Failure to recognize Low non-treponemal titer syphilis infections in pregnancy May lead to widespread under-treatment

Objectives: Rates of maternal syphilis have increased five-fold in Brazil in the past decade. While penicillin remains the only appropriate treatment for maternal syphilis, we hypothesized that low non-treponemal titers (<1:16) may lead to reduced penicillin treatment in Brazil. Methods: Using Brazilian Ministry of Health data on women diagnosed with maternal syphilis between January 1, 2010, and December 31, 2018, we conducted a random-effects logistic regression model with a cluster correction at the state level to evaluate predictive factors of penicillin treatment. Results: We observed yearly increases in cases of pregnant women with syphilis from 2010 to 2018. There was significant variation by state: 52,451 cases were reported in São Paulo, followed by 26,838 in Rio de Janeiro. Among 215,937 cases of maternal syphilis, 91·3% received penicillin. In the random-effects model, a non-treponemal titer ≥1:16 was associated with 1·44 higher odds of receiving penicillin (95% confidence interval [CI]: 1·391·48), and prenatal care was associated with a 2·12 increased odds of receiving penicillin (95% CI: 2·022·21). Although there is an association between the absence of prenatal care and inadequate treatment for syphilis, 83·2% of women in this cohort who did not receive penicillin were engaged in prenatal care. Conclusions: Providers may inappropriately exclude low non-treponemal titers and thereby fail to use penicillin treatment in maternal syphilis. While the cause of the maternal syphilis epidemic in Brazil is multifactorial, we believe our findings can be used to develop targeted interventions throughout Brazil as well as shape public health initiatives globally.National Institute of Mental HealthRevisión por pare

Exercise and antiretroviral adherence in adults living with HIV: A systematic review.

This systematic review assessed the relationship between exercise and ART adherence in adults living with HIV. A comprehensive search through June 2020 for relevant studies was conducted, and PRISMA guidelines were followed. To be included, studies had to meet the following criteria: (a) published in a peer-reviewed journal; and (b) examined the relationship between exercise and ART adherence. A total of 4310 studies were identified, and nine were included. The majority (five out of nine) of studies found a significant and positive relationship between exercise and ART adherence. Strengths, limitations, and future directions are discussed

Exercise preferences for young people at-risk for and living with HIV: a short report.

Exercise can improve physical and mental health for young people at risk for and with HIV, but prevalence rates remain low. This study explored exercise preferences and barriers among young people at risk for and with HIV, and potential gender differences. A total of 129 participants (66.7% male, mean age = 23.8 [SD = 2.1; range: 19-28], 35.7% Black/African American) at-risk for or with HIV were recruited from a larger study and completed an online survey of exercise preferences and barriers. Overall, participants preferred an exercise program that takes place at a fitness center, occurs alone, has a coach/instructor present, is between 30 and 60 minutes, lasts longer than 8 weeks, and includes aerobic and resistance exercises. The fatiguing nature of exercise and cost were common barriers among all genders. Few gender differences emerged. These results should be used to design exercise programs for young adults at risk for and with HIV

Intersection of COVID-19, HIV and exercise: a commentary with home-based exercise recommendations for practice.

The worldwide spread of COVID-19 has led to closures or reduced capacity of non-essential businesses and recreational areas and stay-at-home orders to promote social distancing. Although effective to reduce transmission, these policies may negatively impact exercise behaviors. Exercise is effective at mitigating the risk of developing or exacerbating several of underlining risk factors for a more severe COVID-19 disease course and may be particularly important for people with HIV (PWH). In this commentary, we discuss the intersection of COVID-19 and exercise with a specific focus on people living with HIV. We then provide a pragmatic, home-based exercise routine that can be performed with little to no equipment or supervision. It is important for PWH (and others) to start or maintain at least some level of exercise to reduce the risk of a severe COVID-19 disease course and to improve other health outcomes in this unfamiliar climate

Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers.

BackgroundMultiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its' sequelae diseases are elevated among minority populations.ObjectiveTo examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers.MethodsA purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein-Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions were used to assess the strength of associations between variables.ResultsAlmost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P&lt;.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=-.32), C-reactive protein level (r=-.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein-Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=-.35 to -.44, P&lt;.05).ConclusionsBrief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support

Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers (Preprint)

BACKGROUND There are multiple strategies but no gold standards for self-monitoring diet, physical activity (PA), and perceived stress. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools is dependent on validity and reliability, which is lacking in evidence. African-American and Latina mothers in the United States are high priority populations for applications addressing diet, PA, and stress because mothers typically increase body mass index (BMI) for several years after childbirth and the risks of obesity and its’ sequelae diseases are elevated among minority populations. OBJECTIVE This pilot study examined inter-method reliability and concurrent validity of smartphone-based self-monitoring by ecological momentary assessments (EMA) and daily-diaries for diet, stress, and PA compared to brief recall measures, anthropometric bio-measures and bloodspot biomarkers. METHODS A purposive sample (n=42) of primarily African-American (39%) and Latina (44%) mothers (about one-third normal weight, overweight, or obese) was assigned AndroidTM smartphones with the Ohmage application to self-monitor diet, perceived stress, and PA over six months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, PA assessments adapted from NHANES, and the PSM-9 stress measure. Anthropometric bio-measures included BMI, body fat, waist circumference, and blood pressure (BP). Bloodspot assays for Ebstein-Barr Virus (EBV) and C-Reactive Protein (CRP) were used as biomarkers of systemic load and stress. EMA and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light PA. Units of analysis were follow-up assessments (n=29 to n=45 depending on domain) nested in participants (N=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions assessed strength of associations between variables. RESULTS Almost all participants (93%) completed the study. Inter-method reliability between smartphone EMA/diary reports and their corresponding recall reports was highest for stress and diet, with correlations ranging from .27 to .52 (with p&lt;.05), but was unexpectedly low for PA with no significant associations. Concurrent validity was demonstrated for diet EMA/diary reports with systolic BP (r = -.32), CRP (r = -.34), and moderate and vigorous PA recalls (r = .35 to .48), suggesting co-variation between healthy diet and PA behaviors. Stress EMA/diary reports were not associated with EBV and CRP biomarkers. Moderate and vigorous PA diary reports were negatively associated with BMI and body fat (r = -.35 to -.44, p&lt;.05). CONCLUSIONS Brief smartphone EMA may be valid and reliable for long-term self-monitoring of diet, stress, and PA. Lack of inter-method reliability for PA measures is consistent with prior research. More research is needed on the efficacy of smartphone self-monitoring for self-management and behavior change support

Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers (Preprint)

BACKGROUND There are multiple strategies but no gold standards for self-monitoring diet, physical activity (PA), and perceived stress. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools is dependent on validity and reliability, which is lacking in evidence. African-American and Latina mothers in the United States are high priority populations for applications addressing diet, PA, and stress because mothers typically increase body mass index (BMI) for several years after childbirth and the risks of obesity and its’ sequelae diseases are elevated among minority populations. OBJECTIVE This pilot study examined inter-method reliability and concurrent validity of smartphone-based self-monitoring by ecological momentary assessments (EMA) and daily-diaries for diet, stress, and PA compared to brief recall measures, anthropometric bio-measures and bloodspot biomarkers. METHODS A purposive sample (n=42) of primarily African-American (39%) and Latina (44%) mothers (about one-third normal weight, overweight, or obese) was assigned AndroidTM smartphones with the Ohmage application to self-monitor diet, perceived stress, and PA over six months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, PA assessments adapted from NHANES, and the PSM-9 stress measure. Anthropometric bio-measures included BMI, body fat, waist circumference, and blood pressure (BP). Bloodspot assays for Ebstein-Barr Virus (EBV) and C-Reactive Protein (CRP) were used as biomarkers of systemic load and stress. EMA and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light PA. Units of analysis were follow-up assessments (n=29 to n=45 depending on domain) nested in participants (N=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions assessed strength of associations between variables. RESULTS Almost all participants (93%) completed the study. Inter-method reliability between smartphone EMA/diary reports and their corresponding recall reports was highest for stress and diet, with correlations ranging from .27 to .52 (with p&lt;.05), but was unexpectedly low for PA with no significant associations. Concurrent validity was demonstrated for diet EMA/diary reports with systolic BP (r = -.32), CRP (r = -.34), and moderate and vigorous PA recalls (r = .35 to .48), suggesting co-variation between healthy diet and PA behaviors. Stress EMA/diary reports were not associated with EBV and CRP biomarkers. Moderate and vigorous PA diary reports were negatively associated with BMI and body fat (r = -.35 to -.44, p&lt;.05). CONCLUSIONS Brief smartphone EMA may be valid and reliable for long-term self-monitoring of diet, stress, and PA. Lack of inter-method reliability for PA measures is consistent with prior research. More research is needed on the efficacy of smartphone self-monitoring for self-management and behavior change support

Dual rapid lateral flow immunoassay fingerstick wholeblood testing for syphilis and HIV infections is acceptable and accurate, Port-au-Prince, Haiti.

BackgroundDual rapid tests for HIV and syphilis infections allow for detection of HIV infection&nbsp;and syphilis at the point-of-care. Those tests have been evaluated in laboratory settings and show excellent performance but have not been evaluated in the field. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test in Port-au-Prince, Haiti using whole blood fingerprick specimens.MethodsGHESKIO (Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections) clinic attendees 18&nbsp;years of age or older were invited to participate. Venipuncture blood specimens were used for reference testing with standard commercially available tests for HIV and syphilis in Haiti. The sensitivity and specificity of the Duo test compared to the reference standard were calculated. The exact binomial method was used to determine 95&nbsp;% confidence intervals (CI).ResultsOf 298 study participants, 237 (79.5&nbsp;%) were female, of which 49 (20.7&nbsp;%) were pregnant. For the HIV test component, the sensitivity and specificity were 99.2&nbsp;% (95&nbsp;% CI: 95.8&nbsp;%, 100&nbsp;%) and 97.0&nbsp;% (95&nbsp;% CI: 93.2&nbsp;%, 99.0&nbsp;%), respectively; and for the syphilis component were 96.5&nbsp;% (95&nbsp;% CI: 91.2&nbsp;%, 99.0&nbsp;%) and 90.8&nbsp;% (95&nbsp;% CI: 85.7&nbsp;%, 94.6&nbsp;%), respectively. In pregnant women, the sensitivity and specificity of the HIV test component were 93.3&nbsp;% (95&nbsp;% CI: 68.0&nbsp;%, 99.8&nbsp;%) and 94.1&nbsp;% (95&nbsp;% CI: 80.3&nbsp;%, 99.3&nbsp;%), respectively; and for the syphilis component were 100&nbsp;% (95&nbsp;% CI:81.5&nbsp;%, 100&nbsp;%) and 96.8&nbsp;% (95 % CI:83.3&nbsp;%, 99.9&nbsp;%), respectively.ConclusionThe Standard Diagnostics BIOLINE HIV/Syphilis Duo dual test performed well in a field setting in Haiti and should be considered for wider use