Defining the clinical role of adapted digital light field photography in the treatment of HIV-induced Kaposi\u27s sarcoma lesions

Kaposi’s sarcoma (KS): a vascular tumor associated with HHV8 and HIV infection KS burden at Maputo Central Hospital (MCH): •Referral center for all of southern Mozambique, 1500 beds, \u3e65% HIV+ patients on medical services •Dermatology ward: 50 beds, \u3e30% of admitted patients suffer from Kaposi’s sarcoma and its complications •10-15 cases/month admitted with advanced KS; additional 15-20 cases/month treated outpatient •KS is the most common form of malignancy seen at MCH among men, second most frequent among women Current KS standard of care: •First line treatment: chemo- and concomitant antiretroviral-therapy •Pre-treatment photographs rarely taken to establish a baseline for therapeutic monitoring •Post-therapy improvement is based on gross examination and clinical judgment •Tracking correlation between therapy dosing and shrinkage of lesion size is difficult due to variation and number of lesions Aim of the study: determine the utility of adapted digital light field photography in a resource-limited setting and establish best clinical practice for future KS monitoring via photograph

Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014.

Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing

Risk profile and HIV testing outcomes of women undergoing community-based testing in San Diego 2008-2014.

Women comprised 19% of new HIV diagnoses in the United States in 2014, with significant racial and ethnic disparities in infection rates. This cross-sectional analysis of women enrolled in a cohort study compares demographics, risk behaviour, and sexually transmitted infections (STI) in those undergoing HIV testing in San Diego County. Data from the most recent screening visit of women undergoing voluntary HIV screening April 2008 -July 2014 was used. HIV diagnosis, risk behaviour and self-reported STIs were compared among women aged ≤24, 25-49, and ≥50, as well as between HIV-infected and uninfected women and between Hispanic and non-Hispanic women. Among the 2535 women included, Hispanic women were less likely than other women to report unprotected vaginal intercourse (p = 0.026) or stimulant drug use (p = 0.026), and more likely to report one or fewer partners (p < 0.0001), but also more likely to report sex with an HIV-infected individual (p = 0.027). New HIV infection was significantly more prevalent among Hispanic women (1.6% vs. 0.2%; p < 0.001). Hispanic women were more likely than other women to be diagnosed with HIV despite significantly lower rates of risk behaviour. Culturally specific risk reduction interventions for Hispanic women should focus on awareness of partner risk and appropriate testing

Attitudes and preferences regarding the use of rapid self-testing for sexually transmitted infections and HIV in San Diego area men who have sex with men

BackgroundSexually transmitted infections (STIs) increase the risk of HIV transmission and are present at high rates among men who have sex with men (MSM). Adherence to HIV/STI testing guidelines is low in the United States. Testing programs that utilize rapid self-administered HIV/STI tests improve testing rates, though multiple factors influence their uptake.MethodsMSM were recruited at an HIV/STI testing and treatment program in 2014 and provided consent, demographics, risk behaviors, HIV/STI test preferences, and perceived testing barriers via an online questionnaire. Comparisons of testing preferences and barriers were made based on age, risk group, and HIV serostatus using the Fisher exact test.ResultsHIV testing preferences included rapid oral test (71.1%), home test location (78.5%), electronic delivery of HIV-negative test results (76.4%), and direct provider notification for HIV-positive test results (70%), with respondents age >45 years being significantly more likely to prefer home testing (P = .033). STI testing preferences included self-collection of specimens (73.2%), home test location (61%), electronic delivery of negative STI test results (76.4%), and direct provider notification for positive STI test results (56.6%) with no significant differences between age, HIV serostatus, or risk groups. The most frequently reported HIV and STI testing barrier was lack of known prior HIV/STI exposure (57.3% for HIV, 62.9% for STI) with respondents age <45 years more frequently citing inconvenience as a barrier to testing (HIV: 50.9% vs 17.4%, P = .010; STI: 58.3% vs 31.8%, P = .070).ConclusionsAlthough additional research is needed, increasing resources directed specifically toward home testing has the potential to translate into improved uptake of rapid HIV/STI testing. Efforts to improve convenience in testing programs must be balanced with the need for continued educational outreach

Uniting for Ukraine Tuberculosis Screening Experience, San Francisco, California, USA

Ukraine surveillance data suggest high tuberculosis (TB) incidence, including multidrug resistance. Of 299 newcomers from Ukraine screened in San Francisco, California, USA, by using an interferon-γ-release-assay (IGRA) and chest radiograph, 7.4% were IGRA positive and 1 had laboratory-confirmed pansusceptible TB. Screening with IGRA and chest radiograph can help characterize TB risk

Genetic Network Analysis to Assess the Risk of Human Immunodeficiency Virus Transmission Among Men Who Have Sex With Men Seeking Partners on the Internet.

BackgroundOnline partner seeking (OPS) among men who have sex with men (MSM) is associated with increased risk behavior including frequency of unprotected anal intercourse, number of partners, and incidence of sexually transmitted infections (STIs). However, the impact on transmission of human immunodeficiency virus (HIV) is uncertain.MethodsMSM diagnosed with acute and early HIV infection were recruited from the Primary Infection Resource Consortium. HIV transmission events in the year following infection were inferred using estimated date of infection combined with genetic network analysis with linked sequences defined as ≤0.015 sequences/site difference in the HIV type 1 (HIV-1) pol coding region. Participants completed a detailed baseline questionnaire including reported methods of meeting sexual partners, including OPS, in the prior 3 months, and regression was performed with inferred transmission as the outcome.ResultsFrom 147 MSM who completed the questionnaire, there were an associated 20 inferred HIV transmissions. No association with OPS was found (odds ratio, 0.64 [95% confidence interval, .24-1.69]; P = .37), though individuals who reported OPS were more likely to have reported a greater number of partners (P = .003) and prior STIs (P = .002). Geospatial analysis did not indicate that OPS was associated with increased geographical reach of the user (P = .68).ConclusionsIndividuals reporting OPS did not have increased odds of inferred HIV-1 transmission in the year following infection using genetic linkage analysis despite apparently increased risk behavior. OPS also did not increase the geographic distance between genetically clustered HIV infections, suggesting that individuals mainly use the internet to meet partners in their local region

Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique.

BackgroundPleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis.MethodsCase records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame.ResultsReview of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusions malignant in etiology.ConclusionsThere was no statistically significant difference between the use of bleomycin and NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusion after pleurodesis with NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas

Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique.

BackgroundPleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis.MethodsCase records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame.ResultsReview of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusions malignant in etiology.ConclusionsThere was no statistically significant difference between the use of bleomycin and NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusion after pleurodesis with NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas