Biomedical Interventions Research Articles

Prevention and infection control of HIV infection and AIDS

Background: Although the global incidence of human immunodeficiency virus (HIV) has decreased significantly since modern antiretroviral therapy (ART), new HIV infections steadily occur, in the Republic of Korea. Based on the understanding of the risk factors for HIV infection, combined strategic behavioral and biomedical interventions should be implemented to reduce HIV infection. This paper reviews the strategies for the prevention of HIV infection.Current Concepts: While the consistent use of latex condoms is effective for the prevention of HIV transmission, consistent use of condoms is low among sexually active individuals. ART can be initiated, after exposure, to prevent HIV infection (post-exposure prophylaxis) after occupational or sexual exposure, injection drug use, and other nonoccupational exposures to HIV. There is a negligible risk of sexual transmission of HIV when the HIV-infected sexual partner has durably suppressed viral replication with ART. Antiretroviral agents have been shown to be highly effective when administered prophylactically to HIV-uninfected but at-risk individuals (preexposure prophylaxis). A high-risk group, such as men who have sex with men, is required to be included in health insurance care benefits for pre-exposure prophylaxis, in addition to the current partners of HIV-infected individuals, to ensure its efficacy.Discussion and Conclusion: HIV-related deaths are rapidly decreasing, but new HIV infections continue to occur. In an environment where a cure or the development of vaccines is unlikely, a multifaceted and proactive approach is required to minimize new HIV infections.

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa.

Global mental health [GMH] scholarship and practice has typically focused on the unmet needs and barriers to mental health in communities, developing biomedical and psychosocial interventions for integration into formal health care platforms in response. In this article, we analyse four diverse settings to disrupt the emphasises on health system weaknesses, treatment gaps and barriers which can perpetuate harmful hierarchies and colonial and medical assumptions, or a 'deficit model'. We draw on the experiential knowledge of community mental health practitioners and researchers working in Ghana, India, the Occupied Palestinian Territory and South Africa to describe key assets existing in 'informal' community mental health care systems and how these are shaped by socio-political contexts. These qualitative case studies emerged from an online mutual learning process convened between 39 academic and community-based collaborators working in 24 countries who interrogated key tenets to inform a social paradigm for global mental health. Bringing together diverse expertise gained from professional practice and research, our sub-group explored the role of Community Mental Health Systems in GMH through comparative country case studies describing the features of community care beyond the health and social care system. We found that the socio-political health determinants of global economic structures in all four countries exert significant influence on local community health systems. We identified that key assets across sites included: family and community care, and support from non-profit organisations and religious and faith-based organisations. Strengthening community assets may promote reciprocal relationships between the formal and informal sectors, providing resources for support and training for communities while communities collaborate in the design and delivery of interventions rooted in localised expertise. This paper highlights the value of informal care, the unique social structures of each local context, and resources within local communities as key existing assets for mental health.

“To do so in a patient-centred way is not particularly lucrative”: The effects of neoliberal health care on PrEP implementation and delivery

BackgroundHIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention used by HIV-negative people to prevent HIV acquisition. Despite increased use of PrEP worldwide, several barriers to PrEP implementation have resulted in insufficient uptake, inadequate adherence, and frequent discontinuation. Our objective was to interrogate the social, political, and economic conditions shaping PrEP implementation and delivery among gay, bisexual, queer and other men who have sex with men (GBQM) in Ontario, Canada. MethodsSix focus groups and three interviews with 20 stakeholders in Ontario (e.g., healthcare professionals, clinicians, community-based organization staff, and government staff) were conducted between July and October 2021. Participants were asked about the personal, workplace, and structural factors shaping PrEP delivery strategies for GBQM. Transcripts were analyzed using reflexive thematic analysis informed by the political economy of PrEP and employed a critique of neoliberalism. ResultsParticipants critiqued the problematic arrangements of the current healthcare system in Canada. Neoliberal governmentality and policies have resulted in inequitable PrEP care by establishing funding structures prioritizing profit and requiring patients and providers to function as individual entrepreneurs. Consequently, healthcare disparities are compounded for marginalized peoples who lack the resources and capacity to navigate existing healthcare systems. Participants identified several pathways to improve the implementation of PrEP, including greater institutional and governmental supports for PrEP and healthcare, leveraging communities and collaboration, and moving beyond risk-based health frameworks. ConclusionSocio-political-economic changes reflecting post-neoliberal principles are needed to overcome existing barriers to PrEP care, and sexual and reproductive healthcare more broadly.

Clinical and genetic characterization of 47 Chinese pediatric patients with Pitt–Hopkins syndrome: a retrospective study

BackgroundPitt–Hopkins syndrome (PTHS) is a neurodevelopmental disorder that remains underdiagnosed and its clinical presentations and mutation profiles in a diverse population are yet to be evaluated. This retrospective study aims to investigate the clinical and genetic characteristics of Chinese patients with PTHS.MethodsThe clinical, biochemical, genetic, therapeutic, and follow-up data of 47 pediatric patients diagnosed with PTHS between 2018 and 2021 were retrospectively analyzed.ResultsThe Chinese PTHS patients presented with specific facial features and exhibited global developmental delay of wide severity range. The locus heterogeneity of the TCF4 gene in the patients was highlighted, emphasizing the significance of genetic studies for accurate diagnosis, albeit no significant correlations between genotype and phenotype were observed in this cohort. The study also reports the outcomes of patients who underwent therapeutic interventions, such as ketogenic diets and biomedical interventions.ConclusionsThe findings of this retrospective analysis expand the phenotypic and molecular spectra of PTHS patients. The study underscores the need for a long-term prospective follow-up study to assess potential therapeutic interventions.

Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations

BackgroundImplementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient’s health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term—adjunctive interventions—to classify change methods that are distinct from the common intervention/strategy taxonomy.Main textAdjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients’ motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention (“the thing”), as an adjunctive intervention, or an implementation strategy in different studies—further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients’ attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients’ utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided.ConclusionConceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.

Optimizing Interventions for Equitability: Some Initial Ideas

Interventions (including behavioral, biobehavioral, biomedical, and social-structural interventions) hold tremendous potential not only to improve public health overall but also to reduce health disparities and promote health equity. In this study, we introduce one way in which interventions can be optimized for health equity in a principled fashion using the multiphase optimization strategy (MOST). Specifically, we define intervention equitability as the extent to which the health benefits provided by an intervention are distributed evenly versus concentrated among those who are already advantaged, and we suggest that, if intervention equitability is acknowledged to be a priority, then equitability should be a key criterion that is balanced with other criteria (effectiveness overall, as well as affordability, scalability, and/or efficiency) in intervention optimization. Using a hypothetical case study and simulated data, we show how MOST can be applied to achieve a strategic balance that incorporates equitability. We also show how the composition of an optimized intervention can differ when equitability is considered versus when it is not. We conclude with a vision for next steps to build on this initial foray into optimizing interventions for equitability.

Determinants of HIV Pre-Exposure Prophylaxis (PrEP) Retention among Transgender Women: A Sequential, Explanatory Mixed Methods Study.

Transgender 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.

Hearing voices, but whose? Constructions of schizophrenia in introductory psychology textbooks

Introductory psychology courses have a broad reach; their textbooks are instrumental in disseminating information about mental distress. In this study, we present the theoretical implications of a Foucauldian discourse analysis of constructions of schizophrenia in six introductory psychology textbooks assigned in Aotearoa/New Zealand and Australia. We identify three interconnected discursive constructions within the textbooks: object-for-study, social problem, and unrecoverable illness. These constructions converge to position people with a diagnosis of schizophrenia (PWDS) as sites for biomedical intervention and generate biomedical treatment as necessary but non-curative. Notably, the voices of PWDS are absent from the texts. We contend that amplifying counter discourses and the voices of PWDS is essential to provide the context, meaning, and hope that is missing from these textbooks, and broader society. We work with Mad Studies to present potential ways of theorising otherwise around these experiences—and leveraging this theory in textbook writing.

