupational PEP Seroconverters and Non-Seroconverters in a Community-Based Clinic in Los Angeles, CaliforniaBeymer, Matthew RWeiss, Robert EBolan, Robert KKofron, Ryan MFlynn, Risa PPieribone, David LKulkarni, Sonali PLandovitz, Raphael J2017-04-01BackgroundNonoccupational postexposure prophylaxis (nPEP) is a 28-day regimen of antiretroviral medications taken within 72 hours of human immunodeficiency virus (HIV) exposure to prevent HIV acquisition. Although nPEP has been recommended since 1998, few studies have analyzed the characteristics that distinguish nPEP failures (seroconverters) and successes (non-seroconverters).MethodsThis retrospective study analyzed all nPEP courses prompted by sexual exposure that were prescribed at the Los Angeles LGBT Center between March 2010 and July 2014. Fisher exact tests and logistic regressions were used to determine characteristics that distinguished nPEP seroconverters from non-seroconverters.ResultsOf the nPEP courses administered, 1744 had a follow-up visit for HIV testing within 24 weeks of exposure and 17 individuals seroconverted. Seven reported a known re-exposure, 8 self-reported only condom-protected sex subsequent to the initial exposure, and 2 reported abstinence since the exposure. In multivariable analyses, seroconverters were more likely than non-seroconverters to report methamphetamine use, incomplete medication adherence, and nPEP initiation later in the 72-hour window.ConclusionsNonoccupational postexposure prophylaxis is an important emergency tool for HIV prevention. Our findings corroborate that timing of the initial nPEP dose is an important predictor of seroconversion. Although the current study did not offer the initial nPEP dose at the beginning of the visit, use of this fast-track dosing schedule will ensure that the first dose is taken as early as possible postexposure and may lower the likelihood for seroconversion. Furthermore, we recommend systematic screening for substance use because these individuals may be well suited for pre-exposure prophylaxis given their sustained risk.Biomedical and Clinical SciencesClinical SciencesPediatricClinical ResearchPreventionDrug Abuse (NIDA only)Infectious DiseasesSubstance MisuseHIV/AIDSInfectionGood Health and Well BeingHIV preventionmen who have sex with menpostexposure prophylaxisseroconversionseroconversion.Clinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/858603njarticleOpen Forum Infectious Diseases, vol 4, iss 2ofx061-oai:escholarship.org:ark:/13030/qt925870hq2023-12-11T16:55:36Zqt925870hqSerious concerns regarding a meta-analysis of preexposure prophylaxis use and STI acquisitionHarawa, Nina THolloway, Ian WLeibowitz, ArleenWeiss, RobertGildner, JenniferLandovitz, Raphael JPerez, Mario JKulkarni, SonaliRotheram-Borus, Mary JaneShoptaw, Steven2017-03-13Biomedical and Clinical SciencesHealth SciencesAnti-HIV AgentsHIV InfectionsHumansPre-Exposure ProphylaxisBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/925870hqarticleAIDS, vol 31, iss 5739 - 740oai:escholarship.org:ark:/13030/qt7xt315792023-12-10T04:04:24Zqt7xt31579Sub-national longitudinal and geospatial analysis of COVID-19 tweetsCuomo, Raphael EPurushothaman, VidyaLi, JiaweiCai, MingxiangMackey, Timothy KOladimeji, Olanrewaju2020-01-01ObjectivesAccording to current reporting, the number of active coronavirus disease 2019 (COVID-19) infections is not evenly distributed, both spatially and temporally. Reported COVID-19 infections may not have properly conveyed the full extent of attention to the pandemic. Furthermore, infection metrics are unlikely to illustrate the full scope of negative consequences of the pandemic and its associated risk to communities.MethodsIn an effort to better understand the impacts of COVID-19, we concurrently assessed the geospatial and longitudinal distributions of Twitter messages about COVID-19 which were posted between March 3rd and April 13th and compared these results with the number of confirmed cases reported for sub-national levels of the United States. Geospatial hot spot analysis was also conducted to detect geographic areas that might be at elevated risk of spread based on both volume of tweets and number of reported cases.ResultsStatistically significant aberrations of high numbers of tweets were detected in approximately one-third of US states, most of which had relatively high proportions of rural inhabitants. Geospatial trends toward becoming hotspots for tweets related to COVID-19 were observed for specific rural states in the United States.DiscussionPopulation-adjusted results indicate that rural areas in the U.S. may not have engaged with the COVID-19 topic until later stages of an outbreak. Future studies should explore how this dynamic can inform future outbreak communication and health promotion.Biomedical and Clinical SciencesClinical SciencesEmerging Infectious DiseasesRural HealthInfectious DiseasesInfectionGood Health and Well BeingAttitude to HealthBetacoronavirusCOVID-19Community ParticipationCoronavirus InfectionsGeographyMedicalHumansPandemicsPneumoniaViralProspective StudiesPublic HealthRural PopulationSARS-CoV-2Social MediaTime FactorsUnited StatesUrban PopulationGeneral Science & Technologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7xt31579articlePLOS ONE, vol 15, iss 10e0241330oai:escholarship.org:ark:/13030/qt2gc0t17d2023-12-10T02:45:06Zqt2gc0t17dRecent HIV Risk Behavior and Partnership Type Predict PrEP Adherence in Men Who Have Sex with MenBlumenthal, JillJain, SoniaDube, MichaelSun, XiaoyingEllorin, EricHoenigl, MartinCorado, KatyaMoore, DavidMorris, Sheldon2017-10-01Abstract:
Background:
Individuals engaging in higher risk behavior are often more adherent to PrEP but it is unclear if partnership type itself affects PrEP adherence. We examined the effect of recent HIV risk behaviors and partnership type on PrEP adherence in men who have sex with men (MSM) taking PrEP.
Methods:
CCTG 595 is a 48-week PrEP demonstration study of 398 HIV− at-risk MSM. At baseline and week 48, HIV risk score was estimated as the probability of seroconversion over the next year based on number of condomless anal sex acts with HIV+/unknown partners in the last month and any STI diagnosed at study visit. HIV risk score was categorized as low (<0.12), moderate (0.12−0.59) and high (>0.59) risk based on population seroconversion probabilities. Partnership type was assigned as no/single HIV− partner, single HIV+ partner, or multiple partners of any serostatus in the past 3 months. PrEP adherence was estimated by intracellular tenofovir-diphosphate (TFV-DP) levels as a continuous variable at week 48. Statistical methods included McNemar’s test, Wilcoxon rank-sum test, and linear regression model where appropriate.
Results:
Of 313 MSM who completed week 48, there was no significant change in HIV risk category from baseline to week 48 (low: 44 to 42%; moderate: 27 to 24%; high: 28 to 34%; P = 0.25). There was a significant change in partnership type, with the proportion of those with no or single HIV− partnerships increasing (1 to 9%, P < 0.001). In univariate analysis, moderate and high-risk groups had higher TFV-DP levels than the low-risk group at week 48 (P = 0.018). Participants with no/single HIV− partner had significantly lower TFV-DP levels than those with one HIV+ partner or multiple partners (P = 0.007). In a multivariable linear regression model, only low-risk partnerships remained significant where no/single HIV− partnerships were associated with lower TFV-DP levels (mean difference = −344fmol/punch [−617, −71], P = 0.014).
Conclusion:
Although there was a shift in partnership type towards lower risk partnerships, objective HIV risk behavior remained stable over time. Individuals with higher HIV risk behaviors and risk partnerships had higher TFV-DP levels suggesting maintained strong motivation for PrEP adherence. Thus, recent sexual risk behavior and partnership type may be important predictors of PrEP adherence in MSM.
Disclosures:
All authors: No reported disclosures.Biomedical and Clinical SciencesClinical SciencesClinical ResearchHIV/AIDSInfectious DiseasesBehavioral and Social SciencePreventionSexually Transmitted InfectionsInfectionClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2gc0t17darticleOpen Forum Infectious Diseases, vol 4, iss Suppl 1s15 - s16oai:escholarship.org:ark:/13030/qt5wz8w1972023-12-10T02:31:34Zqt5wz8w197Sexual Risk Compensation in a Pre-exposure Prophylaxis Demonstration Study Among Individuals at Risk of HIVMilam, JoelJain, SoniaDubé, Michael PDaar, Eric SSun, XiaoyingCorado, KatyaEllorin, EricBlumenthal, JillHaubrich, RichardMoore, David JMorris, Sheldon R2019-01-01BackgroundA public health concern regarding HIV pre-exposure prophylaxis (PrEP) is sexual risk compensation (ie, increased unsafe sex among PrEP users that may undermine prevention efforts).MethodsThis demonstration study (NCT#01761643; initiated in 2013) included 398 men who have sex with men who initiated PrEP and were followed over 48 weeks at 4 sites in Southern California. Wilcoxon signed-rank tests compared previous 30-day number of sex partners and condomless insertive anal sex and receptive anal sex (CIAS and CRAS, respectively) acts at weeks 4, 12, 24, 36, and 48 to baseline. At 2 sites, PrEP users were also compared with a lagged, comparison group of 99 men who have sex with men who did not receive PrEP over 24 weeks using linear regression models, adjusting for age, race/ethnicity, education, and respective baseline scores. Logistic regression compared week 24 sexually transmitted infection (STI) rates.ResultsOver 48 weeks in the PrEP group, there were significant decreases in the number of unknown HIV status sex partners and increases in CRAS at all study visits; there was no consistent change in number of HIV+ sex partners or CIAS. Among participants at 2 sites, there were no significant differences between PrEP and non-PrEP users in change in number of partners, CIAS, CRAS, or STI rates at week 24.ConclusionsAmong early adopters of PrEP, there is some evidence for sexual risk compensation. Results support current guidelines of regular STI screening and behavioral risk reduction and adherence counseling with the provision of PrEP.Public HealthBiomedical and Clinical SciencesClinical SciencesHealth SciencesClinical ResearchSexual and Gender Minorities (SGM/LGBT*)PreventionBehavioral and Social ScienceMental HealthInfectious DiseasesSexually Transmitted InfectionsHIV/AIDSInfectionGood Health and Well BeingAdultAnti-HIV AgentsDirective CounselingFemaleHIV InfectionsHealth SurveysHomosexualityMaleHumansMaleModelsTheoreticalPre-Exposure ProphylaxisTenofovirTransgender PersonsUnsafe Sexpre-exposure prophylaxisHIVrisk compensationmen who have sex with menCCTG TeamPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5wz8w197articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 80, iss 1e9 - e13oai:escholarship.org:ark:/13030/qt2fd702jr2023-12-10T02:31:29Zqt2fd702jrEffect of Vitamin D Supplementation on Bone Turnover Markers During HIV Pre-Exposure Prophylaxis Using Tenofovir Disoproxil Fumarate-Emtricitabine in Men Who Have Sex with MenNanayakkara, Deepa DSun, XiaoyingMorris, SheldonLouie, StanMulligan, KathleenOverton, TurnerAsante, IsaacCorado, KatyaJain, SoniaDubé, Michael P2019-07-01Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) reduces bone mineral density in HIV-uninfected men who have sex with men (MSM). We hypothesized that PrEP with TDF-FTC would increase bone turnover markers (BTMs) at week 24 and that vitamin D supplementation from weeks 24 to 48 would blunt this increase. Participants were from a cohort of 398 MSM and transgender women who received daily TDF-FTC for PrEP. At week 24, a prospective intervention group initiated vitamin D3 4,000 IU daily. Concurrent controls were selected from the cohort who took ≤400 IU/day of vitamin D3 matched by age, race, and body mass index. The primary endpoint was the change in procollagen-I N-terminal propeptide (P1NP) from weeks 24 to 48. Paired t-tests were used to compare changes in BTMs between intervention and controls. Among 48 intervention-control pairs, median age was 33 years. At baseline, 68.9% of the intervention group and 77.3% of controls were vitamin D sufficient (≥20 ng/mL, p = .94). P1NP, C-telopeptide, parathyroid hormone (PTH), and 25-OH vitamin D3 did not increase significantly at week 24. P1NP fell by a mean ± SD of -27.6 ± 49.9 pg/mL from weeks 24 to 48 with vitamin D and -2.5 ± 40.2 pg/mL in controls (p = .01). There were no significant between-group differences in the weeks 24-48 change in C-telopeptide, PTH, or 25-OH vitamin D3. Vitamin D3 supplementation with 4,000 IU/day resulted in a significant reduction in the BTM P1NP compared with controls, suggesting that this intervention has potential to improve bone health during PrEP.Biomedical and Clinical SciencesClinical SciencesComplementary and Integrative HealthInfectious DiseasesPreventionSexual and Gender Minorities (SGM/LGBT*)NutritionClinical ResearchHIV/AIDSPrevention of disease and conditionsand promotion of well-being3.3 Nutrition and chemopreventionMusculoskeletalAdultBiomarkersBone RemodelingDietary SupplementsDrug Administration ScheduleEmtricitabineTenofovir Disoproxil Fumarate Drug CombinationFemaleHIV InfectionsHomosexualityMaleHumansMalePeptide FragmentsPre-Exposure ProphylaxisProcollagenProspective StudiesTransgender PersonsVitamin DHIVpre-exposure prophylaxisPrEPvitamin Dbone healthVirologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2fd702jrarticleAIDS Research and Human Retroviruses, vol 35, iss 7608 - 614oai:escholarship.org:ark:/13030/qt3p06p8522023-12-10T02:16:09Zqt3p06p852Randomized Trial of Individualized Texting for Adherence Building (iTAB) Plus Motivational Interviewing for PrEP Adherence in Transgender Individuals: The iM-PrEPT StudyMorris, Sheldon RJain, SoniaBlumenthal, JillBolan, RobertDubé, Michael PHenderson, PhilipCorado, KatyaSun, ShellyHe, FengChow, KarenBurke, LeahAnderson, Peter LMoore, David J2022-12-15BackgroundTransgender and nonbinary individuals at risk for HIV may benefit from adherence support for pre-exposure prophylaxis.MethodsBetween June 2017 and September 2020, 255 transgender and nonbinary individuals received daily oral tenofovir disoproxil fumarate/emtricitabine for 48 weeks randomized 1:1 to receive individualized Texting for Adherence Building (iTAB) or iTAB plus motivational interviewing (iTAB + MI) through phone for nonadherence. The primary end point was dried blood spot tenofovir diphosphate concentrations at weeks 12 and 48 (or last on-drug study visit) ≥1246 fmol/punch consistent with ≥7 doses/week (ie, near-perfect adherence). Secondary outcomes included dried blood spot tenofovir diphosphate concentrations ≥719 fmol/punch consistent with ≥4 doses/week (ie, adequate adherence) and self-reported adherence by daily text messages.ResultsAdherence for the outcome ≥1246 fmol/punch and ≥719 fmol/punch, respectively, was 49.1% and 57.9% for transgender men, 37.7% and 47.2% for nonbinary individuals, and 31.0% and 44.1% for transgender women. No difference was seen in iTAB + MI compared with iTAB alone by drug levels except where it approached significance in transgender women for the outcome of ≥719 fmol/punch in the iTAB + MI group compared with iTAB only (52% versus 35.7%, P = 0.065). There was a significant difference in self-reported daily dose adherence in the iTAB + MI group compared with iTAB alone (57.9% of days versus 46.4%, P = 0.009). In transgender women, the mean percentage of daily doses taken was 58.5% with iTAB + MI and 37.3% with iTAB alone ( P < 0.001).ConclusionsIn addition to automated approaches to adherence promotion, phone-based MI triggered by repeatedly missing doses may improve pre-exposure prophylaxis adherence among transgender women.Biomedical and Clinical SciencesClinical SciencesBehavioral and Social ScienceClinical ResearchPreventionClinical Trials and Supportive ActivitiesGood Health and Well BeingMaleFemaleHumansTransgender PersonsText MessagingAnti-HIV AgentsMotivational InterviewingHIV InfectionsMedication AdherencePre-Exposure ProphylaxisEmtricitabinetransgenderHIV preventiontext messaginginterventionPrEPPublic Health and Health ServicesVirologyClinical sciencesEpidemiologyPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3p06p852articleJAIDS Journal of Acquired Immune Deficiency Syndromes, vol 91, iss 5453 - 459oai:escholarship.org:ark:/13030/qt5tr0p89k2023-12-09T23:55:59Zqt5tr0p89k#HIV: Alignment of HIV-Related Visual Content on Instagram with Public Health Priorities in the USNobles, Alicia LLeas, Eric CLatkin, Carl ADredze, MarkStrathdee, Steffanie AAyers, John W2020-07-01Instagram, with more than 1 billion monthly users, is the go-to social media platform to chronicle one's life via images, but how are people using the platform to present visual content about HIV? We analyzed public Instagram posts containing the hashtag "#HIV" (because they are self-tagged as related to HIV) between January 2017 and July 2018. We described the prevalence of co-occurring hashtags and explored thematic concepts in the images using automated image recognition and topic modeling. Twenty-eight percent of all #HIV posts included hashtags focused on awareness, followed by LGBTQ (24.5%) and living with HIV (17.9%). However, specific strategies were rarely cited, including testing (10.8%), treatment (10.3%), PrEP (6.2%) and condoms (4.1%). Image analyses revealed 44.5% of posts included infographics followed by people (21.3%) thereby humanizing HIV and stigmatized populations and promoting community mobilization. Novel content such as the handwriting image-theme (3.8%) where posters shared their HIV test results appeared. We discuss how this visual content aligns with public health priorities to reduce HIV in the US and the novel, organic messages that public health could help amplify.Public HealthHealth SciencesInfectious DiseasesBehavioral and Social ScienceHIV/AIDSInfectionGood Health and Well BeingDatasets as TopicHIV InfectionsHealth PrioritiesHumansPrevalenceSocial MediaTelemedicineHIVDigital healthHealth surveillanceSocial mediaBig dataPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5tr0p89karticleAIDS and Behavior, vol 24, iss 72045 - 2053oai:escholarship.org:ark:/13030/qt8x0742c22023-12-09T22:08:19Zqt8x0742c2Predictors of Awareness, Accessibility and Acceptability of Pre-exposure Prophylaxis (PrEP) Among English- and Spanish-Speaking Latino Men Who have Sex with Men in Los Angeles, CaliforniaBrooks, Ronald ALandrian, AmandaLazalde, GabrielaGalvan, Frank HLiu, HonghuChen, Ying-Tung2020-08-01Uptake of pre-exposure prophylaxis (PrEP) among Latino men who have sex with men (LMSM) remains low. We examined awareness, accessibility, acceptability and use of PrEP among LMSM. LMSM were recruited using social/sexual networking apps. Multiple Logistic regressions identified significant predictors of PrEP awareness, accessibility and acceptability. Among 276 participants, only 6% reported current PrEP use. Among non-PrEP users, 85% reported PrEP awareness, 71% indicated high likelihood of future PrEP use, but only 35% reported knowledge about accessing PrEP. In multiple logistic regressions, a lower likelihood of PrEP awareness was associated with lower level education, whereas a higher likelihood was associated with reporting 6-10 or over 10 sexual partners. A lower likelihood of PrEP accessibility was associated with lower level education and undocumented status. A lower likelihood of PrEP acceptability was associated with an income of $15,001-30,000, whereas a higher likelihood was associated with lower level education and reporting 6-10 or over 10 sexual partners. PrEP promotion targeting Latino MSM should be expanded for those with lower levels of education and those who are undocumented.Public HealthHealth SciencesHuman SocietyPreventionClinical ResearchBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesAdolescentAdultAwarenessHIV InfectionsHealth KnowledgeAttitudesPracticeHispanic or LatinoHomosexualityMaleHumansLanguageLogistic ModelsLos AngelesMaleMiddle AgedPatient Acceptance of Health CarePre-Exposure ProphylaxisSexual BehaviorSocioeconomic FactorsUndocumented ImmigrantsYoung AdultLatinoHispanicMen who have sex with menPre-exposure prophylaxisAcceptabilityAccessibilityPublic Health and Health ServicesEpidemiologyPublic healthSociologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8x0742c2articleJournal of Immigrant and Minority Health, vol 22, iss 4708 - 716oai:escholarship.org:ark:/13030/qt4z55b4sv2023-12-09T19:09:59Zqt4z55b4svAn examination of consensual sex in a men’s jailLea, Charles HerbertGideonse, Theodore KHarawa, Nina T2018-03-12Purpose The purpose of this paper is to use secondary data from qualitative interviews that examined the sexual behaviors, HIV attitudes, and condom use of 17 gay, bisexual, and transgender women housed in a protective custody unit in the Los Angeles County Jail (Harawa et al., 2010), to develop a better understanding of the consensual sexual behaviors of male prisoners. Design/methodology/approach Study eligibility included: report anal or oral sex with another male in the prior six months; speak and understand English; and incarcerated in the unit for at least two weeks. Data analysis consisted of an inductive, qualitative