Negative Human Immunodeficiency Virus Status Research Articles

Awareness and Willingness to use Condoms and Preexposure Prophylaxis among Gay, Bisexual, and Other Cisgendered Men who Have sex with men in Slum Communities in Ghana. BSGH-004.

Introduction: Research has begun to examine human immunodeficiency virus (HIV) prevention strategies within the Ghanaian context. Still, little is known about specific populations such as gay, bisexual, and other cisgender men who have sex with men (GBMSM) living in slum communities. We studied HIV prevention strategies such as condoms and preexposure prophylaxis (PrEP) in slum communities and the awareness and willingness to use these choices among GBMSM. This qualitative study examines HIV prevention strategies, specifically examining PrEP and condom use behaviors among GBMSM in Ghana. Methods: We conducted in-depth face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi cities in Ghana. Data were analyzed through a summative content analysis with multiple reviewers to develop codes. Data were collected from participants in January 2022. Results: We found the fear and perceived risk of infection were motivators for consistent condom use, especially during anal sex. GBMSM living with HIV receiving antiretroviral therapy were more inclined to use condoms. We found motivations for using PrEP were influenced by the type of sexual activity and a history of negative HIV status. Also, the barriers to PrEP for GBMSM included limited access to healthcare facilities and the distance to these facilities. Conclusions: To improve condom and PrEP access and uptake, we recommend addressing structural barriers by increasing the number of health facilities and implementing targeted interventions to address the lack of information on HIV awareness and prevention. Involving peer educators may also effectively promote HIV prevention strategies, especially in communities with limited access to healthcare such as slums. Overcoming these access constraints could significantly enhance awareness and prevention of HIV, leading to improved health outcomes for GBMSM living in slum communities.

Uptake of and adherence to oral pre-exposure prophylaxis among adolescent girls and young women at high risk of HIV-infection in Kampala, Uganda: A qualitative study of experiences, facilitators and barriers

BackgroundThere is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda.MethodsThis study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14–24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM).ResultsPrEP uptake and adherence were facilitated by factors including: perceptions that one’s own or partner’s sexual behaviour was high risk, a negative attitude towards condoms, social support and wanting to maintain a negative HIV status after receiving a negative HIV test result. Good adherence to PrEP was enabled by effective counselling, support tools such as alarms and phone reminders and incentives like free treatment for STIs and other illnesses during study visits. Barriers to uptake included: anxiety about the pill burden, perceptions of being too young for PrEP and fear of being labelled `prostitute’ or `HIV positive’. Poor adherence was attributed to doubt over the efficacy of PrEP as a result of beliefs that because HIV was incurable, no medicine could prevent it. Alcohol use, side effects experienced, and mobility all had a negative impact on adherence. The majority of PrEP users reported feeling safe as a result of using PrEP which had both good and negative implications on their sexual behaviour, specifically the number of sexual partners and condom use.ConclusionAddressing community misconceptions to maximize uptake of PrEP among AGYW is important. Targeted education messages, and counselling to address misconceptions in ways that capture the attention of AGYW in communities are required.

1352. Changing Quality Indicators by Monitoring Veterans Using the Sexually TRansmitted Infection Key Evaluation (STRIKE) Dashboard

