Prevalence of Sexually Transmitted Infections Among Transgender Women With and Without HIV in the Eastern and Southern United States

BACKGROUND: Data on the epidemiology of sexually transmitted infections (STIs) among transgender women (TGW) with and without human immunodeficiency virus (HIV) are limited. METHODS: We analyzed baseline data collected from a cohort of adult TGW across 6 eastern and southern US cities between March 2018 and August 2020 (n = 1018). Participants completed oral HIV screening, provided self-collected rectal and urogenital specimens for chlamydia and gonorrhea testing, and provided sera specimens for syphilis testing. We assessed associations with ≥1 prevalent bacterial STI using modified Poisson regression. RESULTS: Bacterial STI prevalence was high and differed by HIV status: 32% among TGW with HIV and 11% among those without HIV (demographic-adjusted prevalence ratio = 1.91; 95% confidence interval = 1.39-2.62). Among TGW without HIV, bacterial STI prevalence differed by geographic region, race and ethnicity, and gender identity, and was positively associated with reporting >1 sexual partner, hazardous alcohol use, homelessness, having safety concerns regarding transit to health care, and no prior receipt of gender-affirming health services. Among TGW with HIV, older age was inversely associated with bacterial STI. CONCLUSIONS: TGW had a high prevalence of bacterial STIs. The prevalence and correlates of bacterial STI differed by HIV status, highlighting the unique needs and risks of TGW with and without HIV. Tailored interventions may reduce sexual health-related inequities

R726L androgen receptor mutation is uncommon in prostate cancer families in the united states

Background A mutation in the androgen receptor ( AR ) gene, namely AR R726L, was described in 2% of Finnish men with sporadic or familial prostate cancer and was associated with an approximately sixfold increased risk of prostate cancer. We set out to determine the incidence of this mutation in a sample of men with either early-onset and/or familial prostate cancer in the United States. Methods Five hundred forty-eight men with prostate cancer from 411 unrelated families participating in the University of Michigan Prostate Cancer Genetics Project (PCGP) were studied. Allele-specific oligonucleotide hybridization was used to detect the presence of the AR R726L mutation in germline DNA. Results None of the 548 prostate cancer patients studied, including 513 White, 29 African American, 3 Asian, and 3 Hispanic men, were found to carry the AR R726L allele. Therefore, the prevalence of this allele is significantly less than that observed among Finnish men with prostate cancer (Fisher's exact test, P  = 0.002). Conclusions The AR R726L allele does not account for a significant proportion of early-onset and/or familial prostate cancer in the United States. Prostate 54: 306–309, 2003. © 2003 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34764/1/10195_ftp.pd

Somatic mutational landscape of hereditary hematopoietic malignancies caused by germline variants in <i>RUNX1</i>, <i>GATA2</i>, and <i>DDX41</i>

Individuals with germ line variants associated with hereditary hematopoietic malignancies (HHMs) have a highly variable risk for leukemogenesis. Gaps in our understanding of premalignant states in HHMs have hampered efforts to design effective clinical surveillance programs, provide personalized preemptive treatments, and inform appropriate counseling for patients. We used the largest known comparative international cohort of germline RUNX1, GATA2, or DDX41 variant carriers without and with hematopoietic malignancies (HMs) to identify patterns of genetic drivers that are unique to each HHM syndrome before and after leukemogenesis. These patterns included striking heterogeneity in rates of early-onset clonal hematopoiesis (CH), with a high prevalence of CH in RUNX1 and GATA2 variant carriers who did not have malignancies (carriers-without HM). We observed a paucity of CH in DDX41 carriers-without HM. In RUNX1 carriers-without HM with CH, we detected variants in TET2, PHF6, and, most frequently, BCOR. These genes were recurrently mutated in RUNX1-driven malignancies, suggesting CH is a direct precursor to malignancy in RUNX1-driven HHMs. Leukemogenesis in RUNX1 and DDX41 carriers was often driven by second hits in RUNX1 and DDX41, respectively. This study may inform the development of HHM-specific clinical trials and gene-specific approaches to clinical monitoring. For example, trials investigating the potential benefits of monitoring DDX41 carriers-without HM for low-frequency second hits in DDX41 may now be beneficial. Similarly, trials monitoring carriers-without HM with RUNX1 germ line variants for the acquisition of somatic variants in BCOR, PHF6, and TET2 and second hits in RUNX1 are warranted