approach. Findings Findings illuminate participants' experiences concerning how the correctional facility shaped their sexual choices and behaviors, and the HIV-risk reduction strategies they employed. Originality/value This study contributes to the prison-sex literature, and is timely, given current federal and local HIV/AIDS priorities. Recommendations that address male prisoners' sexual and health needs and risks are posed.CriminologyHuman SocietyInfectious DiseasesAdolescent Sexual ActivityHIV/AIDSClinical ResearchPediatricBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)InfectionCondomsHIV InfectionsHealth KnowledgeAttitudesPracticeHumansLos AngelesMalePrisonersPrisonsSexual BehaviorSexual and Gender MinoritiesSexualityCriminal justice systemOffender healthHIVAIDSQualitative researchSexual healthHarm reductionPublic Health and Health ServicesPolicy and AdministrationSubstance AbusePublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4z55b4svarticleInternational Journal of Prisoner Health, vol 14, iss 156 - 62oai:escholarship.org:ark:/13030/qt16p2p5wf2023-12-09T18:30:54Zqt16p2p5wfRandomized Controlled Trial of Daily Text Messages to Support Adherence to Preexposure Prophylaxis in Individuals at Risk for Human Immunodeficiency Virus: The TAPIR Study.Moore, David JJain, SoniaDubé, Michael PDaar, Eric SSun, XiaoyingYoung, JasonCorado, KatyaEllorin, EricMilam, JoelCollins, DeborahBlumenthal, JillBest, Brookie MAnderson, PeterHaubrich, RichardMorris, Sheldon R2018-05-02BackgroundAdherence is critical for efficacy of tenofovir disoproxil fumarate/emtricitabine (FTC) as preexposure prophylaxis (PrEP).MethodsBetween February 2013 and February 2016, 398 men who have sex with men and transgender women were randomized 1:1 to receive individualized texting for adherence building (iTAB) or standard care (SoC) for 48 weeks. The primary endpoint was dried blood spot (DBS) tenofovir diphosphate (TFV-DP) concentrations at both week 12 and the last on-drug visit of >719 fmol/punch (ie, adequate adherence). Secondary outcomes included DBS TFV-DP concentrations of >1246 fmol/punch (ie, near-perfect adherence) and plasma FTC >350 ng/mL (consistent with dosing within the past 24 hours).ResultsConcentrations >719 fmol/punch of TFV-DP were found in 88.6% of participants at week 12 and 82.5% at week 48. For the primary endpoint, the study arms did not differ (72.0% in iTAB and 69.2% in SoC; P > .05). For the secondary composite endpoint of >1246 fmol/punch the iTAB arm was superior to SoC (33.5% vs 24.8%; P = .06), reaching statistical significance when adjusting for age (odds ratio, 1.56 [95% confidence interval, 1.00-2.42]; P < .05). At week 48, iTAB was superior to SoC for near-perfect adherence (51.0% vs 37.4%; P = .02). At week 12, iTAB was superior to SoC for dosing in past 24 hours by plasma FTC (47.5% vs 33.3%; P = .007), but not at weeks 24, 36, and 48 (all P > .05).ConclusionsAutomated text messaging is a low-burden tool that improves durability of near-perfect PrEP adherence.Clinical trials registrationNCT01761643.Biomedical and Clinical SciencesClinical SciencesPreventionClinical Trials and Supportive ActivitiesClinical Research6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsGood Health and Well BeingAdenineAdultAnti-HIV AgentsHIV InfectionsHumansMaleMedication AdherenceOrganophosphatesPre-Exposure ProphylaxisText MessagingTransgender PersonsMSMHIVtext messagingrandomized controlled trialpreexposure prophylaxisBiological SciencesMedical and Health SciencesMicrobiologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/16p2p5wfarticleClinical Infectious Diseases, vol 66, iss 101566 - 1572oai:escholarship.org:ark:/13030/qt4h3963212023-12-09T18:30:15Zqt4h396321HIV sero disclosure among men who have sex with men and transgender women on HIV pre-exposure prophylaxisHojilla, J CarloMehrotra, MeghaTruong, Hong-Ha MGlidden, David VAmico, K RivetMcMahan, VanessaVlahov, DavidChariyalertsak, SuwatGuanira, Juan VicenteGrant, Robert Mteam, for the iPrEx study2018-04-03HIV pre-exposure prophyalxis (PrEP) might lead individuals to view serodisclosure as unnecessary. We examined the prevalence of non-disclosure and lack of knowledge of partner status in a global cohort of men who have sex with men (MSM) and transgender women (TW) enrolled in the iPrEx Open Label Extension (OLE). We calculated prevalence ratios by fitting a logistic model and estimating predicted probabilities using marginal standardization. Prevalence of non-disclosure and lack of knowledge of partner status were highest in Thailand (73% and 74%, respectively) and lowest in the USA (23% and 37%, respectively). In adjusted analyses, PrEP use was not significantly associated with non-disclosure or lack of knowledge of partner status (p-values>0.05). We found that relationship characteristics were significantly associated with both outcomes. Non-disclosure was higher among casual (adjusted prevalence ratio [aPR] 1.54, [95% confidence interval 1.24-1.84]) and transactional sex partners (aPR 2.03, [1.44-2.62]), and among partners whom participants have known only minutes or hours before their first sexual encounter (aPR 1.62, [1.33-1.92]). Similarly, participants were less likely to know the HIV status of casual partners (aPR 1.50, [1.30-1.71]), transactional sex partners (aPR 1.62, [1.30-1.95]), and those they have known for only days or weeks (aPR 1.13, [0.99-1.27]) or minutes or hours (aPR 1.27, [1.11-1.42]). Our findings underscore the role of dyadic factors in influencing serodisclosure. Comprehensive risk reduction counseling provided in conjunction with PrEP that address relationship characteristics are needed to help patients navigate discussions around HIV status.Public HealthHealth SciencesHIV/AIDSClinical ResearchSexual and Gender Minorities (SGM/LGBT*)InfectionAdultAgedFemaleHIV InfectionsHomosexualityMaleHumansInterpersonal RelationsMaleMiddle AgedPre-Exposure ProphylaxisSelf DisclosureSexual PartnersSouth AfricaSouth AmericaThailandTransgender PersonsUnited StatesYoung AdultHIV serodisclosurepre-exposure prophylaxisPrEPHIV preventionmen who have sex with mentransgender womenPublic Health and Health ServicesPsychologyPublic healthSociologyClinical and health psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4h396321articleAIDS Care, vol 30, iss 4466 - 472oai:escholarship.org:ark:/13030/qt3n95095k2023-12-09T02:13:48Zqt3n95095kEffectiveness of a Peer Navigation Intervention to Sustain Viral Suppression Among HIV-Positive Men and Transgender Women Released From Jail: The LINK LA Randomized Clinical TrialCunningham, William EWeiss, Robert ENakazono, TerryMalek, Mark AShoptaw, Steve JEttner, Susan LHarawa, Nina T2018-04-01ImportanceDiagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release.ObjectiveTo test the effect on viral suppression in released inmates of the manualized LINK LA (Linking Inmates to Care in Los Angeles) peer navigation intervention compared with standard transitional case management controls.Design, setting, and participantsRandomized clinical trial conducted from December 2012 through October 2016 with people living with HIV being released from Los Angeles (LA) County Jail. All participants were (1) 18 years or older; (2) either men or transgender women diagnosed with HIV; (3) English speaking; (4) selected for the transitional case management program prior to enrollment; (5) residing in LA County; and (6) eligible for antiretroviral therapy.Main outcomes and measuresChange in HIV viral suppression (<75 copies/mL) over a 12-month period.InterventionsDuring the 12-session, 24-week LINK LA Peer Navigation intervention, trained peer navigators counseled participants on goal setting and problem solving around barriers to HIV care and adherence, starting while the participants were still in jail. After their release, they continued counseling while they accompanied participants to 2 HIV care visits, then facilitated communication with clinicians during visits.ResultsOf 356 participants randomized, 151 (42%) were black; 110 (31%) were Latino; 303 (85%) were men; 53 (15%) were transgender women; and the mean (SD) age was 39.5 (10.4) years. At 12 months, viral suppression was achieved by 62 (49.6%) of 125 participants in the peer navigation (intervention) arm compared with 45 (36.0%) of 125 in the transitional case management (control) arm, for an unadjusted treatment difference of 13.6% (95% CI, 1.34%-25.9%; P = .03). In the repeated measures, random effects, logistic model the adjusted probability of viral suppression declined from 52% at baseline to 30% among controls, while those in the peer navigation arm maintained viral suppression at 49% from baseline to 12 months, for a difference-in-difference of 22% (95% CI, 0.03-0.41; P = .02).Conclusions and relevanceThe LINK LA peer navigation intervention was successful at preventing declines in viral suppression, typically seen after release from incarceration, compared with standard transitional case management. Future research should examine ways to strengthen the intervention to increase viral suppression above baseline levels.Trial registrationclinicaltrials.gov Identifier: NCT01406626.Medical MicrobiologyBiomedical and Clinical SciencesHealth SciencesHealth ServicesInfectious DiseasesClinical ResearchClinical Trials and Supportive ActivitiesHIV/AIDSPreventionNeurosciences7.1 Individual care needsManagement of diseases and conditionsInfectionGood Health and Well BeingAdultBlack or African AmericanAnti-HIV AgentsCase ManagementContinuity of Patient CareFemaleHIV InfectionsHispanic or LatinoHumansLogistic ModelsLos AngelesMaleMiddle AgedPatient NavigationPeer GroupPrisonsRNAViralSustained Virologic ResponseTransgender PersonsWhite PeopleClinical SciencesOpthalmology and OptometryPublic Health and Health ServicesClinical sciencesHealth services and systemsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3n95095karticleJAMA Internal Medicine, vol 178, iss 4542 - 553oai:escholarship.org:ark:/13030/qt19q004qp2023-12-09T01:31:48Zqt19q004qpA learning health system approach to COVID‐19 exposure notification system rolloutTai‐Seale, MingMay, NicoleSitapati, AmyLonghurst, Christopher A2022-04-01IntroductionDigital exposure notification (EN) approaches may offer considerable advantages over traditional contact tracing in speed, scale, efficacy, and confidentiality in pandemic control. We applied the science of learning health systems to test the effect of framing and digital means, email vs Short Message Service (SMS), on EN adoption among patients of an academic health center.MethodsWe tested three communication approaches of the Apple and Google EN system in a rapid learning cycle involving 15 000 patients pseudorandomly assigned to three groups. The patients in the first group received a 284-word email that presented EN as a tool that can help slow the spread. The patients in the second group received a 32-word SMS that described EN as a new tool to help slow the spread (SlowTheSpreadSMS). Patients in the third group received a 47-word SMS that depicted the system as a new digital tool that can empower them to protect their family and friends (EmpowerSMS). A brief four-question anonymous survey of adoption was included in a reminder message sent 2 days after the initial outreach.ResultsOne hundred and sixty people responded to the survey within 1 week: 2.33% from EmpowerSMS, 0.97% from SlowTheSpreadSMS, and 0.53% from emails; 29 (41.43%), 24 (41.38%), and 11 (34.38%) reported having adopted EN from each group, respectively. Patient reported barriers to adoption included iOS version incompatibility, privacy concerns, and low trust of government agencies or companies like Apple and Google. Patients recommended that healthcare systems play an active role in disseminating information about this tool. Patients also recommended advertising on social media and providing reassurance about privacy.ConclusionsThe EmpowerSMS resulted in relatively more survey responses. Both SMS groups had slightly higher, but not statistically significant EN adoption rates compared to email. Findings from the pilot not only informed operational decision-making in our health system but also contributed to EN rollout planning in our State.Information and Computing SciencesHealth Services and SystemsHealth SciencesClinical ResearchHealth Services7.1 Individual care needsManagement of diseases and conditionsGood Health and Well Beingcommunication strategyCOVID exposure notificationrapid-cycle learningrapid‐cycle learningapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/19q004qparticleLearning Health Systems, vol 6, iss 2e10290oai:escholarship.org:ark:/13030/qt9x8371jv2023-12-09T00:23:57Zqt9x8371jvDoes HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, CaliforniaBeymer, Matthew RDeVost, Michelle AWeiss, Robert EDierst-Davies, RhodriShover, Chelsea LLandovitz, Raphael JBeniasians, CorinneTalan, Ali JFlynn, Risa PKrysiak, RobynMcLaughlin, KaylaBolan, Robert K2018-09-01BackgroundPre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California.MethodsThe present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period).ResultsIn a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02).ConclusionsThere were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.Biomedical and Clinical SciencesPublic HealthHealth SciencesClinical SciencesSexually Transmitted InfectionsHIV/AIDSSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesPreventionClinical ResearchClinical Trials and Supportive ActivitiesInfectionGood Health and Well BeingAdultCross-Over StudiesHealth KnowledgeAttitudesPracticeHomosexualityMaleHumansIncidenceLos AngelesMaleMiddle AgedPre-Exposure ProphylaxisSexual BehaviorSexually Transmitted DiseasesYoung Adultchlamydia infectiongay menprophylaxissexual healthsyphilisMedical MicrobiologyPublic Health and Health ServicesClinical sciencesPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9x8371jvarticleSexually Transmitted Infections, vol 94, iss 6457oai:escholarship.org:ark:/13030/qt1h37m6qx2023-12-08T23:09:33Zqt1h37m6qxMultilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern CaliforniaOgunbajo, AdedotunStorholm, Erik DOber, Allison JBogart, Laura MReback, Cathy JFlynn, RisaLyman, PhoebeMorris, Sheldon2021-07-01Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.Public HealthHealth SciencesHIV/AIDSPediatric AIDSSexual and Gender Minorities (SGM/LGBT*)PediatricInfectious DiseasesBehavioral and Social ScienceClinical Research7.1 Individual care needsManagement of diseases and conditionsInfectionGood Health and Well BeingBlack or African AmericanAnti-HIV AgentsFemaleHIV InfectionsHispanic or LatinoHumansLos AngelesPre-Exposure ProphylaxisTransgender PersonsUnited StatesTransgender womenPrEP adherenceBlackHispanicLatinxHIV preventionHispanic/LatinxPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1h37m6qxarticleAIDS and Behavior, vol 25, iss 72301 - 2315oai:escholarship.org:ark:/13030/qt87j6t6zg2023-12-08T16:48:50Zqt87j6t6zgCRISPR–Cas9-mediated nuclear transport and genomic integration of nanostructured genes in human primary cellsLin-Shiao, EnriquePfeifer, Wolfgang GShy, Brian RSaffari Doost, MohammadChen, EvelynVykunta, Vivasvan SHamilton, Jennifer RStahl, Elizabeth CLopez, Diana MSandoval Espinoza, Cindy RDeyanov, Alexander ELew, Rachel JPoirer, Michael GMarson, AlexanderCastro, Carlos EDoudna, Jennifer A2022-02-22DNA nanostructures are a promising tool to deliver molecular payloads to cells. DNA origami structures, where long single-stranded DNA is folded into a compact nanostructure, present an attractive approach to package genes; however, effective delivery of genetic material into cell nuclei has remained a critical challenge. Here, we describe the use of DNA nanostructures encoding an intact human gene and a fluorescent protein encoding gene as compact templates for gene integration by CRISPR-mediated homology-directed repair (HDR). Our design includes CRISPR-Cas9 ribonucleoprotein binding sites on DNA nanostructures to increase shuttling into the nucleus. We demonstrate efficient shuttling and genomic integration of DNA nanostructures using transfection and electroporation. These nanostructured templates display lower toxicity and higher insertion efficiency compared to unstructured double-stranded DNA templates in human primary cells. Furthermore, our study validates virus-like particles as an efficient method of DNA nanostructure delivery, opening the possibility of delivering nanostructures in vivo to specific cell types. Together, these results provide new approaches to gene delivery with DNA nanostructures and establish their use as HDR templates, exploiting both their design features and their ability to encode genetic information. This work also opens a door to translate other DNA nanodevice functions, such as biosensing, into cell nuclei.Biological SciencesBiotechnologyGeneticsNanotechnologyBioengineeringHuman GenomeGene TherapyUnderpinning research1.1 Normal biological development and functioningGeneric health relevanceActive TransportCell NucleusCRISPR-Cas SystemsDNAGene EditingGene Transfer TechniquesGenomeHumansNanostructuresEnvironmental SciencesInformation and Computing SciencesDevelopmental BiologyBiological sciencesChemical sciencesEnvironmental sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/87j6t6zgarticleNucleic Acids Research, vol 50, iss 31256 - 1268oai:escholarship.org:ark:/13030/qt3wp9f2c22023-12-08T14:49:18Zqt3wp9f2c2Concomitant Utilization of Pre-Exposure Prophylaxis (PrEP) and Meningococcal Vaccine (MenACWY) Among Gay, Bisexual, and Other Men Who Have Sex with Men in Los Angeles County, CaliforniaHolloway, Ian WTan, DianeBednarczyk, Robert AFenimore, Vincent LRandall, LauraLutz, Chelsea SFrew, Paula M2020-01-01Recent outbreaks of serogroup C meningococcal disease in Southern California have led the California Department of Public Health to recommend the quadrivalent meningococcal vaccine (MenACWY) for gay, bisexual, and other men who have sex with men (GBMSM) in Southern California. High-risk GBMSM have also been advised to utilize pre-exposure prophylaxis (PrEP) for HIV prevention. Data collected from a community-based sample of HIV-negative GBMSM in Los Angeles County (N = 476) were used in a multinomial logit regression analysis to identify patterns in MenACWY and PrEP usage and evaluate factors associated with use of both, one, or neither of these prevention methods. More than half (56%) of participants had neither been vaccinated nor used PrEP. A smaller percentage (34%) had either been vaccinated or were PrEP users, leaving 10% who had concomitant PrEP and MenACWY use. Higher education, more recent sex partners, illicit drug use, and recent receptive condomless anal sex (CAS) were significantly associated with greater odds of using both prevention methods relative to neither. Higher education, prior sexually transmitted infection diagnosis, more recent sex partners, and recent receptive CAS were significantly associated with greater odds of just PrEP use relative to neither. Higher education was the only factor significantly associated with greater odds of just MenACWY immunization relative to neither. Findings highlight important gaps in immunization among PrEP users and opportunities to screen for PrEP eligibility among GBMSM in conjunction with immunization. Public health practitioners should consider the ways in which strategies to increase PrEP and vaccine-preventable illnesses among GBMSM may complement one another.Clinical and Health PsychologySocial and Personality PsychologyHuman SocietyPsychologyGender StudiesPreventionInfectious DiseasesVaccine RelatedSexually Transmitted InfectionsImmunizationHIV/AIDSInfectionGood Health and Well BeingAdultHIV InfectionsHomosexualityMaleHumansLos AngelesMaleMeningococcal VaccinesPre-Exposure ProphylaxisSexual and Gender MinoritiesUnited StatesVaccinesConjugatePrEPMeningitisVaccinationMen who have sex with menSexual orientationPublic Health and Health ServicesOther Studies in Human SocietyClinical PsychologyGender studiesClinical and health psychologySocial and personality psychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3wp9f2c2articleArchives of Sexual Behavior, vol 49, iss 1137 - 146oai:escholarship.org:ark:/13030/qt9mg3d4c42023-12-08T11:08:57Zqt9mg3d4c4Food Insecurity and Unmet Needs Among Youth and Young Adults Living With HIV in the San Francisco Bay AreaReeder, ChristianNeilands, Torsten BPalar, KartikaSaberi, Parya2019-08-01PurposeLittle is known about food insecurity and unmet subsistence needs and their association with antiretroviral therapy adherence among youth and young adults living with HIV (YLWH).MethodsWe conducted a cross-sectional survey to examine this association in 101 YLWH (aged 18-29 years). Poisson regression models with robust standard errors were used to estimate adjusted risk ratios (RRs) and 95% confidence intervals (CIs).ResultsApproximately 51.7% of participants experienced at least one unmet subsistence need (difficulty finding enough to eat [36.6%], clothing [22.8%], place to sleep [21.8%], place to wash [17.8%], and bathroom [15.8%]), and 64.2% reported being food insecure. For every additional unmet need, the risk of very good/excellent adherence was reduced by 15% (RR = .85; 95% CI = .72-.99; p value = .04). The risk of very good/excellent