Development of a Machine Learning Modelling Tool for Predicting HIV Incidence Using Public Health Data from a County in the Southern United States.

BACKGROUND: Recent advancements in Machine Learning (ML) have significantly improved the accuracy of models predicting HIV incidence. These models typically utilize electronic medical records and patient registries. This study aims to broaden the application of these tools by utilizing de-identified public health datasets for notifiable sexually transmitted infections (STIs) from a southern U.S. County known for high HIV incidence rates. The goal is to assess the feasibility and accuracy of ML in predicting HIV incidence, which could potentially inform and enhance public health interventions. METHODS: We analyzed two de-identified public health datasets, spanning January 2010 to December 2021, focusing on notifiable STIs. Our process involved data processing and feature extraction, including sociodemographic factors, STI cases, and social vulnerability index (SVI) metrics. Various ML algorithms were trained and evaluated for predicting HIV incidence, using metrics such as accuracy, precision, recall, and F1 score. RESULTS: The study included 85,224 individuals, with 2,027 (2.37%) newly diagnosed with HIV during the study period. The ML models demonstrated high performance in predicting HIV incidence among males and females. Influential predictive features for males included age at STI diagnosis, previous STI information, provider type, and SVI. For females, they included age, ethnicity, previous STIs information, overall SVI, and race. CONCLUSIONS: The high accuracy of our ML models in predicting HIV incidence highlights the potential of using public health datasets for public health interventions such as tailored HIV testing and prevention. While these findings are promising, further research is needed to translate these models into practical public health applications.

Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021.

Despite universal prenatal syphilis screening recommendations and availability of effective antibiotic treatment, syphilis prevalence during pregnancy and the incidence of congenital syphilis have continued to increase in the United States (1,2). Concurrent increases in methamphetamine, injection drug, and heroin use have been described in women with syphilis (3). CDC used data on births that occurred during January 1, 2018-December 31, 2021, from two states (Arizona and Georgia) that participate in the Surveillance for Emerging Threats to Pregnant People and Infants Network (SET-NET) to describe the prevalence of substance use among pregnant persons with syphilis by congenital syphilis pregnancy outcome (defined as delivery of a stillborn or live-born infant meeting the surveillance case definition for probable or confirmed congenital syphilis). The prevalence of substance use (e.g., tobacco, alcohol, cannabis, illicit use of opioids, and other illicit, nonprescription substances) in persons with a congenital syphilis pregnancy outcome (48.1%) was nearly double that among those with a noncongenital syphilis pregnancy outcome (24.6%). Persons with a congenital syphilis pregnancy outcome were six times as likely to report illicit use of opioids and four times as likely to report using other illicit, nonprescription substances during pregnancy than were persons with a noncongenital syphilis pregnancy outcome. Approximately one half of persons who used substances during pregnancy and had a congenital syphilis pregnancy outcome had late or no prenatal care. Tailored interventions should address barriers and facilitators to accessing screening and treatment for syphilis among persons who use substances. The need for syphilis screening and treatment should be addressed at any health care encounter during pregnancy, especially among persons who use substances.

HIV and Sexually Transmitted Infections Among Persons with Monkeypox - Eight U.S. Jurisdictions, May 17-July 22, 2022.

High prevalences of HIV and other sexually transmitted infections (STIs) have been reported in the current global monkeypox outbreak, which has affected primarily gay, bisexual, and other men who have sex with men (MSM) (1-5). In previous monkeypox outbreaks in Nigeria, concurrent HIV infection was associated with poor monkeypox clinical outcomes (6,7). Monkeypox, HIV, and STI surveillance data from eight U.S. jurisdictions* were matched and analyzed to examine HIV and STI diagnoses among persons with monkeypox and assess differences in monkeypox clinical features according to HIV infection status. Among 1,969 persons with monkeypox during May 17-July 22, 2022, HIV prevalence was 38%, and 41% had received a diagnosis of one or more other reportable STIs in the preceding year. Among persons with monkeypox and diagnosed HIV infection, 94% had received HIV care in the preceding year, and 82% had an HIV viral load of <200 copies/mL, indicating HIV viral suppression. Compared with persons without HIV infection, a higher proportion of persons with HIV infection were hospitalized (8% versus 3%). Persons with HIV infection or STIs are disproportionately represented among persons with monkeypox. It is important that public health officials leverage systems for delivering HIV and STI care and prevention to reduce monkeypox incidence in this population. Consideration should be given to prioritizing persons with HIV infection and STIs for vaccination against monkeypox. HIV and STI screening and other recommended preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.

Impact of health care reform legislation on uninsured and medicaid-insured cancer patients.

The Patient Protection and Affordable Care Act of 2010 is the most important US health legislation since the creation of Medicare and Medicaid in 1965. Repeated attempts at a complete overhaul of the health care system under various administrations and 4 decades of incrementalism in our approach to health policy making paved the way for this historic legislation. Major components of the recently enacted legislation include a substantial expansion of the Medicaid program to include 17.1 million currently uninsured adults with incomes below 133% of the federal poverty line, a mandated minimum health benefits package, a renewed focus on prevention, the establishment of state health exchanges with special provisions to permit affordability by those with incomes below 400% of the federal poverty line, and the establishment of high-risk health insurance pools for patients who were previously denied coverage because of preexisting conditions. The time for change was long overdue. Although many challenges exist, particularly for the states, in the implementation phase of the Affordable Care Act, the benefit to low-income cancer patients is increased access to guideline-recommended levels of screening, diagnostic, treatment, and follow-up services.

Role of NaBH(4) stabilizer in the oxazaborolidine-catalyzed asymmetric reduction of ketones with BH(3-)THF.

When stabilized BH(3-)THF (BTHF) was added to a mixture of ketone and tetrahydro-1-methyl-3,3-diphenyl-1H,3H-pyrrolo[1,2-c][1,3,2]oxazaborole (MeCBS-ozaxaborolidine, MeCBS) catalyst 1, low enantioselectivities resulted. Several relative rate experiments showed that a borohydride species in BTHF catalyzed the nonselective borane reduction of ketones, effectively competing with enantioselective MeCBS reduction of ketones, lowering the overall selectivity of the reaction. Improved enantioselectivities in the reaction are obtained by reversing the mode of addition (ketone to BTHF and catalyst), lowering the concentration of NaBH(4) stabilizer in the BTHF solution (87-95% ee) and increasing the concentration or addition rate of BTHF. Decreased reaction temperature and increased catalyst loading only slightly improved the selectivity of the reaction. Upon reaction parameter optimization, simultaneous addition of substrate and BTHF to MeCBS catalyst stabilizer resulted in the highest overall enantioselectivities (96% ee) and diminished the effect of the borohydride. Alternatively, the addition of Lewis acids such as BF(3-)THF to the reaction mixture effectively destroyed the NaBH(4) stabilizer in BTHF solutions, restoring the enantioselectivity to acceptable levels.