HIV PRE-EXPOSURE PROPHYLAXIS ENGAGEMENT TRAJECTORIES AMONG TRANSGENDER WOMEN IN THE UNITED STATES

Background: Transgender women shoulder the highest HIV prevalence within the United States’ epidemic with 14% of all transgender women in the US living with HIV. HIV pre-exposure prophylaxis (PrEP) has been available in the US since 2012 yet uptake has been slow and adherence challenges have emerged. A comprehensive understanding of the factors that impact PrEP engagement among transgender women is needed to optimize PrEP engagement and address inequities in HIV incidence. Methods: This explanatory, sequential mixed-methods study utilized group-based multi-trajectory modeling to identify groups of transgender women who followed similar patterns of PrEP engagement and indication and to identify factors associated with membership in each trajectory. We then used Cox regression to estimate rates and predictors of PrEP initiation and discontinuation. Building on quantitative findings, we conducted in-depth interviews to qualitatively explore the mechanisms by which multi-level factors impacted PrEP engagement trajectories. Findings were integrated analytically to generate archetypes of PrEP discontinuation and to develop a conceptual framework of engagement in prevention-effective adherence practices among transgender women. Results: We identified five PrEP engagement trajectories. One quarter of transgender women followed prevention-effective adherence trajectories. Those diagnosed with sexually transmitted infections and those experiencing homelessness were more likely to follow non-prevention-effective trajectories. We observed 6.5 PrEP initiations per 100 person-years (95% CI: 5.5-7.7) and 37.5 discontinuations per 100 person-years (95% CI: 31.7-44.3). Four archetypes of discontinuation emerged: 1. Seroconversion following discontinuation, 2. Ongoing HIV acquisition risk following discontinuation, 3. Reassessment of HIV/STI prevention strategy following discontinuation, and 4. Dynamic PrEP use coinciding with changes in HIV acquisition risk. Qualitatively, we found that the capacity to safely engage with the healthcare system and compatibility between PrEP and individual values and preferences were primary factors impacting engagement in prevention-effective adherence practices. Upstream factors, including stigmas, identity-based oppression and marginalization, and sociostructural context indirectly influenced engagement in prevention-effective adherence practices. Conclusion: This dissertation provides insights into the multi-level factors impacting PrEP engagement among transgender women in the United States. Our findings underscore the importance of addressing structural vulnerabilities to optimize PrEP implementation and address HIV inequities within transgender women communities

Influences on Hunter Support for Deer Herd Reduction as a Chronic Wasting Disease (CWD) Management Strategy

This thesis is written in 2 chapters and each will be submitted to different journals for publication. Stylistic formatting follows guidelines for the Journal of Wildlife Management and Human Dimensions of Wildlife. Duplication of figures and material in the Introduction, Study Area, Methods, Analysis, and Results is intentional.On February 28, 2002, scientists made a discovery in southern Wisconsin that would have a profound impact on the hunting culture in the state. Three male whitetailed deer (Odocoileus virginianus) harvested in Dane County, Wisconsin tested positive for chronic wasting disease (CWD), a transmissible spongiform encephalopathy (TSE). First identified in mule deer (O. hemionus) in a wildlife research facility in Colorado in 1967, CWD has since been identified in free-ranging and captive Rocky Mountain elk (Cervus elaphus nelsoni), mule deer, and white-tailed deer in at least 14 states, 2 provinces and South Korea (Mathiason et al. 2006, Williams et al. 2002). In 2005, CWD was found in a hunter harvested free-ranging moose in Colorado (Alces alces) (Colorado Division of Wildlife 2005). TSEs are a group of diseases caused by abnormal, proteinaceous agents known as prions that form lesions on the brain and inevitably result in death (Williams and Barker 2001). Researchers have found that prions have the potential to persist in the environment for up to two years and can be transmitted through saliva, blood, placental fluid, feces and urine (Mathiason et al. 2006, Miller et al. 2000, Williams and Barker 2001). The potential ability for prions to persist in the environment allows for both direct and indirect transmission between and among susceptible cervid populations (Williams et al. 2002). To decrease direct and indirect contact with the disease, managers in states and provinces with CWD have designed management plans focused around reducing deer densities. Following the lead of other states (i.e., CO, WY, SD) and provinces (i.e., Saskatchewan, Alberta) impacted by CWD, Wisconsin banned feeding and baiting of deer where CWD is present, initiated intense surveillance and testing programs, practiced random and selective culling and conducted hunter harvest-based surveys (Williams et al. 2002). In addition, Wisconsin created three disease management zones (Eastern Disease Eradication Zone, Western Disease Eradication Zone, and the Herd Reduction Zone). Of particular interest has been the western disease eradication zone (DEZ) which encompasses the core area where CWD was first discovered in the state. Within these three zones, Wisconsin wildlife managers set a goal of eradicating CWD from the deer herd. The goal within the boundaries of the DEZ is to reduce deer densities to 5-deer/square mile as a means of reducing the frequency of contacts between infected and susceptible deer. Since the discovery of CWD in the state, the Wisconsin Department of Natural Resources (DNR) has asked deer hunters to reduce deer densities within the DEZ. In pursuit of this objective, gun season lengths were extended and liberal harvest quotas were employed to encourage hunters to harvest as many deer as possible. Unfortunately, recreational hunters have not significantly reduced deer densities (R. Rolley, Wisconsin Department of Natural Resources, unpublished data) within the DEZ despite extended season lengths and liberal harvest regulations. While managers continue to express concern over the potential risks and impacts of CWD, hunters express minimal concern over the potential risks posed to deer populations and humans from CWD and are more concerned about the future of deer hunting (Holsman 2005, Holsman and Petchenik 2006, Holsman and Smail 2006). The apparent lack of concern on the part of hunters for the presence of CWD in the state and reluctance to reduce deer densities has and will continue to have implications for the management of CWD in the state.Wisconsin Department of Natural Resource

