PLoS One

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6-11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06-1.14, p<0.0001 and 1.06, 95% CI 1.01-1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables

Couple-Based Behavioral HIV Interventions by the Social Intervention Group: Progress, Gaps, and Future Directions

Purpose: This paper reports a review of couple-based behavioral HIV interventions conducted by the Social Intervention Group (SIG); and addresses gaps, future directions, and implications for couple-based HIV interventions. Method: We performed a literature review for SIG research on intervention and prevention studies involving couples/partners. Results: We identified nine couple-based interventions. Outcomes included reduced sexual and substance use-related risk behaviors and improved use of anti-retroviral treatment. We conducted these studies in diverse venues, including needle/syringe exchange programs, primary care clinics, and criminal justice settings. Conclusions: The findings of this review provide strong evidence for the efficacy of couple-based HIV interventions in reducing sexual HIV risks and linkage to HIV and substanceuse treatment. SIG has advanced couple-based HIV intervention research science by improving study design, intervention core components, conceptual models, and implementation strategies; which have informed scientific directions and transformed couple-based HIV prevention research

Long Term Security Auditing of Large Venues

This research investigates the process of security auditing for large venues. For this study, one large venue was examined over a period of two years for security concerns and procedural handling of security threats. Responsible parties for large venues include the venue’s owners operators, local business, and government which share in the responsibility of keeping the venue safe. This research was conducted using a group of volunteers who made observations about the venue during live events which were reported and measured using a tool called Qualtrics. Qualtrics functioned as a real-time data gathering tool while observers were given feedback about what they should be looking for at the venue. After this study was conducted, it was found that large venues have specific security concerns in contrast to traditional offices or businesses and that these venues should have improvement planning in place to continuously adapt to security threats

How does an introduced vertebrate host species affect the risk of Lyme disease? Characterising Grey squirrels (Sciurus carolinensis) as tick hosts and reservoir hosts of Borrelia burgdorferi s.l. in Scotland

Volume: 26Start Page: 49End Page: 4

Dyadic analysis of criminal justice involvement and hiv risks among couples who inject drugs and their intimate partners in almaty, kazakhstan

Incarceration increases HIV risk behaviors and strains intimate partnerships of couples of people who inject drugs (PWID) in Kazakhstan. Studies are yet to examine dyadic relationships between criminal justice involvement and injection drug and sexual HIV risk behaviors of couples who inject drugs in Kazakhstan. This study examined associations between individual and partner level criminal justice involvement and injection drug and sexual HIV risk behaviors among 216 intimate dyads (n = 432) of PWID in Almaty, Kazakhstan. The Actor Partner Interdependence Model (APIM) using structural equation modeling examined individual (actor), partner and dyadic patterns (actor-partner) of associations between arrest, incarceration and drug crime conviction of dyads of male and female intimate partners of PWID using baseline data from Project Renaissance, a couples-focused HIV prevention intervention for PWID and their intimate partners. Results from the APIM identified significant associations between lifetime (β=0.10, CI95%=0.01.20, p=.021) and recent (β=0.12, CI95%=0.01.26, p=.045) arrest and increased risk of injection drug use with any partner for female partners. Partner-only effects were identified in which male PWID's recent arrest was associated with an increase in their study partners’ injection drug risk behaviors (β=0.10 CI95%=0.02, 0.20, p=.044). For female partners, prior incarceration was associated with increased engagement in injection drug risk behaviors (β=0.10 CI95% =0.02, 0.20, p=.035) with any partner. For male partners’ prior incarceration was associated with injection drug risk behaviors with their study partners (β=0.10 CI95%= 0.02, 0.20. p<.05). Female partners prior drug crime conviction was associated with their own (β=0.14 CI95%=0.01, 0.28, p=.048) and their intimate partners’ (β=0.18, CI95%=0.03, 0.33, p=.024) engagement in injection drug risk behaviors with any injecting partner. Recent drug crime conviction (β=0.12, CI95%=0.01, 0.24, p=.038) and arrest (β=0.13, CI95%, p=.022) was associated with increased engagement in sexual risk behaviors among female partners. Findings from this study identified differences in how criminal justice involvement impacts sexual and injection drug and sexual risk behaviors between male and female partners of PWID. Future research must investigate how structural interventions at the dyadic level could address the negative impact of criminal justice involvement on sexual and injection drug HIV risks within the contexts of couples who are PWID

