A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea

Background: In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. This paper examines the socio-ecological factors that encourage or hinder HIV treatment initiation and adherence among HIV positive members of key populations in PNG. Methods: As part of a larger biobehavioural survey of key populations in PNG, 111 semi-structured interviews were conducted with FSW, MSM and TGW, of whom 28 identified as living with HIV. Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence. Results: Enablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and nonjudgmental and supportive HIV service provision. Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services. Conclusion: Exploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations

The Prevalence of Antimicrobial Resistant Neisseria gonorrhoeae in Papua New Guinea: A Systematic Review and Meta-Analysis

Neisseria gonorrhoeae antimicrobial resistance (NG AMR) has become an urgent concern globally. The World Health Organization, the United States of America Centers for Disease Control, and other regulators have called to improve resistance-testing methods to enhance NG AMR surveillance. NG AMR surveillance remains critical in informing treatment; unfortunately, this is often lacking in settings with limited resources, such as Papua New Guinea (PNG). We conducted a systematic review and a prevalence meta-analysis, and provided an overview of NG AMR in PNG. We showed the lack of NG AMR data in the last decade, and emphasized the need for NG AMR surveillance in PNG. Since NG AMR testing by the NG culture method is unreliable in PNG, we suggested using molecular tests to complement and enhance NG AMR surveillance

Associations of <i>Toll-Like Receptor</i> and <i>β-Defensin</i> Polymorphisms with Measures of Periodontal Disease (PD) in HIV+ North American Adults: An Exploratory Study

<div><p>Polymorphisms in toll-like receptor (<i>TLR</i>) and β-defensin (<i>DEFB</i>) genes have been recognized as potential genetic factors that can influence susceptibility to and severity of periodontal diseases (PD). However, data regarding associations between these polymorphisms and PD are still scarce in North American populations, and are not available in HIV+ North American populations. In this exploratory study, we analyzed samples from HIV+ adults (n = 115), who received primary HIV care at 3 local outpatient HIV clinics and were monitored for PD status. We genotyped a total of 41 single nucleotide polymorphisms (SNPs) in 8 <i>TLR</i> genes and copy number variation (CNV) in <i>DEFB4</i>/<i>103A</i>. We performed regression analyses for levels of 3 periodontopathogens in subgingival dental plaques (<i>Porphyromonas gingivalis</i> [<i>Pg</i>], <i>Treponema denticola</i> [<i>Td</i>], and <i>Tannerella forsythia</i> [<i>Tf</i>]) and 3 clinical measures of PD (periodontal probing depth [PPD], gingival recession [REC], and bleeding on probing [BOP]). In all subjects combined, 2 SNPs in <i>TLR1</i> were significantly associated with <i>Td</i>, and one SNP in <i>TLR2</i> was significantly associated with BOP. One of the 2 SNPs in <i>TLR1</i> was significantly associated with <i>Td</i> in Caucasians. In addition, another SNP in <i>TLR1</i> and a SNP in <i>TLR6</i> were also significantly associated with <i>Td</i> and <i>Pg</i>, respectively, in Caucasians. All 3 periodontopathogen levels were significantly associated with PPD and BOP, but none was associated with REC. Instrumental variable analysis showed that 8 SNPs in 6 <i>TLR</i> genes were significantly associated with the 3 periodontopathogen levels. However, associations between the 3 periodontopathogen levels and PPD or BOP were not driven by associations with these identified SNPs. No association was found between <i>DEFB4</i>/<i>103A</i> CNV and any periodontopathogen level or clinical measure in all samples, Caucasians, or African Americans. Our exploratory study suggests a role of <i>TLR</i> polymorphisms, particularly <i>TLR1</i> and <i>TLR6</i> polymorphisms, in PD in HIV+ North Americans.</p></div

Association Between Periodontopathogen Levels and <i>TLR</i> SNPs^*.

<p>Association Between Periodontopathogen Levels and <i>TLR</i> SNPs^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164075#t002fn001" target="_blank">*</a>}.</p

Diagrammatic Representation of Instrumental Variable Analysis.

<p>Instrumental variable models use associations C and A to estimate the relationship between an exposure/risk factor and an outcome (B). Note that the instrument is not supposed to have a direct effect on the outcome, hence this line (C) is dashed. Abbreviations: <i>Pg</i>, <i>Porphyromonas gingivalis</i>; <i>Td</i>, <i>Treponema denticola</i>; <i>Tf</i>, <i>Tannerella forsythia</i>; PPD, periodontal probing depth; BOP, bleeding on probing.</p

Characteristics of the Study Cohort^*.

<p>Characteristics of the Study Cohort^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164075#t001fn001" target="_blank">*</a>}.</p

Association Between Clinical Measures of PD and <i>TLR</i> SNPs^*.

<p>Association Between Clinical Measures of PD and <i>TLR</i> SNPs^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164075#t003fn001" target="_blank">*</a>}.</p