Could We Trust Parents? Bioethical Analysis of Biomedical Intervention on Healthy Children

This text deals with the bioethical analysis of biotechnologies and biomedical interventions for healthy children to achieve a better life for them. The study of such a situation requires that the relationship between respect for autonomy and beneficence should be considered from two perspectives: first, from the perspective of parents as holders of the right to make decisions about the treatment and improvement of their minor children (the principle of respect for autonomy). In that case, parents are guided by the principle of benevolence and paternalistically demand interventions with new bio-medical technologies to make their children's lives better, that is, to improve them. Another approach to the same problem refers to the pressure of children on their parents to provide them with a better life through medical interventions that are increasingly imposed as a social, gender, and aesthetic demand and promoted as an exit of "social suffering," to which individuals who do not meet such requirements are exposed. Bearing in mind both aspects, we analyze the possibility of solving emerging social problems through the potential transfer of the principle of autonomy (owned by parents) to the creditors of the right to make decisions regarding medical interventions for healthy children. Such concerns become particularly relevant given the complexity of the old question: Do parents see their children as an extension of their motives and ambitions? In that case, instead of the decision of the children and the family, an active role in deciding on the implementation of the interventions above should be played by independent professional and ethical commissions, which assess whether the holders of the right to make decisions aim to treat or improve healthy children and that these interventions would be possibly more adequate before some invasive application of biotechnological means.

Autobiography and Transgender Worlds: Body and Queer Corporeality

In the context of rapidly changing biomedical interventions and emerging non-surgical practices of gender transformation, the paper explores various issues associated with trans procedures that trans people in the three autobiographies go through namely, Manobi Bandyopadhyay’s A Gift of Goddess Lakshmi, A. Revathi’s The Truth About Me: A Hijra Life Story, and Living Smile Vidya’s I am Vidya: A Transgender’s journey. One of the main events of the three autobiographies is the sex change surgery that the three protagonists, Somnath (later, Manobi after sex change operation) in A Gift of Goddess Lakshmi, Doraisamy (later, Revathi after sex change operation) in The Truth About Me, and Preeti (later, Vidya after sex change operation) Living Smile Vidya’s I am Vidya: A Transgender’s journey undergo. The paper problematizes various issues related to trans procedures that Somnath, Doraisamy and Preeti undergo and attempts to find answers to questions such as if Somnath’s and Doriaswamy’s undergoing transgender procedures can be ‘simply’ equated with other forms of body modification such as tattooing, piercing and cosmetic surgery, and is not to be considered as a ‘complete, pathological rearrangement of identity’; can these transgender procedures be called a way of reorganizing the protagonists’ body to suit their image of themselves; is it possible to extricate social and political implications of transgender procedures that the three protagonists experience; if ‘trans’ procedures that the three protagonists experience can be seen in context of pseudo-medical accounts of transsexual autobiographies that tolerate body-modificatory practices so far as they enable a move away from strangeness and towards normalcy; do the protagonists opt for ‘trans’ procedures to alleviate the pain of being strange and engender a process of becoming ‘normal’; and whether or not trans practices constitute some form of self-mutilation.

審慎地擁抱未來

LANGUAGE NOTE | Document text in Chinese; abstract also in English.
 As a measure of biomedical intervention, brain–computer interfaces in the era of artificial intelligence (AI-BCI technology, ABT) pose enormous ethical challenges in terms of human autonomy, mental integrity, identity, data privacy, and control while achieving therapeutic goals. It is necessary to analyze and differentiate these ethical challenges one by one, but more importantly, to find the truly safest, most effective, and most ethical ways to implement biomedical interventions and ensure “responsible research and innovation” in biomedical fields. In the context of the international development of consistent ABT standards, the policy formulation of “a right to mental privacy” and brain data security in Chinese bioethics will be a heavy and arduous task.

Biological Aging Acceleration Due to Environmental Exposures: An Exciting New Direction in Toxicogenomics Research.

Biological clock technologies are designed to assess the acceleration of biological age (B-age) in diverse cell types, offering a distinctive opportunity in toxicogenomic research to explore the impact of environmental stressors, social challenges, and unhealthy lifestyles on health impairment. These clocks also play a role in identifying factors that can hinder aging and promote a healthy lifestyle. Over the past decade, researchers in epigenetics have developed testing methods that predict the chronological and biological age of organisms. These methods rely on assessing DNA methylation (DNAm) levels at specific CpG sites, RNA levels, and various biomolecules across multiple cell types, tissues, and entire organisms. Commonly known as 'biological clocks' (B-clocks), these estimators hold promise for gaining deeper insights into the pathways contributing to the development of age-related disorders. They also provide a foundation for devising biomedical or social interventions to prevent, reverse, or mitigate these disorders. This review article provides a concise overview of various epigenetic clocks and explores their susceptibility to environmental stressors.

Mediation Analysis Identifies Amyloid Imaging Genetic Patterns for Cognitive Outcomes in Alzheimer’s Disease

AbstractBackgroundPrevious genetic studies of Alzheimer’s Disease (AD) utilized features derived from florbetapir (AV45) PET imaging (Lee et al., BMC Genomics 85(2022)). Genetic analysis of florbetaben (FBB) PET FreeSurfer‐defined ROI‐specific SUVrs provided by the Alzheimer’s Disease Neuroimaging Initiative (ADNI) can extend this work by nominating ROIs likely to play a specific role in mediating genetic effects on AD‐related cognitive decline. Nominated ROIs may be suitable targets for biomedical interventions that slow the progression of AD.MethodGenetic and neuroimaging data were obtained from the ADNI 3 cohort. Amyloid burden measurements (SUVrs) were extracted and intensity‐normalized using the provided whole‐cerebellum reference region SUVr (Landau et al., 2021 ADNI). Imputed genotyping data included 5,402,690 variants from 308 individuals. Genome‐wide association studies predicted FBB changes in each of 68 FreeSurfer cortical ROIs utilizing age, gender, years of education, and the first 10 principal components as covariates. Within each individual imaging feature, FDR‐corrected P value thresholds determined significance (ɑ = 0.05). Mediation analysis combined identified SNP‐imaging feature associations with clinical cognitive score data to determine if changes in amyloid burden mediate genetic effects on clinical outcomes.Result149 unique SNPs and 28 unique imaging features were implicated in 881 FBB SNP‐feature associations (P values as low as 8.97e‐9). Although most associations are linked to known AD genes, a number of SNPs on chromosomes 18, 15, 14, 12, 6, 4, and 2 were also identified (Fig 1). Significant GWAS associations were carried forward to identify 83 mediation relationships (Bonferroni P < 1.56e‐6). An especially large number of significant causal mediation relationships implicated the entorhinal cortex and parahippocampal gyri, both of which play a significant role in learning and memory (Fig 2).ConclusionGenetic association traced some of the variation in FBB measures of amyloid burden to genetic drivers throughout the genome. Mediation analysis confirms that the FBB measures in the entorhinal cortex and parahippocampal gyri mediate the effects of some genetic findings on learning and global cognition. Future analyses of FBB measures as imaging endophenotypes may inspire pathway analyses and integrate additional clinical or biological information.

Efficient regulatory approval of two novel HIV prevention interventions in a resource-limited setting: experiences from Zimbabwe.

