High acceptance rate of anal pap screening despite limited knowledge about anal dysplasia among HIV+ MSM

Anal cancer in the general population is more prevalent in women, but in most HIV populations, MSM have the highest risk. Data suggest that screening can prevent invasive carcinoma. Use of routine cervical pap smears resulted in an 80% reduction in cervical cancer rates. The current study examines the effectiveness of a clinical intervention designed to increase anal dysplasia education, screening, and treatment for HIV+ MSM

Detection and quantitation of HPV in anogenital and oral tissues and fluids of HIV-positive individuals by real-time PCR

Human papillomaviruses (HPV) remain a serious world health problem due to their association with anogenital and oral cancers and warts. While over 100 HPV types have been identified, only a subset is associated with malignancy. HPV16 and 18 are the most common oncogenic types, while HPV6 and 11 are the most common types responsible for anogenital warts. These four types cause up to 90% of HPV-associated disease. While other quantitative PCR (qPCR) assays can be used to detect oncogenic HPV, there is no single tube assay that distinguishes the most frequent oncogenic types and the most common types found in warts. A qPCR assay was developed that allowed for detection and quantitation of these 4 HPV types

Experiences with HIV Testing, Entry, and Engagement in Care by HIV-Infected Women of Color, and the Need for Autonomy, Competency, and Relatedness

Self-determination theory examines the needs of people adopting new behaviors but has not been applied to the adoption of HIV healthcare behaviors. The current study applied self-determination theory to descriptions of healthcare behaviors adopted by ethnic minority women after an HIV diagnosis. Women of color were asked to describe their experiences with HIV testing, entry, and engagement-in-care in qualitative interviews and focus groups. Participants were mostly African-American (88%), over 40 years old (70%), had been diagnosed for more than 6 years (87%) and had disclosed their HIV infection to more than 3 people (73%). Women described unmet self-determination needs at different time points along the HIV Continuum of Care. Women experienced a significant loss of autonomy at the time of HIV diagnosis. Meeting competency and relatedness needs assisted women in entry and engagement-in-care. However, re-establishing autonomy was a key element for long-term engagement-in-care. Interventions that satisfy these needs at the optimal time point in care could improve diagnosis, entry-to-care, and retention-in-care for women living with HIV

Characterizing HIV-Associated Neurocognitive Disorder in Two Underserved Sociodemographic Groups

The purpose of this project is to characterize neurocognitive functioning and correlates of neurocognitive functioning, as well as to examine the diagnostic accuracy of relatively promising neurocognitive tests in two underserved sociodemographic groups living with HIV: monolingual Spanish-speaking Hispanics and English-speaking African-Americans, in order to better understand HIV-Associated Neurocognitive Disorder (HAND) within these groups. Examining HAND in underserved groups is paramount to the development of effective HAND screening and treatment algorithms in clinics that serve these groups, such as the AIDS Clinical Research Unit (ACRU) at the University of Miami. The current project was drawn from an initiative to develop a HAND screening algorithm for this clinic, such that patients with milder forms of HAND can be identified. The current study examined the performance of convenience samples of English-speaking African-Americans (n = 38) and monolingual Spanish-speaking Hispanics (n = 50) on a variety of easy-to-use, sensitive neurocognitive tests we previously collected at the ACRU: Grooved Pegboard (GP), Trail Making Test (TMT), Action Fluency (AF), and the Hopkins Verbal Learning Test-Revised (HVLT-R). I used these tests and medical chart review to classify HAND via the 2007 Frascati diagnostic criteria, the most up-to-date criteria for classifying HAND. Furthermore, I examined the association between an array of psychosocial, medical, and behavioral factors and HAND classification, which may aid in informing HAND screening and testing algorithms. Finally, I also examined the sensitivity and specificity of promising measures, Action Fluency (which tests the ability to generate novel verbs) and Trail Making Test, in detecting HAND, in order to elucidate whether these free and easy-to-administer measures should be added to screening batteries to detect HAND within these groups. Using logistic regression analyses, I analyzed associations between medical, behavioral, and psychosocial correlates and HAND. Perceived stress and poorer sleep quality were found to be at least marginally associated with increased odds of HAND, while social support from friends was found to be associated with decreased odds of HAND. Using HAND diagnosis via GP, HVLT-R, and medical chart review as the gold standard, I calculated the sensitivity and specificity of the AF and TMT, as well as performed ROC analyses to evaluate the overall diagnostic accuracy of these measures. Both the AF and TMT measure did not demonstrate adequate sensitivity (> 70%) in detecting HAND in the overall sample, as well as within each of the sociodemographically distinct groups. Furthermore, the AF and TMT demonstrated poor AUC estimates (> .70), indicating poor overall diagnostic accuracy. Though the sample size was limited, results indicate that psychosocial factors such as stress, sleep quality, and social support from specific sources may aid in identifying individuals at risk for or living with HAND. These results also indicated poor diagnostic accuracy for the AF and TMT in the study samples. Future work should evaluate these measures using larger samples and more extensive testing batteries.</p

Ethnicity and Benefit Finding in HIV+ MSM

HIV+ men who have sex with men (MSM) in ethnic minority groups have significantly poorer psychosocial and health-related outcomes as compared with HIV+ individuals in majority groups (e.g. white, heterosexual). The current study seeks to examine a positive psychological pattern found in previous studies comparing ethnic minority and white patients with chronic disease; specifically, that ethnic minorities tend to exhibit higher levels of benefit finding in response to chronic disease. Understanding the factors that may uniquely contribute to benefit finding in minority HIV+ MSM may aid in the development of interventions designed to improve psychosocial and health-related outcomes for this group in particular. Based on the findings of previous work, it was hypothesized that benefit finding would be significantly greater in minority MSM than in white MSM. It was also hypothesized that both the relationship between perceived stress and benefit finding and the relationship between social support and benefit finding would differ as a function of ethnicity. Finally, it was hypothesized that religious coping would mediate the relationship between ethnicity and benefit finding. The current study utilized baseline and 3-month follow-up (T2) data drawn from a previous trial of Cognitive Behavioral Stress Management (CBSM) intervention in HIV+ MSM. Participants were 94 HIV+ MSM; 56% were white and 44% belonged to minority ethnic groups (African-American, AfroCarribean-American, Hispanic). Analyses revealed that benefit finding was greater in minority MSM at baseline; however, this difference became non-significant when age, education level, and HAART adherence were added to the model. Ethnicity was not a significant predictor of T2 benefit finding. There were no significant interactions found between social support and ethnicity in predicting either T1 or T2 benefit finding. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in minority MSM only. Mediated regression and bootstrapping analyses revealed religious coping to be a provisional intermediary variable in the relationship between ethnicity and T1 benefit finding in a model which was not adjusted for covariates. The current study’s results highlight potential differences in the association between stress and benefit finding processes between white and minority MSM

Vaginal Infections in Haitian Immigrant Women Living in Miami, Florida

To characterize vulvovaginal candidiasis (VC), trichomonas vaginalis (TV), and bacterial vaginosis (BV) among Haitian women living in Miami to identify contributing factors to cervical cancer disparity in this population. Using a CBPR framework, 246 Haitian women (ages 21-65) were recruited. Self-collected cervical cytology specimens were analyzed for VC, TV, and BV. The proportion of participants with VC, TV, and BV, were 7.3%, 9.3%, and 19.9%, respectively. Haitian women may have a higher prevalence of TV than the general U.S. population, which may increase susceptibility to HPV, the primary cause of cervical cancer