Quantitative analysis of restricted metals and metalloids in tattoo inks: A systematic review and meta-analysis.

The various ingredients and impurities that can be detected within tattoo inks have been associated with a myriad of dermatologic complications. Legislation regarding these antigenic substances varies widely around the world, with Europe serving as both the research and regulatory center on these intradermal formulations. Although industry is said to be moving away from metallic and metalloid pigments in exchange for organic or organometallic dyes, surveys of commercially available inks continue to detect these elements at concentrations considered unsafe for application into the dermis. In order to better assess the formulation and safety of tattoo ink, we present a systematic review and meta-analysis of studies quantifying restricted metals and metalloids in commercially available tattoo ink products. Among the papers selected, inconsistencies were noted in the degree of specificity by which ink products were identified and the elements sampled for. In addition, the analytical targets' valency and/or solubility were not always considered in accordance with regulation criteria. Of note, chromium, by total content and that of its regulated +6 valency, exceeded its maximum allowed concentration in nearly every sample tested. Total copper content exceeded the limit for soluble copper in half of inks sampled. In descending order, concentrations of cadmium, barium, mercury, soluble copper, arsenic, zinc, antimony, and lead violated regulations in one-sixth or fewer of samples tested. Cobalt and tin levels never violated regulation. Overall, our findings indicate that unsafe levels of restricted elements continue to be detected across studies, warranting further investigation under a regulatory lens.

Adapting a Motivational Interviewing Intervention to Improve HIV Prevention Among Young, Black, Sexual Minority Men in Alabama: Protocol for the Development of the Kings Digital Health Intervention.

BACKGROUND: African American or Black young men who have sex with men (BYMSM) are at a disproportionate risk for contracting HIV and have high rates of undiagnosed, and therefore untreated, HIV infection. In the southern United States, BYMSM face region-specific hurdles to HIV prevention, such as limited access to care and high levels of racism and intersectional stigma, necessitating HIV testing and pre-exposure prophylaxis interventions that address sociocultural and structural barriers while motivating BYMSM to engage in prevention. Brothers Saving Brothers (BSB) is a motivational interviewing behavioral intervention that successfully and simultaneously increased community-based HIV testing and prevention counseling and education among BYMSM in the midwestern United States. OBJECTIVE: The aim of this protocol is to detail the process for the adaption of the BSB intervention for midwestern BYMSM to the Kings intervention for southern BYMSM. During the adaptation process, the intervention will be modernized to include rapid HIV testing, as opposed to HIV testing that requires BYMSM to return for test results, pre-exposure prophylaxis, and the provision of structural supports, and for relevance in the southern United States. METHODS: Aim 1 is to gather qualitative data through focus groups and in-depth interviews with BYMSM aged 18 to 29 years in Alabama and in-depth interviews with prevention and outreach workers who routinely work with BYMSM in Alabama. NVivo qualitative software (QSR International) will be used for the coding and analysis of the transcripts via a thematic analysis approach. For aim 2, intervention mapping will guide the adaptation process, intervention content, components, and design. Both aims 1 and 2 will leverage the Exploration, Preparation, Implementation, Sustainment implementation science framework, with emphasis on the exploration and preparation phases of this model. By applying these frameworks, the original midwestern BSB intervention will be scientifically adapted to the southern BYMSM Kings intervention. RESULTS: This study is ongoing as of 2022 and is expected to conclude in 2024, with aims 1 and 2 being completed in 2023. Qualitative data will offer insight into the current real-world experiences and preferences of BYMSM in Alabama. Feedback will be collected through the adaptation process to inform intervention refinement. Institutional review board approvals have been received. CONCLUSIONS: The findings will inform next steps, that is, testing the Kings intervention for feasibility, acceptability, and preliminary effectiveness in a pilot hybrid type 1 effective-implementation randomized controlled trial. The study results will provide insights about important considerations for HIV prevention among BYMSM in the southern United States. TRIAL REGISTRATION: ClinicalTrials.gov NCT03680729; https://clinicaltrials.gov/ct2/show/NCT03680729. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/36655.

Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research.

PURPOSE OF REVIEW: Although many HIV prevention and/or treatment digital health interventions (DHIs) have shown feasibility and acceptability, fewer have indicated efficacy, and only a subset have been adapted for new contexts. Adaptation is a key element of pragmatic implementation science research. Adaptation is cost effective and time efficient compared with new development. Leveraging adaptation can lead to accelerated scale-up and enhanced public health impact. Considering the value of adaptation, the purpose of this piece is to present examples of DHI to DHI adaptation sequences to inform future HIV prevention and/or treatment research. RECENT FINDINGS: From an examination of recent academic articles (01 November 2016 to 31 October 2021), we identified adaptation sequences that included an original DHI with at least two adaptations. Four models are presented herein; examples consist of adapted DHIs for new population, health outcome, geography, or a combination thereof. SUMMARY: Adaptation is a promising scientific approach to expeditiously respond to the evolving HIV landscape. We present examples of DHI adaptations alongside considerations for each type of adaptation; we also present adaptation challenges with responsive strategies. We suggest when conducted with attention to rigor (leveraging adaptation frameworks, community engagement, and tailoring content), adaptation is a powerful tool to pragmatically address the HIV epidemic.