adherence was lowered by 39% (RR = .61; 95% CI = .43-.87; p value = .005) among food insecure youth, compared with those who were food secure.ConclusionsThese data highlight the need for more research and structural interventions targeting food assistance strategies among YLWH.Biomedical and Clinical SciencesPublic HealthHealth SciencesHIV/AIDSPreventionZero HungerAdolescentAdultCross-Sectional StudiesFemaleFood SupplyHIV InfectionsIll-Housed PersonsHumansMaleMedication AdherenceSan FranciscoYoung AdultYouthHIVFood insecurityUnmet needsAntiretroviral therapyAdherenceMedical and Health SciencesEducationPsychology and Cognitive SciencesBiomedical and clinical sciencesHealth sciencesPsychologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9mg3d4c4articleJournal of Adolescent Health, vol 65, iss 2262 - 266oai:escholarship.org:ark:/13030/qt0s09m8112023-12-08T01:39:30Zqt0s09m811Use of ‘eradication’ in HIV cure-related research: a public health debateDubé, KarineLuter, StuartLesnar, BreanneNewton, LukeGalea, JeromeBrown, BrandonGianella, Sara2018-12-01BackgroundThe landscape of Human Immunodeficiency Virus (HIV) research has changed drastically over the past three decades. With the remarkable success of antiretroviral treatment (ART) in decreasing AIDS-related mortality, some researchers have shifted their HIV research focus from treatment to cure research. The HIV cure research community often uses the term eradication to describe the science, and talks about eradicating the virus from the body. In public discourse, the term eradication could be conflated with disease eradication at the population level. In this paper, we call for a reframing of HIV cure research as control, as it is a more accurate descriptor and achievable goal in the foreseeable future.DiscussionThe properties of HIV are discordant with eradicability standards at both the individual level (as a clinical concept), and at the population level (as a public health concept). At the individual level, true eradication would necessitate absolute elimination of all latent HIV reservoirs from the body. Current HIV cure-related research strategies have proven unsuccessful at accurately quantifying, let alone eliminating these reservoirs. At the population level, eradication implies the permanent global reduction of HIV to zero new cases and to zero risk for future cases. Given the absence of an efficacious HIV vaccine and the impracticality and unethicality of eliminating animal reservoirs, global eradication of HIV is highly implausible. From a public health perspective, HIV eradication remains an elusive goal.ConclusionThe term 'eradication' is a misleading description of current HIV cure-related research. Instead, we call for the use of more realistic expressions such as 'sustained virologic HIV suppression (or control)' or 'management of HIV persistence' to describe HIV cure-related research. Using these terms reorients what HIV cure science can potentially achieve in the near future and avoids creating unrealistic expectations, particularly among the millions of people globally who live with HIV.EpidemiologyHealth Services and SystemsPublic HealthHealth SciencesInfectious DiseasesHIV/AIDSInfectionGood Health and Well BeingBiomedical ResearchDisease EradicationHIV InfectionsHumansTerminology as TopicHIV cureEradicationPublic healthTerminology*Biomedical Research Disease Eradication HIV Infections/*prevention & control Humans Public Health *Terminology as Topic *Eradication *HIV cure *Public health *TerminologyPublic Health and Health ServicesHealth services and systemsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0s09m811articleBMC Public Health, vol 18, iss 1245oai:escholarship.org:ark:/13030/qt9vn4h9q22023-12-08T01:39:27Zqt9vn4h9q2Cytomegalovirus and HIV Persistence: Pouring Gas on the FireChristensen-Quick, AaronVanpouille, ChristopheLisco, AndreaGianella, Sara2017-11-01The inherent stability of a small population of T cells that are latently infected with HIV despite antiretroviral therapy (ART) remains a stubborn obstacle to an HIV cure. By exploiting the memory compartment of our immune system, HIV maintains persistence in a small subset of quiescent cells with varying phenotypes, thus evading immune surveillance and clinical detection. Understanding the molecular and immunological mechanisms that maintain the latent reservoir will be critical to the success of HIV eradication strategies. Human cytomegalovirus (CMV), another chronic viral infection, frequently co-occurs with HIV and occupies an oversized proportion of memory T cell responses. CMV and HIV have both evolved complex strategies to manipulate our immune system for their own advantage. Given the increasingly clear links between CMV replication, chronic immune activation, and increased HIV reservoirs, we present a closer examination of the interplay between these two chronic coinfections. Here we review the effects of CMV on the immune system and show how they may affect persistence of the latent HIV reservoir during ART. The studies described herein suggest that hijacking of cytokine and chemokine signaling, manipulation of cell development pathways, and transactivation of HIV expression by CMV might be pouring gas on the fire of HIV persistence. Future interventional studies are required to formally determine the extent to which CMV is causally associated with inflammation and HIV reservoir expansion.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyClinical ResearchHIV/AIDSInfectious DiseasesAetiology2.1 Biological and endogenous factorsInfectionAnti-HIV AgentsCD4-Positive T-LymphocytesCoinfectionCytomegalovirusCytomegalovirus InfectionsHIV InfectionsHIV-1HumansImmune EvasionVirus LatencyVirus ReplicationCMVHIVinflammationpersistencereservoirAnti-HIV Agents/therapeutic use CD4-Positive T-Lymphocytes/immunology/virology Coinfection/pathology/virology Cytomegalovirus/growth & development/*immunology Cytomegalovirus Infections/*immunology/virology HIV Infections/*immunology/virology HIV-1/growth & development/*immunology Humans Immune Evasion/*immunology Virus Latency/*immunology Virus Replication/physiology Cmv Hiv inflammation persistence reservoirClinical SciencesVirologyClinical sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9vn4h9q2articleAIDS Research and Human Retroviruses, vol 33, iss S1s-23-s-30oai:escholarship.org:ark:/13030/qt4497j5152023-12-08T01:39:14Zqt4497j515Elevated cytomegalovirus IgG antibody levels are associated with HIV-1 disease progression and immune activationPatel, Eshan UGianella, SaraNewell, KevinTobian, Aaron ARKirkpatrick, Allison RNalugoda, FredrickGrabowski, Mary KGray, Ronald HSerwadda, DavidQuinn, Thomas CRedd, Andrew DReynolds, Steven J2017-03-27ObjectiveTo assess the association between cytomegalovirus (CMV) IgG antibody levels, HIV disease progression, and immune activation markers.DesignA prospective cohort study was conducted among women enrolled in a trial that was designed to determine the effect of acyclovir on HIV disease progression in Rakai, Uganda.MethodsThe primary endpoints were progression to a CD4 T-cell count less than 250 cells/μl, nontraumatic death, or initiation of antiretroviral therapy (ART). CD4 T-cell counts, HIV viral load, C-reactive protein (CRP), and soluble CD14 levels were assessed biannually for 24 months. CMV IgG antibodies were measured at baseline among all women and annually among a subset of women who initiated ART.ResultsThere were 300 HIV/CMV-coinfected participants who contributed a total of 426.4 person-years with a median follow-up time of 1.81 years. Compared with the lowest CMV IgG tertile group at baseline, the highest CMV IgG tertile group was associated with an increased risk to reach a primary endpoint independent of acyclovir use, age, CD4 T-cell count, and HIV viral load at baseline [adjusted hazard ratio = 1.59; (95% CI = 1.05-2.39); P = 0.027]. Among pre-ART visits (n = 1200), women in the highest baseline CMV IgG tertile had increasing annual rates of soluble CD14 and CRP levels, which was not observed for the low CMV IgG tertile group. Compared with pre-ART visits, CMV IgG antibody levels were higher post-ART initiation, and concurrent levels remained associated with soluble CD14 and CRP during suppressive ART (n = 88 person-visits).ConclusionThe magnitude of the immune response to CMV was associated with HIV disease progression and immune activation in sub-Saharan Africa.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyHIV/AIDSClinical ResearchInfectious DiseasesInfectionInflammatory and immune systemAcyclovirAntibodiesViralAntiviral AgentsCD4 Lymphocyte CountCytomegalovirus InfectionsDisease ProgressionFemaleHIV InfectionsHIV-1HumansImmunoglobulin GProspective StudiesUgandaViral LoadAcyclovir/therapeutic use AntibodiesViral/*blood Antiviral Agents/therapeutic use CD4 Lymphocyte Count Cytomegalovirus Infections/*complications/drug therapy/*immunology *Disease Progression Female HIV Infections/*complications HIV-1/isolation & purification Humans Immunoglobulin G/*blood Prospective Studies Uganda/epidemiology Viral LoadBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologyBiomedical and clinical sciencesHealth sciencespubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4497j515articleAIDS, vol 31, iss 6807 - 813oai:escholarship.org:ark:/13030/qt98c6k4hz2023-12-08T01:39:06Zqt98c6k4hzIncreased cell-free mitochondrial DNA is a marker of ongoing inflammation and better neurocognitive function in virologically suppressed HIV-infected individualsPérez-Santiago, JosuéDe Oliveira, Michelli FVar, Susanna RDay, Tyler RCWoods, Steven PGianella, SaraMehta, Sanjay R2017-04-01Cell-free mitochondrial DNA (mtDNA) is a highly immunogenic molecule that is associated with several inflammatory conditions and with neurocognitive impairment during untreated HIV infection. Here, we investigate how cell-free mtDNA in cerebrospinal fluid (CSF) is associated with inflammation, neuronal damage, and neurocognitive functioning in the context of long-term suppressive antiretroviral therapy (ART). We quantified the levels of cell-free mtDNA in the CSF from 41 HIV-infected individuals with completely suppressed HIV RNA levels in blood plasma (<50 copies/mL) by droplet digital PCR. We measured soluble CD14, soluble CD163, interferon γ-induced protein 10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-α (TNF-α), neopterin, and neurofilament light chain (NFL) by immunoassays in CSF supernatant or blood plasma. Higher levels of mtDNA in CSF were associated with higher levels of MCP-1 (r = 0.56, p < 0.01) in CSF and TNF-α (r = 0.43, p < 0.01) and IL-8 (r = 0.44, p < 0.01) in blood plasma. Subjects with a previous diagnosis of AIDS showed significantly higher levels of mtDNA (p < 0.01) than subjects without AIDS. The associations between mtDNA and MCP-1 in CSF and TNF-α in blood remained significant after adjusting for previous diagnosis of AIDS (p < 0.01). Additionally, higher levels of mtDNA were associated with a lower CD4 nadir (r = -0.41, p < 0.01) and lower current CD4% (r = -0.34, p = 0.03). Paradoxically, higher levels of mtDNA in CSF were significantly associated with better neurocognitive performance (r = 0.43, p = 0.02) and with less neuronal damage (i.e. lower NFL). Higher cell-free mtDNA is associated with inflammation during treated HIV infection, but the impact on neurocognitive functioning and neuronal damage remains unclear and may differ in the setting of suppressive ART.Medical MicrobiologyBiomedical and Clinical SciencesImmunologyHIV/AIDSInfectious DiseasesClinical ResearchNeurosciencesPreventionGenetics2.1 Biological and endogenous factorsAetiologyInfectionAdultAntigensCDAntigensDifferentiationMyelomonocyticAntiviral AgentsBiomarkersChemokine CCL2Chemokine CXCL10CognitionCognitive DysfunctionDNAMitochondrialDisease ProgressionFemaleGene ExpressionHIVHIV InfectionsHumansInterleukin-8Lipopolysaccharide ReceptorsMaleMiddle AgedNeuropsychological TestsRNAViralReceptorsCell SurfaceRetrospective StudiesTumor Necrosis Factor-alphamtDNAddPCRInflammation.Neurocognitive performanceNeurodegenerationInflammationAdult AntigensCD/blood/genetics AntigensDifferentiationMyelomonocytic/blood/genetics Antiviral Agents/therapeutic use Biomarkers/blood/cerebrospinal fluid Chemokine CCL2/cerebrospinal fluid/genetics Chemokine CXCL10/blood/genetics *Cognition Cognitive Dysfunction/cerebrospinal fluid/complications/*diagnosis/drug therapy DNAMitochondrial/*cerebrospinal fluid Disease Progression Female Gene Expression HIV/drug effects/growth & development/pathogenicity HIV Infections/cerebrospinal fluid/complications/*diagnosis/drug therapy Humans Interleukin-8/blood/genetics Lipopolysaccharide Receptors/blood/genetics Male Middle Aged Neuropsychological Tests RNAViral/*blood ReceptorsCell Surface/blood/genetics Retrospective Studies Tumor Necrosis Factor-alpha/blood/genetics *Inflammation *Neurocognitive performance *Neurodegeneration *ddPCR *mtDNAClinical SciencesVirologyClinical sciencesMedical microbiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/98c6k4hzarticleJournal of NeuroVirology, vol 23, iss 2283 - 289oai:escholarship.org:ark:/13030/qt1373904v2023-12-08T00:15:23Zqt1373904vSmall Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM).Harawa, Nina TSchrode, Katrina MMcWells, CharlesWeiss, Robert EHilliard, Charles LBluthenthal, Ricky N2020-08-01We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87%; p < .001) and STI (28% to 80%; p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black MSM along the HIV prevention continuum.Health Services and SystemsPublic HealthHealth SciencesPreventionClinical ResearchSexual and Gender Minorities (SGM/LGBT*)Behavioral and Social ScienceHIV/AIDSPediatric AIDSPediatricMental HealthInfectious DiseasesClinical Trials and Supportive ActivitiesPrevention of disease and conditionsand promotion of well-being3.1 Primary prevention interventions to modify behaviours or promote wellbeingGood Health and Well BeingAdultBlack or African AmericanAnti-HIV AgentsHIV InfectionsHealth KnowledgeAttitudesPracticeHomosexualityMaleHumansLos AngelesMaleOutcome and Process AssessmentHealth CarePeer GroupPost-Exposure ProphylaxisPre-Exposure ProphylaxisSexually Transmitted DiseasesSurveys and QuestionnairesUnsafe SexHIV preventionHIV testingpre-exposure prophylaxisBlack/African American MSMpost-exposure prophylaxisPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1373904varticleAIDS Education and Prevention, vol 32, iss 4311 - 324oai:escholarship.org:ark:/13030/qt1d87k6792023-10-09T09:25:45Zqt1d87k679Community engagement to improve access to healthcare: a comparative case study to advance implementation science for transgender health equityThompson, Hale MClement, Allison MOrtiz, ReynaPreston, Toni MarieQuantrell, Ava L WellsEnfield, MichelleKing, AJKlosinski, LeeReback, Cathy JHamilton, AlisonMilburn, Norweeta2022-12-01BackgroundRecent calls to action have been made for Implementation Science to attend to health inequities at the intersections of race, gender, and social injustice in the United States. Transgender people, particularly Black and Latina transgender women, experience a range of health inequities and social injustices. In this study, we compared two processes of transgender community engagement in Los Angeles and in Chicago as an implementation strategy to address inequitable access to care; we adapted and extended the Exploration Planning Implementation and Sustainment (EPIS) framework for transgender health equity.MethodsA comparative case method and the EPIS framework were used to examine parallel implementation strategies of transgender community engagement to expand access to care. To foster conceptual development and adaptation of EPIS for trans health equity, the comparative case method required detailed description, exploration, and analyses of the community-engagement processes that led to different interventions to expand access. In both cities, the unit of analysis was a steering committee made up of local transgender and cisgender stakeholders.ResultsBoth steering committees initiated their exploration processes with World Café-style, transgender community-engaged events in order to assess community needs and structural barriers to healthcare. The steering committees curated activities that amplified the voices of transgender community members among stakeholders, encouraging more effective and collaborative ways to advance transgender health equity. Based on analysis and findings from the Los Angeles town hall, the steering committee worked with a local medical school, extending the transgender medicine curriculum, and incorporating elements of transgender community-engagement. The Chicago steering committee determined from their findings that the most impactful intervention on structural racism and barriers to healthcare access would be to design and pilot an employment program for Black and Latina transgender women.ConclusionIn Los Angeles and Chicago, transgender community engagement guided implementation processes and led to critical insights regarding specific, local barriers to healthcare. The steering committee itself represented an important vehicle for individual-, organizational-, and community-level relationship and capacity building. This comparative case study highlights key adaptations of EPIS toward the formation of an implementation science framework for transgender health equity.Health Services and SystemsPublic HealthHealth SciencesHuman SocietyHealth ServicesClinical ResearchSexual and Gender Minorities (SGM/LGBT*)8.1 Organisation and delivery of servicesHealth and social care services researchGeneric health relevanceGood Health and Well BeingDelivery of Health CareFemaleHealth EquityHealth FacilitiesHumansImplementation ScienceTransgender PersonsUnited StatesTransgenderCommunity engagementHealth equityEPIS frameworkComparative case studyWorld Cafe modelHuman-centered designWorld Café modelPublic Health and Health ServicesSociologyHealth services and systemsPublic healthPolicy and administrationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1d87k679articleInternational Journal for Equity in Health, vol 21, iss 1104oai:escholarship.org:ark:/13030/qt3420s1xw2023-10-09T07:39:12Zqt3420s1xwEvidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single MothersNarain, Kimberly Danae CauleyHarawa, Nina2023-01-01We investigated the impact of State-level Earned Income Tax Credit (SEITC) generosity on HIV risk behavior among single mothers with low education. We merged individual-level data from the Behavioral Risk Factor Surveillance System (2002-2018) with state-level data from the University of Kentucky Center for Poverty Research and conducted a multi-state, multi-year difference-in-differences (DID) analysis. We found that a refundable SEITC ≥ 10% of the Federal Earned Income Tax Credit was associated with 21% relative risk reduction in reporting any high-risk behavior for HIV in the last year, relative to no SEITC. We also found that a 10-percentage point increase in SEITC generosity was associated with 38% relative risk reduction in reporting any high-risk HIV behavior in the last year. SEITC policy may be an important strategy to reduce the burden of HIV infections among women with low socioeconomic status, particularly single mothers.Public HealthHealth SciencesPediatric AIDSPediatricHIV/AIDSPreventionBehavioral and Social ScienceBasic Behavioral and Social ScienceInfectious DiseasesReduced InequalitiesFemaleHumansUnited StatesIncome TaxHIV InfectionsIncomeRisk Reduction BehaviorRisk-TakingHIVRisk-takingPovertyHealth equityPublic Health and Health ServicesSocial WorkPublic healthapplication/pdfCC-BYeScholarship, University of Californiahttps://escholarship.org/uc/item/3420s1xwarticleAIDS and Behavior, vol 27, iss 1182 - 188oai:escholarship.org:ark:/13030/qt7wx1q6fj2023-10-07T11:56:26Zqt7wx1q6fjWe are family: designing and developing a mobile health application for the San Francisco bay area House Ball and Gay Family communitiesSaberi, ParyaBerrean, BethMilionis, CynthiaWong, Jeffrey OArnold, Emily2020-01-01BackgroundThe House Ball community (HBC) and its affiliated Gay Families (GFs) consist of predominantly African American and Latinx sexual, gender, and ethnic minorities (SGEM), who form chosen families often as a way to provide support, and in the case of the HBC, to constitute houses that then compete in performative categories in balls. Members of both communities are disproportionately impacted by HIV. Although public health professionals have engaged with the HBC and GFs to improve HIV testing and clinical care, most intervention activities have relied on in-person modes of outreach and delivery. Little research has been conducted with the members of the HBC and GFs to develop and produce culturally-informed mobile health (mHealth) applications that would enable them to increase HIV-related knowledge, connect to HIV-related resources, receive HIV health support, and to celebrate their unique identities and communities in a safe space.MethodsWe conducted 45 in-depth interviews with HBC and GF members who attended balls. Topics included HIV-related health needs, suggestions for mHealth components, current usage of apps and desirable features, and wishes around privacy and security. Following analysis of the interview data, we