Improving HIV service delivery for people who inject drugs in Kazakhstan: study protocol for the Bridge stepped-wedge trial

Background People who inject drugs (PWID) in Kazakhstan face many barriers to HIV testing as well as to accessing HIV care, to retention in HIV care, and to initiating and adhering to anti-retroviral treatment (ART). Needle and syringe programs (NSPs) are an opportune setting for integrated interventions to link PWID to HIV care. Methods This Hybrid Type II study employs a stepped-wedge design to evaluate both effectiveness and implementation outcomes of Bridge, an intervention to identify, test, and link HIV-positive PWID to HIV care. The study is conducted at 24 NSPs in three different regions of Kazakhstan, to assess outcomes on the individual, organizational, and policy levels. Discussion This trial responds to an identified need for new models of HIV service delivery for PWID through harm reduction settings. Trial registration NCT02796027 on June 10, 2016

Effectiveness of an Intervention to Improve HIV Service Delivery for People Who Inject Drugs in Kazakhstan: A Cluster Trial

The increasing HIV incidence rates and suboptimal rates of testing, engagement, and retention in care for people who inject drugs (PWID) in Kazakhstan underscore the need for effective HIV care continuum interventions for PWID. To determine the effectiveness of the Bridge HIV care continuum intervention implemented in needle and syringe programs (NSPs) in Kazakhstan. This stepped-wedge cluster trial was conducted from February 2017 to May 2020, with implementation beginning sequentially across 3 cities (Almaty, Karaganda-Temirtau, and Shymkent) in August 2017, January 2018, and May 2019. Intervention effect sizes were estimated via population-averaged models, and hypothesis testing relied on a permutation testing approach. The primary unit of analysis was an NSP. Data analysis was performed from October 2020 to April 2022. The intervention addresses the full HIV care continuum: identification, testing, referral to services, and linkage to HIV care. The 3 intervention components were (1) a social network strategy, a peer-driven recruitment approach for HIV testing; (2) HIV counseling, rapid testing, and referral following international and national guidelines and protocols; and (3) enhanced antiretroviral treatment and access to services. The primary outcomes were the effectiveness of implementing Bridge's enhanced service integration approach in increasing the number of PWID served at NSPs, increasing the number of PWID who are tested for HIV in NSPs, and improving linking HIV-positive PWID with HIV care. Secondary outcomes included numbers of clients registered for HIV care, initiation of antiretroviral therapy, and viral suppression. Twenty-four NSPs (8 in each city) served a total of 1225 PWID (369 in Almaty, 618 in Karaganda-Temirtau, and 238 in Shymkent) at the preimplementation study step; 1015 clients (82.9%) were male, and the mean (SD) age was 36.7 (7.1) years. Compared with preimplementation study steps, during Bridge intervention implementation steps, NSPs experienced a significant increase in the number of PWID clients registered (incidence rate ratio, 2.37; 95% CI, 1.48-3.78) and the number of PWID who received rapid HIV tests (incidence rate ratio, 3.98; 95% CI, 2.30-6.90). No significant increase in referral to HIV care was observed. The study also found significant support for secondary outcomes of antiretroviral therapy initiation and the number of clients who achieved viral suppression. In this stepped-wedge cluster trial, the findings suggest that implementation of the Bridge intervention was associated with significant improvement in several steps in the continuum of HIV care for PWID in Kazakhstan. ClinicalTrials.gov Identifier: NCT02796027