The global burden of HIV remains unacceptably high despite significant progress made in HIV treatment and prevention. There is an urgent need to scale up the comprehensive HIV prevention strategies that include pre-exposure prophylaxis (PrEP). Oral PrEP is highly effective in preventing HIV acquisition when taken regularly, but this remains a challenge for some at-risk individuals. Therefore, there is a need for other HIV prevention options. The dapivirine vaginal ring (DVR) and long-acting injectable cabotegravir (CAB-LA) are novel biomedical interventions that are safe and efficacious for HIV pre-exposure prophylaxis, as demonstrated in recently completed clinical trials. Timely roll-out and scalability of efficacious interventions depend on the registration process with the national medicine regulatory authorities (NMRAs). The Medicines Control Authority of Zimbabwe (MCAZ) was the first NMRA globally to approve the DVR in July 2021 and the first in Africa to approve CAB-LA for HIV prevention in July 2022. The regulatory review process for DVR and CAB-LA by MCAZ took 4.5 and 5.5 months, respectively. This efficient review process of the two interventions by MCAZ, a regulatory body in a resource-limited setting, provides important lessons to shorten timelines between the completion of the clinical development process and the registration of essential medicines.

Alcohol and inflammation: Examining differences at the intersection of sexual identity and race/ethnicity

Sexual minorities (SMs; e.g., lesbian, gay, bisexual, and other non-heterosexual individuals) are more likely to be current alcohol drinkers than their heterosexual peers while separately experiencing elevated inflammation. Yet, little research has assessed the association between alcohol use and inflammation among subgroups of SMs, let alone potential differences among people with multiple marginal identities (e.g., race/ethnicity and sexual identity).Data came from the National Health and Nutrition Survey 2015–2016. Survey-weighted multivariable linear regression analysis was used to assess the relationship between alcohol use categories, heavy episodic drinking, and log-CRP (C-reactive protein). Models were stratified by sexual identity to determine whether associations between alcohol use and inflammation or between race/ethnicity and inflammation differed by sexual identity.Among 3220 participants, 1000 (36.8%) reported light alcohol use, 870 (32.0%) reported moderate use, and 483 (17.8%) reported heavy use. Mean raw CRP was 4.1 mg/L (SD = 8.1). The association between race/ethnicity and CRP differed in stratified relative to non-stratified models with key differences in CRP among individuals with multiple marginalized identities. We also observed that while the “classic” J-shaped relationship between alcohol use and systemic inflammation persists among heterosexuals in this sample, it does not hold among subgroups of sexual minorities. In particular, bisexuals who report heavy alcohol use, compared to non-users, experience significantly elevated CRP. Finally, we did not observe any association between heavy episodic drinking and CRP among subgroups of sexual minorities.Future studies assessing alcohol and biomarker data need to strive to include subgroups of sexual minorities and people with multiple marginal identities to better target behavioral and biomedical interventions aimed at reducing health disparities.

A follow-up study: 6-year cART-free virologic control of rhesus macaques after PD-1-based DNA vaccination against pathogenic SHIVSF162P3CN challenge.

An effective vaccine for combination antiretroviral therapy (cART)-free virologic control of HIV-1 by enhancing antigen-specific effector-memory CD8+ T lymphocytes could be useful in controlling the AIDS pandemic. Previously, we demonstrated that a programmed death-1 (PD-1)-based DNA vaccine, pRhPD1-p27, was effective in inducing Gag-p27-specific effector-memory CD8+ T cells for viremia suppression in rhesus macaques infected with pathogenic SHIVSF162P3CN for 2 years. In this follow-up study, we report on two pRhPD1-p27-vaccinated and SHIVSF162P3CN-infected macaques that have remained alive to date with undetectable viremia levels and low proviral loads over 6 years in the absence of cART, achieving a state of sustained virologic control. Polyfunctional effector-memory Gag-p27-specific T cells were maintained in these macaques. Moreover, several T cell epitopes found at 6 years post-viral challenge were identical to those induced during the vaccination phase, indicating sustained vaccine-induced memory T cell responses. The viral challenge resulted in de novo Nef-specific T cell responses, which were also maintained. These Gag-p27- and Nef-specific T cell responses were stronger than those in some SHIVSF162P3CN-infected macaques that showed viremia control after experimental therapy using a tandem bispecific neutralizing antibody. Our findings indicate that the PD-1-based DNA vaccine strategy holds promise as a clinical immunotherapy for long-term HIV-1 suppression.IMPORTANCEEfficient strategies for HIV-1 cART-free virologic control are critical for ending the AIDS pandemic. The essential role of effector-memory CD8+ T cells in controlling viremia and eliminating virus-infected cells has made them a promising target for vaccine development. It has been previously reported that PD-1-based DNA vaccination was effective in inducing polyfunctional effector-memory CD8+ T cells for AIDS virus control for 2 years in rhesus monkeys. This follow-up study extends the findings and shows that a viremia-free period of over 6 years was detected in two monkeys immunized with PD-1-based DNA vaccine against pathogenic SHIVSF162P3CN infection in the absence of antiretroviral therapy. Long-term vaccine-induced memory T cell responses were detected. Our results warrant the clinical trials of PD-1-based DNA vaccines for achieving HIV-1 cART-free virologic control used either alone or in combination with other biomedical interventions.

Molecular and Biological Aspects of Orthodontic Tooth Movement: Possibilities for Bioengineering Intervention: A Narrative Review.

The current review's goal is to examine, with a critical eye, the effect of various biomedical parameters on orthodontic tooth movement in an attempt to provide the reader with related mechanisms of this issue focusing on certain key points. This critical review was conducted using the following keywords in the search strategy: "biomedical molecules", "biomarkers", "orthodontics", "orthodontic tooth movement", "acceleration", "gene therapy", and "stem cells". Cochrane Library, Medline (PubMed), and Scopus were the databases that were used for the electronic search. Studies published until June 2023 were considered. The use of biomedical approaches in orthodontic tooth movement has been investigated via different procedures and applications. Surgical approaches, biomarkers affecting orthodontic tooth movement, different biological events and mechanisms, RANK, RANK-L, OPG molecular triad, and vibration methods are the basic parameters of biomedical interventions that are examined in the present review. The biomedical approach seems to offer a variety of applications to control orthodontic tooth movement. The scarcity of human studies, as well as the high cost and complexity of these methods, currently limit the available accurate data concerning this issue.

Increasing Spiritual Beliefs are Associated With Lower HIV Incidence Among Black Men Who Have Sex With Men: Results From HPTN 061 Longitudinal Study.

There is a limited understanding about the impact of spiritual beliefs and activities on HIV seroconversion among black men who have sex with men (BMSM), which we investigate in this study. United States. The HIV Prevention Trials Network Study 061 collected demographic and biomedical assessments among BMSM across 6 United States cities for longitudinal analysis. Spiritual beliefs and spiritual activities are constructed composite scales. Bivariate analyses among 894 who provided data at 12-month follow-up compared men who seroconverted to HIV between baseline and 6 months with those who remained uninfected with HIV at 12 months. Cox proportional hazard regression among 944 men tested spiritual beliefs and activities on the longitudinal risk of HIV seroconversion adjusting for age and any sexually transmitted infection (STI). Among this sample, HIV incidence between baseline and 6 months was 1.69%, (95% confidence intervals [CI]: 1.04 to 2.77). Men who seroconverted to HIV were significantly younger than those who remained uninfected at the 12-month follow-up: (mean age 27, SD = 11 vs 37, SD = 12) and a higher proportion reported any STI (46.67% vs 11.39%, P < 0.01). A one-unit increase in spiritual beliefs was associated with lower hazard rate of seroconverting to HIV at follow-up [adjusted hazard ratio (aHR) = 0.37, 95% CI: = (0.16 to 0.87)]. Religious service attendance and spiritual activities were unrelated to seroconverting. Spirituality is important in the lives of BMSM. Biomedical and behavioral HIV prevention interventions should consider assessing spiritual beliefs in HIV care among BMSM.