convened a series of four workshops with N=15 participants who were split into two groups. The purpose of the workshops was to co-design a digital tool to help provide information, reduce HIV-related stigma, and locate HIV resources for participants. Each group attended two workshops. Data were analyzed by a team of social scientists, community members, and mobile health experts. Findings were used to design an mHealth app related to HIV prevention and care.ResultsParticipants requested an app that clearly reflected the community. The desired features of the app included accurate information and education on HIV transmission; links to resources such as HIV testing, lube and condoms, PrEP, and other health-related services; and the ability to rate and review local resources. In workshops, participants proposed several design elements and functions for the app. It had to be 'Mobile and Modern', 'Relatable, Raw, and "Reflective of Me"', 'Positive and Fun', feature community-generated content, and provide a safe space for users. Using these clear directives, the team designed an mHealth tool to be fielded as part of the larger "We Are Family" intervention that would provide HIV-specific information, resources, and support in a platform that was congruent with community norms and expectations.ConclusionsDesigning and fielding an mHealth app as part of a larger HIV prevention intervention that reflects the social support and relationships within existing House Ball and Gay Family communities allows those youth most at risk for HIV-related health disparities to gain access to HIV testing, or link and re-engage young people to care.Health Services and SystemsHealth SciencesPediatric AIDSPediatricClinical Trials and Supportive ActivitiesPreventionNetworking and Information Technology R&D (NITRD)HIV/AIDSClinical ResearchInfectious DiseasesBehavioral and Social ScienceManagement of diseases and conditions7.1 Individual care needsGood Health and Well BeingMobile health applicationparticipatory designHouse Ball communityGay Family communitymHealthmobile health applicationHouse Ball CommunitymhealthHealth services and systemsApplied computingInformation systemsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7wx1q6fjarticlemHealth, vol 6, iss 042 - 42oai:escholarship.org:ark:/13030/qt782382wf2023-08-29T11:26:34Zqt782382wfSocio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender WomenHotton, Anna LChen, Yen-TyngSchumm, PhilKhanna, Aditya SBrewer, RussellSkaathun, BrittIssema, Rodal SRamani, SanthoshiniRamachandran, ArthiOzik, JonathanFujimoto, KayoHarawa, Nina TSchneider, John A2020-10-01Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.HIV/AIDSPreventionBehavioral and Social ScienceSubstance MisuseInfectious DiseasesSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchInfectionPeaceJustice and Strong InstitutionsAdolescentAdultBlack or African AmericanChicagoCohort StudiesCrimeCriminalsFemaleForecastingHIV InfectionsHomosexualityMaleHumansLogistic ModelsMaleResidence CharacteristicsRisk-TakingSocioeconomic FactorsTransgender PersonsYoung AdultHIVCriminal justice involvementIncarcerationHealth inequitiesSexual and gender minoritiesResilienceSocio-structural factorsHuman Movement and Sports SciencesPublic Health and Health ServicesPublic Healthapplication/pdfCC-BYeScholarship, University of Californiahttps://escholarship.org/uc/item/782382wfarticleJournal of Urban Health, vol 97, iss 5623 - 634oai:escholarship.org:ark:/13030/qt0b44p24g2023-08-29T01:35:05Zqt0b44p24gLimited engraftment of donor microbiome via one-time fecal microbial transplantation in treated HIV-infected individualsVujkovic-Cvijin, IvanRutishauser, Rachel LPao, MonthaHunt, Peter WLynch, Susan VMcCune, Joseph MSomsouk, Ma2017-09-03Many HIV-infected individuals on antiretroviral therapy (ART) exhibit persistent systemic inflammation, which predicts morbidity and mortality. ART-treated subjects concurrently exhibit marked compositional alterations in the gut bacterial microbiota and the degree of dysbiosis correlates with systemic inflammation. Whether interventions to modulate the microbiome can affect systemic inflammation is unknown. An open-label fecal microbial transplantation (FMT) was delivered by colonoscopy to asymptomatic HIV-infected ART-suppressed individuals without antibiotic pre-treatment. Stool was assessed before and after FMT for engraftment of donor microbes, and peripheral blood was assayed for immune activation biomarkers. Six participants received FMT and 2 participants served as controls. No serious adverse effects occurred during 24 weeks of follow-up. At baseline, HIV-infected individuals exhibited microbiota profiles distinct from uninfected donors. During the 8 weeks post-FMT, recipients demonstrated partial engraftment of the donor microbiome (P < 0.05). Recipient microbiota remained significantly distant from donors, unlike that observed following FMT for treatment of C. difficile infection. Systemic inflammatory markers showed no significant change post-FMT. FMT was well-tolerated in ART-treated, HIV-infected individuals. Engraftment was detectable but modest, and appeared to be limited to specific bacterial taxa. Whether antibiotic conditioning can enhance engraftment and the capacity of microbiota to modulate inflammation remains to be investigated.TransplantationClinical ResearchInfectious DiseasesHIV/AIDSDigestive DiseasesEvaluation of treatments and therapeutic interventionsAetiology6.1 Pharmaceuticals2.1 Biological and endogenous factorsInfectionGood Health and Well BeingAdultAgedDysbiosisFecal Microbiota TransplantationGastrointestinal MicrobiomeHIV InfectionsHumansMaleMiddle AgedTreatment OutcomeMicrobiotafecal transplantengraftmentHIVinflammationfecal microbiome transplantmicrobiome engraftmentMicrobiologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0b44p24garticleGut Microbes, vol 8, iss 5440 - 450oai:escholarship.org:ark:/13030/qt3424h8bm2023-08-28T02:36:39Zqt3424h8bmFood Insecurity and Unmet Needs Among Youth and Young Adults Living With HIV in the San Francisco Bay AreaReeder, ChristianNeilands, Torsten BPalar, KartikaSaberi, Parya2019-08-01PurposeLittle is known about food insecurity and unmet subsistence needs and their association with antiretroviral therapy adherence among youth and young adults living with HIV (YLWH).MethodsWe conducted a cross-sectional survey to examine this association in 101 YLWH (aged 18-29 years). Poisson regression models with robust standard errors were used to estimate adjusted risk ratios (RRs) and 95% confidence intervals (CIs).ResultsApproximately 51.7% of participants experienced at least one unmet subsistence need (difficulty finding enough to eat [36.6%], clothing [22.8%], place to sleep [21.8%], place to wash [17.8%], and bathroom [15.8%]), and 64.2% reported being food insecure. For every additional unmet need, the risk of very good/excellent adherence was reduced by 15% (RR = .85; 95% CI = .72-.99; p value = .04). The risk of very good/excellent adherence was lowered by 39% (RR = .61; 95% CI = .43-.87; p value = .005) among food insecure youth, compared with those who were food secure.ConclusionsThese data highlight the need for more research and structural interventions targeting food assistance strategies among YLWH.PreventionHIV/AIDSZero HungerAdolescentAdultCross-Sectional StudiesFemaleFood SupplyHIV InfectionsHomeless PersonsHumansMaleMedication AdherenceSan FranciscoYoung AdultYouthHIVFood insecurityUnmet needsAntiretroviral therapyAdherenceIll-Housed PersonsMedical and Health SciencesEducationPsychology and Cognitive SciencesPublic Healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3424h8bmarticleJournal of Adolescent Health, vol 65, iss 2262 - 266oai:escholarship.org:ark:/13030/qt30x7r7gc2023-08-20T11:40:30Zqt30x7r7gcA qualitative study of antiretroviral therapy adherence interruptions among young Latino men who have sex with men with HIV: Project D.A.I.L.Y.Sheehan, Diana MDe La Cruz, YazmineRamírez-Ortiz, DaisySwendeman, DallasMuñoz-Laboy, MiguelDuncan, Dustin TCano, Miguel ÁngelDevieux, Jessy GTrepka, Mary Jo2021-07-03Consistent antiretroviral therapy (ART) adherence is necessary for HIV viral suppression. However, adherence may fluctuate around daily routines and life events, warranting intervention support. We examined reasons for ART adherence interruptions, using in-depth, semi-structured qualitative interviews, among young (18-34-year-old) Latino men who have sex with men (YLMSM) with HIV. Interviews (n = 24) were guided by the Theory of Planned Behavior, the Information-Motivation-Behavioral Skills Theory, and the Socio-Ecological Model. Two coders independently coded transcripts using NVivo 12 software and synthesized codes into themes using Thematic Content Analysis. Results suggested 4 primary influences on ART adherence interruptions: (1) HIV diagnosis denial, (2) breaks in daily routine, (3) substance use, and (4) HIV status disclosure. Participant quotes highlighted routinization of pill-taking and planning ahead for breaks in routine as critically important. The narrative suggested modification of pill-taking routines during alcohol use, and that periods most vulnerable for long-term interruptions in ART adherence were following an HIV diagnosis and during periods of drug use. Support at the time of HIV diagnosis, including a plan for routinization of pill taking, and adaptive interventions incorporating real-time support during breaks in routines and substance use episodes may be one way to help YLMSM adhere to ARTs.Behavioral and Social ScienceClinical ResearchPediatric AIDSHIV/AIDSPreventionInfectious DiseasesMental HealthPediatricSubstance Misuse7.1 Individual care needsManagement of diseases and conditionsInfectionGood Health and Well BeingAdolescentAdultAnti-Retroviral AgentsHIV InfectionsHispanic or LatinoHumansMaleMedication AdherenceQualitative ResearchYoung AdultHuman immunodeficiency virusantiretroviral therapyLatinosadherencePublic Health and Health ServicesPsychologyPublic HealthpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/30x7r7gcarticleAIDS Care, vol 33, iss 7962 - 969oai:escholarship.org:ark:/13030/qt2j30w6qp2023-08-20T10:02:33Zqt2j30w6qpGrindr Users Take More Risks, but Are More Open to Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis: Could This Dating App Provide a Platform for HIV Prevention Outreach?Hoenigl, MartinLittle, Susan JGrelotti, DavidSkaathun, BrittWagner, Gabriel AWeibel, NadirStockman, Jamila KSmith, Davey M2020-10-23BackgroundTechnology has changed the way that men who have sex with men (MSM) seek sex. More than 60% of MSM in the United States use the internet and/or smartphone-based geospatial networking apps to find sex partners. We correlated use of the most popular app (Grindr) with sexual risk and prevention behavior among MSM.MethodsA nested cohort study was conducted between September 2018 and June 2019 among MSM receiving community-based human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening in central San Diego. During the testing encounter, participants were surveyed for demographics, substance use, risk behavior (previous 3 months), HIV pre-exposure prophylaxis (PrEP) use, and Grindr usage. Participants who tested negative for HIV and who were not on PrEP were offered immediate PrEP.ResultsThe study included 1256 MSM, 1090 of whom (86.8%) were not taking PrEP. Overall, 580 of 1256 (46%) participants indicated that they used Grindr in the previous 7 days. Grindr users reported significantly higher risk behavior (greater number of male partners and condomless sex) and were more likely to test positive for chlamydia or gonorrhea (8.6% vs 4.7% of nonusers; P = .005). Grindr users were also more likely to be on PrEP (18.7% vs 8.7% of nonusers; P < .001) and had fewer newly diagnosed HIV infections (9 vs 26 among nonusers; P = .014). Grindr users were also nearly twice as likely as nonusers to initiate PrEP (24.6% vs 14%; P < .001).ConclusionsGiven the higher risk behavior and greater acceptance of PrEP among MSM who used Grindr, Grindr may provide a useful platform to promote HIV and STI testing and increase PrEP uptake.HIV/AIDSBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)PreventionClinical ResearchInfectious DiseasesSexually Transmitted InfectionsInfectionGood Health and Well BeingCohort StudiesHIVHIV InfectionsHomosexualityMaleHumansMaleMobile ApplicationsPre-Exposure ProphylaxisSexual and Gender MinoritiesUnited StatesHIV riskdating apppre-exposure prophylaxissubstance userisk behaviorBiological SciencesMedical and Health SciencesMicrobiologyapplication/pdfCC-BY-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/2j30w6qparticleClinical Infectious Diseases, vol 71, iss 7e135 - e140oai:escholarship.org:ark:/13030/qt1hn2z6n02023-08-20T02:51:31Zqt1hn2z6n0Opportunities and challenges for the development of “core outcome sets” in neuro-oncologyMillward, Christopher PArmstrong, Terri SBarrington, HeatherBrodbelt, Andrew RBulbeck, HelenByrne, AnthonyDirven, LindaGamble, CarrolGrundy, Paul LIslim, Abdurrahman IJavadpour, MohsenKeshwara, Sumirat MKrishna, Sandhya TMallucci, Conor LMarson, Anthony GMcDermott, Michael WMeling, Torstein ROliver, KathyPizer, BarryPlaha, PuneetPreusser, MatthiasSantarius, ThomasSrikandarajah, NisaharanTaphoorn, Martin JBWatts, ColinWeller, MichaelWilliamson, Paula RZadeh, GelarehNajafabadi, Amir H ZamanipoorJenkinson, Michael D2022-07-01Core Outcome Sets (COS) define minimum outcomes to be measured and reported in clinical effectiveness trials for a particular health condition/health area. Despite recognition as critical to clinical research design for other health areas, none have been developed for neuro-oncology. COS development projects should carefully consider: scope (how the COS should be used), stakeholders involved in development (including patients as both research partners and participants), and consensus methodologies used (typically a Delphi survey and consensus meeting), as well as dissemination plans. Developing COS for neuro-oncology is potentially challenging due to extensive tumor subclassification (including molecular stratification), different symptoms related to anatomical tumor location, and variation in treatment options. Development of a COS specific to tumor subtype, in a specific location, for a particular intervention may be too narrow and would be unlikely to be used. Equally, a COS that is applicable across a wider area of neuro-oncology may be too broad and therefore lack specificity. This review describes why and how a COS may be developed, and discusses challenges for their development, specific to neuro-oncology. The COS under development are briefly described, including: adult glioma, incidental/untreated meningioma, meningioma requiring intervention, and adverse events from surgical intervention for pediatric brain tumors.Clinical Trials and Supportive ActivitiesRare DiseasesNeurosciencesClinical ResearchCancerBrain DisordersBrain CancerEvaluation of treatments and therapeutic interventions6.9 Resources and infrastructure (treatment evaluation)Generic health relevanceAdultChildConsensusDelphi TechniqueHumansMeningeal NeoplasmsMeningiomaResearch DesignTreatment Outcomeclinical trialcore outcome seteffectivenessgliomameningiomaOncology and CarcinogenesisOncology & Carcinogenesisapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1hn2z6n0articleNeuro-Oncology, vol 24, iss 71048 - 1055oai:escholarship.org:ark:/13030/qt5sc8n8fv2023-08-13T19:51:03Zqt5sc8n8fvMethamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trial.Goodman-Meza, DavidShoptaw, SteveWeiss, Robert ENakazono, TerryHarawa, Nina TTakada, SaeGarland, Wendy HCunningham, William E2019-09-01BackgroundPeople living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants.MethodsWe analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction.ResultsAt baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p < 0.001).ConclusionHigh-risk drug use, dominated by methamphetamine use, independently correlated with decreased VS among recently incarcerated PLWH. Improving HIV care continuum outcomes among populations leaving jail requires attention to efforts to address high-risk drug use.HumansHIV InfectionsSubstance-Related DisordersMethamphetamineCocaineAnalgesicsOpioidAnti-HIV AgentsLinear ModelsPrisonsAdultMiddle AgedPrisonersContinuity of Patient CarePatient Acceptance of Health CareLos AngelesFemaleMaleHIV viral suppressionJailStimulantSubstance useBrain DisordersClinical ResearchPreventionSubstance MisuseDrug Abuse (NIDA only)Clinical Trials and Supportive ActivitiesHIV/AIDSGood Health and Well BeingMedical and Health SciencesPsychology and Cognitive SciencesSubstance Abuseapplication/pdfCC-BYeScholarship, University of Californiahttps://escholarship.org/uc/item/5sc8n8fvarticleoai:escholarship.org:ark:/13030/qt5806j36c2023-08-13T14:42:40Zqt5806j36cWhat does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV.Saberi, ParyaMing, KristinDawson-Rose, Carol2018-01-01PurposeGiven the consistent associations between younger age and numerous suboptimal clinical outcomes, there is a critical need for more research in youth living with human immunodeficiency virus (YLWH) and tailoring of health care delivery to the unique and complex needs of this population. The objective of this study was to examine the facilitators of and barriers to engagement in care among YLHW at the system and provider/staff level, as well as the barriers to using technology-based forms of communication with YLWH to improve retention and engagement in care.Patients and methodsWe conducted in-depth qualitative interviews with health care providers and staff members at the clinics and organizations serving YLWH in the San Francisco Bay Area.ResultsWe interviewed 17 health care providers and staff members with a mean of 8 years of experience in providing clinical care to YLWH. Interviewees noted various facilitators of and barriers to engagement in care among YLWH, including the environment of the clinic (e.g., clinic location and service setting), provision of youth-friendly services (e.g., flexible hours and use of technology), and youth-friendly providers/staff (e.g., nonjudgmental approach). With regard to barriers to using technology in organizations and clinics, interviewees discussed the challenges at the system level (e.g., availability of technology, clinic capacity, and Health Insurance Portability and Accountability Act compliance), provider/staff level (e.g., time constraints and familiarity with technology), and youth level (e.g., changing of cellular telephones and relationship with provider/staff).ConclusionGiven the need for improved clinical outcomes among YLWH, our results can provide guidance for clinics and institutions providing care for this population to enhance the youth-friendliness of their services and examine their guidelines around the use of technology.HIVbarriershealth care providertechnologyyoung adultsyouthPediatricClinical ResearchHealth ServicesPediatric Research InitiativeBehavioral and Social SciencePrevention8.1 Organisation and delivery of servicesHealth and social care services researchGeneric health relevanceGood Health and Well BeingClinical SciencesPaediatrics and Reproductive Medicineapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5806j36carticleoai:escholarship.org:ark:/13030/qt2vg285g22023-07-10T08:16:52Zqt2vg285g2Effect of CMV and EBV replication on intestinal mucosal gene expression and microbiome composition of HIV-infected and uninfected individuals.Gianella, SaraChaillon, AntoineMutlu, Ece AEngen, Phillip AVoigt, Robin MKeshavarzian, AliLosurdo, JohnChakradeo, PrachiLada, Steven MNakazawa, MasatoLanday, Alan L2017-07-07HIV-infection is associated with dramatic changes in the intestinal mucosa. The impact of other viral pathogens is unclear.Eighty biopsies from left and right colon (n=63) and terminal ileum (n = 17) were collected from 19 HIV-infected and 22 HIV-uninfected subjects. Levels of cytomegalovirus (CMV) and Epstein Barr Virus (EBV) DNA were measured by droplet-digital (dd)PCR. Mucosal gene expression was measured via multiplex-assay. Microbiome analysis was performed using bacterial 16S-rDNA-pyrosequencing. The effect of CMV and EBV replication on the microbiome composition and mRNA-expression of selected cytokines (IL-6,IFN-γ,IL-1β, CCL2,IL-8 IFN-β1) was evaluated.Overall, CMV and EBV were detected in at least one intestinal site in 60.5% and 78.9% of subjects, respectively. HIV-infected individuals demonstrated less detectable CMV (p = 0.04); CMV was more frequently detected in terminal ileum than colon (p = 0.04). Detectable EBV was more frequent among HIV-infected (p = 0.05) without differences by intestinal site. The number of operational taxonomic units did not differ by CMV or EBV detection status. Among HIV-infected subjects, higher CMV was only associated with lower relative abundance of Actinobacteria in the ileum (p = 0.03). Presence of CMV was associated with up-regulated expression of all selected cytokines in the ileum (p < 0.02) and higher expression of IL-8 and IFN-β1 in the colon (P < 0.05) of HIV-uninfected subjects, but not among HIV-infected. EBV had no effect on cytokine expression or microbiome composition whatsoever.These results illustrate a complex interplay between HIV-infection, intestinal CMV