"Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas.

BACKGROUND: Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS: This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS: Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS: Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.

High-speed molecular cloudlets around the Galactic center's supermassive black hole.

We present 1″-resolution ALMA observations of the circumnuclear disk (CND) and the interstellar environment around Sgr A*. The images unveil the presence of small spatial scale 12CO (J=3-2) molecular "cloudlets" (≲20,000 AU size) within the central parsec of the Milky Way, in other words, inside the cavity of the CND, and moving at high speeds, up to 300 km s-1 along the line-of-sight. The 12CO-emitting structures show intricate morphologies: extended and filamentary at high negative-velocities (vLSR ≲-150 km s-1), more localized and clumpy at extreme positive-velocities (vLSR ≳+200 km s-1). Based on the pencil-beam 12CO absorption spectrum toward Sgr A* synchrotron emission, we also present evidence for a diffuse molecular gas component producing absorption features at more extreme negative-velocities (vLSR <-200 km s-1). The CND shows a clumpy spatial distribution traced by the optically thin H13CN (J=4-3) emission. Its motion requires a bundle of non-uniformly rotating streams of slightly different inclinations. The inferred gas density peaks, molecular cores of a few 105 cm-3, are lower than the local Roche limit. This supports that CND cores are transient. We apply the two standard orbit models, spirals vs. ellipses, invoked to explain the kinematics of the ionized gas streamers around Sgr A*. The location and velocities of the 12CO cloudlets inside the cavity are inconsistent with the spiral model, and only two of them are consistent with the Keplerian ellipse model. Most cloudlets, however, show similar velocities that are incompatible with the motions of the ionized streamers or with gas bounded to the central gravity. We speculate that they are leftovers of more massive molecular clouds that fall into the cavity and are tidally disrupted, or that they originate from instabilities in the inner rim of the CND that lead to fragmentation and infall from there. In either case, we show that molecular cloudlets, all together with a mass of several 10 M ⊙, exist around Sgr A*. Most of them must be short-lived, ≲104 yr: photoevaporated by the intense stellar radiation field, G 0≃105.3 to 104.3, blown away by winds from massive stars in the central cluster, or disrupted by strong gravitational shears.

Evaluation of nifurtimox treatment of chronic Chagas disease by means of several parasitological methods.

Currently, evaluation of drug efficacy for Chagas disease remains a controversial issue with no consensus. In this work, we evaluated the parasitological efficacy of Nifurtimox treatment in 21 women with chronic Chagas disease from an area of endemicity in Chile who were treated according to current protocols. Under pre- and posttherapy conditions, blood (B) samples and xenodiagnosis (XD) samples from these patients were subjected to analysis by real-time PCR targeting the nuclear satellite DNA of Trypanosoma cruzi (Sat DNA PCR-B, Sat DNA PCR-XD) and by PCR targeting the minicircle of kinetoplast DNA of T. cruzi (kDNA PCR-B, kDNA PCR-XD) and by T. cruzi genotyping using hybridization minicircle tests in blood and fecal samples of Triatoma infestans feed by XD. In pretherapy, kDNA PCR-B and kDNA PCR-XD detected T. cruzi in 12 (57%) and 18 (86%) cases, respectively, whereas Sat DNA quantitative PCR-B (qPCR-B) and Sat DNA qPCR-XD were positive in 18 cases (86%) each. Regarding T. cruzi genotype analysis, it was possible to observe in pretherapy the combination of TcI, TcII, and TcV lineages, including mixtures of T. cruzi strains in most of the cases. At 13 months posttherapy, T. cruzi DNA was detectable in 6 cases (29.6%) and 4 cases (19.1%) by means of Sat DNA PCR-XD and kDNA PCR-XD, respectively, indicating treatment failure with recovery of live parasites refractory to chemotherapy. In 3 cases, it was possible to identify persistence of the baseline genotypes. The remaining 15 baseline PCR-positive cases gave negative results by all molecular and parasitological methods at 13 months posttreatment, suggesting parasite response. Within this follow-up period, kDNA PCR-XD and Sat DNA qPCR-XD proved to be more sensitive tools for the parasitological evaluation of the efficacy of Nifurtimox treatment than the corresponding PCR methods performed directly from blood samples.