The why, what and how of preconception care: an exploratory descriptive qualitative study in Karnataka, India

BackgroundWomen’s health and nutrition are key to their reproductive health and are important for optimising pregnancy outcomes. Formation of most foetal organs starts soon after conception and much before the woman has her first antenatal visit. The provision of biomedical, behavioural and social interventions to couples to address health, nutrition, behaviour issues and individual environmental risk factors that could contribute to improved maternal and child health outcomes before conception is crucial. Most rural women in India, do not seek pregnancy care before the second trimester because of socio-cultural factors. Therefore, intervening in the preconception period is important. The objective of the study was to explore the challenges and opportunities of implementing preconception care interventions.MethodsIndividual, in-depth, semi-structured interviews (n = 25) were conducted with primary stakeholders (newly married women, newly married men, and family members) in Shorapur taluk of Yadgir district and Devadurga taluk of Raichur district. Thirty-one interviews were conducted with taluk, district, state officials and academicians. This descriptive qualitative study conducted four focus group discussions with front-line health workers. The in-depth interviews (IDIs) and Focus-group discussions (FGDs) used separate pre-tested semi-structured interview/discussion guides. Data analysis was carried out using NVivo software using a phenomenological approach with both inductive and deductive analysis.ResultsA strong influence of social and cultural norms shapes healthcare-seeking behaviour at the community level. Poor dietary diversity, lack of awareness, poor literacy levels, work pressure for women, lack of decision-making power and empowerment among women, pressure to conceive early, and gender norms are the roadblocks to successful preconception care programs in the rural Karnataka setting. The stakeholders expressed the need for interventions during the preconception period. The government functionaries recommended several interventions which could be potentially integrated into the existing Reproductive Maternal, Neonatal, Child and Adolescent Health (RMNCH + A) strategy to improve the health and nutrition of women before they conceive.ConclusionThe study highlights the need for structured interventions during the preconception period to improve maternal health and pregnancy outcomes. The recommendations provided by government functionaries are indicative of the feasibility of integrating interventions in the RMNCH + A strategy.

Individual endogenous pain modulation profiles within a multidimensional context of people with cervicogenic headache – A retrospective exploratory study

BackgroundOne in four individuals with cervicogenic headache (CeH) are unresponsive to therapy. Such therapy involves predominantly biomedical interventions targeting the upper-cervical spine. A recurring theme within musculoskeletal practice is the multidimensional nature and substantial heterogeneity of the condition. Such heterogeneity might be a reason for failure of a biomedical approach. Therefore, future studies investigating efficacy of managing CeH should ideally be based on identification, and better understanding of the heterogeneity of this population based on a comprehensive evaluation of clinically relevant contributing factors. ObjectivesThe objective was to map profiles of individuals with CeH based on pain modulation within a multidimensional context. DesignPain Modulation Profiles (PMPs) of 18 adults (29–51 years) with CeH were mapped retrospectively. MethodThe PMPs consisted of a Pain-Profile (bilateral suboccipital, erector spinae, anterior tibialis pressure pain thresholds), a Psycho-Social-Lifestyle-Profile (Depression, Anxiety, Stress Scale, Headache Impact test, Pittsburgh Sleep Quality Index), or a combination of both. Individual results were compared to normative data. Two Pain-Profiles were defined: normal or altered. Psycho-Social-Lifestyle-Profiles were categorized based on the number of altered psycho-social-lifestyle factors (range 0–5). ResultsMapping PMPs in individuals with CeH resulted in 50% presenting with a dominant altered Pain-Profile, 16.7% with a dominant altered Psycho-Social-Lifestyle-Profile, and 5.6% with dominant alterations in both Pain-Profile and Psycho-Social-Lifestyle-Profile. ConclusionOur results indicate heterogeneity of PMPs within the CeH population. Replication of these results is needed through dynamic assessment of the Pain-Profile before evaluating if these profiles can help patient-stratification.