Factors influencing neonatal male circumcision uptake among expecting couples in Zambia: formative findings.

Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children's autonomy and rights, and men's dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers' MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention.

Using unsupervised machine learning to classify behavioral risk markers of bacterial vaginosis.

INTRODUCTION: This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition.  METHODS: Participants were 391 cisgender women in Miami, Florida, with a mean of 30.8 (SD = 7.81) years of age; 41.7% identified as Hispanic; 41.7% as Black and 44.8% as White. Participants completed measures of demographics, risk behaviors [sexual, medical, and reproductive history, substance use, and intravaginal practices (IVP)], and underwent collection of vaginal samples; 135 behavioral variables were analyzed. BV was diagnosed using Nugent criteria. RESULTS: We identified four clusters, and variables were ranked by importance in distinguishing clusters: Cluster 1: nulliparous women who engaged in IVPs to clean themselves and please sexual partners, and used substances frequently [n = 118 (30.2%)]; Cluster 2: primiparous women who engaged in IVPs using vaginal douches to clean themselves (n = 112 (28.6%)]; Cluster 3: primiparous women who did not use IVPs or substances [n = 87 (22.3%)]; and Cluster 4: nulliparous women who did not use IVPs but used substances [n = 74 (18.9%)]. Clusters were related to BV (p < 0.001). Cluster 2, the cluster of women who used vaginal douches as IVPs, had the highest prevalence of BV (52.7%). CONCLUSIONS: Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, in developing interventions intended to reduce BV and IVP, and ultimately in reducing the risk of HIV infection among women.

Parenting Measures and Their Psychometrics in LGBTQIA+ Families: A Systematic Review.

Parenting significantly influences youth development, yet there's a dearth of research on measuring parenting among LGBTQIA+ caregivers, or caregivers of LGBTQIA+ children (hereafter LGBTQIA+ families). In this systematic review we identified and evaluated the psychometrics of parenting scales validated for this population. The inclusion criteria encompassed studies with LGBTQIA+ families in major databases and secondary sources, psychometric assessment, and English language. Eight studies validating ten scales measuring parenting practices, parental attitudes, beliefs, and perceptions were identified. Generally, studies reported promising psychometrics, showing evidence of construct validity in all and reliability in seven. However, the review also unveiled crucial gaps: a paucity of scales validated among LGBTQIA+ fathers, and predominantly featured non-Hispanic White participants. Findings underscore the necessity for more inclusive samples that reflect the diversity of LGBTQIA+ families. The validation of parenting scales is crucial for understanding parenting in LGBTQIA+ families and developing parenting interventions to promote their well-being.

Zambian Parents' Perspectives on Early-Infant Versus Early-Adolescent Male Circumcision.

Despite increasing interest in Early-Infant and Early-Adolescent Medical Circumcision (EIMC and EAMC, respectively) in Zambia, parental willingness to have their sons undergo the procedure has not been explored. This study describes Zambian parents' perspectives on EIMC and EAMC. A total of N = 600 men and women (n = 300 couples) were recruited. Most parents, 89% and 83%, planned to have their newborn or adolescent sons circumcised, respectively, and 70% and 57% had plans for EIMC and EAMC, respectively. Most (91% for infants and 86% for adolescents) reported they were considering the pros and cons of circumcision. Parents' age (OR 1.05), having children living in one's home (OR 3.58), and lower education (OR 0.63) were associated with sons' circumcision. The minimal risks associated with circumcision and the lifetime benefits conferred underscore its contribution to public health in high HIV prevalence areas.

