Predictors of Persistent and Recurrent Bacterial Vaginosis (BV) among Young African American (AA) women in the United States

Bacterial vaginosis (BV) is a common vaginal dysbiosis among women of reproductive age. Literature presents discordant findings with respect to the predictors of BV and there is a paucity of literature examining the mechanisms by which multiple episodes of BV occur. This dissertation summarized current literature on BV, identified BV incidence patterns over a twelve-month period, and estimated the risk of sexually transmitted infections (STI) among women with episodic and persistent BV. Previously collected randomized clinical trial data were analyzed, where oral metronidazole was the administered treatment. Latent class analysis (LCA) was used to assess BV incidence patterns. Multinomial Logistic Regression was used to estimate adjusted Odds Ratios (adjOR) associated with the predictors of BV incidence patterns. Binary Logistic Regression models were used to estimate adjOR associated with STI acquisition among women with persistent BV compared to episodic BV. The results of the review identified conflicts in the literature further highlighted what little is known about the etiology and pathogenesis of BV, recurrent BV and persistent BV. LCA illustrated three emergent patterns of multiple cases of BV: persistent (55.9%; 95 % Confidence Interval [CI]: 52.5%-59.3%), recurrent (30.5%; 95% CI: 27.5%-33.7%) and clearance (13.5%; 95% CI:1.3%-16.0%). Compared with belonging to the clearance group, women who had sex with women (WSW) had significantly lower odds of belonging to the persistent class (adjOR: 0.38; 95% CI: 0.22-0.68) and the recurrent class (adjOR: 0.43; 95% CI: 0.23-0.81) than women who did not. Those who were treated with metronidazole had significantly increased odds of being in the recurrent class (adjOR: 1.92; 95% CI: 1.22-3.03) than those who were not treated. Additionally, women with persistent and episodic BV were at increased risk (p= 0.02) of developing an STI. Women without BV did not acquire an STI. Assessment of BV cases revealed distinct patterns of recurrence and persistence despite treatment with oral metronidazole. These preliminary findings suggest, Metronidazole may not be the most effective treatment to reduce the prevalence of recurrent and persistent cases of BV. More effective treatment of singular episodes of BV may reduce the adverse sequalae of incident STI, we reported associated with recurrent, episodic and persistent BV. The review identified gaps in the literature, which were addressed by the second and third aims

Factors Associated With the Recurrence, Persistence, and Clearance of Asymptomatic Bacterial Vaginosis Among Young African American Women: A Repeated-Measures Latent Class Analysis

Background Although risk factors of recurrent and persistent bacterial vaginosis (BV) have been explored in the literature, the longitudinal incidence patterns of BV remain elusive. Methods We conducted a secondary analysis of longitudinal data from a randomized clinical trial of metronidazole treatment for asymptomatic BV. Repeated-measures latent class analysis was used to identify distinct longitudinal patterns of incident BV cases. Multinomial regression analysis was used to determine the predictors of class membership. The multivariable model included age, last BV treatment, douching frequency, birth control, sexual risk behavior, and assignment to treatment arm. Results A total of 858 African American women who were asymptomatic for BV were included in the analysis. Three emergent patterns of BV for 12 months were identified by repeated-measures latent class analysis: persistent (55.9%), recurrent (30.5%), and clearance (13.5%). Participants who had douched at least once had significantly lower odds to be in the recurrent class versus the clearance class (adjusted odds ratio [adjOR], 0.55; 95% confidence interval [CI], 0.18-0.63). Women who had sex with women had significantly lower odds of belonging to the persistent class versus the clearance class (adjOR, 0.38; 95% CI, 0.22-0.68) and the recurrent class (adjOR, 0.43; 95% CI, 0.23-0.81). Those who were assigned to the treatment arm had significantly increased odds of being in the recurrent class versus the clearance class (adjOR, 1.92; 95% CI, 1.22-3.03). Women older than 21 years were significantly more likely to be in the recurrent class (adjOR, 1.88; 95% CI, 1.17-3.00) than in the clearance class. Conclusions Assessment of BV cases revealed distinct patterns of recurrence and persistence of BV, which were significantly associated with douching, being in the treatment arm, and being a woman who had sex with women.12 month embargo; published 01 December 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities

BACKGROUND: COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. OBJECTIVE: To characterize COVID-19 vaccine hesitancy in underserved diverse populations. METHODS: The Minority and Rural Coronavirus Insights Study recruited a convenience sample of adults (ages ≥18, n=3,735) from Federally Qualified Health Centers in California, Midwest (Illinois/Ohio), Florida and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as responses no or undecided to the question Would you get a coronavirus vaccine, if it was available? ( yes categorized as not hesitant). The cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed by the chi-squared test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Interactions between geography and each demographic characteristic were evaluated in separate models. RESULTS: The strongest vaccine hesitancy variability was by geographic region: in California 28.3% (26.5-31.1), the Midwest 36.1 % (32.1-40.2), Louisiana 59.1% (56.0-62.1), Florida 67.9% (65.0-70.8). The expected estimates for the general population were lower: 9.7% (California), 15.2 % (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shape age pattern was found, with the highest prevalence among ages 25-34 in the Midwest (39.3%), Florida (79.5%,) and Louisiana (79.4%) (p \u3c0.05). Females were more hesitant than males in the Midwest (36.5% vs 23.9%), Florida (71.6% vs 59.4%), and Louisiana (66.5% vs. 46.4%) (p\u3c0.05). Racial/ethnic differences were found in California with the highest prevalence among non-Hispanic Black (45.8%) and in Florida with the highest among Hispanic (69.3%) participants (p\u3c0.05) but not in the Midwest and Louisiana. The main effect model confirmed the U-shape association with age: strongest association with age 25-34, OR=2.28 (1.74, 2.99). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. The associations with the female gender were strongest in Florida and Louisiana: ORs were 7.83 (5.94, 10.33) and 6.04 (4.52, 8.06) compared to males in California, respectively. Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida and Black in Louisiana: ORs were 11.18 (7.01, 17.85) and 8.94 (5.53, 14.47), respectively. However, the strongest race/ethnicity variability was observed within California and Florida: ORs varied 4.7- and 2-fold between racial/ethnic groups in these regions, respectively. CONCLUSIONS: These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns