HIV Research Research Articles

An exploratory investigation of the CSF metabolic profile of HIV in a South African paediatric cohort using GCxGC-TOF/MS

Introduction Because cerebrospinal fluid (CSF) samples are difficult to obtain for paediatric HIV, few studies have attempted to profile neurometabolic dysregulation.Aim and objectiveThe aim of this exploratory study was to profile the neurometabolic state of CSF from a South African paediatric cohort using GCxGC-TOF/MS. The study included 54 paediatric cases (< 12 years), 42 HIV-negative controls and 12 HIV-positive individuals.ResultsThe results revealed distinct metabolic alterations in the HIV-infected cohort. In the PLS-DA model, 18 metabolites significantly discriminated between HIV-infected and control groups. In addition, fold-change analysis, Mann–Whitney U tests, and effect size measurements verified these findings. Notably, lactose, myo-inositol, and glycerol, although not significant by p-value alone, demonstrated practical significance based on the effect size.ConclusionsThis study provided valuable insights on the impact of HIV on metabolic pathways, including damage to the gut and blood–brain barrier, disruption of bioenergetics processes, gliosis, and a potential marker for antiretroviral therapy. Nevertheless, the study recognized certain constraints, notably a limited sample size and the absence of a validation cohort. Despite these limitations, the rarity of the study’s focus on paediatric HIV research underscores the significance and unique contributions of its findings.

Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020.

Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.

Evolution of Virology: Science History through Milestones and Technological Advancements.

The history of virology, which is marked by transformative breakthroughs, spans microbiology, biochemistry, genetics, and molecular biology. From the development of Jenner's smallpox vaccine in 1796 to 20th-century innovations such as ultrafiltration and electron microscopy, the field of virology has undergone significant development. In 1898, Beijerinck laid the conceptual foundation for virology, marking a pivotal moment in the evolution of the discipline. Advancements in influenza A virus research in 1933 by Richard Shope furthered our understanding of respiratory pathogens. Additionally, in 1935, Stanley's determination of viruses as solid particles provided substantial progress in the field of virology. Key milestones include elucidation of reverse transcriptase by Baltimore and Temin in 1970, late 20th-century revelations linking viruses and cancer, and the discovery of HIV by Sinoussi, Montagnier, and Gallo in 1983, which has since shaped AIDS research. In the 21st century, breakthroughs such as gene technology, mRNA vaccines, and phage display tools were achieved in virology, demonstrating its potential for integration with molecular biology. The achievements of COVID-19 vaccines highlight the adaptability of virology to global health.

Partnering Research and Clinical Practice to Implement a Photon-Counting Detector CT Myocardial Perfusion Imaging Study

Implementation of research studies in clinical practice may encounter institutional, cultural, or resource barriers. Lack of nursing representation during the development of research protocols and decision-making, as well as financial constraints and competing priorities can impact translating research evidence into practice. At a large Midwestern teaching hospital, these barriers are addressed using professional nursing practice and a team-based approach to patient care and innovation, which in turn improves health outcomes for patients. The institution's commitment to nursing research in the radiology department aids in the implementation of innovative imaging technologies with the potential for improved detection and diagnosis of coronary artery disease. This article will outline radiology nursing involvement in the development of a dual-purpose research and clinical exam utilizing advanced computed tomography scanner technology. This article will also show how the institution works through common barriers to nursing research and how its efforts aid in the translation of evidence-based research into clinical practice.

Complex umbilical cord entanglement: A case report

Background: Complex umbilical cord entanglement occurs less frequently and is associated with an increased risk of adverse perinatal outcomes. It is associated with umbilical artery pH and base excess levels that are significantly unfavorable, higher incidence of nonreassuring fetal heart rate, meconium-stained amniotic fluid, neonatal intensive care unit admissions, emergency cesarean section, and stillbirth. Case presentation: A 44-year-old para 2+0 gravida 3, with 2 previous cesarean delivery scars at 35 weeks presented with a history of reduced fetal movements for 24 hours. She had attended two antenatal care visits. Her blood group was A, rhesus negative, with hemoglobin levels of 11.2 g/dl, and normal platelets. Urinalysis and serology for HIV, hepatitis B, and Venereal Disease Research Laboratory test were nonreactive. She had received anti-D prophylaxis after her previous deliveries. An urgent obstetric ultrasound scan showed features consistent with intrauterine fetal death. Her coagulation profile was within the normal range. She was admitted for hysterotomy. Intraoperatively, a fresh stillborn baby boy was extracted with a cord around the neck tightly twice and entangled around the trunk. Conclusion: Complex umbilical cord entanglement occurs less frequently and associated with an increased risk of adverse perinatal outcomes. The risk of adverse perinatal outcomes increases with ≥3 loops of the umbilical cord. It is important to look out for cord entanglement antenatally by ultrasonography, particularly when assessing cases of decreased fetal movements.