BackgroundDuring the COVID-19 pandemic, there have been multiple reports concerning patients falling out of healthcare. The National VA HIV and Hepatitis and Related Conditions (HHRC) has created the Sexually TRansmitted Infection Key Evaluation (STRIKE) Dashboard to help clinicians identify Veterans who need to complete co-testing for sexually transmitted infections (STIs) or human immunodeficiency virus (HIV) and allows providers to document if the Veteran was offered pre-exposure prophylaxis (PrEP).STRIKE Interface Screen MethodsA national VA Veteran dataset was generated from data within the Corporate Data Warehouse (CDW) that included all active PLWH. Positive HIV status is evaluated based on positive antibody test and positive confirmatory result or positive viral load lab result. Negative HIV status is evaluated based on a negative antibody test in the past year. Of the 140 sites, 39 participated but only 9 were active throughout the period of October 1, 2020 to March 31, 2021. Active and nonactive participating sites had metrics assessed across the study period at 3 time points: October 1, 2020, January 1, 2021 and April 1, 2021. Sites with at least 48 visits to report across the 6-month QI period were considered active.Patient level data for review Additional patient level data for review ResultsMultiple sites had scarcity of supplies due to the national shortage of CT/NG Test Kits during COVID-19. To improve access to CT/NG testing, the dashboard suppress the list of Veterans with + syphlis who were not co-tested for CT/NG. Co-testing improved from 60.2% to 77.2% in active sites and from 61.9% to 68.7% for nonactive across the study period. Percent of Veterans with completed HIV testing on or after STI diagnosis in active sites had an upward trend of 2.1% compared to the nonactive which increased 0.6%. Likewise, new diagnosis of STI for those on PrEP increased 2.6% in active and 0.5% increase in nonactive. On average, active sites increased percent of high risk veterans with active PrEP prescriptions by 2%, compared with nonactive that only increased 1%.STRIKE Co Testing and HIV Screen performed This graph shows average of Syphilis Co Testing and HIV screen performed by active and nonactive sites as measured at three different time point.Number of Veterans on PrEP with STIs This graph shows the average percent of veterans on PrEP with STIs between active versus nonactive sites as measured at three time pointsActive PrEP Prescriptions Across All Sites This graph shows average percent of active PrEP prescriptions for high risk patients between active versus nonactive sites as measured at three time pointsConclusionThe STRIKE Dashboard efficiently flags Veterans with STI diagnosis who need completion of STI co-testing, including HIV testing and PrEP offer. Active participating facilities who used the STRIKE Dashboard improved STI Co-testing and PrEP prescription in a short 6 month period even during COVID-19. Disclosures All Authors: No reported disclosures

Tuberculosis Treatment Outcomes and Associated Factors Among Patients Treated at Woldia General Hospital in Northeast Ethiopia: An Institution-Based Cross-Sectional Study.

BackgroundTuberculosis remains a major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. For effective tuberculosis control, it is a prerequisite to detect the cases as early as possible and to ensure that the tuberculosis patients complete their treatment and get cured. However, the burden of the problem is still a national issue, and there is a scarcity of research to show treatment outcomes and associated factors of tuberculosis at the North Wollo Zone, specifically Woldia.MethodsInstitution-based, retrospective register-based data were collected from medical records of tuberculosis patients from 2015 up to 2018 at Woldia General Hospital. The data were analyzed using SPSS version 24, and multiple logistic regression methods were used to investigate the association between independent and dependent variables. A P-value of less than 5% was considered statistically significant in the final model.ResultsThe prevalence of successful tuberculosis treatment outcomes was 80.7%. Among all patients, 73% were pulmonary tuberculosis cases. This study results show that age less than 24 years old [AOR: 4.7; 95% CI (1.3–10.1)], male sex [AOR: 2.8; 95% CI (2.1–4.8)], year of registration in 2018 [AOR: 4.8; 95% CI (3.9–7.4)], and HIV negative status [AOR: 3.9; 95% CI (1.4–10.7)] were found to be significantly associated factors with the treatment outcomes of tuberculosis.ConclusionThe study showed that nearly 20% of tuberculosis patients had an unsuccessful treatment outcome. Older age, female sex, year of registration in 2015, and being HIV positive were found significantly associated with poor tuberculosis treatment outcomes. Therefore, targeted measures should be considered to decrease poor TB treatment outcomes among high-risk patients through careful monitoring, making the DOTs program more accessible, counseling, and linking HIV patients.

Influence of patients' living conditions on tuberculosis treatment outcomes in a South African health sub-district.

BackgroundTuberculosis (TB) remains a serious public health concern because it continues devastating communities. This survey was conducted in the sub-district 2 of the Tshwane health district, South Africa. It aimed at determining the influence of patients’ living conditions on TB treatment outcomes. Human immunodeficiency virus (HIV) status, food security and exposure to cigarette smoke were considered as living conditions; and cure, death, default, failure and relapse were considered TB treatment outcomes.MethodsRecord review using the Aitahealth database, clinic registers as well as a piloted, structured and administered questionnaire.ResultsConvenience sampling applied; 180 respondents were obtained. Tuberculosis respondents with negative HIV status had a cure rate of 67.3% whilst those with positive HIV status had 37%. Tuberculosis respondents with good food security had 45.9% of cure rate. Tuberculosis respondents exposed to cigarette smoke had a death rate of 65.2%, while respondents not exposed to cigarette smoke showed 75% of cure rate.ConclusionHIV status, food security and exposure to cigarette smoke, as components of living conditions, showed an association with TB treatment outcomes in the selected sample; in the sense HIV infection reduced the cure rate, increased the death and default rates of TB patients in the same sample. Good food security increased the cure rate of TB patients, but exposure to cigarette smoke decreased the cure rate and increased the death rate amongst respondents having TB treatment in the current survey.

Conceptualising, measuring, and addressing HIV-related stigma: Towards reducing disparities in HIV testing and HIV-related outcomes among migrants of HIV unknown or negative status in high-income countries.

Human immunodeficiency virus (HIV)-related stigma (termed 'stigma') is a pervasive factor in the HIV epidemic, with significant implications for HIV-related outcomes (1, 2). For example, people may not undergo HIV testing if they perceive others may stigmatise them should they test, or test positive, for HIV (3-11). Stigma's continued presence stems, at least partially, from the inability to reach a consensus on the definition, and subsequently measures, of stigma and, therefore, instill and evaluate appropriate interventions (1, 2). This is likely to be compounded by its dynamic, non-static nature (10).

Uptake and Impact of Short Message Service Reminders via Sexually Transmitted Infection Partner Services on Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Frequency Among Men Who Have Sex With Men.

Sexually transmitted infection (STI) partner services (PS) allow provision of human immunodeficiency virus (HIV)/STI prevention interventions to high-risk individuals, including testing reminders via short message service (SMS). In King County, Washington, PS attempt to reach all men who have sex with men (MSM) with early syphilis and those with gonorrhea or chlamydia as resources allow. Since 2013, PS offered quarterly SMS testing reminders. We evaluated correlates of reminder uptake and the association between reminder uptake and postinterview asymptomatic STI diagnosis using Poisson regression, and the association between preinterview SMS reminder use and intertest interval among HIV-negative MSM using median regression. During July 1, 2013 to January 17, 2018, 8236 MSM were reported with 1 or more STI diagnoses and 5237 received PS interviews. Of these, 4087 (78%) were offered SMS reminders; 545 (13%) accepted, 265 (7%) were already receiving SMS, 3277 (80%) refused. Of 2602 patients who refused and were asked about other reminders, 37% used none, 16% received reminders from medical providers, 20% tested at routine physicals, and 26% used other reminders. SMS reminder use before and after PS interview was associated with negative HIV status, younger age, and diagnosis with gonorrhea or chlamydia (vs. syphilis) (P < 0.05 for all). Preinterview intertest interval was longer among MSM testing at physicals (9.6 months) than those using no reminder (5.6), SMS reminders (4.7, P < 0.05 vs. physicals), and non-SMS reminders (3.6, P < 0.001 vs. SMS). Reminder uptake was not associated with postinterview STI diagnosis. Offering SMS reminders through STI PS is feasible. Uptake was low, but higher among young MSM not on preexposure prophylaxis. The SMS reminders may increase testing frequency.

