Background

The human papillomavirus (HPV) is the precursor and the single, most important risk factor for cervical cancer. It is also the most commonly sexually transmitted infection in the United States. An estimated 20 million persons are currently infected with the virus, with an estimated 6 million new infections occurring annually and 12,000 new cervical cancer cases and 4,000 cervical cancer deaths annually. The human papillomavirus (HPV) vaccine is thus an especially important preventive measure for racial/ethnic groups who bear an unequal burden of cervical cancer mortality.

Purpose

This study aimed to develop a culturally and linguistically appropriate intervention to educate and empower Latino and Korean Americans to make an informed HPV vaccination decision for their minor children.

Methods

A parent-focused HPV vaccine education DVD was developed through focus groups and cognitive interviews with Latino and Korean Americans parents of children ages 11-17. A randomized controlled efficacy trial was subsequently conducted with 708 Latino and Korean Americans parents to assess knowledge gains, decisional conflict, decision self-efficacy and informed decision-making resulting from viewing the intervention DVD.

Results

Differences between treatment and control groups for pre-post changes in knowledge, informed decision-making and decisional conflict were statistically significant among the parents exposed to the education intervention DVD.

Conclusion

The study demonstrated that a culturally and linguistically appropriate intervention DVD designed to educate parents about the risks and benefits of the HPV vaccine promoted informed decision-making regarding HPV vaccination among at-risk populations.

Background Despite an effective vaccine, 60,000 new HBV infections were reported in the US in 2004; 95% in adults. We evaluate HBV sero-prevalence, risk behaviors and self-reported vaccination among Latino immigrant, Asian immigrant and US born low income men in five northern California counties. Methods Population based, cross sectional survey of HBV sero-prevalence and risk behaviors in men aged 18 to 35 years. Results Among 1,512 men screened, Asian immigrants were most likely to have had prior HBV infection (15.1%) and chronic infection (3.8%) compared to US born (prior 5.1%, chronic 0.6%) and Latino immigrant men (prior 2.0%, chronic 0.3%.) Reported HBV vaccination was lowest for Latino immigrants (12%) compared to Asian immigrants and US born men (35% in both.) Latino immigrants reported less educational attainment, medical insurance coverage and access to a physician in the last six months. Discussion Healthcare providers should routinely screen Asian immigrants for HBV regardless of their self reported vaccination status. Latino immigrants may comprise an important group of under-vaccinated, at risk persons in California. HBV testing and vaccination of immigrants soon after US arrival should be encouraged.

Background

Daily preexposure prophylaxis (PrEP) with oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) decreases the risk of human immunodeficiency virus (HIV) acquisition. Initiation of TDF decreases bone mineral density (BMD) in HIV-infected people. We report the effect of FTC/TDF on BMD in HIV-seronegative men who have sex with men and in transgender women.

Methods

Dual-energy X-ray absorptiometry was performed at baseline and 24-week intervals in a substudy of iPrEx, a randomized, double-blind, placebo-controlled trial of FTC/TDF PrEP. Plasma and intracellular tenofovir concentrations were measured in participants randomized to FTC/TDF.

Results

In 498 participants (247 FTC/TDF, 251 placebo), BMD in those randomized to FTC/TDF decreased modestly but statistically significantly by 24 weeks in the spine (net difference, -0.91% [95% confidence interval {CI}, -1.44% to -.38%]; P = .001) and hip (-0.61% [95% CI, -.96% to -.27%], P = .001). Changes within each subsequent 24-week interval were not statistically significant. Changes in BMD by week 24 correlated inversely with intracellular tenofovir diphosphate (TFV-DP), which was detected in 53% of those randomized to FTC/TDF. Net BMD loss by week 24 in participants with TFV-DP levels indicative of consistent dosing averaged -1.42% ± 29% and -0.85% ± 19% in the spine and hip, respectively (P < .001 vs placebo). Spine BMD tended to rebound following discontinuation of FTC/TDF. There were no differences in fractures (P = .62) or incidence of low BMD.

Conclusions

In HIV-uninfected persons, FTC/TDF PrEP was associated with small but statistically significant decreases in BMD by week 24 that inversely correlated with TFV-DP, with more stable BMD thereafter.

Clinical trials registration

NCT00458393.