replication and mucosal gut environment, and highlight a possible modulatory effect of CMV on the microbial and immune homeostasis.Digestive DiseasesClinical ResearchGeneticsHIV/AIDSHuman GenomeInfectious Diseases2.1 Biological and endogenous factorsAetiologyInfectionBiopsyColonCytokinesCytomegalovirus InfectionsDNABacterialDNARibosomalDNAViralEpstein-Barr Virus InfectionsFemaleGastrointestinal MicrobiomeGene Expression ProfilingGene Expression RegulationHIV InfectionsHumansIleumIntestinal MucosaMaleMicrobiotaMiddle AgedPolymerase Chain ReactionRNARibosomal16SSequence AnalysisDNAViral Loadcytomegalovirus and Epstein-Barr virus replicationHIV infectionintestinal microbiomemucosal cytokine expressionBiopsy Colon/pathology Cytokines/analysis Cytomegalovirus Infections/*pathology/virology DNABacterial/chemistry/genetics DNARibosomal/chemistry/genetics DNAViral/analysis Epstein-Barr Virus Infections/*pathology/virology Female *Gastrointestinal Microbiome Gene Expression Profiling *Gene Expression Regulation HIV Infections/complications Humans Ileum/pathology Intestinal Mucosa/*pathology Male *Microbiota Middle Aged Polymerase Chain Reaction RNARibosomal16S/genetics Sequence AnalysisDNA Viral LoadBiological SciencesMedical and Health SciencesPsychology and Cognitive SciencesVirologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2vg285g2articleAIDS (London, England), vol 31, iss 152059 - 2067oai:escholarship.org:ark:/13030/qt5h58j9h22023-07-10T05:40:49Zqt5h58j9h2Effective use of pre-exposure prophylaxis (PrEP) Among stimulant users with multiple condomless sex partners: a longitudinal study of men who have sex with men in Los Angeles.Goodman-Meza, DavidBeymer, Matthew RKofron, Ryan MAmico, K RivetPsaros, ChristinaBushman, Lane RAnderson, Peter LBolan, RobertJordan, Wilbert CRooney, James FWohl, Amy RLandovitz, Raphael J2019-10-01PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.HumansHIV InfectionsAdenineCentral Nervous System StimulantsAnti-Retroviral AgentsLongitudinal StudiesCondomsHomosexualityMaleUnsafe SexAdultSexual PartnersLos AngelesMaleMedication AdherenceOrganophosphatesPre-Exposure ProphylaxisTenofovirMSMPrEPadherencecondomless anal sexstimulantSexual and Gender Minorities (SGM/LGBT*)Clinical ResearchHIV/AIDSPreventionPublic Health and Health ServicesPsychologyPublic HealthpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5h58j9h2articleAIDS care, vol 31, iss 101228 - 1233oai:escholarship.org:ark:/13030/qt5d54n9gh2023-07-09T14:07:26Zqt5d54n9ghSheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women.Sevelius, Jae MNeilands, Torsten BDilworth, SamanthaCastro, DanielleJohnson, Mallory O2020-05-01Transgender women experience disproportionate risk of HIV acquisition and transmission. We piloted 'Sheroes', a peer-led group-level intervention for transgender women of any HIV status emphasizing empowerment and gender affirmation to reduce HIV risk behaviors and increase social support. Participants (N = 77) were randomized to Sheroes (n = 39) or a time- and attention-matched control (n = 38). Sheroes is 5 weekly group sessions; topics include sexuality, communication, gender transition, and coping skills. Control participants attended 5 weekly group movie sessions. At 6-month follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control. Among participants living with HIV, both the control and intervention groups reduced their total number of sex partners; this change was sustained at 6-month follow-up for Sheroes participants but not for control participants relative to baseline. Sheroes was deemed highly feasible and acceptable to participants; findings support preliminary efficacy of Sheroes.HumansHIV InfectionsFeasibility StudiesSexual BehaviorTranssexualismFemaleTransgender PersonsAffirmationHIVInterventionSexual riskTransgender womenPediatric AIDSMental HealthPediatricPreventionInfectious DiseasesClinical Trials and Supportive ActivitiesBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)HIV/AIDSClinical ResearchManagement of diseases and conditions7.1 Individual care needs3.1 Primary prevention interventions to modify behaviours or promote wellbeingPrevention of disease and conditionsand promotion of well-beingGender EqualityPublic Health and Health ServicesSocial WorkPublic Healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5d54n9gharticleAIDS and behavior, vol 24, iss 51551 - 1559oai:escholarship.org:ark:/13030/qt3c4950fx2023-07-09T13:33:24Zqt3c4950fxLife Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail.Takada, SaeEttner, Susan LHarawa, Nina TGarland, Wendy HShoptaw, Steve JCunningham, William E2020-02-01Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.HumansHIV InfectionsAnti-Retroviral AgentsAnti-HIV AgentsMass ScreeningCriminal LawPrisonsSocial SupportAdultMiddle AgedPrisonersContinuity of Patient CareLos AngelesFemaleMaleMedication AdherenceSocial StigmaTransgender PersonsHIV-related stigmaHIV/AIDSIncarcerationLife chaosSocial supportMental HealthBehavioral and Social ScienceSexual and Gender Minorities (SGM/LGBT*)PreventionInfectious DiseasesClinical Research7.1 Individual care needsManagement of diseases and conditionsPeaceJustice and Strong InstitutionsHIVAIDSPublic Health and Health ServicesSocial WorkPublic Healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3c4950fxarticleAIDS and behavior, vol 24, iss 2491 - 505oai:escholarship.org:ark:/13030/qt4g4144bb2023-07-09T12:44:11Zqt4g4144bbUse of technology for delivery of mental health and substance use services to youth living with HIV: a mixed-methods perspective.Saberi, ParyaDawson Rose, CarolWootton, Angie RMing, KristinLegnitto, DominiqueJeske, MelaniePollack, Lance MJohnson, Mallory OGruber, Valerie ANeilands, Torsten B2020-08-01Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.HumansHIV InfectionsSubstance-Related DisordersAnti-Retroviral AgentsAnti-HIV AgentsAntiretroviral TherapyHighly ActiveMental HealthMental DisordersMental Health ServicesTelemedicineAdolescentAdultChildSan FranciscoFemaleMaleMedication AdherenceYoung AdultHIVTechnologymental healthtelehealthyouthBehavioral and Social ScienceClinical ResearchDrug Abuse (NIDA only)Brain DisordersHealth ServicesPediatric AIDSPediatric Research InitiativeHIV/AIDSPreventionPediatricSubstance MisuseHealth and social care services research7.1 Individual care needsManagement of diseases and conditions8.1 Organisation and delivery of servicesMental healthGood Health and Well BeingPublic Health and Health ServicesPsychologyPublic Healthapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4g4144bbarticleAIDS care, vol 32, iss 8931 - 939oai:escholarship.org:ark:/13030/qt6n81p37h2023-07-09T12:09:10Zqt6n81p37hHIV transmission networks among transgender women in Los Angeles County, CA, USA: a phylogenetic analysis of surveillance data.Ragonnet-Cronin, ManonHu, Yunyin WMorris, Sheldon RSheng, ZhijuanPoortinga, KathleenWertheim, Joel O2019-03-01BackgroundTransgender women are among the groups at highest risk for HIV infection, with a prevalence of 27·7% in the USA; and despite this known high risk, undiagnosed infection is common in this population. We set out to identify transgender women and their partners in a molecular transmission network to prioritise public health activities.MethodsSince 2006, HIV protease and reverse transcriptase gene (pol) sequences from drug resistance testing have been reported to the Los Angeles County Department of Public Health and linked to demographic data, gender, and HIV transmission risk factor data for each case in the enhanced HIV/AIDS Reporting System. We reconstructed a molecular transmission network by use of HIV-TRAnsmission Cluster Engine (with a pairwise genetic distance threshold of 0·015 substitutions per site) from the earliest pol sequences from 22 398 unique individuals, including 412 (2%) self-identified transgender women. We examined the possible predictors of clustering with multivariate logistic regression. We characterised the genetically linked partners of transgender women and calculated assortativity (the tendency for people to link to other people with the same attributes) for each transmission risk group.Findings8133 (36·3%) of 22 398 individuals clustered in the network across 1722 molecular transmission clusters. Transgender women who indicated a sexual risk factor clustered at the highest frequency in the network, with 147 (43%) of 345 being linked to at least one other person (adjusted odds ratio [aOR] 2·0, p=0·0002). Transgender women were assortative in the network (assortativity 0·06, p<0·001), indicating that they tended to link to other transgender women. Transgender women were more likely than expected to link to other transgender women (OR 4·65, p<0·001) and cisgender men who did not identify as men who have sex with men (MSM; OR 1·53, p<0·001). Transgender women were less likely than expected to link to MSM (OR 0·75, p<0·001), despite the high prevalence of HIV among MSM. Transgender women were distributed across 126 clusters, and cisgender individuals linked to one transgender woman were 9·2 times more likely to link to a second transgender woman than other individuals in the surveillance database. Reconstruction of the transmission network is limited by sample availability, but sequences were available for more than 40% of diagnoses.InterpretationClustering of transgender women and the observed tendency for linkage with cisgender men who did not identify as MSM, shows the potential to use molecular epidemiology both to identify clusters that are likely to include undiagnosed transgender women with HIV and to improve the targeting of public health prevention and treatment services to transgender women.FundingCalifornia HIV and AIDS Research Program and National Institutes of Health-National Institute of Allergy and Infectious Diseases.HumansHIVHIV InfectionsHIV ProteaseCluster AnalysisSequence AnalysisDNAGenotypeAdolescentAdultAgedAged80 and overMiddle AgedChildLos AngelesFemaleMalepol Gene ProductsHuman Immunodeficiency VirusDisease TransmissionInfectiousYoung AdultMolecular EpidemiologyTransgender PersonsPediatricSexual and Gender Minorities (SGM/LGBT*)Infectious DiseasesClinical ResearchPediatric AIDSGeneticsPreventionHIV/AIDS2.3 Psychologicalsocial and economic factorsAetiology2.4 Surveillance and distributionInfectionGood Health and Well BeingMedical and Health Sciencesapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6n81p37harticleThe lancet. HIV, vol 6, iss 3e164 - e172oai:escholarship.org:ark:/13030/qt3gf4c14h2023-07-09T10:47:01Zqt3gf4c14hPerceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men.Blumenthal, JillJain, SoniaMulvihill, EvanSun, ShellyHanashiro, MarvinEllorin, EricGraber, SaraHaubrich, RichardMorris, Sheldon2019-02-01BackgroundInaccurate HIV risk perception by men who have sex with men is a barrier to HIV prevention. Providing information about objective HIV risk could improve pre-exposure prophylaxis (PrEP) uptake.MethodsPrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of men who have sex with men to determine whether an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors, and HIV self-perceived risk (SPR). The survey generated a calculated HIV risk (CalcR) score, estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine whether they initiated PrEP.ResultsOf 171 participants (median age 32 years; 37% Hispanic or non-Hispanic Black; median 5 sexual partners in the past 6 months), 81% had heard of PrEP, and 57% believed they were good PrEP candidates. SPR had poor agreement with CalcR (kappa = 0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, P > 0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (P = 0.06) but no difference between arms (P = 0.29).ConclusionProviding an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP, given enthusiasm for PrEP on the testing day to facilitate greater uptake.HumansHIV InfectionsAnti-HIV AgentsHealth KnowledgeAttitudesPracticeRisk-TakingSexual BehaviorHomosexualityMaleAdultPatient Acceptance of Health CareUnited StatesMaleMedication AdherencePre-Exposure ProphylaxisPediatric AIDSPediatricHIV/AIDSBehavioral and Social SciencePreventionClinical ResearchClinical Trials and Supportive ActivitiesMental HealthInfectious DiseasesSexual and Gender Minorities (SGM/LGBT*)InfectionGood Health and Well Beingpre-exposure prophylaxisHIV risk perceptionmen who have sex with menClinical SciencesPublic Health and Health ServicesVirologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3gf4c14harticleJournal of acquired immune deficiency syndromes (1999), vol 80, iss 2e23 - e29oai:escholarship.org:ark:/13030/qt2j06j07p2023-07-07T14:45:44Zqt2j06j07pCurrent and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals.Beymer, Matthew RHolloway, Ian WPulsipher, CraigLandovitz, Raphael J2019-08-01Purpose of reviewPre-exposure prophylaxis (PrEP) is a potent HIV prevention strategy, but uptake of daily oral PrEP remains low. This review covers PrEP agents currently available and agents and modalities under investigation.Recent findingsInjectable ARV preparations have high acceptability among users but are likely to require adherence to 8-week interval injections. Topical microbicide gels and vaginal rings have underperformed by intention-to-treat analyses in efficacy studies, at least in large part due to challenges with adherence and/or sustained use. However, daily oral TDF-FTC also underperformed in randomized, placebo-controlled trials compared to expectations and subsequent real-world pragmatic use. On-demand (2-1-1 dosing strategy for MSM) and injectable PrEP appear to be acceptable among participants in clinical trials. These modalities are particularly compelling alternatives for individuals who either do not want to take a daily medication (both on-demand and injectable) and/or want to take PrEP without a long commitment (on-demand). Emerging modalities such as vaginal films, microneedles, and subdermal implants have numerous advantages but are still in early stages of development.HumansHIV InfectionsAnti-Infective AgentsAnti-HIV AgentsAdministrationTopicalInjectionsContraceptive DevicesFemaleHomosexualityMaleAdultFemaleMalePre-Exposure ProphylaxisTenofovirEmtricitabineSexual and Gender MinoritiesHIV/AIDSInjectablesMicrobicide gelsOn-demandPre-exposure prophylaxisVaginal ringsTopical MicrobicidesClinical Trials and Supportive ActivitiesClinical ResearchPrevention6.1 PharmaceuticalsEvaluation of treatments and therapeutic interventionsHIVAIDSImmunologyMedical MicrobiologyVirologypubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2j06j07particleCurrent HIV/AIDS reports, vol 16, iss 4349 - 358oai:escholarship.org:ark:/13030/qt71m422682022-11-01T18:46:09Zqt71m42268Impacts of COVID-19 on HIV/AIDS-Related Services in California.Koester, Kimberly AFuller, Shannon MSteward, Wayne TArnold, Emily A2022-01-01The degree to which COVID-19 has disrupted the advances in reducing new HIV infections and preventing AIDS-related deaths is unknown. We present findings related to the effect COVID-19 had on HIV, sexual health and harm reduction service delivery in the state of California. We conducted a qualitative rapid assessment with health care providers, as well as representatives from non-medical support service agencies serving clients living with HIV in a range of counties in California. Some organizations adapted fairly easily while others struggled or were unable to adapt at all. Clinics were better positioned than community-based organizations to accommodate COVID restrictions and to quickly reestablish services. Influential forces that softened or calcified the hardships created by COVID-19 included influx of funding, flexibility in managing funds, networking and relationships, and workforce vulnerabilities. These data clearly suggest that an enhanced level of flexibility within funding streams and reporting requirements should be continued.Acquired Immunodeficiency Syndrome: epidemiologyCOVID-19California: epidemiologyHIV Infections: prevention & controlHealth PersonnelHumansapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/71m42268articleoai:escholarship.org:ark:/13030/qt07c6r5p82020-08-20T20:17:45Zqt07c6r5p8Attitudes about community pharmacy access to HIV prevention medications in CaliforniaKoester, Kimberly ASaberi, ParyaFuller, Shannon MArnold, Emily ASteward, Wayne T2020-08-13Objective: Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP.Methods: We conducted a qualitative case study with key pharmacy stakeholders. Semi- structured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences.Results: We launched the study in October 2018 and interviewed pharmacists (n 1⁄4 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n 1⁄4 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n 1⁄4 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: com- munity pharmacists are widely accessible, PrEP and PEP protocols are similar to other pre- ventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to di- agnose and treat other health conditions.Conclusion: This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This in- formation may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.HIVPrEPpharmacypolicyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/07c6r5p8articleoai:escholarship.org:ark:/13030/qt76q4f8b12020-05-01T18:38:31Zqt76q4f8b1Documenting best practices for maintaining access to HIV prevention, care and treatment in an era of shifting immigration policy and discourseArnold, Emily AFuller, Shannon MMartinez, OmarLechuga, JuliaSteward, Wayne T2020-02-18Changes in the United States federal-level political landscape have been felt within immi- grant communities, and the public health clinics that serve them. We sought to document how HIV prevention and care clinics are reaching and retaining their immigrant community patients during a period of retrenchment of accessible public resources and immigrant rights. From May 2018 through January 2019, we conducted 20 in-depth interviews with cli- nicians, case workers, advocates, legal experts, and peer navigators in Northern and Cen- tral California. Interviews were recorded and transcribed. Several themes emerged which can be grouped into three primary areas: changes post-election, challenges meeting the needs of patients, and best practices for maintaining access to prevention and care ser- vices. Post-election, providers reported some of their patients skipping clinic appointments due to fear of Immigration and Customs Enforcement (ICE) raids and deportation while other patients had moved to locations that they felt were less policed. Challenges emerged around linguistic competency, meeting basic needs such as housing stability and employ- ment, and treating mental health sequelae resulting from trauma experienced in home coun- tries or during migration itself. Best practices included hiring bi-lingual and bi-cultural staff, linking to legal services to assist with immigration status, holding trainings around immigrant rights and responses to ICE raids, and building trust with immigrant patients by assuring them that their status would not be collected or reported. In light of adverse policy changes affecting immigrants, agencies have begun to institute best practices to mitigate the nega- tive impact of those policies on their clients and patients.HIVImmigrationEngagement in Careapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/76q4f8b1articlePLOS ONE, vol 15, iss 2e0229291oai:escholarship.org:ark:/13030/qt75m1s0z12020-05-01T18:38:15Zqt75m1s0z1Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from CaliforniaFuller, Shannon MSteward, Wayne TMartinez, OmarArnold, Emily A2019-07-22The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical–legal part- nerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations.HIVImmigrationLegalpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/75m1s0z1articleJournal of Immigrant and Minority Health, vol 22, iss 1212 - 215oai:escholarship.org:ark:/13030/qt2wd2z3v62020-05-01T18:36:38Zqt2wd2z3v6Shaping the Patient-Centered Medical Home to the Needs of HIV Safety Net Patients: The Impact of Stigma and the Need for TrustSteward, Wayne TKoester, Kimberly AFuller, Shannon M2018-11-01The patient-centered medical home (PCMH) is a promising model for increasing the efficiency and quality of HIV care. We evaluated the implementation of PCMH-related demonstration projects in HIV care settings serving safety net populations. We conducted 113 qualitative interviews with key informants and patients to understand which PCMH components were perceived as best meeting patient medical and support service needs. Our results demonstrate the value and limitations of the PCMH, as currently conceived, for HIV care settings. Clinics focused on modifying workflows and improving care coordination. Patients welcomed such changes because they reinforced existing trust in the providers. Clinics dedicated less attention to promoting patient activation, such as building self-management skills, because such changes were seen as duplicative or undermined existing practices to meet patient social support needs. Research should explore how components of the PCMH could be modified to more fully meet the needs of this patient population.HIVpatient centered medical homestigmatrustpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2wd2z3v6articleJournal