HIV and STI among women in Uganda, Zimbabwe and Thailand: associations with male circumcision and changes in condom use

The results of most HIV-prevention programs over the 25-year history of the AIDS epidemic have been disappointing. Two interventions have been notable exceptions in the string of prevention failures: in 1983, researchers reported that consistent use of male condoms reduced risk of HIV transmission, and much more recently, in February 2007, large-scale randomized trials determined that circumcision reduced men's risk of HIV acquisition by 40-65%. These separate interventions - male circumcision and condom use - are the focus of these dissertation analyses. We examined whether the circumcision status of women's primary sexual partner was associated with her risk of HIV and three sexually transmitted infections (STIs): Chlamydia trachomatis (Ct), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (Tv). We used data from a prospective cohort study on hormonal contraception and incident HIV and STI (HC-HIV study) among women from Uganda, Zimbabwe and Thailand (HIV analyses included 4,417 Ugandan and Zimbabwean women; STI analyses included 5,925 women from Uganda, Zimbabwe and Thailand). After adjustment, women with circumcised partners had similar risk to women with uncircumcised partners for HIV (hazard ratio (HR): 1.03, 95% confidence interval (CI): 0.69-1.53), Ct (HR: 1.22, 95% CI: 0.94-1.59), GC (HR: 0.93, 95% CI: 0.70-1.24), and Tv (HR: 1.05, 95% CI: 0.81-1.37). Among women who became HIV-infected during HC-HIV, we also examined whether HIV diagnosis, together with counseling and free condoms, was sufficient to induce changes in women's condom use over both short (2-6 months) and longer time periods (12-16 months). After diagnosis, the number of HIV-infected women reporting any unprotected acts in a typical month declined significantly (short-term: from 72% to 56%; long-term: from 74% to 56%). After adjustment, among women reporting any unprotected acts, HIV-infected women also reduced the number of unprotected acts by 29% (short term) and 38% (long term). When assessing the proportion of acts where male condoms were used, however, women had no reduction over time. Circumcision was not associated with women's risk of HIV, Ct, Tv or GC among most participants. HIV-infected women reduced their overall number of unprotected sex acts, but the proportion of unprotected acts was unchanged from pre-infection behavior

The Impact of a Short-Term Pharmacology Enrichment Program on Knowledge and Science Attitudes in Precollege Students

As our nation and the global economy place an increased demand for science, technology, engineering, and mathematics (STEM) jobs, science educators must implement innovative approaches to pique precollege student’s interests in these careers. Pharmacology remains a relevant and engaging platform to teach biology and chemistry concepts, and this strategy applied over several months in the formal classroom increases science literacy in high school students. In order to improve the affordability and accessibility of this educational approach, we developed and assessed the impact of a short-term pharmacology day camp, ‘Pills, Potions, and Poisons’ (PPP), on high school students’ science knowledge and attitudes toward science careers. The PPP program was offered annually from 2009 through 2012, and participants spent 6 days learning about pharmacology and careers in the biomedical sciences. All PPP student participants (n=134) completed surveys assessing their basic science knowledge and science attitudes before and after the program. Students achieved significant gains in their science knowledge by the end (Day 6) of the PPP program (from 41% mean test score to 65%; p<0.001). In addition, the majority of participants agreed or strongly agreed that the PPP program positively impacted their attitudes toward science (p<0.001). This study provides evidence that a short-term pharmacology-centered science enrichment program can achieve significant gains in participant’s science knowledge as well as motivation and confidence towards science careers. Moreover, we report benefits experienced by the undergraduate, graduate, and professional pharmacy student teaching assistants (TAs, n=10) who reported improved communication skills and an increased interest in future educational work.   Type: Original Researc

Depressive Symptoms and Perception of COVID-19 Risk in Ohio Adults

Background: We assessed the relationship between depressive symptoms and perceived COVID-19 risk in the next month. Methods: This analysis used survey data collected during a July 2020 cross-sectional study using a household-based probability sampling design. A total of 615 noninstitutionalized, English- and/or Spanish-speaking adults in Ohio were included. Depressive symptoms screening occurred using the Patient Health Questionnaire-2 (PHQ-2). We applied survey weights so that presented analyses represent the adult population in Ohio. We performed log-risk regression modeling (generalized linear model with binomial distribution and log link) to estimate unadjusted and covariate-adjusted prevalence ratios examining the association between screening positive for depressive symptoms and perceived risk of COVID-19 in the next month. Results: The study population was majority female (59.1%) and White (90.3%). The mean age was 55.9 years (standard deviation (SD)=17.3). About 1 in 20 (4.6%) screened positive for depressive symptoms. A positive depressive symptoms screen was not significantly associated with perceived risk of COVID-19 in the next month (prevalence ratio [PR]=0.75; 95% confidence interval [CI]=0.25–2.24). After confounder adjustment, the adjusted prevalence ratio (aPR) was nearly unchanged (aPR=0.78; 95% CI=0.24–2.55). Conclusion: As depression is often associated with anxiety and pessimism toward the future, the lack of association between depressive symptoms screening and perception of COVID-19 risk in the next month is surprising. Social withdrawal, which is also associated with depression, may have concealed any increased perceived COVID-19 risk, as depressed individuals who remained socially isolated may have had lower perceived COVID-19 risk

In Populo

While the Latin phrase in vitro and in vivo are well understood in the medical literature, neither term accurately describes the science performed at the level of the population by epidemiologists and others. In particular, results in a single organism can differ broadly from results in a population, for reasons from random error to herd immunity. We suggest that in populo, meaning literally “in the people”, can fill this gap in the literature, and urge its wide adoption

Hormonal contraceptive methods and risk of HIV acquisition in women : a systematic review of epidemiological evidence

Peer reviewedPublisher PD

Estimating Seroprevalence of SARS-CoV-2 in Ohio: A Bayesian Multilevel Poststratification Approach with Multiple Diagnostic Tests

Globally the SARS-CoV-2 coronavirus has infected more than 59 million people and killed more than 1.39 million. Designing and monitoring interventions to slow and stop the spread of the virus require knowledge of how many people have been and are currently infected, where they live, and how they interact. The first step is an accurate assessment of the population prevalence of past infections. There are very few population-representative prevalence studies of the SARS-CoV-2 coronavirus, and only two American states -- Indiana and Connecticut -- have reported probability-based sample surveys that characterize state-wide prevalence of the SARS-CoV-2 coronavirus. One of the difficulties is the fact that the tests to detect and characterize SARS-CoV-2 coronavirus antibodies are new, not well characterized, and generally function poorly. During July, 2020, a survey representing all adults in the State of Ohio in the United States collected biomarkers and information on protective behavior related to the SARS-CoV-2 coronavirus. Several features of the survey make it difficult to estimate past prevalence: 1) a low response rate, 2) very low number of positive cases, and 3) the fact that multiple, poor quality serological tests were used to detect SARS-CoV-2 antibodies. We describe a new Bayesian approach for analyzing the biomarker data that simultaneously addresses these challenges and characterizes the potential effect of selective response. The model does not require survey sample weights, accounts for multiple, imperfect antibody test results, and characterizes uncertainty related to the sample survey and the multiple, imperfect, potentially correlated tests

Vaginal Practices of HIV-Negative Zimbabwean Women

Background. Vaginal practices (VPs) may increase HIV risk by injuring vaginal epithelium or by increasing risk of bacterial vaginosis, an established risk factor for HIV. Methods. HIV-negative Zimbabwean women (n = 2,185) participating in a prospective study on hormonal contraception and HIV risk completed an ancillary questionnaire capturing detailed VP data at quarterly followup visits for two years. Results. Most participants (84%) reported ever cleansing inside the vagina, and at 40% of visits women reported drying the vagina using cloth or paper. Vaginal tightening using cloth/cotton wool, lemon juice, traditional herbs/powders, or other products was reported at 4% of visits. Women with ≥15 unprotected sex acts monthly had higher odds of cleansing (adjusted odds ratio (aOR): 1.17, 95% CI: 1.04–1.32). Women with sexually transmitted infections had higher odds of tightening (aOR: 1.42, 95% CI: 1.08–1.86). Conclusion. Because certain vaginal practices were associated with other HIV risk factors, synergism between VPs and other risk factors should be explored

Heteroresistance to the model antimicrobial peptide polymyxin B in the emerging Neisseria meningitidis lineage 11.2 urethritis clade: mutations in the pilMNOPQ operon

Clusters of Neisseria meningitidis (Nm) urethritis among primarily heterosexual males in multiple US cities have been attributed to a unique non‐encapsulated meningococcal clade (the US Nm urethritis clade, US_NmUC) within the hypervirulent clonal complex 11. Resistance to antimicrobial peptides (AMPs) is a key feature of urogenital pathogenesis of the closely related species, Neisseria gonorrhoeae. The US_NmUC isolates were found to be highly resistant to the model AMP, polymyxin B (PmB, MICs 64–256 µg ml–1). The isolates also demonstrated stable subpopulations of heteroresistant colonies that showed near total resistant to PmB (MICs 384–1024 µg ml–1) and colistin (MIC 256 µg ml–1) as well as enhanced LL‐37 resistance. This is the first observation of heteroresistance in N. meningitidis. Consistent with previous findings, overall PmB resistance in US_NmUC isolates was due to active Mtr efflux and LptA‐mediated lipid A modification. However, whole genome sequencing, variant analyses and directed mutagenesis revealed that the heteroresistance phenotypes and very high‐level AMP resistance were the result of point mutations and IS1655 element movement in the pilMNOPQ operon, encoding the type IV pilin biogenesis apparatus. Cross‐resistance to other classes of antibiotics was also observed in the heteroresistant colonies. High‐level resistance to AMPs may contribute to the pathogenesis of US_NmUC

Effect of consistent condom use on 6-month prevalence of bacterial vaginosis varies by baseline BV status

Bacterial vaginosis (BV) is a condition characterized by a disturbed vaginal ecosystem which fluctuates in response to extrinsic and intrinsic factors. BV recurrence is common. To explore whether consistent condom use was associated with BV occurrence or recurrence, we compared the effect of condom use on BV prevalence after six months, among women with and without BV at baseline