Effect of ABO Blood Group on Asymptomatic, Uncomplicated and Placental Plasmodium Falciparum Infection: Systematic Review and Meta-Analysis

BACKGROUND: Malaria clinical outcomes vary by erythrocyte characteristics, including ABO blood group, but the effect of ABO blood group on asymptomatic, uncomplicated and placental Plasmodium falciparum (P. falciparum) infection remains unclear. We explored effects of ABO blood group on asymptomatic, uncomplicated and placental falciparum infection in the published literature. METHODS: A systematic review and meta-analysis was performed using the preferred reporting items for systematic reviews and meta-analyses guidelines. Articles in Pubmed, Embase, Web of Science, CINAHL and Cochrane Library published before February 04, 2017 were searched without restriction. Studies were included if they reported P. falciparum infection incidence or prevalence, stratified by ABO blood group. RESULTS: Of 1923 articles obtained from the five databases (Embase = 728, PubMed = 620, Web of Science = 549, CINAHL = 14, Cochrane Library = 12), 42 met criteria for systematic review and 37 for meta-analysis. Most studies (n = 30) were cross-sectional, seven were prospective cohort, and five were case-control studies. Meta-analysis showed similar odds of uncomplicated P. falciparum infection among individuals with blood group A (summary odds ratio [OR] 0.96, 15 studies), B (OR 0.89, 15 studies), AB (OR 0.85, 10 studies) and non-O (OR 0.95, 17 studies) as compared to those with blood group O. Meta-analysis of four cohort studies also showed similar risk of uncomplicated P. falciparum infection among individuals with blood group non-O and those with blood group O (summary relative risk [RR] 1.03). Meta-analysis of six studies showed similar odds of asymptomatic P. falciparum infection among individuals with blood group A (OR 1.05), B (OR 1.03), AB (OR 1.23), and non-O (OR 1.07) when compared to those with blood group O. However, odds of active placental P. falciparum infection was significantly lower in primiparous women with non-O blood groups (OR 0.46, 95% confidence interval [CI] 0.23 - 0.69, I CONCLUSIONS: This study suggests that ABO blood group may not affect susceptibility to asymptomatic and/or uncomplicated P. falciparum infection. However, blood group O primiparous women appear to be more susceptible to active placental P. falciparum infection

Development and validation of vulnerable and enabling indices for hiv viral suppression among people with hiv enrolled in the ryan white program

Background: Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). Methods: We used Ryan White Program (RWP) data and principal component analysis to develop general and gender-and racial/ethnic-specific indices. We assessed internal reliability (Cronbach’s alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. Results: Three general factors accounting for 79.2% of indicators’ variability surfaced: mental health, drug use, and socioeconomic status (Cronbach’s alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender-or racial/ethnic-specific indices did not improve psychometric performance. Discussion: General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender-and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations

Developing Triage Tools for Retention in Care and Viral Suppression, and Identifying Predictors of Sexually Transmitted Infections among People with HIV

This study developed risk prediction tools for non-retention in HIV care and non-viral suppression, and identified factors associated with self-reported chlamydia and gonorrhea diagnosis among people with HIV (PHIV) in the Miami-Dade County Ryan White Program (RWP). Using retrospective cohort study data, we used stepwise logistic regression to develop score-based risk prediction tools for non-retention in care and non-viral suppression. We then used bootstrapping to internally validate the risk prediction tools. We also assessed the prevalence of self-reported chlamydia and gonorrhea diagnoses and factors associated with the diagnoses cross-sectionally using multivariate logistic regression. Among the 7439 people meeting the inclusion criteria for the retention analysis, we found that non-retention in care in the next year could be predicted using current age, race, poverty level, homelessness, problematic alcohol/drug use and viral suppression status. The risk prediction tool had low discrimination (c-statistic=0.65), and the total score ranged from 0 to 17. Among the 6492 people meeting the inclusion criteria for the viral suppression analysis, non-viral suppression in the next year could be predicted using current age, race, poverty level, AIDS status, homelessness, problematic alcohol/drug use and current viral suppression status. The risk prediction tool for non-viral suppression had good discrimination (c-statistic=0.77), and the total score ranged from 0 to 26. Of the 7,419 adult PHIV in active Ryan White care during 2017, about half (n= 3528) reported being screened for chlamydia or gonorrhea during 2017. Of these, 2.3% reported having been diagnosed with chlamydia or gonorrhea or both in 2017. Having a chlamydia or gonorrhea diagnosis was associated with being in the age group 18–39 and having multiple sexual partners during the previous 12 months. In conclusion, using routinely available variables, we developed risk prediction tools for non-retention in care and non-viral suppression that can assist healthcare providers in identifying high-risk individuals to target for intervention. Both risk prediction tools need external validation. The risk prediction tool for non-retention in care additionally needs to include more prognostic factors in order to increase the discrimination. In order to prevent chlamydia or gonorrhea, targeted behavioral risk reduction techniques are highly recommended among those 18–39 years of age and those who have multiple sexual partners