RESUMEN: A pesar del creciente interés en la Circuncisión Médica Temprana de Niños y Adolescentes (EIMC y EAMC, respectivamente, por su siglas en ingles) en Zambia, no se ha explorado la voluntad de los padres, de dar consentimiento, para que sus hijos se sometan al procedimiento. Este studio, describe las perspectivas de los padres de Zambia sobre EIMC y EAMC. Se reclutaron un total de N = 600 hombres y mujeres (n = 300 parejas) que esperaban tener un hijo. La mayoría de los padres, 89% y 83%, planeaban circuncidar a sus hijos recién nacidos o adolescentes, respectivamente, y 70% y 57% tenían planes para EIMC y EAMC, respectivamente. La mayoría (91% para bebés y 86% para adolescentes) informaron que estaban considerando las ventajas y desventajas de la circuncisión. La edad de los padres (OR 1,05), tener hijos viviendo en el hogar (OR 3,58) y menor educación (OR 0,63) se asociaron con la circuncisión de los hijos. Los riesgos mínimos asociados con la circuncisión y los beneficios conferidos de por vida subrayan su contribución a la salud pública en áreas de alta prevalencia del VIH.

Assessing Intravaginal Practices in HIV Prevention Research: Development and Validation of an Intravaginal Practices Questionnaire.

Intravaginal practices (IVPs) refer to placing items (e.g., water, soap, commercial douches, fingers, rags) inside the vagina. IVPs have been shown to contribute to the development of bacterial vaginosis (BV) and may increase sexually transmitted infections and HIV risk. We developed the Intravaginal Practices Questionnaire (IVQ). The purpose of this study was to validate the IVQ, with the goal of establishing a consistent method of assessing IVP across studies. Women enrolled in this study (n = 180) were on average 30 years of age (SD = 8.32). Half (54%) identified as non-Hispanic, and 45% identified as Black; 41% reported lifetime IVP. Past month IVP use included commercial douches (9%), water (35%), fingers (41%), soap (21%), cloths/rags/wipes (10%), and vinegar (3%), which were placed in the vagina. No women used yogurt or herbs. An exploratory factor analysis indicated that a single-factor structure best explained the underlying constructs in participant responses in six endorsed items assessing commercial douches, water, fingers, soap, clothes/rags/ wipes, and vinegar use, suggesting that a common factor underlies these behaviors. All factor loadings were > 0.496. Cronbach's α was 0.99, suggesting that the reliability of the scale was excellent. Lastly, a total IVQ score was related to BV diagnosis (p = .007) as well as self-reported symptoms of BV (p = .034). Results illustrate that the IVQ has adequate psychometric properties. This tool may be used by public health experts and clinicians to identify IVPs that may potentially increase HIV risk.

Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner's HIV status, in six South African districts with a high antenatal HIV burden.

BACKGROUND: Elimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women's decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner's HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden. METHODS: A mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis. RESULTS: Overall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman's disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure. CONCLUSION: User-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.

Impact of vaginal microbiome communities on HIV antiretroviral-based pre-exposure prophylaxis (PrEP) drug metabolism.

Despite the efficacy of antiretroviral-based pre-exposure prophylactics (PrEP) in men who have sex with men, studies in women have produced widely varying outcomes. Recent evidence demonstrates that vaginal microbial communities are associated with increased HIV acquisition risk and may impact PrEP efficacy. Here, we investigate the mechanisms underlying how vaginal bacteria alter PrEP drug levels and impact HIV infection rates ex vivo. Using cervicovaginal lavages (CVLs) from women with or without bacterial vaginosis (BV), we identified microbial metabolism of PrEP drugs in BV samples through LC-MS/MS analysis of soluble drug levels and metabolite formation in dual T-cell cultures. CVL samples were assessed for microbiome analysis using sequencing of bacterial 16S rRNA genes. We also observed non-Lactobacillus bacteria that are associated with BV may potentially impact PrEP efficacy through increased HIV infection rates in co-cultures containing Lactobacillus or BV bacteria, PrEP drugs, CEM-GFP cells, and HIV-1LAI virus. Finally, we used these data to develop a novel predictive mathematical simulation modeling system to predict these drug interactions for future trials. These studies demonstrate how dysbiotic vaginal microbiota may impact PrEP drugs and provides evidence linking vaginal bacteria to PrEP efficacy in women.

Psychometric Properties of a Vaccine Hesitancy Scale Adapted for COVID-19 Vaccination Among People with HIV.