Integrating Oral Health Within Kenyan HIV Research & Policy Structure: Stakeholder Analysis.

Kenya has a remarkably high burden of oral diseases, especially in vulnerable communities like persons with HIV (PWH). In the last few decades, the National AIDS & STI Control Programme has efficiently and successfully provided care and prevention against HIV for people living in Kenya. To assess the feasibility of integrating oral health into HIV research and policy structures in Kenya. The study took place between November 2021 and April 2022 in the cities of Nairobi, Kisumu, Mombasa, and Eldoret town. Using a semi-structured interview, three remote and 14 in-person sessions were conducted. Participants included individuals with professional experience in HIV and/or oral health such as researchers, potential mentors, institutional administrators, and other grant-funded experts. A qualitative analysis of recordings was performed by nine pretested independent reviewers, all with qualitative data analysis experience. Areas of interest included research, motivation, obstacles, and support. The free coding phase as well as an iterative grouping analysis (MIRO) was used. Of the 22 stakeholders interviewed in the study, researchers accounted for the majority (48%) of stakeholders, with the rest composed of practitioners (29%), university administrators (19%), and one public health administrator. University administrators were identified as having the most ability for resource mobilization followed by researchers and practitioners. All participants desired improved health outcomes using an evidence-based approach. The primary motivators were increased networks, collaborations, publications, and bridging the gap between oral health and HIV. While the obstacles to their desires included time and lack of funding, Institutional support through recruitment of qualified personnel, mentors, and mentees was their major desirable support. Stakeholders were unanimous in supporting integrating oral health within the current research and policy environment to address the gap between oral health and HIV, and to improve health outcomes through evidence-based interventions.

The HI V O pen Call on I nformed C onsent and E thics in Research (VOICE) for Adolescents and Young Adults: A Digital Crowdsourcing Open Call in Low- and Middle-Income Countries.

Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes.

Implementing ecological momentary assessments to measure violence and adolescent HIV transmission risk: Lessons from Johannesburg, South Africa.

Ecological Momentary Assessment (EMA) is an important methodology to understand risky behaviour and holds promise for HIV research. EMA is still novel in sub-Saharan Africa. We describe challenges and lessons learned on a novel study implementing mobile phone EMAs with adolescent boys in South Africa. The Tsamaisano study was a longitudinal study from 2020-2023 to recruit adolescent boys aged 15-19 years; including those without HIV and those perinatally infected and living with HIV. Participants were prompted to complete 52 weekly mobile phone survey on emotional state, exposure to and perpetration of violence, and sexual risk behaviour. Surveys were delivered using a random algorithm to choose the day. We incorporated mechanisms to assess challenges and optimize survey completion: weekly team meetings with youth representation and real-time data monitoring. Additionally, 20 frequent vs infrequent survey submitters participated in qualitative interviews about barriers and recommendations. Real-time monitoring indicated low (defined as <50%) survey completion in the first months of study implementation. To ensure that both the adolescent participant and their caregiver understood the commitment required for successful EMA, we created and implemented a guided discussion around mobile phone access during the enrolment visit. We identified a need for increased and ongoing technical support; addressed by creating technical guides, implementing a standard two-week check-in call after enrolment, adding an automated request button for call-back assistance, creating a WhatsApp messaging stream, and reaching out to all participants failing to submit two sequential surveys. Entry-level smartphones, including those initially distributed by the study, did not have capacity for certain updates and had to be replaced with more expensive models. Participants struggled with randomly allocated survey days; completion improved with set completion days and targeted reminder messages. Together, these steps improved survey completion from 40% in December 2020 to 65% in April 2022. We describe key lessons learned to inform future study designs with mobile phone EMAs, drawing on our experience implementing such among adolescent boys, including persons living with HIV, in a low-and-middle income setting. The key lessons learned through the Tsamaisano study are important to inform future study designs with EMA utilizing mobile phone, electronic data collection among adolescent boys in low-and-middle-income settings.

The Development of Positive Father Scale: A Tool for Enhancing Family Dynamics

The study aims to develop the Positive Father Scale, a tool for assessing positive father traits from a child’s perspective. The stages of the cross-sectional research design involved interviewing individuals, developing a 24-item scale with four distinct sub-dimensions (behavioral closeness, autonomy support, conscientiousness, extraversion), testing the scale, and conducting factor, validity, and reliability analyses on two sample groups. The scale exhibited high consistency in all sub-dimensions and overall score, confirming its reliability and validity. This validated scale, designed to measure positive father traits, highlights characteristics of effective fathering, identifies areas for growth, and aids research in psychology, sociology, and family science. Future studies could utilize the Positive Father Scale across diverse cultural backgrounds and age demographics for long-term validation, and its adoption could pave the way for similar scales addressing other family roles, enriching our holistic understanding of family dynamics.

N-Glycan Profiles of Neuraminidase from Avian Influenza Viruses.

The cleavage of sialic acids by neuraminidase (NA) facilitates the spread of influenza A virus (IV) descendants. Understanding the enzymatic activity of NA aids research into the transmission of IVs. An effective method for purifying NA was developed using p-aminophenyloxamic acid-modified functionalized hydroxylated magnetic particles (AAMPs), and from 0.299 to 0.401 mg of NA from eight IV strains was isolated by 1 mg AAMP. A combination of lectin microarrays and MALDI-TOF/TOF-MS was employed to investigate the N-glycans of isolated NAs. We found that more than 20 N-glycans were identified, and 16 glycan peaks were identical in the strains derived from chicken embryo cultivation. Multi-antennae, bisected, or core-fucosylated N-glycans are common in all the NAs. The terminal residues of N-glycans are predominantly composed of galactose and N-acetylglucosamine residues. Meanwhile, sialic acid residue was uncommon in these N-glycans. Further computational docking analysis predicted the interaction mechanism between NA and p-aminophenyloxamic acid.

Estimation of place-based vulnerability scores for HIV viral non-suppression: an application leveraging data from a cohort of people with histories of using drugs

The relationships between place (e.g., neighborhood) and HIV are commonly investigated. As measurements of place are multivariate, most studies apply some dimension reduction, resulting in one variable (or a small number of variables), which is then used to characterize place. Typical dimension reduction methods seek to capture the most variance of the raw items, resulting in a type of summary variable we call “disadvantage score”. We propose to add a different type of summary variable, the “vulnerability score,” to the toolbox of the researchers doing place and HIV research. The vulnerability score measures how place, as known through the raw measurements, is predictive of an outcome. It captures variation in place characteristics that matters most for the particular outcome. We demonstrate the estimation and utility of place-based vulnerability scores for HIV viral non-suppression, using data with complicated clustering from a cohort of people with histories of injecting drugs.

Marine microfossils: Tiny archives of ocean changes through deep time.

Microorganisms have inhabited the oceans since the dawn of Earth. Some of them have organic walls and some produce mineral tests that are usually composed of carbonate minerals or silica. They can therefore be preserved with original parts during sedimentary deposition or fossilized through permineralization or carbonization processes. The most common marine fossil groups studied by micropaleontologists are cyanobacteria, coccolithophores, dinoflagellates, diatoms, silicoflagellates, radiolarians, foraminifers, red and green algae, ostracods, and pteropods. Dormant or reproductive cysts can also be used for determinations of the fossil microbiota. Microfossils can be studied in petrographic slides prepared from rocks or separated from loosely consolidated rocks by disaggregation or dissolution and wet sieving. Their presence is sometimes recognized by biomarkers. Transmitted light microscopy and reflected light stereomicroscopy are necessary for micropaleontological studies whereas scanning electronic microscopy (SEM) aids research on the tiniest fossils and reveals fine skeletal details. Microorganisms have influenced the oxygenation of water and the atmosphere, as well as Earth's carbon cycle and have contributed to the formation of sedimentary rocks. By studying microfossils, paleontologists depict the age of the rock and identify depositional environments. Such studies help us recognize periods of stress in Earth's history and understand their influence on living organisms. Biogenic rocks, made of microfossils, can be used as raw materials, such as fossil fuels, building stone, or additives for the food industry, agricultural, or cosmetic purposes.

The Tulumbe! Partnership: a case study in developing a community-led research agenda to address HIV among African immigrants in the United States.

Grassroots, community organizations are trusted resources within communities, which puts them in an ideal position to effectively engage individuals impacted by health inequities in defining meaningful research priorities. A community-centered approach to HIV research is critical for African immigrants living in the United States, who experience stigma and other socio-structural barriers to HIV prevention, care, and research engagement. Supporting community organizations with financial resources and capacity building activities to lead the development of research agendas ensures better alignment with community interests and fosters sustainability. We developed a community-initiated and -led research engagement project-Tulumbe!, which prioritized community leadership in all project activities. Community forums, health care provider and community questionnaires, interviews, and report-back sessions were held to examine the research interests and health concerns voiced by African immigrants. The iterative, community-led engagement process of more than 200 African immigrants, health providers, and researchers resulted in a community-defined research agenda with six areas of focus: family communication; self-efficacy for African immigrant women; deconstructing masculinity for African immigrant men; sexual health education for African immigrant youth; HIV stigma; and health literacy. Time, resources, and flexibility are needed to develop a viable community-led research partnership. Investing in community leadership not only produced a patient-centered research agenda but also led to community ownership of the process and results; thus, all partners were committed to sustaining the work.

Prediction of HIV drug resistance through in silico approach

The development of drug resistance continues to be one of the most significant obstacles in the fight against human immunodeficiency virus type 1 (HIV-1) infection. Due to its exceptional replication kinetics, HIV is able to evade the selection pressure of the human immune system and the current combination drug therapy. Given that there are so many distinct mutations and mutational patterns that may confer drug resistance, it can be challenging to interpret the results of genotypic assays designed to detect them. The quantitative evaluation of resistance or susceptibility at the phenotypic level is made possible by cell culture studies. Nevertheless, the procedure is time-consuming and expensive. This study concentrates on the prediction of HIV drug resistance using an innovative “in silico” method that employs three potent resistance prediction tools: HIVdb, HIV-GRADE, and Geno2pheno[resistance]. These tools play a crucial role in the evaluation of HIV drug resistance, enabling clinicians and researchers to make informed decisions regarding antiretroviral (ARV) therapy. This study investigates the integration of these tools, emphasizing their individual strengths and collective utility in providing accurate and exhaustive HIV drug resistance predictions. Through a comprehensive analysis of genotypic data, this study seeks to improve our understanding of HIV drug resistance profiles, ultimately contributing to the optimization of ARV treatment strategies for HIV-positive individuals.

Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study.

"Sick quitting," a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported >monthly drinking and 18% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95% confidence interval [95% CI] [1.13-2.15]) and reducing (HR: 1.35, 95% CI [1.13-1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95% CI [1.20-2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.

Rat hepatitis E virus (Rocahepevirus ratti) in people living with HIV

ABSTRACT Rat hepatitis E virus (ratHEV; species Rocahepevirus ratti) is considered a newly emerging cause of acute hepatitis of zoonotic origin. ratHEV infection of people living with HIV (PLWH) might portend a worse, as with hepatitis E virus (HEV; species Paslahepevirus balayani), and consequently this group may constitute a high-risk population. We aimed to evaluate the prevalence of ratHEV by measuring viral RNA and specific IgG antibodies in a large Spanish cohort of PLWH. Multicentre study conducted in Spain evaluating PLWHIV included in the Spanish AIDS Research Network (CoRIS). Patients were evaluated for ratHEV infection using PCR at baseline and anti-ratHEV IgG by dot blot analysis to evaluate exposure to ratHEV strains. Patients with detectable ratHEV RNA were followed-up to evaluate persistence of viremia and IgG seroconversion. Eight-hundred and forty-two individuals were tested. A total of 9 individuals showed specific IgG antibodies against ratHEV, supposing a prevalence of 1.1 (95% CI; 0.5%−2.1%). Of these, only one was reactive to HEV IgG antibodies by ELISA. One sample was positive for ratHEV RNA (prevalence of infection: 0.1%; 95% CI: 0.08%−0.7%). The case was a man who had sex with men exhibiting a slightly increased alanine transaminase level (49 IU/L) as only biochemical alteration. In the follow-up, the patients showed undetectable ratHEV RNA and seroconversion to specific ratHEV IgG antibodies. Our study shows that ratHEV is geographical broadly distributed in Spain, representing a potential zoonotic threat.

Preexposure prophylaxis availability among health facilities participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status and the availability of PrEP services across HIV care sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium. We used country-level PrEP drug registration status from the AIDS Vaccine Advocacy Coalition and data from IeDEA surveys conducted in 2014, 2017 and 2020 among participating HIV clinics in seven global regions. We used descriptive statistics to assess PrEP availability across IeDEA sites serving adult patients in 2020 and examined trends in PrEP availability among sites that responded to all three surveys. Of 199 sites that completed the 2020 survey, PrEP was available in 161 (81%). PrEP availability was highest at sites in North America (29/30; 97%) and East Africa (70/74; 95%) and lowest at sites in Central (10/20; 50%) and West Africa (1/6; 17%). PrEP availability was higher among sites in countries where PrEP was officially registered (146/161; 91%) than where it was not (14/32; 44%). Availability was higher at health centers (109/120; 90%) and district hospitals (14/16; 88%) compared to regional/teaching hospitals (36/63). Among the 94 sites that responded to all three surveys, PrEP availability increased from 47% in 2014 to 60% in 2017 and 76% in 2020. PrEP availability has substantially increased since 2014 and is now available at most IeDEA sites. However, PrEP service provision varies markedly across global regions.

EMPOWERING AND ADDRESSING AGE-RELATED CONCERNS AMONG OLDER WOMEN LIVING WITH HIV

Abstract There are currently over 100,000 older (ages 50+ years) women living with HIV/AIDs in the United States. Older women living with HIV (OWLH) face unique psychosocial challenges with HIV prevention and care, including intimate partner violence, gender discrimination, ageism, and caregiving responsibilities. These factors can impede self-care and contribute to increased mental, emotional, and physical burdens. Little is known about the resources OWLH draw upon to help manage psychosocial stressors and their perspectives of aging with HIV. This qualitative study identified sources of strength and self-care among OWLH, as well as their concerns about aging with HIV. We recruited participants through HIV clinics and community support groups. We conducted one-on-one, semi-structured in-depth phone interviews with OWLH. Interviews were recorded and transcribed verbatim. Following a Grounded Theory approach, two coders performed open coding then thematic coding. Participants (N = 23) were on average 60 years old (range 51 – 68) and had been living with HIV for an average of 23.7 years. We found that a desire to self-educate, community activism, and engagement with other OWLH reduced participants’ internalized stigma and were sources of empowerment. However, concerns about aging with HIV persists, including pervasive HIV stigma, comorbidities, shrinking caregiver networks, long-term effects of treatment, and lack of HIV research and programs focusing on older women. These findings suggest that while OWLH are empowered agents in their own HIV care journey, structural interventions (e.g., inclusion of older women in HIV trials) are still needed to address the unique concerns of this population.

Developing a diversity, equity and inclusion compass to guide scientific capacity strengthening efforts in Africa.

Diversity, equity and inclusion (DEI) in science is vital to improve the scientific process and ensure societal uptake and application of scientific results. DEI challenges include a full spectrum of issues from the lack of, and promotion of, women in science, to the numerous barriers in place that limit representation of African scientists in global scientific efforts. DEI principles in African science remain relatively underdeveloped, with limited engagement and discussion among all stakeholders to ensure that initiatives are relevant to local environments. The Sub-Saharan African Network for TB/HIV research Excellence (SANTHE) is a network of African-led research in HIV, tuberculosis (TB), associated co-morbidities, and emerging pathogens, now based in eight African countries. Our aim, as a scientific capacity strengthening network, was to collaboratively produce a set of DEI guidelines and to represent them visually as a DEI compass. We implemented a consortium-wide survey, focus group discussions and a workshop where we were able to identify the key DEI challenges as viewed by scientists and support staff within the SANTHE network. Three thematic areas were identified: 1. Conquering Biases, 2. Respecting the Needs of a Diverse Workforce (including mental health challenges, physical disability, career stability issues, demands of parenthood, and female-specific challenges), and 3. Promotion of African Science. From this we constructed a compass that included proposed steps to start addressing these issues. The use of the compass metaphor allows 're-adjustment/re-positioning' making this a dynamic output. The compass can become a tool to establish an institution's DEI priorities and then to progress towards them.

The Social, Mental, and Physical Health Impacts of the COVID-19 Pandemic on People With HIV: Protocol of an Observational International Multisite Study.

As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; HIV continuum of care indicators; mental and social health; COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study will contribute to knowledge that can inform responses to future public health crises to minimize their impacts on vulnerable populations such as PWH.