Development and Validation of Vulnerable and Enabling Indices for HIV Viral Suppression among People with HIV Enrolled in the Ryan White Program

Background: Numerous factors impact HIV care, often requiring consideration of indices to prevent collinearity when using statistical modeling. Using the Behavioral Model for Vulnerable Populations, we developed vulnerable and enabling indices for people living with HIV (PLWH). Methods: We used Ryan White Program (RWP) data and principal component analysis to develop general and gender- and racial/ethnic-specific indices. We assessed internal reliability (Cronbach’s alpha), convergent validity (correlation coefficient), and predictive utility (logistic regression) with non-viral suppression. Results: Three general factors accounting for 79.2% of indicators’ variability surfaced: mental health, drug use, and socioeconomic status (Cronbach’s alpha 0.68). Among the overall RWP population, indices showed convergent validity and predictive utility. Using gender- or racial/ethnic-specific indices did not improve psychometric performance. Discussion: General mental health, drug use, and socioeconomic indices using administrative data showed acceptable reliability, validity, and utility for non-viral suppression in an overall PLWH population and in gender- and racial/ethnic-stratified populations. These general indices may be used with similar validity and utility across gender and racial/ethnic diverse populations

Role of Country of Birth, Testing Site, and Neighborhood Characteristics on Nonlinkage to HIV Care Among Latinos

The objective of this study was to estimate disparities in linkage to human immunodeficiency virus (HIV) care among Latinos by country/region of birth, HIV testing site, and neighborhood characteristics. A retrospective study was conducted using Florida HIV surveillance records of Latinos/Hispanics aged ≥13 diagnosed during 2014-2015. Linkage to HIV care was defined as a laboratory test (HIV viral load or CD4) within 3 months of HIV diagnosis. Multi-level Poisson regression models were used to estimate adjusted prevalence ratios (aPR) for nonlinkage to care. Of 2659 Latinos, 18.8% were not linked to care within 3 months. Compared with Latinos born in mainland United States, those born in Cuba [aPR 0.60, 95% confidence interval (CI) 0.47-0.76] and Puerto Rico (aPR 0.61, 95% CI 0.41-0.90) had a decreased prevalence of nonlinkage. Latinos diagnosed at blood banks (aPR 2.34, 95% CI 1.75-3.12), HIV case management and screening facilities (aPR 1.76, 95% CI 1.46-2.14), and hospitals (aPR 1.42, 95% CI 1.03-1.96) had an increased prevalence of nonlinkage compared with outpatient general, infectious disease, and tuberculosis/sexually transmitted diseases/family planning clinics. Latinos who resided in the lowest (aPR 1.57, 95% CI 1.19-2.07) and third lowest (aPR 1.33, 95% CI 1.01-1.76) quartiles of neighborhood socioeconomic status compared with the highest quartile were at increased prevalence. Latinos who resided in neighborhoods with &lt;25% Latinos also had increased prevalence of nonlinkage (aPR 1.23, 95% CI 1.01-1.51). Testing site at diagnosis may be an important determinant of HIV care linkage among Latinos due to neighborhood or individual-level resources that determine location of HIV testing.</p