We evaluated the psychometric properties of a modified version of the Vaccine Hesitancy Scale (VHS) among people with HIV (PWH) for COVID-19 vaccination in a cross-sectional study in the US. Self-report data from an online questionnaire were collected from a sample of N = 175 PWH. Participants were surveyed in English or Spanish regarding attitudes towards COVID-19 vaccination using the adapted VHS. Participants were on average 51.55 years of age (SD = 13.90) 55% were women. The reliability of the scale was acceptable (α = 0.72). An exploratory factor analysis showed that "Lack of confidence" and "Risks" explained 45.55% and 12.31% of the variance. Related items showed expected associations with these factors, supporting construct validity. Results illustrate that the modified VHS for COVID-19 vaccination has adequate psychometric properties. We replicated the original factor structure of the VHS and demonstrated adequate internal consistency and construct validity. Validated tools are essential to guide vaccination policy and campaigns towards populations at risk.

RESUMEN: En este estudio transversal, evaluamos las propiedades psicométricas de la Escala de Reticencia a la Vacunación (VHS, por sus siglas en inglés) para la vacuna contra el COVID-19 en personas con VIH (PCV) en los EE. UU. Los participantes (N = 175) respondieron a una encuesta en línea en inglés o en español, sobre las actitudes hacia la vacuna contra el COVID-19 utilizando una version adaptada de la VHS. La edad promedio de los participantes fue de 51,55 años (DE = 13,90;) y 55% eran mujeres. La fiabilidad de la escala fue aceptable (α = 0,72). Un análisis factorial exploratorio mostró que la "falta de confianza" y los "riesgos" explicaron el 45,55% y el 12,31% de la varianza. Los elementos relacionados mostraron asociaciones esperadas con dichos factores, apoyando la validez de la VHS adaptada para esta población. Los resultados ilustran que la VHS modificada para la vacuna contra el COVID-19 tiene propiedades psicométricas adecuadas. Replicamos la estructura factorial original de la VHS y demostramos una adecuada validez y consistencia interna. La validación de instrumentos de recolección de datos es esencial para orientar las políticas y campañas de vacunación para poblaciones en riesgo, tal como PCV.

Blood Pressure, Depression, and Suicidal Ideation Among Pregnant Women with HIV.

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.

RESUMEN: Aunque investigaciones anteriores han examinado las asociaciones entre la presión arterial (PA), depresión e ideación suicida, pocos estudios han examinado esto en poblaciones de alto riesgo, como las mujeres embarazadas con VIH. El estudio actual examinó la asociación de la PA con la depresión y la ideación suicida entre mujeres embarazadas con VIH (n = 217) en zonas rurales de Sudáfrica. Los datos de PA (medidos ≤ 1 mes antes de la visita del estudio) se extrajeron de los registros médicos. La sintomatología depresiva y la ideación suicida se evaluaron mediante la Escala de depresión posnatal de Edimburgo. La PA diastólica se asoció positivamente tanto con la ideación suicida como con la sintomatología depresiva, incluso después de controlar variables demográficas, edad gestacional y violencia de la pareja íntima. Estos hallazgos sugieren que mujeres embarazadas con VIH con PA elevada puede tener un mayor riesgo de depresión prenatal e ideación suicida. Las investigaciones futuras deberían aprovechar diseños longitudinales para examinar los posibles mecanismos y la direccionalidad de la relación, así como otros factores contribuyentes.

A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis.

Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.

RESUMEN: La vaginosis bacteriana (VB) es la infección genital más común en mujeres y está asociada con un mayor riesgo de enfermedades de transmisión sexual (ETS) y de VIH. Este estudio utilizó un enfoque sindémico para evaluar factores asociados con VB. Entre noviembre del 2018 y junio del 2021, se reclutaron mujeres cisgénero de entre 18­45 años, que no estuvieran embarazadas, que fueran VIH negativas y sexualmente activas, y que vivieran en Miami, Florida. Las participantes completaron un cuestionario sociodemográfico y de comportamiento junto con un examen ginecológico. Se diagnosticó VB empleando los criterios de Amsel y se confirmó empleando el criterio de Nugent con una puntuación ≥ 4. La puntuación sindémica fue calculada como la suma de factores asociados con VB utilizando. La asociación entre la puntuación sindémica con VB se evaluó mediate una regresión logística. De 166 mujeres incluidas, 60.2% fueron diagnosticadas con VB. Los factores incluidos en la puntuación sindémica fueron la raza, etnia, educación, sexo vaginal, consumo reciente de cannabis, y el uso de prácticas intravaginales. Se encontraron mayores probabilidades de VB en mujeres con una puntuación ≥ 3 en comparación con aquellas con una puntuación de 0/1. Una puntuación sindémica alta se asoció con una mayor probabilidad de tener VB. Son necesarias intervenciones multinivel para disminuir la VB y disminuir el riesgo de que las mujeres contraigan ETS y VIH.