Non-Occupational HIV Post-exposure Prophylaxis: A 10-Year Retrospective Review of Data Following Sexual Exposure From Yaounde Central Hospital, Cameroon.

Background:Human Immunodeficiency Virus (HIV) post exposure prophylaxis (PEP) consists of administering antiretroviral therapy within 72 hours of viral exposure and continued for four weeks. PEP has been shown to be an important means of preventing and decreasing the number of new HIV infections in the general population. The purpose of this study was to describe the profile of patients who consulted at the HIV/AIDS Care and Treatment Center of the Yaounde Central Hospital (YCH) for PEP following non-occupational exposure to HIV. To attain our objective, we carried out a 10-year retrospective review of patient records of all persons who consulted for accidental HIV exposure at the YCH, Cameroon.Methods:This study was an observational, retrospective analysis of hospital records of persons who consulted for PEP following accidental exposure to HIV in the outpatient HIV clinic at YCH between January 2007 and December 2016. Data extracted from patients’ records were: type of HIV exposure, sex, age, profession, level of education, HIV status of source and time to consultation. Descriptive and inferential statistics were analyzed using STATA IC 12.0. Results were presented as median and interquartile range for continuous variables. Categorical variables were expressed as frequencies and proportions.Results:There were 628 consultations for PEP of which 48% (299/628) were as a result of non-occupational post exposure prophylaxis (nPEP). Of those who consulted for HIV PEP following non-occupational exposure, 78% (234/299) were females; adolescents group (15-19 years) and young adults group (20 – 24yrs.) constituted 41% (125/299). Forty percent (1208/299) were secondary or high school students (level of education) and 88% (262/299) were non-healthcare workers. The median time-to-consultation for non-occupational PEP (nPEP) was 19 hours (IQR: 12.4-25.0) and HIV status of the source was unknown in 64% (191/299) of cases and positive for 8% (25/299) of cases. The most frequent indications for consulting were sexual assault, 75% (224/299); condom slippage or breakage, 10% (30/299); and unprotected consensual sexual intercourse, 15% (45/299).Conclusion and Global Health Implications:Consultations for nPEP are as frequent as those occupational PEP (48% vs 52% in this study) in clinical practice at YCH. A good history of the source is important as it prevents unnecessary prescriptions of ART (which themselves have potential side effects) for persons consulting for potential HIV non-occupational exposure. In our study, we found that 27% (82/299) unnecessary ART prescriptions were avoided by determining that the exposure source person had negative HIV status. In addition, adolescent or young females consulting for nPEP in clinics could be potential victims of sexual assault or gender-based violence. Where possible, we recommend that clinicians consider the source of suspected viral exposure in clinical practice prior to administering ART for PEP.

A clinical study on genital warts and HIV in Bangladesh

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Like other sexually&lt;strong&gt; &lt;/strong&gt;transmitted diseases (STD), ano-genital warts (AGW) is associated with human immunodeficiency virus (HIV) infection and this study of AGW was conducted among HIV positive and HIV negative patients. The aim of the study was to study the risk factors and clinical presentations of ano-genital warts in HIV infected patients&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Northern part of Bangladesh from July 2015 to December 2016. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Significant association of HIV positivity (p&amp;lt;0.05) was&lt;strong&gt; &lt;/strong&gt;observed between age group of 15-30 years and HIV negative status (p&amp;lt;0.05) in age group of 31-45 years. HIV positive status significantly higher in patients with self-admitted multiple sexual partners (p&amp;lt;0.01), homosexuality (p&amp;lt;0.05) and presentation with anal warts (p&amp;lt;0.01). HIV negative status correlated significantly with single sexual partner admission (p&amp;lt;0.01) and hetero-sexuality (p&amp;lt;0.05). Gender did not show significant association with number of sexual partners or HIV positivity. Extra-genital or only genital warts had no association with HIV status. Co-STDs though more in number in seropositive group, did not show any significant association with HIV positivity (p&amp;gt;0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein tumour (BLT)&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;HIV positivity was significantly associated with&lt;strong&gt; &lt;/strong&gt;the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant AGW. Follow up of these patients with human papilloma virus (HPV) sub-typing is necessary. &lt;/span&gt;&lt;/p&gt;

Ano-Genital Warts and HIV Status- A Clinical Study.