HIV PRE-EXPOSURE PROPHYLAXIS ENGAGEMENT TRAJECTORIES AMONG TRANSGENDER WOMEN IN THE UNITED STATES

Background: Transgender women shoulder the highest HIV prevalence within the United States’ epidemic with 14% of all transgender women in the US living with HIV. HIV pre-exposure prophylaxis (PrEP) has been available in the US since 2012 yet uptake has been slow and adherence challenges have emerged. A comprehensive understanding of the factors that impact PrEP engagement among transgender women is needed to optimize PrEP engagement and address inequities in HIV incidence. Methods: This explanatory, sequential mixed-methods study utilized group-based multi-trajectory modeling to identify groups of transgender women who followed similar patterns of PrEP engagement and indication and to identify factors associated with membership in each trajectory. We then used Cox regression to estimate rates and predictors of PrEP initiation and discontinuation. Building on quantitative findings, we conducted in-depth interviews to qualitatively explore the mechanisms by which multi-level factors impacted PrEP engagement trajectories. Findings were integrated analytically to generate archetypes of PrEP discontinuation and to develop a conceptual framework of engagement in prevention-effective adherence practices among transgender women. Results: We identified five PrEP engagement trajectories. One quarter of transgender women followed prevention-effective adherence trajectories. Those diagnosed with sexually transmitted infections and those experiencing homelessness were more likely to follow non-prevention-effective trajectories. We observed 6.5 PrEP initiations per 100 person-years (95% CI: 5.5-7.7) and 37.5 discontinuations per 100 person-years (95% CI: 31.7-44.3). Four archetypes of discontinuation emerged: 1. Seroconversion following discontinuation, 2. Ongoing HIV acquisition risk following discontinuation, 3. Reassessment of HIV/STI prevention strategy following discontinuation, and 4. Dynamic PrEP use coinciding with changes in HIV acquisition risk. Qualitatively, we found that the capacity to safely engage with the healthcare system and compatibility between PrEP and individual values and preferences were primary factors impacting engagement in prevention-effective adherence practices. Upstream factors, including stigmas, identity-based oppression and marginalization, and sociostructural context indirectly influenced engagement in prevention-effective adherence practices. Conclusion: This dissertation provides insights into the multi-level factors impacting PrEP engagement among transgender women in the United States. Our findings underscore the importance of addressing structural vulnerabilities to optimize PrEP implementation and address HIV inequities within transgender women communities

Understanding the social and structural context of oral PrEP delivery: an ethnography exploring barriers and facilitators impacting transgender women who engage in street-based sex work in Baltimore, Maryland

Abstract Transgender women who sell sex (TWSS) experience high rates of HIV acquisition. Antiretrovirals for pre-exposure prophylaxis (PrEP) represent an efficacious HIV prevention strategy. The social and structural factors affecting PrEP delivery amongst TWSS are underexplored in the literature. We conducted ethnographic research to examine how multilevel social and structural factors manifest in TWSS’s lived experiences and affect PrEP delivery and use. Twenty-four transgender women were recruited from the SAPPHIRE cohort and completed interviews focused on barriers and facilitators to PrEP engagement in the context of street-based sex work. Stakeholder interviews (N = 7) were also conducted. Our findings suggest there are unique features of the risk environment that can collectively impede PrEP use among TWSS