Psychological and physical intimate partner violence and sexual risk behavior among South African couples: a dyadic analysis.

This study aimed to examine intimate partner violence (IPV) as it relates to both partners' perceptions of IPV and sexual behaviors, considering how their IPV might be interdependent within the relationship dynamics. The sample consisted of 713 female-male dyads in which women were pregnant and living with HIV in rural South Africa. Using an actor-partner interdependence model (APIM), we examined the interdependent influence of psychological and physical IPV on men by their female partners and psychological and physical IPV on women by their male partners on sexual risk behavior. The APIM model found there were no actor (b = -0.06, SE = 0.05, p = .221) or partner (b = -1.2, SE = 0.06, p = .056) effects contributing to protected sex by female IPV victimization. In contrast, significant actor (b = -0.28, SE = 0.06, p < .001) and partner (b = -0.29, SE = 0.06, p < .001) effects for protection were related to male IPV victimization. The model also found that the covariate of female HIV disclosure was associated with both male (b = 0.5, SE = 0.12, p < .001) and female protected sexual intercourse (b = 0.58, SE = 0.1, p < .001). Female HIV disclosure was related to an increased likelihood of protected sex by both male and female partners. As male partners reported more IPV victimization, the likelihood of protected sex between male and female partners decreased.Trial registration: ClinicalTrials.gov identifier: NCT02085356.

Factor Structure and Differential Item Functioning of the Edinburgh Postnatal Depression Scale: A Comparison of Zulu and English Versions Among Ante- and Postnatal Women Living with HIV in South Africa.

PURPOSE: Measuring perinatal depression in women with HIV poses a challenge to accurate assessment. South Africa has particularly high rates of perinatal depression, with antenatal depression rates ranging from 21 to 47% and postnatal depression rates ranging from 17 to 50%. With the goal of providing an examination of the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) in a population at greater risk for depression, the current manuscript examined the factor structures and reliability of the English and Zulu versions of the EPDS among pre- and postnatal women with HIV in South Africa. METHODS: This study included n = 1179 women who completed the EPDS in Zulu (n = 709) and English (n = 470) antenatally, and n = 866 women were analyzed at 12-months after birth (n = 494 in Zulu and n = 372 in English). RESULTS: Using factor analytic and item response theory approaches, the English and Zulu versions of the EPDS were compared. Although a few items performed poorly, particularly item 4, the construct validity of the English and Zulu versions of the pre- and postnatally administered EPDS was supported; the reliability of the scale was also supported, with adequate reliability in Zulu and English ante-natally (α = .78), and postnatally (α = .82 and α = .77 respectively). DISCUSSION: This study contributes to improved measurement of depressive symptoms among vulnerable women in a resource constrained setting. The early and accurate detection of depressive symptoms ante- and postnatally among perinatal women living with HIV can facilitate increased treatment which may in turn help prevent the negative maternal and neonatal outcomes associated with depression.

Male Partner Involvement and Development of HIV-exposed Infants in Rural South Africa.