Ano-Genital Warts (AGW) like other Sexually Transmitted Diseases (STD) is associated with Human Immunodeficiency Virus (HIV) infection. This study of AGW was done in HIV positive and HIV negative patients. To study the risk factors and clinical presentations of ano-genital warts in HIV positive and negative patients. A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Dr. D. Y. Patil Hospital and Research Centre from July 2014 to July 2016. Significant association of HIV positivity (p<0.05) was observed between age group of 15-30 years and HIV negative status (p<0.05) in age group of 31-45 years. HIV positive status significantly higher in patients with self-admitted multiple sexual partners (p<0.01), homosexuality (p<0.05) and presentation with anal warts (p<0.01). HIV negative status correlated significantly with single sexual partner admission (p<0.01) and hetero-sexuality (p<0.05). Gender did not show significant association with number of sexual partners or HIV positivity. Extra-genital or only genital warts had no association with HIV status. Co-STDs though more in number in ser-positive group, did not show any significant association with HIV positivity (p>0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein Tumour (BLT). HIV positivity was significantly associated with the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant ano-genital warts. Follow up of these patients with Human Papilloma Virus (HPV) sub-typing is necessary.

Programmatic utility of tuberculosis cluster investigation using a social network approach in Birmingham, United Kingdom.

Birmingham, United Kingdom, 2010-2014. To investigate predictors for clustering of tuberculosis (TB) cases and cluster size and to evaluate the impact of cluster investigation using social network data. Retrospective observational cohort study. Prioritised cases linked using 24-locus mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) were interviewed using a social network approach to find epidemiological links. Of 2055 TB cases notified, 56% could be typed. Clustering was associated with younger age, UK birth, Black Caribbean ethnicity, social risk factors, pulmonary TB and negative human immunodeficiency virus status. Only UK birth and presence of more than one social risk factor were associated with larger cluster size, while drug resistance was associated with smaller cluster size. Social network data from 139/431 clustered cases found new epidemiological links in 11/19 clusters with ⩾5 members (undirected median network density 0.09, interquartile range 0.05-0.4). Ninety-eight additional contacts were assessed, with one case of active TB and 24 with latent tuberculous infection diagnosed. A social network approach increased knowledge of likely transmission events, but few additional TB cases were diagnosed. Obtaining social network data for all typed and untyped TB cases may improve contact tracing and reduce unexpected transmission detected from molecular data.

Lung functions among patients with pulmonary tuberculosis in Dar es Salaam - a cross-sectional study.

BackgroundApproximately 40–60 % of patients remain sufferers of sequela of obstructive, restrictive or mixed patterns of lung disease despite treatment for pulmonary tuberculosis (PTB). The prevalence of these abnormalities in Tanzania remains unknown.MethodsA descriptive cross-sectional study was carried out among 501 patients with PTB who had completed at least 20 weeks of treatment. These underwent spirometry and their lung functions were classified as normal or abnormal (obstructive, restrictive or mixed). Logistic regression models were used to explore factors associated with abnormal lung functions.ResultsAbnormal lung functions were present in 371 (74 %) patients. There were 210 (42 %) patients with obstructive, 65 (13 %) patients with restrictive and 96 (19 %) patients with mixed patterns respectively. Significant factors associated with abnormal lung functions included recurrent PTB (Adj OR 2.8, CI 1.274 - 6.106), Human Immunodeficiency Virus (HIV) negative status (Adj OR 1.7, CI 1.055 - 2.583), age more than 40 years (Adj OR 1.7, CI 1.080 - 2.804) and male sex (Adj OR 1.7, CI 1.123 - 2.614).ConclusionThe prevalence of abnormal lung functions is high and it is associated with male sex, age older than 40 years, recurrent PTB and HIV negative status.