of the Association of Nurses in AIDS Care, vol 29, iss 6807 - 821oai:escholarship.org:ark:/13030/qt2q10r8tx2020-05-01T18:35:58Zqt2q10r8txThe Impact Of Medicaid Expansion On People Living With HIV And Seeking Behavioral Health ServicesArnold, Emily AFuller, ShannonKirby, ValerieSteward, Wayne T2018-09-01While Medicaid expansion created healthcare access for millions in California, its impact on people living with HIV (PLWH) is more nuanced. Newly covered PLWH with behavioral health needs had to navigate separate mental health and substance use care systems, rather than receiving them in integrated care settings as they had under the Ryan HIV/AIDS White Program (RWHAP). We conducted 47 interviews to examine the impact of Medicaid expansion on PLWH with behavioral health needs in California. California’s historical division in its Medicaid funding streams created challenges in determining which payer should cover clients’ behavioral healthcare. Compounding these challenges was a perceived lack of cultural competence for serving PLWH, insufficient infrastructure to facilitate continuity of care, and unmet need for non-medical supportive services. The multi-payer model under health reform has compromised the administrative simplicity and integrated delivery of HIV and behavioral health services previously available to uninsured patients through the RWHAP.application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2q10r8txarticleHealth Affairs, vol 37, iss 91450 - 1456oai:escholarship.org:ark:/13030/qt2qb2g5nv2018-07-10T05:44:16Zqt2qb2g5nvHuman Immunodeficiency Virus Type 1 Nef Inhibits Autophagy through Transcription Factor EB SequestrationCampbell, GRRawat, PBruckman, RSSpector, SA2015-01-01© 2015 Campbell et al. HIV Nef acts as an anti-autophagic maturation factor through interaction with beclin-1 (BECN1). We report that exposure of macrophages to infectious or non-infectious purified HIV induces toll-like receptor 8 (TLR8) and BECN1 dependent dephosphorylation and nuclear translocation of TFEB and that this correlates with an increase in autophagy markers. RNA interference for ATG13, TFEB, TLR8, or BECN1 inhibits this HIV-induced autophagy. However, once HIV establishes a productive infection, TFEB phosphorylation and cytoplasmic sequestration are increased resulting in decreased autophagy markers. Moreover, by 7 d post-infection, autophagy levels are similar to mock infected controls. Conversely, although Nef deleted HIV similarly induces TFEB dephosphorylation and nuclear localization, and increases autophagy, these levels remain elevated during continued productive infection. Thus, the interaction between HIV and TLR8 serves as a signal for autophagy induction that is dependent upon the dephosphorylation and nuclear translocation of TFEB. During permissive infection, Nef binds BECN1 resulting in mammalian target of rapamycin (MTOR) activation, TFEB phosphorylation and cytosolic sequestration, and the inhibition of autophagy. To our knowledge, this is the first report of a virus modulating TFEB localization and helps to explain how HIV modulates autophagy to promote its own replication and cell survival.application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2qb2g5nvarticlePLoS Pathogens, vol 11, iss 6oai:escholarship.org:ark:/13030/qt7x81h91p2018-07-10T01:39:58Zqt7x81h91pCommunity member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: Implications for implementationGalindo, GRWalker, JJHazelton, PLane, TSteward, WTMorin, SFArnold, EA2012-11-26Background: An international randomized clinical trial (RCT) on pre-exposure prophylaxis (PrEP) as an human immunodeficiency virus (HIV)-prevention intervention found that taken on a daily basis, PrEP was safe and effective among men who have sex with men (MSM) and male-to-female transgender women. Within the context of the HIV epidemic in the United States (US), MSM and transgender women are the most appropriate groups to target for PrEP implementation at the population level; however, their perspectives on evidenced-based biomedical research and the results of this large trial remain virtually unknown. In this study, we examined the acceptability of individual daily use of PrEP and assessed potential barriers to community uptake.Methods: We conducted semi-structured interviews with an ethnoracially diverse sample of thirty HIV-negative and unknown status MSM (n = 24) and transgender women (n = 6) in three California metropolitan areas. Given the burden of disease among ethnoracial minorities in the US, we purposefully oversampled for these groups. Thematic coding and analysis of data was conducted utilizing an approach rooted in grounded theory.Results: While participants expressed general interest in PrEP availability, results demonstrate: a lack of community awareness and confusion about PrEP; reservations about PrEP utilization, even when informed of efficacious RCT results; and concerns regarding equity and the manner in which a PrEP intervention could be packaged and marketed in their communities.Conclusions: In order to effectively reduce HIV health disparities at the population level, PrEP implementation must take into account the uptake concerns of those groups who would actually access and use this biomedical intervention as a prevention strategy. Recommendations addressing these concerns are provided. © 2012 Galindo et al.; licensee BioMed Central Ltd.application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7x81h91particleImplementation Science, vol 7, iss 1oai:escholarship.org:ark:/13030/qt6nm0383n2017-11-01T22:07:58Zqt6nm0383nPlasma Tenofovir-levels to Support Adherence to TDF/FTC Pre-exposure Prophylaxis for HIV Prevention in MSM in Los Angeles, CaliforniaLandovitz, Raphael JBeymer, MatthewKofron, RyanAmico, K. RivetPsaros, ChristinaBushman, LaneAnderson, Peter LFlynn, RisaLee, David PBolan, Robert KJordan, Wilbert CTseng, Chi-HongDierst-Davies, RhodriRooney, JimWohl, Amy Rock2017-09-01publiceScholarship, University of Californiahttps://escholarship.org/uc/item/6nm0383narticleoai:escholarship.org:ark:/13030/qt6fj963112017-09-14T00:50:59Zqt6fj96311Longitudinal imaging of HIV-1 spread in humanized mice with parallel 3D immunofluorescence and electron tomographyKieffer, CollinLadinsky, Mark SNinh, AllenGalimidi, Rachel PBjorkman, Pamela J2017-02-15publiceScholarship, University of Californiahttps://escholarship.org/uc/item/6fj96311articleeLife, vol 6oai:escholarship.org:ark:/13030/qt273484zb2017-09-14T00:49:20Zqt273484zbMultiscale imaging of HIV-1 transmission in humanized miceKieffer, CollinLadinsky, Mark SBjorkman, Pamela J2017-09-07application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/273484zbarticleoai:escholarship.org:ark:/13030/qt5148h1vs2016-06-03T01:40:35Zqt5148h1vsA comparison of HIV testing protocols with Latino day laborersGalvan, Frank HWohl, Amy RockCarlos, Juli-AnnChen, Ying-Tung2016-03-22This project compared two HIV testing protocols, an HIV test alone or as part of a bundled package with other tests, to examine which resulted in a higher test uptake in a sample of 725 Latino day laborers. The testing uptake was 29.1% for the HIV-only protocol and 13.6% for the HIV-bundled protocol (p < 0.001). Thus higher levels of testing among day laborers may occur when the HIV test is offered alone. However, no HIV-positive tests were found and few risk behaviors reported. This would argue against the need for routine HIV screening with this population as a whole. HIV testing among Latino day laborers should target those involved in actual high HIV risk behaviors, such as unprotected sex with men or injection drug use.HIV testingbundlingLatinosday laborersimmigrantsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/5148h1vsarticleJournal of HIV/AIDS & Social Services, vol 15, iss 169 - 82oai:escholarship.org:ark:/13030/qt34t0d3nt2016-06-03T01:01:22Zqt34t0d3ntChronic Stress Among Latino Day LaborersGalvan, F. HWohl, A. RCarlos, J.-A.Chen, Y.-T.2015-02-20Latino day laborers endure many hardships as they struggle to adjust as an immigrant community in the United States. This study sought to identify the extent of chronic stress reported by day laborers and the factors associated with stress. 725 Latino day laborers were interviewed. The most reported sources of stress were having immigration-related problems, not having enough money to cover basic needs, having no savings and having work hours change for the worse. Higher chronic stress was associated with homelessness (p < .001) and HIV-related risk behaviors in the previous twelve months (p < .05). In addition, chronic stress was found to be higher among respondents reporting incomes of $5,000 to $10,000 (p = 0.007) and still higher among respondents reporting incomes greater than $10,000 (p < 0.001) compared to those in the lowest income level. Lower chronic stress was associated with having a partner (p < .05) or being single (p = .001) compared to being married. Addressing the stress experienced by day laborers is necessary to prevent potential negative health and mental health consequences among this population.Latinosday laborersimmigrantschronic stressapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/34t0d3ntarticleHispanic Journal of Behavioral Sciences, vol 37, iss 175 - 89oai:escholarship.org:ark:/13030/qt4vt6h9b92016-04-22T20:04:15Zqt4vt6h9b9Vitamin D levels and markers of inflammation and metabolism in HIV-infected individuals in suppressive antiretroviral therapyHoffman, Risa2015-01-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4vt6h9b9articleAIDS Research and Human Retroviruses, vol 31, iss 00oai:escholarship.org:ark:/13030/qt4867h2q62016-03-05T00:57:09Zqt4867h2q6The immunologic effects of mesalamine in treated HIV-infected individuals with incomplete CD4+ T cell recovery: a randomized crossover trial.Somsouk, MaDunham, Richard MCohen, MichelleAlbright, RebeccaAbdel-Mohsen, MohamedLiegler, TeriLifson, JeffreyPiatak, MichaelGorelick, RobertHuang, YongWu, YuanerHsue, Priscilla YMartin, Jeffrey NDeeks, Steven GMcCune, Joseph MHunt, Peter W2014-12-29The anti-inflammatory agent, mesalamine (5-aminosalicylic acid) has been shown to decrease mucosal inflammation in ulcerative colitis. The effect of mesalamine in HIV-infected individuals, who exhibit abnormal mucosal immune activation and microbial translocation (MT), has not been established in a placebo-controlled trial. We randomized 33 HIV-infected subjects with CD4 counts <350 cells/mm3 and plasma HIV RNA levels <40 copies/ml on antiretroviral therapy (ART) to add mesalamine vs. placebo to their existing regimen for 12 weeks followed by a 12 week crossover to the other arm. Compared to placebo-treated subjects, mesalamine-treated subjects did not experience any significant change in the percent CD38+HLA-DR+ peripheral blood CD4+ and CD8+ T cells at week 12 (P = 0.38 and P = 0.63, respectively), or in the CD4+ T cell count at week 12 (P = 0.83). The percent CD38+HLA-DR+ CD4+ and CD8+ T cells also did not change significantly in rectal tissue (P = 0.86, P = 0.84, respectively). During the period of mesalamine administration, plasma sCD14, IL-6, D-dimer, and kynurenine to tryptophan ratio were not changed significantly at week 12 and were similarly unchanged at week 24. This study suggests that, at least under the conditions studied, the persistent immune activation associated with HIV infection is not impacted by the anti-inflammatory effects of mesalamine.ClinicalTrials.gov NCT01090102.Biomarkers: metabolismBrachial Artery: drug effectsphysiopathologyCD4-Positive T-Lymphocytes: drug effectsimmunologyCardiovascular Diseases: immunologyphysiopathologyvirologyCross-Over StudiesFemaleFollow-Up StudiesHIV Infections: drug therapyimmunologyHumansInflammation: pathologyLymphocyte Activation: immunologyMaleMesalamine: adverse effectspharmacologytherapeutic useMiddle AgedRectum: pathologySolubilityVasodilation: drug effectsapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4867h2q6articlePloS one, vol 9, iss 12e116306 - e1163e116306oai:escholarship.org:ark:/13030/qt31v5s9vr2016-03-04T23:41:04Zqt31v5s9vrNucleic acid template and the risk of a PCR-Induced HIV-1 drug resistance mutation.Varghese, ViciWang, ElijahBabrzadeh, FarbodBachmann, Michael HShahriar, RajinLiu, TommyMappala, Svetlana Jean MGharizadeh, BabackFessel, W JeffreyKatzenstein, DavidKassaye, SebleShafer, Robert W2010-06-07The HIV-1 nucleoside RT inhibitor (NRTI)-resistance mutation, K65R confers intermediate to high-level resistance to the NRTIs abacavir, didanosine, emtricitabine, lamivudine, and tenofovir; and low-level resistance to stavudine. Several lines of evidence suggest that K65R is more common in HIV-1 subtype C than subtype B viruses.We performed ultra-deep pyrosequencing (UDPS) and clonal dideoxynucleotide sequencing of plasma virus samples to assess the prevalence of minority K65R variants in subtype B and C viruses from untreated individuals. Although UDPS of plasma samples from 18 subtype C and 27 subtype B viruses showed that a higher proportion of subtype C viruses contain K65R (1.04% vs. 0.25%; p<0.001), limiting dilution clonal sequencing failed to corroborate its presence in two of the samples in which K65R was present in >1.5% of UDPS reads. We therefore performed UDPS on clones and site-directed mutants containing subtype B- and C-specific patterns of silent mutations in the conserved KKK motif encompassing RT codons 64 to 66 and found that subtype-specific nucleotide differences were responsible for increased PCR-induced K65R mutation in subtype C viruses.This study shows that the RT KKK nucleotide template in subtype C viruses can lead to the spurious detection of K65R by highly sensitive PCR-dependent sequencing techniques. However, the study is also consistent with the subtype C nucleotide template being inherently responsible for increased polymerization-induced K65R mutations in vivo.Base SequenceDNA PrimersDNAViral: geneticsDrug ResistanceViral: geneticsHIV-1: drug effectsgeneticsMutagenesisSite-DirectedMutationPlasmidsPolymerase Chain ReactionTemplatesGeneticpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/31v5s9vrarticlePloS one, vol 5, iss 6e10992 - e109e10992oai:escholarship.org:ark:/13030/qt2j8581md2016-03-04T23:40:20Zqt2j8581mdStandardized comparison of the relative impacts of HIV-1 reverse transcriptase (RT) mutations on nucleoside RT inhibitor susceptibility.Melikian, George LRhee, Soo-YonTaylor, JonathanFessel, W JeffreyKaufman, DavidTowner, WilliamTroia-Cancio, Paolo VZolopa, AndrewRobbins, Gregory KKagan, RonIsraelski, DennisShafer, Robert W2012-05-13Determining the phenotypic impacts of reverse transcriptase (RT) mutations on individual nucleoside RT inhibitors (NRTIs) has remained a statistical challenge because clinical NRTI-resistant HIV-1 isolates usually contain multiple mutations, often in complex patterns, complicating the task of determining the relative contribution of each mutation to HIV drug resistance. Furthermore, the NRTIs have highly variable dynamic susceptibility ranges, making it difficult to determine the relative effect of an RT mutation on susceptibility to different NRTIs. In this study, we analyzed 1,273 genotyped HIV-1 isolates for which phenotypic results were obtained using the PhenoSense assay (Monogram, South San Francisco, CA). We used a parsimonious feature selection algorithm, LASSO, to assess the possible contributions of 177 mutations that occurred in 10 or more isolates in our data set. We then used least-squares regression to quantify the impact of each LASSO-selected mutation on each NRTI. Our study provides a comprehensive view of the most common NRTI resistance mutations. Because our results were standardized, the study provides the first analysis that quantifies the relative phenotypic effects of NRTI resistance mutations on each of the NRTIs. In addition, the study contains new findings on the relative impacts of thymidine analog mutations (TAMs) on susceptibility to abacavir and tenofovir; the impacts of several known but incompletely characterized mutations, including E40F, V75T, Y115F, and K219R; and a tentative role in reduced NRTI susceptibility for K64H, a novel NRTI resistance mutation.Adenine: administration & dosageanalogs & derivativestherapeutic useAlgorithmsAnti-HIV Agents: administration & dosagetherapeutic useDideoxynucleosides: administration & dosagetherapeutic useDrug ResistanceMultipleViral: drug effectsgeneticsGenomicsGenotypeHIV Infections: drug therapyvirologyHIV Reverse Transcriptase: antagonists & inhibitorsgeneticsHIV-1: drug effectsgeneticsisolation & purificationHumansLeast-Squares AnalysisMutationNucleosides: geneticsOrganophosphonates: administration & dosagetherapeutic usePhenotypeReverse Transcriptase Inhibitors: administration & dosagetherapeutic useTenofovirThymidine: administration & dosagetherapeutic useZidovudine: administration & dosagetherapeutic usepubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2j8581mdarticleAntimicrobial agents and chemotherapy, vol 56, iss 52305 - 2313oai:escholarship.org:ark:/13030/qt0hv6f8sx2016-03-04T23:39:28Zqt0hv6f8sxCollinearity of protease mutations in HIV-1 samples with high-level protease inhibitor class resistance.Babrzadeh, FarbodVarghese, ViciPacold, MaryLiu, Tommy FNyrén, PålSchiffer, CeliaFessel, W JeffreyShafer, Robert W2013-02-19To determine whether pan-protease inhibitor (PI)-resistant virus populations are composed predominantly of viruses with resistance to all PIs or of diverse virus populations with resistance to different subsets of PIs.We performed deep sequencing of plasma virus samples from nine patients with high-level genotypic and/or phenotypic resistance to all licensed PIs. The nine virus samples had a median of 12 PI resistance mutations by direct PCR Sanger sequencing.For each of the nine virus samples, deep sequencing showed that each of the individual viruses within a sample contained nearly all of the mutations detected by Sanger sequencing. Indeed, a median of 94.9% of deep sequence reads had each of the PI resistance mutations present as a single chromatographic peak in the Sanger sequence. A median of 5.0% of reads had all but one of the Sanger mutations that were not part of an electrophoretic mixture.The collinearity of PI resistance mutations in the nine virus samples demonstrated that pan-PI-resistant viruses are able to replicate in vivo despite their highly mutated protease enzymes. We hypothesize that the marked collinearity of PI resistance mutations in pan-PI-resistant virus populations results from the unique requirements for multi-PI resistance and the extensive cross-resistance conferred by many of the accessory PI resistance mutations.Drug ResistanceViralHIV Protease: geneticsHIV Protease Inhibitors: pharmacologyHIV-1: drug effectsgeneticsisolation & purificationHigh-Throughput Nucleotide SequencingHumansMicrobial Sensitivity TestsMutationMissensePlasma: virologyRNAViral: geneticspubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0hv6f8sxarticleThe Journal of antimicrobial chemotherapy, vol 68, iss 2414 - 418oai:escholarship.org:ark:/13030/qt8nx9j50z2015-11-11T00:53:02Zqt8nx9j50zC-Terminal Domain of Integrase Binds between the Two Active SitesRoberts, Victoria A.2015-07-22application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8nx9j50zarticleJournal of Chemical Theory and Computation, vol 11, iss 94500 - 4511oai:escholarship.org:ark:/13030/qt1bq2q26h2015-10-14T17:51:02Zqt1bq2q26hSupporting policy interventions for injection drug users: The importance of building partnerships between pharmacies and local health jurisdictionsRose, Valerie J2015-10-14Not available. Manuscript unpublished.Injection drug userspharmacypolicynon-prescription syringe salesapplication/pdfCC-BY-NC-NDeScholarship, University of Californiahttps://escholarship.org/uc/item/1bq2q26harticleoai:escholarship.org:ark:/13030/qt23p4b8hb2015-10-14T17:50:35Zqt23p4b8hbPrimary and Secondary Analysis of Local Elected Officials’ Decisions to Support or Oppose Pharmacy Sale of Syringes in CaliforniaBackes, GlennRose, Valerie J2010-07-01Under California law, local governments may authorize pharmacies within their jurisdictions to sell ten or fewer syringes to an adult without prescription, proof of identity, or proof of medical need. Local governments may simultaneously exempt adults from prosecution for violation of state drug paraphernalia codes for possession of ten or fewer syringes for personal use. Both of these provisions are temporary and sunset on December 31, 2010, unless subsequent state legislation amends that date. The objective of our study was to ascertain how and why local policymakers made their decisions regarding non-prescription syringe sale (NPSS). We examined influences on their decisions, including specific messengers and the arguments that were most salient to their decision making. We selected jurisdictions that were geographically representa tive of California counties; those with and without syringe exchange programs, and those that had passed or rejected NPSS. We conducted nine semi-structured interviews in five jurisdictions. To enrich primary data collection, we analyzed secondary data by reviewing audio, video, and written transcripts of public hearings and newspaper coverage in five jurisdictions, including three jurisdictions without primary interview data. Among proponents of NPSS, we identified common themes, including: (1) public ealth research provided conclusive evidence for reduction in HIV and hepatitis transmission without problems of crime, drug use, or unsafe discard of syringes; (2) the local health officer was the key to influencing local policymakers; (3) recall of prior debates over syringe exchange served to inform their decision making; and (4) a lack of local opposition or controversy. Common concerns among opponents of NPSS included: (1) that there would be an increase in unsafe discard of syringes; (2) loss of an important law enforcement tool; (3) that drug users were incapable of desired behavior change; and (4) that research was inconclusive, or proved that syringe access would not work in reducing rates of disease. Themes held in common by proponents and opponents of NPSS were identified as well. Syringe access through NPSS is in fact supported by a robust body of public health research and is considered an important component of a comprehensive strategy to reduce HIV and hepatitis transmission. Our study highlights the importance of understanding the perspectives of elected officials in order to ameliorate their concerns without undermining the public health goal of reducing death, disease, and suffering in at-risk communities. Policypharmacynon-prescription syringe salespublic policyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/23p4b8hbmonographJournal of Urban Health, vol 87, iss 4oai:escholarship.org:ark:/13030/qt6s29d4032015-09-28T22:46:42Zqt6s29d403Plasmacytoid dendritic cell number and responses to Toll-like receptor 7 and 9 agonists vary in HIV Type 1-infected individuals in relation to clinical state.Kaushik, ShwetaTeque, FernandoPatel, MiraFujimura, Sue HSchmidt, BarbaraLevy, Jay A2013-03-15In HIV-1 infection, plasmacytoid dendritic cell (PDC) numbers and function are decreased. No detailed comparisons of PDC responses to various stimuli in HIV-1-infected patients are available. Using for the first time purified PDCs, we compared PDC responses [interferon (IFN)-α production/cell] to various stimuli in a large number (n=48) of HIV-1-infected patients and healthy volunteers (n=19). Toll-like receptor (TLR)7- and TLR9-induced expression of PDC surface activation and maturation markers was also compared in the two populations. We have confirmed that PDC number coincides with CD4(+) T cell counts and clinical state. Notably, we have shown that a direct association of PDC function in terms of IFN-α production/cell exists with PDC numbers and CD4(+) cell counts when PDCs are exposed to a TLR9 ligand and HIV-infected cells, but not with a TLR7 ligand. Moreover, in the HIV-infected subjects but not the healthy controls, the magnitude of IFN-α release per PDC in response to the TLR7 ligand is significantly (p<0.01) lower than that to the TLR9 ligand. However, in both study populations, the TLR7 stimulation in comparison to TLR9 stimulation induced higher expression of PDC surface activation and maturation markers and significantly (p<0.05) decreased the expression of BDCA-2, a negative regulator of interferon. Furthermore, the cross-ligation of BDCA-2 significantly (p<0.05) inhibited TLR9- but not TLR7-induced IFN-α production by PDCs from both clinical groups. These findings suggest that differences exist in TLR7- and TLR9-induced IFN-α production by PDCs in HIV-infected individuals that are not directly related to BDCA-2 down-modulation.AdultAgedCD4-Positive T-Lymphocytes: immunologyDendritic Cells: immunologyFemaleHIV Infections: immunologypathologyHIV-1: pathogenicityHumansInterferon-alpha: secretionLectinsC-Type: biosynthesisLeukocyte CountMaleMembrane Glycoproteins: biosynthesisMiddle AgedReceptorsImmunologic: biosynthesisToll-Like Receptor 7: agonistsimmunologyToll-Like Receptor 9: agonistsimmunologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6s29d403articleAIDS research and human retroviruses, vol 29, iss 3501 - 510oai:escholarship.org:ark:/13030/qt2h63c9r42015-09-28T22:46:08Zqt2h63c9r4Virus-host interactions in HIV pathogenesis: directions for therapy.Levy, J A2011-04-01The challenge of controlling HIV infection involves an understanding of the heterogeneity of the virus, its wide cellular host range, its primary routes of transmission, and the immunologic and intrinsic cellular factors that can prevent its transmission and replication. Identification of HIV-infected individuals who have survived more than 10 years without signs of the infection and without therapy encourages studies examining the natural mechanisms for resistance to infection and disease. Within the immune system, emphasis should be given to the innate or natural response that appears within minutes of the infection and offers the optimal time for controlling HIV. All these parameters in HIV pathogenesis underline the information needed to develop optimal anti-HIV therapies and an effective AIDS vaccine.AntibodiesBlocking: physiologyCD4-Positive T-Lymphocytes: virologyCD8-Positive T-Lymphocytes: physiologyHIV Infections: drug therapyimmunologyvirologyHIV Long-Term SurvivorsHIV-1: geneticsimmunologyHost-Pathogen Interactions: geneticsimmunologyHumansImmunityInnate: physiologyMacrophages: virologyVirus InternalizationVirus Replicationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2h63c9r4articleAdvances in dental research, vol 23, iss 113 - 18oai:escholarship.org:ark:/13030/qt3n83670z2015-09-28T22:45:39Zqt3n83670zHIV/AIDS: 30 years of progress and future challenges.Killian, M ScottLevy, Jay A2011-12-01Acquired immune deficiency syndrome (AIDS) was first described 30 years ago in a report from the US Centers for Disease Control. Two years later the causative virus was identified and afterwards named the human immunodeficiency virus (HIV). This article reviews the progress made in the three decades since the recognition of AIDS and the discovery of HIV, with respect to the virus, the infected cell, and the host, as well as directions for future studies.Acquired Immunodeficiency Syndrome: drug therapyimmunologyvirologyAnimalsForecastingHIV: immunologyHIV Infections: drug therapyimmunologyvirologyHumansapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3n83670zarticleEuropean journal of immunology, vol 41, iss 123401 - 3411oai:escholarship.org:ark:/13030/qt7nr8k5p22015-09-28T22:44:33Zqt7nr8k5p2A metallopeptide assembly of the HIV-1 gp41 coiled coil is an ideal receptor in fluorescence detection of ligand binding.Gochin, Miriam, PhDGuy, Rodney K, PhDCase, Martin A, PhD2003-11-1022'-Dipyridyl: chemistryAmino Acid SequenceCell Membrane: chemistrymetabolismCircular DichroismFluorescence Resonance Energy TransferHIV Envelope Protein gp41: chemistrymetabolismHIV-1: metabolismHumansIron: chemistryLigandsMagnetic Resonance SpectroscopyMetalloproteins: chemistryMolecular Sequence DataNickel: chemistryPeptides: chemistryProtein BindingProtein StructureTertiaryapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7nr8k5p2articleAngewandte Chemie (International ed. in English), vol 42, iss 435325 - 5328oai:escholarship.org:ark:/13030/qt8wt6w8hp2015-09-28T22:39:05Zqt8wt6w8hpNatural suppression of human immunodeficiency virus type 1 replication is mediated by transitional memory CD8+ T cells.Killian, M ScottJohnson, CarlTeque, FernandoFujimura, SueLevy, Jay A2011-02-08HIV replication is suppressed in vitro by a CD8(+) cell noncytotoxic antiviral response (CNAR). This activity directly correlates with an asymptomatic clinical state. The objective of this study was to identify the phenotype of CD8(+) cell subsets having strong CNAR activity. CD8(+) cell subset frequencies and CNAR levels were measured for human immunodeficiency virus (HIV)-uninfected individuals and three groups of HIV type 1 (HIV-1)-infected individuals: asymptomatic individuals with low-level viremia (vHIV), antiretroviral-drug-treated subjects with undetectable virus levels (TxHIV), and therapy-naïve aviremic elite controllers (EC). CD8(+) cells from the vHIV individuals exhibited the highest HIV-suppressing activity and had elevated frequencies of CD45RA(-) CD27(+) and PD-1(+) (CD279(+)) cells. Functional assessments of CD8(+) cells sorted into distinct subsets established that maximal CNAR activity was mediated by CD45RA(-) CCR7(-) CD27(+) and PD-1(+) CD8(+) cells. T cell receptor (TCR) repertoire profiles of CD8(+) cell subsets having strong CNAR activity exhibited increased perturbations in comparison to those of inactive subsets. Together, these studies suggest that CNAR is driven by HIV replication and that this antiviral activity is associated with oligoclonally expanded activated CD8(+) cells expressing PD-1 and having a transitional memory cell phenotype. The findings better describe the identity of CD8(+) cells showing CNAR and should facilitate the evaluation of this important immune response in studies of HIV pathogenesis, resistance to infection, and vaccine development.AdultAntigensCD: metabolismApoptosis Regulatory Proteins: metabolismCD8-Positive T-Lymphocytes: immunologyFemaleHIV Infections: immunologyvirologyHIV-1: immunologyphysiologyHumansImmunologic Memory: immunologyLymphocyte ActivationMaleMiddle AgedProgrammed Cell Death 1 ReceptorT-Lymphocyte Subsets: immunologyViral LoadVirus Replication: immunologyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/8wt6w8hparticleJournal of virology, vol 85, iss 41696 - 16705oai:escholarship.org:ark:/13030/qt3wr3t9x22015-09-24T19:35:09Zqt3wr3t9x2Single Room Occupancy (SRO) hotels as mental health risk environments among impoverished women: the intersection of policy, drug use, trauma, and urban spaceKnight, Knight R.Lopez, Andrea M.Comfort, MeganShumway, MarthaCohen, JenniferRiley, Elise2013-11-08Due to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consideration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women. We report data from a qualitative interview study (n=30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs. Women in the study lived in a range of SRO built environments, from publicly-funded, newly built SROs to privately-owned, dilapidated buildings, which presented a rich opportunity for ethnographic comparison. Applying Rhodes et al.’s framework of socio-structural vulnerability, we explore how SROs can operate as “mental health risk environments” in which macro-structural factors (housing policies shaping the built environment) interact with meso-level factors (social relations within SROs) and micro-level, behavioral coping strategies to impact women’s mental health. The degree to which SRO built environments were “trauma-sensitive” at the macro level significantly influenced women’s mental health at meso- and micro- levels. Women who were living in SROs which exacerbated fear and anxiety attempted, with limited success, to deploy strategies on the meso- and micro- level to manage their mental health symptoms. Study findings underscore the importance of housing polices which consider substance use in the context of current and cumulative trauma experiences in order to improve quality of life and mental health for unstably housed women.built environmentSRO hotelswomentraumamental healthdrug useethnographyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3wr3t9x2articleThe International journal on drug policy, vol 25, iss 3556 - 561oai:escholarship.org:ark:/13030/qt90q9r9xt2015-09-24T19:34:15Zqt90q9r9xtNon-prescription Syringe Sales in California: A Qualitative Examination of Practices among 12 Local Health JurisdictionsRose, Valerie J2010-07-01Legislation permitting non-prescription syringe sales (NPSS) was passed in2004 in California as a structural intervention designed to expand access to syringes for injection drug users. As of December 2009, 19 of California’s 61 local health jurisdictions (LHJs) have approved policies to authorize pharmacies to sell nonprescription syringes. The legislation faces termination in 2010 if current evaluationefforts fail to demonstrate outcomes defined in the legislation. Using qualitative methods, we examined the systems and procedures associated with implementation; identified facilitators and barriers to implementation among 12 LHJs, and documented the role of public health in initiating and sustaining local programs. We identified consistent activities that led to policy implementation among LHJs and discovered several barriers that were associated with failure to implement local programs. Factors leading to NPSS were public health leadership; an inclusive planning process, marketing the program as a public health initiative; learning from others’ efforts, successes, andfailures; and identifying acceptable syringe disposal options in advance of programimplementation. Health departments that were confronted with political and moralarguments lost momentum and ultimately assigned a lower priority to the initiativeciting the loss of powerful public health advocates or a lack of human resources.Additional barriers were law enforcement, elected officials, and pharmacy opposition,and failure to resolve syringe disposal options to the satisfaction of importantstakeholders. The lessons learned in this study should provide useful guidance for the remaining LHJs in California without NPSS programs.Non-prescription syringe salesIDULocal health jurisdictionSB1159PharmacyCaliforniaapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/90q9r9xtarticleJournal of Urban Health, vol 87, iss 4oai:escholarship.org:ark:/13030/qt8n6009362015-09-24T19:33:44Zqt8n600936Conserved herpesviral kinase promotes viral persistence by inhibiting the IRF-3-mediated type I interferon responseHwang, SeungminKim, KyeongFlano, EmilioWu, Ting-TingTong, LemingPark, AnnSong, MoonSanchez, DavidO’Connell, RyanCheng, GenhongSun, Ren2009-02-19publiceScholarship, University of Californiahttps://escholarship.org/uc/item/8n600936articleCell Host & Microbe, vol 5, iss 2oai:escholarship.org:ark:/13030/qt50k061z92015-09-24T19:19:17Zqt50k061z9Human NK cell repertoire diversity reflects immune experience and correlates with viral susceptibilityBlish, Catherine A2015-07-01publiceScholarship, University of Californiahttps://escholarship.org/uc/item/50k061z9articleScience Translational Medicine, vol 297, iss 297oai:escholarship.org:ark:/13030/qt0ws7d2pg2015-09-24T19:18:12Zqt0ws7d2pgLearning From and With Incarcerated Women: Emerging Lessons from a Participatory Action Study of Sexuality EducationFields, Jessica2008-01-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0ws7d2pgarticleSexuality Research and Social Policy, vol 5, iss 2oai:escholarship.org:ark:/13030/qt9w77b4kb2015-09-18T01:26:49Zqt9w77b4kbTuberculosis from Mycobacterium bovis in Binational Communities, United StatesRodwell, Timothy C.Moore, MarisaMoser, Kathleen S.Brodine, Stephanie K.Strathdee, Steffanie A.2008-06-01The incidence in San Diego is increasing and is concentrated mostly in persons of Mexican origin.The epidemiology of tuberculosis (TB) in the United States is changing as the incidence of disease becomes more concentrated in foreign-born persons. Mycobacterium bovis appears to be contributing substantially to the TB incidence in some binational communities with ties to Mexico. We conducted a retrospective analysis of TB case surveillance data from the San Diego, California, region from 1994 through 2005 to estimate incidence trends, identify correlates of M. bovis disease, and evaluate risk factors for deaths during treatment. M. bovis accounted for 45% (62/138) of all culture-positive TB cases in children (<15 years of age) and 6% (203/3,153) of adult cases. M. bovis incidence increased significantly (p = 0.002) while M. tuberculosis incidence declined (p<0.001). Almost all M. bovis cases from 2001 through 2005 were in persons of Hispanic ethnicity. Persons with M. bovis were 2.55× (p = 0.01) as likely to die during treatment than those with M. tuberculosis.Mycobacterium bovistuberculosistrendsincidenceepidemiologyimmigrationMexicomortalityHispanicresearchpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9w77b4kbarticleEmerging Infectious Diseases, vol 14, iss 6909 - 916oai:escholarship.org:ark:/13030/qt7787k6bj2015-09-18T01:25:11Zqt7787k6bjHuman Immunodeficiency Virus Type 1 Nef Inhibits Autophagy through Transcription Factor EB Sequestration.Campbell, Grant RRawat, PratimaBruckman, Rachel SSpector, Stephen A2015-06-26HIV Nef acts as an anti-autophagic maturation factor through interaction with beclin-1 (BECN1). We report that exposure of macrophages to infectious or non-infectious purified HIV induces toll-like receptor 8 (TLR8) and BECN1 dependent dephosphorylation and nuclear translocation of TFEB and that this correlates with an increase in autophagy markers. RNA interference for ATG13, TFEB, TLR8, or BECN1 inhibits this HIV-induced autophagy. However, once HIV establishes a productive infection, TFEB phosphorylation and cytoplasmic sequestration are increased resulting in decreased autophagy markers. Moreover, by 7 d post-infection, autophagy levels are similar to mock infected controls. Conversely, although Nef deleted HIV similarly induces TFEB dephosphorylation and nuclear localization, and increases autophagy, these levels remain elevated during continued productive infection. Thus, the interaction between HIV and TLR8 serves as a signal for autophagy induction that is dependent upon the dephosphorylation and nuclear translocation of TFEB. During permissive infection, Nef binds BECN1 resulting in mammalian target of rapamycin (MTOR) activation, TFEB phosphorylation and cytosolic sequestration, and the inhibition of autophagy. To our knowledge, this is the first report of a virus modulating TFEB localization and helps to explain how HIV modulates autophagy to promote its own replication and cell survival.application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/7787k6bjarticlePLoS pathogens, vol 11, iss 6e1005018 - e10050e1005018oai:escholarship.org:ark:/13030/qt6sq7n4562015-09-18T01:23:30Zqt6sq7n456Inhibition of human immunodeficiency virus type-1 through autophagy.Campbell, Grant RSpector, Stephen A2013-06-05As an obligatory intracellular pathogen, human immunodeficiency virus type-1 (HIV) is dependent upon its ability to exploit host cell machinery for replication and dissemination, and to circumvent cellular processes that prevent its growth. One such intracellular process is autophagy, a component of the host defense against HIV with roles in innate immune signaling, adaptive immunity and intracellular degradation of HIV. During permissive infection, HIV down-modulates autophagy, promoting its own replication. Inducers of autophagy can overcome this suppression and inhibit HIV. This review summarizes recent advances in understanding the antiviral and replicative roles of autophagy during HIV infection. Dissecting the molecular mechanisms by which HIV utilizes autophagy may lead to the identification of novel drug candidates to treat and potentially eradicate HIV infection.AutophagyHIV Infections: immunologyvirologyHIV-1: immunologyHost-Pathogen InteractionsHumansImmunityInnatepubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6sq7n456articleCurrent Opinion in Microbiology, vol 16, iss 3349 - 354oai:escholarship.org:ark:/13030/qt67f2h0sj2015-09-18T01:22:58Zqt67f2h0sjArtificial ion channel biosensor in human immunodeficiency virus gp41 drug sensing.Hou, YanxiaGochin, Miriam2008-08-01An ion channel biosensor is described for label-free detection of inhibitors which bind to the coiled coil domain of human immunodeficiency virus type 1 gp41. gp41 is the viral transmembrane glycoprotein responsible for fusion between HIV-1 and host cells. The N-terminal coiled coil domain binds three antiparallel C-heptad repeat peptides in the six helix bundle structure of trimeric gp41 that forms during fusion. Compounds able to prevent six-helix bundle formation by binding to the gp41 coiled coil could inhibit fusion and have important therapeutic potential. We have immobilized on gold a positively charged metallopeptide mimic of a section of the gp41 coiled coil containing a hydrophobic pocket suitable for small molecule binding. We demonstrate that the resulting sensor is able to transmit a current in the presence of negatively charged redox marker ions, therefore acting as an artificial ion channel. The electrochemical signal, measured by cyclic voltammetry, was modulated by specific analyte binding to the coiled coil. Nanomolar quantities of peptides and small molecules that bind in the hydrophobic pocket could be selectively detected, providing a method for label-free detection of binding to gp41.Biosensing Techniques: methodsDrug Monitoring: instrumentationElectrochemistry: instrumentationmethodsHIV Envelope Protein gp41: antagonists & inhibitorsHIV Fusion Inhibitors: analysisHumansIonsMolecular MimicryPeptides: diagnostic useapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/67f2h0sjarticleAnalytical chemistry, vol 80, iss 155924 - 5929oai:escholarship.org:ark:/13030/qt61f098mq2015-09-18T01:22:36Zqt61f098mqHost cell interactome of HIV-1 Rev includes RNA helicases involved in multiple facets of virus production.Ambrus, Geza2012-04-01publiceScholarship, University of Californiahttps://escholarship.org/uc/item/61f098mqarticleoai:escholarship.org:ark:/13030/qt4m58v21t2015-09-18T01:19:48Zqt4m58v21tIntravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United