Male partner involvement (MPI) during the prenatal and postnatal periods has been proven to have a beneficial effect on infant development. Infants born to HIV seropositive mothers with lacking or no prenatal and postnatal male partner support may be at a higher risk for adverse developmental outcomes. This study examined the effect of MPI on cognitive, communicative, fine, and gross motor development in 160 infants born to HIV seropositive mothers attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. Results of the bivariate logistic regression showed that both prenatal (OR 1.13; 95% CI 1.01, 1.26; p < 0.05) and postnatal MPI (at 12 months) (1.19; 1.07, 1.31; p < 0.005) were associated with risk for delayed gross motor development in HIV exposed infants. Decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. Not living together with a male partner (2.01; 1.06, 3.80; p < 0.05) was significantly associated with risk for delayed cognitive development. In the multivariate logistic regression analysis, decreased postnatal MPI (0.85; 0.75, 0.98; p < 0.05) was significantly associated with risk for delayed cognitive development. On the other hand, postnatal MPI (1.30; 1.12, 1.50; p < 0.005) was associated with risk for delayed gross motor development among HIV exposed infants. Increased MPI can have beneficial effects on infants' cognitive development. Interventions in PMTCT programs should promote increased prenatal and postnatal MPI to improve cognitive development in HIV exposed infants.

Mental Health, Coping, and Social Support Among People Living with HIV in the Americas: A Comparative Study Between Argentina and the USA During the SARS-CoV-2 Pandemic.

The COVID-19 pandemic poses a risk to mental health and may disproportionately affect people living with HIV (PLWH). This study examined the interaction of social support and resilient coping in predicting depressive symptoms among PLWH. PLWH residing in Buenos Aires, Argentina and in Miami, Florida (US) were asked to complete an anonymous survey on the impact of COVID-19. Statistical analysis included ordinary least squares regression. A total of 1,554 participants were included. Mean age was 47.30 years; 63.70% were men. A test of three-way interaction of social support × resilient coping × study site indicated differences by site (b = -0.63, p = 0.04, 95%CI [-1.24, -0.02]). In Argentina, higher levels of social support and resilient coping were associated with lower depressive symptoms. Lower levels of social support and resilient coping were associated with higher depressive symptoms. The impact of COVID-19 on mental health illustrates the need for developing innovative strategies to support resilience and to enhance coping with stress and adversity among PLWH.

RESUMEN: La pandemia de COVID-19 presenta riesgos importantes para la salud mental y puede afectar desproporcionadamente a personas con VIH. Este estudio examinó el efecto entre el apoyo social y la resiliencia para afrontar situaciones difíciles en predecir síntomas depresivos en personas con VIH. Personas con VIH residentes de Buenos Aires (Argentina) y Miami, Florida (EE.UU) completaron una encuesta anónima sobre el impacto del COVID-19. El análisis estadístico incluyó un modelo clásico de regresión lineal con mínimos cuadrados ordinarios. Se incluyeron 1554 participantes. La edad promedio fue 47.30 años y 63.7% eran hombres. La prueba de interacción de apoyo social × resiliencia para hacer frente a situaciones difíciles × país indicó diferencias entre países (b = −0.63, p = 0.043, IC 95% [1.24, −0.02]). En Argentina, los participantes con mayor apoyo social y resiliencia para hacer frente a situaciones difíciles mostraron síntomas depresivos más bajos; y aquellos con menor apoyo social y resiliencia para hacer frente a situaciones difíciles, mostraron síntomas depresivos más altos. Este efecto no se observó en los participantes de Miami. El impacto de COVID-19 en la salud mental en personas con VIH ilustra la necesidad de desarrollar estrategias innovadoras para apoyar la resiliencia y mejorar el enfrentamiento del estrés y la adversidad.

Motivational Interviewing Training for HIV Care Physicians in Argentina: Uptake and Sustainability of an Effective Behavior Change Intervention.

Motivational interviewing (MI) utilizes a patient-centered approach to address patient ambivalence about treatment and has been found to improve treatment ART adherence among patients living with HIV disengaged from care. This study examined MI training for clinicians, uptake, and sustainability over time. Clinics (n = 7) with N = 38 physicians were randomized to condition (MI, Enhanced Standard of Care). Physicians completed video- recorded patient consultations at baseline and 6, 12, and 18-month follow-up. MI condition physicians had greater relational and technical scores over time and were more likely to adhere to and sustain MI over time. Overall, physicians found the MI training highly acceptable and were able to sustain their skills. Results illustrate the feasibility of MI training, implementation, and sustainment over 18 months. Findings support previous research in Argentina in which trained physicians found MI useful with challenging patients. Broader implementation of MI among HIV care physicians in Argentina is merited.