Comparison of the New Alere HIV Combo with Alere Determine HIV-1/2 Ag/Ab Combo in Acute Primo and Established HIV Infections

Background: Most human immunodeficiency virus (HIV) point-of-care tests detect antibodies but not p24 antigen. Individuals with an acute or early primary HIV infection have generally high viral loads, but do not produce antibodies yet. The first 4th generation rapid test – Alere Determine HIV-1/2 Combo test, disappointedly, gave rarely positive p24-antigen results in acute or early infections. To improve the sensitivity, a new test was developed: Alere HIV Combo test. Methods and Findings: A pilot study should elucidate the performance of the new Alere HIV Combo assay in comparison with Alere Determine HIV-1/2 Combo, and with the reference method. Samples of HIV-1 and HIV-2 infections of patients, who had not been under antiretroviral treatment before, were tested with both the new Alere HIV Combo and the Alere Determine HIV-1/2 Combo. Results were compared with Western blot and HIV viral loads from the reference laboratory. Fifteen samples were from patients with established HIV-1 infections, and two were of HIV-2; six samples were from acute or early primary HIV-1 infections. Fifteen samples were of negative HIV status. Alere Determine HIV-1/2 Combo gave correct results in established infections, where antibodies are produced, whereas in primary infections only HIV-1 of Clade B reacted weakly at the p24-antigen site. The new Alere HIV Combo assay reacted very well with all the positive samples of all clades, also in acute or early primary infections. Conclusions: The new Alere HIV Combo rapid test performs well in detecting anti- HIV antibodies as well as p24-antigen.

Are registered sputum smear-negative tuberculosis patients in Karnataka, India, diagnosed by national algorithm?

Four districts of Karnataka State, India, that have implemented the National Tuberculosis Control Programme (RNTCP). To assess the proportion of patients diagnosed according to the nationally recommended algorithm among new smear-negative (NSN) PTB cases registered under the RNTCP. Information on 201 registered NSN-PTB patients as regards date of initial sputum examination, repeat sputum examination and chest X-ray (CXR) if undertaken, treatment initiation and number of days of antibiotic treatment after initial sputum examination, were collected through record review and patient interviews. In patients with negative or unknown human immunodeficiency virus (HIV) status, the algorithm was considered completed if the patient underwent initial sputum examination, antibiotic trial for ⩾10 days, repeat sputum examination ⩾10 days after initial sputum examination, CXR after repeat sputum examination and anti-tuberculosis treatment ⩾10 days after initial sputum examination. In HIV-positive patients, the algorithm was considered completed if CXR was performed after or at the same time as initial sputum examination. Complete information was available for 170 patients. Of these, the algorithm was completed in 14 (8.2%, 95%CI 0.9-15.5): 1/140 patients with negative or unknown HIV status and 13/30 HIV-positive patients. The algorithm was not completed in most patients registered for treatment. Measures are needed to improve the diagnostic process for smear-negative PTB.

Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya.

1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya. Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.

High HIV Prevalence Among Low-Income, Black Women in New York City with Self-Reported HIV Negative and Unknown Status

Black women are disproportionally affected by human immunodeficiency virus (HIV). This study investigates factors associated with newly identified HIV infection among previously self-reported HIV negative or unknown status black women living in high risk areas (HRAs) of New York City (NYC). Heterosexuals residing in or socially connected to NYC HRAs were recruited using respondent driven sampling for participation in the United States Centers for Disease Control-sponsored National HIV Behavioral Surveillance System in 2010. Eligible individuals were interviewed and offered an HIV test. The analysis reported here focused on black women with valid HIV results who did not report being HIV positive, and examined factors related to HIV infection in this group. Of 153 black women who did not report being HIV positive at enrollment, 15 (9.8%) tested HIV positive. Age ≥40 years, ever injected drugs, and in the last 12 months had unprotected vaginal sex, exchange sex, last sex partner used crack, non-injection crack use, and non-injection heroin use were significantly associated with HIV infection (p<0.05). Only ever injected drugs (prevalence ratio: 5.1; 95% confidence interval: 2.0, 12.9) was retained in the final model. Black women who had reported being either HIV negative or unaware of their serostatus had high HIV prevalence. Efforts to identify and treat HIV positive black women in HRAs should target those with a history of injection drug use. Frequent testing for HIV should be promoted in HRAs.

HIV Status Determination Among Tuberculosis Patients From California During 2008

Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV. We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence. We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. California TB programs. All TB patients reported from California in 2008. Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types. Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a known HIV status before TB diagnosis. Among the remaining 280 patients, 187 patients (67%) were diagnosed with TB by a private provider. The HIV status determination of TB patients was selective and not routine as recommended. Private providers can play a key role in testing for HIV at TB diagnosis. California TB programs should ensure that all TB patients have an HIV status by promulgating national recommendations, educating private providers on the benefits of testing TB patients for HIV, and monitoring completeness of HIV status determination.

Eosinophilic Appendicitis Attributable to Strongyloides Infection in a Pediatric Renal Transplant Patient

The patient was born in a town near Bogota, Colombia and was adopted in the United States at 2 years of age. At the time of adoption, there was a suspicion of renal disease with failure to thrive. Within a year of arriving in Alabama, she was diagnosed with hypoplastic-dysplastic syndrome. Her renal disease resulted in dialysis at age 16, and she received a living unrelated renal transplant from her adoptive mother at age 18. She was treated with an immunosuppressive regimen that included tacrolimus, mycophenolate, and prednisone. Her immediate posttransplant course was notable only for complaints of mild diarrhea that worsened when her regimen changed from tacrolimus to sirolimus in the 8th month after transplant for a research protocol. At 9 months posttransplant, she developed severe, constant, right lower quadrant abdominal pain. Her diarrhea worsened and she developed headaches, but she denied having fever, cough, difficulty breathing, vomiting, or bloody stools. A computerized tomography scan showed findings associated with appendicitis, which prompted appendectomy. Pathologic examination of the specimen identified intense transmural eosinophilic infiltration of the appendiceal wall consistent with eosinophilic appendicitis (Figure ​(Figure1).1). Biopsies of the terminal ileum, cecum, and colon at the hepatic flexure also revealed eosinophilic infiltrates. No parasitic forms were found in any of the tissue samples by direct visualization. A peripheral eosinophilia of up to 9.5%was documented, and a stool test was negative for ova and parasites (O&P). Figure 1. Pathology of appendix. Numerous eosinophils fill the lamina propria (left panel) and infiltrate the submucosa (right panel) of the appendix (hematoxylin and eosin stain, ×132). After appendectomy, the patient's abdominal pain resolved and her diarrhea improved. However, her eosinophilia persisted, rising as high as 18.3% 3 months later, even after empiric treatment with 2 doses of mebendazole for “intestinal parasite” 1 month after appendectomy. Subsequent evaluation by the gastrointestinal and allergy/immunology services included negative immunoassays for food and upper respiratory allergens, negative screens for celiac disease, negative serology for Toxocara, and a Strongyloides immunoglobulin G (IgG) antibody by enzyme-linked immunosorbent assay (ELISA) that was positive (4.28, reference range <1.00, sensitivity and specificity of 90%; Focus Diagnostics, Cypress, CA). Based on these results, the eosinophilia and gastrointestinal findings were attributed to infection by Strongyloides. The patient was treated with a 4-day course of ivermectin (200 mcg/kg per day) 2 weeks before initial Infectious Diseases (ID) consultation. In ID clinic, additional history included a positive tuberculin skin test during pretransplant evaluation with a history of Bacillus Calmette-Guerin vaccination, which prompted a 9-month course of isoniazid. The patient reported intermittent “hive-like” rashes in “small red circles” mainly affecting her head, lower extremities, arms, and occasionally buttocks since early childhood, which she attributed to skin allergies. She lived with her parents and with 2 healthy dogs and cats. She reported walking outside barefoot frequently, but she denied any travel outside of the country since arriving in the United States. Investigation of the patient's available records revealed negative human immunodeficiency virus status and negative serologies for Trympanosoma cruzi, but testing was not performed for Strongyloides or other parasites on pretransplant evaluation. Any medical evaluation performed in the international adoption process was not available in our patient's medical record. However, her mother denied any medical issues at the time of adoption other than failure to thrive, a suspicion of renal disease, and bow-leggedness. One finding of particular interest was evidence of long-standing (up to 8 years before transplant) significant eosinophilia (>10%) that subsided with transplant but reappeared with the onset of her abdominal symptoms (Figure ​(Figure22). Figure 2. Eosinophil percentage from peripheral blood samples over a 10-year span. Time of transplant (a: 5/21/09), appendectomy (b: 2/18/10), and completion of first (c: 6/5/10) and second (d: 6/27/10) treatments with ivermectin are marked with arrows. On physical examination the patient was well-appearing and of short stature (143.5 cm, <3% for age), with a soft, nontender abdomen, palpable transplant kidney mass in the lower right quadrant, a well-healed surgical scar over her right abdomen, and no hepatomegaly. No rashes were observed. Although a single stool O&P before initial treatment had been negative, 3 daily stool O&P examinations were repeated and were negative. Serologies for human T-lymphotropic virus (HTLV) and filaria were likewise negative. A complete blood count after the first course of ivermectin revealed that her eosinophilia had improved (white blood cells of 6.27, 3.2% eosinophils). To ensure eradication in an immunocompromised patient, a second course of ivermectin was given (200 mcg/kg per day for 2 days). At a follow-up visit 6 months later the patient continued to do well with no new symptoms and no further reports of rashes. A repeat Strongyloides IgG level was undetectable.