StatesBrown, Joelle2013-04-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4m58v21tarticleObstetrics & Gynecology, vol 121, iss 4773 - 780oai:escholarship.org:ark:/13030/qt3n29686q2015-09-18T01:18:50Zqt3n29686qStructural characterization of a paramagnetic metal-ion-assembled three-stranded alpha-helical coiled coil.Gochin, MiriamKhorosheva, ValentinaCase, Martin A2002-09-18A helical peptide designed to present an all-leucine core upon folding has been shown to exhibit concentration-dependent helicity and to exist as an ill-defined equilibrium population of oligomers. In marked contrast, an identical peptide covalently modified with a 2,2'-bipyridyl group at the N terminus forms a stable three-stranded parallel coiled coil in the presence of transition metal ions. We have employed paramagnetic Ni(2+) and Co(2+) ions to stabilize the trimeric assembly and to exploit their shift and relaxation properties in NMR structural studies. We find that metal-ion binding and helix-bundle folding are tightly coupled. Surprisingly, the three-helix bundle exhibits a dynamic N-terminal region, and a well-structured C-terminal half. The spectra indicate the presence of a dual conformation for the bundle extending from the N terminus to residue 12. The structure of the two isomeric forms has been ascertained from interpretation of NOEs in the Ni(II) complex and (1)H pseudocontact shifts in the Co(II) complex. Two different facial isomers with distinct susceptibility tensors were identified. The bulky leucine side chain at position 3 in the peptide chain appears to play a role in the conformational variation at the N terminus.22'-Dipyridyl: chemistryAmino Acid SequenceCobalt: chemistryComputer SimulationKineticsLeucine: chemistryMetalloproteins: chemical synthesischemistryModelsChemicalModelsMolecularMolecular Sequence DataNickel: chemistryNuclear Magnetic ResonanceBiomolecular: methodsOligopeptides: chemical synthesischemistryProtein IsoformsProtein StructureSecondaryProtein StructureTertiarySpectrophotometryUltravioletapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3n29686qarticleJournal of the American Chemical Society, vol 124, iss 3711018 - 11028oai:escholarship.org:ark:/13030/qt9hv4d7752015-09-16T17:20:10Zqt9hv4d775Distress Tolerance, Emotion Dysregulation, and Anxiety and Depressive Symptoms Among HIV+ IndividualsBrandt, Charles PZvolensky, Michael JBonn-Miller, Marcel O2012-11-13application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9hv4d775articleCognitive Therapy and Research, vol 37, iss 3446 - 455oai:escholarship.org:ark:/13030/qt6g94g4z42015-09-16T17:18:40Zqt6g94g4z4Blood T-cell receptor diversity decreases during the course of HIV infection, but the potential for a diverse repertoire persists.Baum, Paul2012-04-12HIV infection results in a decrease in circulating CD4(+) T-cell and naive T-cell numbers. If such losses were associated with an erosion of T-cell receptor (TCR) repertoire diversity in the peripheral T-cell pool, this might exacerbate the state of persistent immunodeficiency. Existing methods for the analysis of the TCR repertoire have demonstrated skewed distributions of TCR genes in HIV-infected subjects but cannot directly measure TCR diversity. Here we used AmpliCot, a quantitative assay based on DNA hybridization kinetics, to measure TCR diversity in a cross-sectional comparison of 19 HIV-infected persons to 18 HIV-uninfected controls. HIV-infected persons had a 10-fold decrease in total TCR repertoire diversity in 1.5 mL of blood compared with uninfected controls, with decreased diversity correlating most closely with a lower CD4(+) T-cell percentage. Nonetheless, the TCR repertoire diversity of sort-purified T-cell subpopulations in HIV-infected and HIV-uninfected subjects was comparable. These observations suggest that the TCR repertoire diversity changes in whole blood during HIV disease progression are primarily the result of changes in the number and proportion of T-cell subpopulations and that most HIV-infected persons may retain a sufficiently diverse TCR repertoire to permit immune reconstitution with antiretroviral therapy alone, without thymopoiesis.AIDSHIVimmunologyTCRT cellT cell receptorreconstitutionAmpliCotapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/6g94g4z4articleBlood, vol 119, iss 15oai:escholarship.org:ark:/13030/qt4zz719wn2015-09-16T17:17:57Zqt4zz719wnIdentifying HIV-1 host cell factors by genome-scale RNAi screening.Pache, LarsKönig, RenateChanda, Sumit K2011-01-21Advances in the application of RNA interference (RNAi) have facilitated the establishment of systematic cell-based loss-of-function screening platforms. Widespread implementation of this technology has enabled genome-wide genetic analysis of a diverse array of cellular phenotypes, including the identification of host cell factors involved in viral replication. Four recent studies employed whole-genome RNAi technologies to elucidate cellular genes important for the replication of HIV-1. While these four genome-scale screens shared a common objective, they differ in their scope and experimental design. In this review we explore alternative strategies for developing RNAi screens, and discuss potential pitfalls of the technology. Important technical considerations include the choice of silencing reagents, experimental systems, assay readout and analysis methods. We focus on experimental and computational parameters that can impact the outcome of high-throughput genetic screens, and provide guidelines for the development of reliable cell-based RNAi screens.Data InterpretationStatisticalGenome-Wide Association StudyHEK293 CellsHIV Infections: metabolismvirologyHIV-1: geneticsphysiologyHigh-Throughput Screening AssaysHost-Derived Cellular Factors: geneticsmetabolismHumansRNA InterferenceRNASmall Interfering: geneticsTransfection: methodsVirus ReplicationpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4zz719wnarticleMethods (San Diego, Calif.), vol 53, iss 13 - 12oai:escholarship.org:ark:/13030/qt4n5193592015-09-16T17:10:03Zqt4n519359Global landscape of HIV–human protein complexesJäger, StefanieCimermancic, PeterGulbahce, NataliJohnson, Jeffrey R.McGovern, Kathryn E.Clarke, Starlynn C.Shales, MichaelMercenne, GaellePache, LarsLi, KathyHernandez, HildaJang, Gwendolyn M.Roth, Shoshannah L.Akiva, EyalMarlett, JohnStephens, MelanieD’Orso, IvanFernandes, JasonFahey, MarieMahon, CathalO’Donoghue, Anthony J.Todorovic, AleksandarMorris, John H.Maltby, David A.Alber, TomCagney, GerardBushman, Frederic D.Young, John A.Chanda, Sumit K.Sundquist, Wesley I.Kortemme, TanjaHernandez, Ryan D.Craik, Charles S.Burlingame, AlmaSali, AndrejFrankel, Alan D.Krogan, Nevan J.2011-12-21Human immunodeficiency virus (HIV) has a small genome and therefore relies heavily on the host cellular machinery to replicate. Identifying which host proteins and complexes come into physical contact with the viral proteins is crucial for a comprehensive understanding of how HIV rewires the host’s cellular machinery during the course of infection. Here we report the use of affinity tagging and purification mass spectrometry1-3 to determine systematically the physical interactions of all 18 HIV-1 proteins and polyproteins with host proteins in two different human cell lines (HEK293 and Jurkat). Using a quantitative scoring system that we call MiST, we identified with high confidence 497 HIV–human protein–protein interactions involving 435 individual human proteins, with ~40% of the interactions being identified in both cell types. We found that the host proteins hijacked by HIV, especially those found interacting in both cell types, are highly conserved across primates. We uncovered a number of host complexes targeted by viral proteins, including the finding that HIV protease cleaves eIF3d, a subunit of eukaryotic translation initiation factor 3. This host protein is one of eleven identified in this analysis that act to inhibit HIV replication. This data set facilitates a more comprehensive and detailed understanding of how the host machinery is manipulated during the course of HIV infection.HIVMiSThost complexeseIF3dpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4n519359articleNature, vol 481, iss 7381365 - 370oai:escholarship.org:ark:/13030/qt4jk1b0b22015-09-16T17:02:12Zqt4jk1b0b2PD-1/PD-L1 blockade can enhance HIV-1 Gag-specific T cell immunity elicited by dendritic cell-directed lentiviral vaccinesWang, Pin2012-09-01Exhaustion of CD8+ T cells and upregulation of programmed death 1 (PD-1), a negative regulator of T cell activation, are characteristic features of individuals chronically infected with human immunodeficiency virus type 1. In a previous study, we showed in mice that a dendritic cell-directed lentiviral vector (DCLV) system encoding the human immunodeficiency virus (HIV)-1 Gag protein was an efficient vaccine modality to induce a durable Gag-specific T cell immune response. In this study, we demonstrate that blocking of the PD-1/PD-1 ligand (PD-L) inhibitory signal via an anti-PD-L1 antibody generated an enhanced HIV-1 Gag-specific CD8+ immune response following both a single round of DCLV immunization and a homologous prime/boost regimen. The prime/boost regimen combined with PD-L1 blockade generated very high levels of Gag-specific CD8+ T cells comprising several valuable features: improved ability to produce multiple cytokines, responding to a broader range of Gag-derived epitopes, and long-lasting memory. This enhanced cellular immune response generated by DCLV immunization combined with anti-PD-L1 blockade correlated with improved viral control following challenge with Gag-expressing vaccinia virus. Taken together, our studies offer evidence to support the use of PD-1/PD-L1 blockade as an adjuvant modality to enhance antigen-specific immune responses elicited by T cell-based immunizations such as DCLV.application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/4jk1b0b2articleMolecular Therapy, vol 20, iss 9oai:escholarship.org:ark:/13030/qt49k8d6hq2015-09-16T17:01:32Zqt49k8d6hqCannabis use and HIV antiretroviral therapy adherence and HIV-related symptomsBonn-Miller, Marcel OOser, Megan LBucossi, Meggan MTrafton, Jodie A2012-10-07application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/49k8d6hqarticleJournal of Behavioral Medicine, vol 37, iss 11 - 10oai:escholarship.org:ark:/13030/qt3783w85s2015-09-16T16:22:34Zqt3783w85sA comprehensive analysis of recruitment and transactivation potential of K-Rta and K-bZIP during reactivation of Kaposi's sarcoma-associated herpesvirus.Ellison, Thomas JIzumiya, YoshihiroIzumiya, ChieLuciw, Paul AKung, Hsing-Jien2009-04-25Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiologic agent of Kaposi's sarcoma. K-Rta and K-bZIP are two major viral transcription factors that control reactivation of this virus. Here we report a genome-wide analysis of transcriptional capacity by evaluation of a comprehensive library of 83 putative KSHV promoters. In reporter assays, 34 viral promoters were activated by K-Rta, whereas K-bZIP activated 21 promoters. When K-Rta and K-bZIP were combined, 3 K-Rta responsive promoters were repressed by K-bZIP. The occupancy of K-Rta and K-bZIP across KSHV promoters was analyzed by chromatin immunoprecipitation with a viral promoter-chip in BCBL-1 cells. In addition, acetylation of local histones was examined to determine accessibility of promoters during latency and reactivation. Finally, 10 promoters were selected to study the dynamics of transcription factor recruitment. This study provides a comprehensive overview of the responsiveness of KSHV promoters to K-Rta and K-bZIP, and describes key chromatin changes during viral reactivation.Basic-Leucine Zipper Transcription FactorsCell LineDNAViral: geneticsGene Expression RegulationViralHerpesvirus 8Human: geneticsphysiologyHumansImmediate-Early Proteins: metabolismPromoter RegionsGenetic: physiologyTrans-Activators: chemistrymetabolismphysiologyTranscriptional ActivationVirus ActivationVirus Replicationapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/3783w85sarticleVirology, vol 387, iss 176 - 788oai:escholarship.org:ark:/13030/qt2qg6b23f2015-09-16T16:22:09Zqt2qg6b23fExamining Associations Between Cognitive-Affective Vulnerability and HIV Symptom Severity, Perceived Barriers to Treatment Adherence, and Viral Load Among HIV-Positive AdultsLeyro, Teresa MVujanovic, Anka ABonn-Miller, Marcel O2014-03-19application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2qg6b23farticleInternational Journal of Behavioral Medicine, vol 22, iss 1139 - 148oai:escholarship.org:ark:/13030/qt2bk071ng2015-09-16T16:21:34Zqt2bk071ngHIV Medication Adherence and HIV Symptom Severity: The Roles of Sleep Quality and MemoryBabson, Kimberly AHeinz, Adrienne JBonn-Miller, Marcel O2013-10-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/2bk071ngarticleAIDS Patient Care and STDs, vol 27, iss 10544 - 552oai:escholarship.org:ark:/13030/qt1m8138pf2015-09-16T16:20:23Zqt1m8138pfAnxiety Sensitivity in Relation to Sleep Quality Among HIV-Infected IndividualsLeyro, Teresa MBabson, Kimberly ABonn-Miller, Marcel O2014-11-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1m8138pfarticleJournal of the Association of Nurses in AIDS Care, vol 25, iss 6638 - 645oai:escholarship.org:ark:/13030/qt1j72r86g2015-09-16T16:19:32Zqt1j72r86gImproving the efficiency of HIV testing with peer recruitment, financial incentives, and the involvement of persons living with HIV infection.McCoy, Sandra IShiu, KarenMartz, Tyler ESmith, Carla DillardMattox, LorisGluth, Dale RMurgai, NeenaMartin, MarshaPadian, Nancy S2013-06-01The authors piloted an HIV testing and counseling (HTC) approach using respondent-driven sampling (RDS), financial incentives, and persons living with HIV infection (PLHIV).Eligible participants were aged 30-60 years, African American or black, and residents of Oakland, CA. Participants were tested for HIV infection and asked to refer up to 3 others. The authors compared the efficiency of RDS to conventional outreach-based HTC with the number needed to screen (NNS). They evaluated the effect of 2 randomly allocated recruitment incentives on the enrollment of high-risk or HIV-positive network associates: a flat incentive ($20) for eligible recruits or a conditional incentive ($10-35) for eligible recruits in priority groups, such as first-time testers.Forty-eight participants (10 PLHIV and 38 HIV negative) initiated recruitment chains resulting in 243 network associates. Nine (3.7%) participants tested HIV positive, of whom 7 (78%) were previously recognized. RDS was more efficient than conventional HTC at identifying any PLHIV (new or previously recognized; RDS: NNS = 27, 95% CI: 14 to 59; conventional: NNS = 154, 95% CI: 95 to 270). There was no difference between the 2 incentive groups in the likelihood of recruiting at least 1 high-risk HIV-negative or HIV-positive network associate (adjusted odds ratio = 0.89, 95% CI: 0.06 to 13.06) or in total number of high-risk HIV-negative or HIV-positive associates (adjusted odds ratio = 0.79, 95% CI: 0.23 to 2.71).Social network HTC strategies may increase demand for HTC and efficiently identify PLHIV. The flat incentive was as successful as the conditional incentive for recruiting high-risk individuals. Unexpectedly, this method also reidentified PLHIV aware of their status.AIDS SerodiagnosisAdultCounseling: economicsEarly DiagnosisFemaleHIV Infections: diagnosisHIV SeropositivityHumansMaleMass ScreeningMiddle AgedMotivationPatient SelectionPeer Groupapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/1j72r86garticleJournal of acquired immune deficiency syndromes (1999), vol 63, iss 2e56 - e563oai:escholarship.org:ark:/13030/qt0z6532922015-09-16T16:04:25Zqt0z653292Construction of stable producer cells to make high-titer lentiviral vectors for dendritic cell-based vaccinationWang, Pin2012-06-01Lentiviral vectors (LVs) enveloped with an engineered Sindbis virus glycoprotein can specifically bind to dendritic cells (DCs) through the surface receptor DC-SIGN and induce antigen expression, thus providing an efficient method for delivering DC-directed vaccines. In this study, we constructed a stable producer line (LV-MGFP) for synthesizing DC-SIGN-targeted HIV-1-based LVs (DC-LVs) encoding green fluorescent protein (GFP) by a concatemeric array transfection technique. We demonstrated that the established stable clones could routinely produce vector supernatants with titers above 107 transduction units per milliliter (TU/mL) during a continuous 3-month cell passage. The producer cells were also capable of generating similar titers of DC-LVs in serum-free medium. Moreover, the addition of 1-deoxymannojirimycin (DMJ) enabled the producer cells to manufacture DC-LVs with both improved titers and enhanced potency to evoke antigen-specific CD8+ T cell responses in mice. The stable lines could accommodate the replacement of the internal murine stem cell virus (MSCV) promoter with the human ubiquitin-C (Ubi) promoter in the lentiviral backbone. The resulting DC-LVs bearing Ubi exhibited the enhanced potency to elicit vaccine-specific immunity. Based on accumulated evidence, our studies support the application of this production method in manufacturing DC-LVs for preclinical and clinical testing of novel DC-based immunization.self-inactivating lentiviral vectortargeted gene deliveryproducer cellinducible gene expressionT cell vaccinetetracyclineapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0z653292articleBiotechnology and Bioengineering, vol 109, iss 6oai:escholarship.org:ark:/13030/qt0j28j3w72015-09-16T15:34:25Zqt0j28j3w7Differential Associations Between Perceived and Objective Measurement of Distress Tolerance in Relation to Antiretroviral Treatment Adherence and Response Among HIV-Positive IndividualsOser, Megan LTrafton, Jodie ALejuez, Carl WBonn-Miller, Marcel O2013-09-01application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/0j28j3w7articleBehavior Therapy, vol 44, iss 3432 - 442oai:escholarship.org:ark:/13030/qt06w534p72015-09-16T15:33:18Zqt06w534p7NF-kappaB serves as a cellular sensor of Kaposi's sarcoma-associated herpesvirus latency and negatively regulates K-Rta by antagonizing the RBP-Jkappa coactivator.Izumiya, YoshihiroIzumiya, ChieHsia, DatsunEllison, Thomas JLuciw, Paul AKung, Hsing-Jien2009-05-25Successful viral replication is dependent on a conducive cellular environment; thus, viruses must be sensitive to the state of their host cells. We examined the idea that an interplay between viral and cellular regulatory factors determines the switch from Kaposi's sarcoma-associated herpesvirus (KSHV) latency to lytic replication. The immediate-early gene product K-Rta is the first viral protein expressed and an essential factor in reactivation; accordingly, this viral protein is in a key position to serve as a viral sensor of cellular physiology. Our approach aimed to define a host transcription factor, i.e., host sensor, which modulates K-Rta activity on viral promoters. To this end, we developed a panel of reporter plasmids containing all 83 putative viral promoters for a comprehensive survey of the response to both K-Rta and cellular transcription factors. Interestingly, members of the NF-kappaB family were shown to be strong negative regulators of K-Rta transactivation for all but two viral promoters (Ori-RNA and K12). Recruitment of K-Rta to the ORF57 and K-bZIP promoters, but not the K12 promoter, was significantly impaired when NF-kappaB expression was induced. Many K-Rta-responsive promoters modulated by NF-kappaB contain the sequence of the RBP-Jkappa binding site, a major coactivator which anchors K-Rta to target promoters via consensus motifs which overlap with that of NF-kappaB. Gel shift assays demonstrated that NF-kappaB inhibits the binding of RBP-Jkappa and forms a complex with RBP-Jkappa. Our results support a model in which a balance between K-Rta/RBP-Jkappa and NF-kappaB activities determines KSHV reactivation. An important feature of this model is that the interplay between RBP-Jkappa and NF-kappaB on viral promoters controls viral gene expression mediated by K-Rta.Cell LineDown-RegulationGene Expression RegulationViralHerpesvirus 8Human: geneticsmetabolismHumansImmediate-Early Proteins: geneticsmetabolismImmunoglobulin J Recombination Signal Sequence-Binding Protein: antagonists & inhibitorsmetabolismNF-kappa B: geneticsmetabolismPromoter RegionsGenetic: geneticsTrans-Activators: geneticsmetabolismVirus ActivationVirus Latencyapplication/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/06w534p7articleJournal of virology, vol 83, iss 94435 - 4446oai:escholarship.org:ark:/13030/qt05f1b8js2015-09-16T15:32:32Zqt05f1b8jsProblematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom SeverityHeinz, Adrienne JFogler, Kethera ANewcomb, Michael ETrafton, Jodie ABonn-Miller, Marcel O2013-08-25application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/05f1b8jsarticleAIDS and Behavior, vol 18, iss 71302 - 1314oai:escholarship.org:ark:/13030/qt9w67c6x62015-08-13T22:38:08Zqt9w67c6x6RGPO Open Access PolicyResearch Grants Program Office, University of California Office of the President2014-04-22application/pdfpubliceScholarship, University of Californiahttps://escholarship.org/uc/item/9w67c6x6article