RESUMEN: La entrevista motivacional (EM) es una intervención con enfoque en el paciente que sirve para abordar la ambivalencia del paciente sobre el tratamiento. Se ha descubierto que EM mejora la adherencia al tratamiento antirretroviral en pacientes con VIH y que no están recibiendo tratamiento. En este estudio se examinó la capacitación de EM entre médicos, como también la aceptación y la sostenibilidad de EM a lo largo del tiempo. Las clínicas (n = 7) con N = 38 médicos se asignaron al azar a la condición (EM o estándar de atención mejorada). Los médicos hicieron consultas de pacientes, las cuales fueron grabadas en video al inicio del estudio y a los 6, 12 y 18 meses de seguimiento. Los médicos de la condición de EM obtuvieron puntuaciones relacionales y técnicas más altas a lo largo del tiempo y fueron más propensos ha adherirse y usar la EM con el tiempo. En general, los médicos consideraron que la formación en EM era muy aceptable y pudieron mantener sus habilidades. Los resultados ilustran la viabilidad de la capacitación, implementación y mantenimiento de la EM durante 18 meses. Los descubrimientos sustentan investigaciones anteriores en Argentina en las que médicos capacitados encontraron que la EM era útil para pacientes desafiantes. Una implementación más amplia de la EM entre los médicos de atención del VIH en Argentina es necesaria para mejorar el tratamiento de personas con VIH.

The contribution of syndemic conditions to cardiovascular disease risk.

The syndemic conditions of low education, childhood maltreatment, depression, HIV, alcohol and cocaine use, and obesity have been established as independent risk factors for cardiovascular risk, but research examining the association between syndemic conditions and cardiovascular risk in high-risk populations is lacking. A total of N = 503 participants underwent an ultrasound of the carotid artery to assess for atherosclerotic plaque. Participants, HIV-infected (n = 202) and HIV-uninfected (n = 301) with and without a history of cocaine use, were a mean age of 36.13 years (SD = 9.51); 50% were male, and 62% were African-American. Each syndemic condition was associated with 8% greater odds of atherosclerotic plaque (OR = 1.08), 9% greater odds of systolic blood pressure (OR = 1.09), and 10% greater odds of diastolic blood pressure (OR = 1.10). Multilevel research, interventions, and public policy initiatives are needed to activate stakeholders at each level to maximize their impact at a community level among populations with high rates of syndemic conditions.

Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina.

BACKGROUND: Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. METHOD: Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. RESULTS: Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). CONCLUSION: This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.

Maternal Health Outcomes and Male Partner Involvement Among HIV Infected Women in Rural South Africa.

INTRODUCTION: This study aimed to investigate the association between Male Partner Involvement (MPI) and maternal health outcomes among women attending Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in rural South Africa. The association between Male Partner Participation in the main study (MPP) and maternal health outcomes among these women was also investigated. METHODS: The study utilized data collected from 535 HIV infected women in a randomized controlled trial between 2015 and 2016. Maternal health outcome data (delivery mode, pregnancy systolic and diastolic blood pressure, pregnancy body mass index, pregnancy CD4 count, and pregnancy viral load) were collected from the women's antenatal record forms accessed from the primary healthcare facilities. Bivariate and multivariable logistic regression models were used to estimate the association between socio-demographic characteristics of the women, MPI, and MPP with maternal health outcomes. RESULTS: The mean age of the women was 29.03 years (SD = 5.89). No significant associations were found between MPI and any of the maternal health outcomes contrary to what was hypothesized. Both the bivariate and multivariate analysis indicated a significant association between MPP and higher pregnancy viral load, contrary to the study hypothesis. Insignificant associations were found between MPP and both pregnancy CD4 count and pregnancy blood pressure. The only significant association between maternal health outcomes and socio-demographic characteristics, was between educational attainment and higher pregnancy CD4 count in both the bivariate and multivariate analysis. CONCLUSION FOR PRACTICE: The study showed no significant support for MPI in improving maternal health outcomes of women in PMTCT in rural South Africa. Future studies should include additional maternal health outcomes for investigation.