Comparison of hepatitis C virus treatment between incarcerated and community patients

The prevalence of chronic hepatitis C virus (HCV) infection among incarcerated individuals in the United States is estimated to be between 12% and 31%. HCV treatment during incarceration is an attractive option because of improved access to health care and directly observed therapy. We compared incarcerated and nonincarcerated HCV-infected patients evaluated for treatment at a single academic center between January 1, 2002 and December 31, 2007. During this period, 521 nonincarcerated and 388 incarcerated patients were evaluated for HCV treatment. Three hundred and nineteen (61.2%) nonincarcerated patients and 234 (60.3%) incarcerated patients underwent treatment with pegylated interferon and ribavirin. Incarcerated patients were more likely to be male, African-American race, and have a history of alcohol or intravenous drug use. Treated incarcerated patients were less likely to have genotype 1 virus and were less likely to have undergone previous treatment. There was a similar prevalence of coinfection with human immunodeficiency virus (HIV) in both groups. A sustained viral response (SVR) was achieved in 97 (42.9%) incarcerated patients, compared to 115 (38.0%) nonincarcerated patients (P = 0.304). Both groups had a similar proportion of patients that completed a full treatment course. Stepwise logistic regression was conducted, and the final model included full treatment course, non-genotype 1 virus, younger age at treatment start, and negative HIV status. Incarceration status was not a significant predictor when added to this model (P = 0.075). In a cohort of HCV-infected patients managed in an academic medical center ambulatory clinic, incarcerated patients were as likely to be treated for HCV and as likely to achieve an SVR as nonincarcerated patients.

Molecular strain typing of Mycobacterium tuberculosis complex in Bamako, Mali

To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles. Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali. Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%). This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.