Association of Partnership-Level Methamphetamine Use on Inconsistent PrEP Care Engagement Among GBMSM in Los Angeles County.

There are limited quantitative studies describing the association between meth use in the context of male-male sexual partnerships and PrEP care engagement. We assessed the longitudinal relationship between individual and partnership level meth use with inconsistent PrEP engagement among young gay, bisexual and other men who have sex with men (GBMSM) in Los Angeles. The primary exposure was meth use at the partnership level with a ternary variable (neither partner nor participant used meth, either used meth, or both used meth). Generalized estimating equations were used to assess odds of inconsistent PrEP engagement at different levels of partner-participant meth use, adjusting for age at visit, number of recent male partners and partner intimacy. Among inconsistent PrEP engagement, 61% (n = 84, vs. 79.5%, n = 346 continuous) reported that neither they nor their partner used meth, 22% (n = 31, vs. 18%, n = 56) reported that either partner or participant used meth and 17% (n = 24, vs. 8%, n = 33) reported that both partner and participant used meth (P < 0.01). There were increased odds of inconsistent PrEP engagement when both partner and participant reported meth use (aOR: 3.82; 95%CI: 1.83-7.99) and when either partner or participant reported meth use (aOR: 2.46; 95%CI: 1.28-4.75). Meth use plays an important role in consistent PrEP engagement among GBMSM in mSTUDY. PrEP users who use meth with partners may benefit from integrated interventions addressing both meth use and PrEP engagement.

Changes in Substance Use and Sexual Behaviors After a Sexually Transmitted Infection Diagnosis Among a Cohort of Men Who Have Sex With Men in Los Angeles, CA.

Sexually transmitted infections (STIs), STI reinfection, human immunodeficiency virus (HIV) acquisition, and changes in behaviors after an STI were examined in a cohort of men who have sex with men (MSM) in Los Angeles, CA. Data from a longitudinal study of MSM enrolled from 2014 with at least 1 follow-up visit through March 2020 were analyzed (n = 447; 1854 visits). Study visits every 6 months included self-interviews for sexual behaviors, substance use, and specimen collection for chlamydia, gonorrhea, syphilis, and HIV testing. Changes in behaviors were assessed using the McNemar test, and participants not diagnosed with an STI served as controls for a difference-in-difference (DiD) analysis of changes over time. Cumulative incidence of an STI was 55% (248 of 447). At 24 months after STI diagnosis, methamphetamine use declined from 50% to 35% ( P < 0.01), and median number of sex partners declined from 5 (interquartile range, 2­11) to 2 (interquartile range, 1­6; P < 0.01). Among participants at risk for HIV and diagnosed with an STI (n = 102), postexposure prophylaxis use was 35% and HIV seroconversion was 6%. Based on DiD analyses, participants diagnosed with an STI had higher levels of substance and a higher number of sex partners when compared with those with no STIs; however, declines in these behaviors were comparable to participants not diagnosed with an STI ( PDID > 0.05). Despite behavior modifications after an STI diagnosis, STI/HIV incidence was high, suggesting that MSM with STIs occupy sexual networks where reductions in sexual and substance using behaviors do not protect them from ongoing exposure to STIs and HIV.

Maintaining essential tuberculosis services during the COVID-19 pandemic, Philippines.

OBJECTIVE: To describe the implementation, use and cost of a phone-based tuberculosis case finding and case management intervention during the coronavirus disease 2019 (COVID-19) pandemic in two regions in the Philippines. METHODS: We implemented this phone-based intervention to maintain tuberculosis treatment support, active case finding and contact investigation efforts in 42 facilities, starting in June 2020. We established a dedicated mobile phone number for each centre and promoted the intervention on different media platforms. We recruited and trained staff members and provided them with tools for screening and patient follow-up. We collected data on tuberculosis screening, diagnosis and treatment initiation for this intervention and three comparator interventions over the same period. We collected data on number and type of calls placed and received. We estimated the additional cost of this intervention compared to the standard of care. FINDINGS: From October 2020 to September 2021, 14 tuberculosis contact centres, for which complete data were available, identified 43.5% (827/1901) of patients with bacteriologically confirmed tuberculosis enrolled in treatment among all comparator interventions. These centres managed 6187 calls over the same period. The additional cost of implementing and running the centre for 12 months was 398 United States dollars per facility. CONCLUSION: The tuberculosis contact centre is a low-technology telehealth intervention which contributed to overall treatment initiation during the COVID-19 pandemic. Additional work should assess the extent to which the contact centre identifies tuberculosis patients previously missed by the health system, regardless of the pandemic.

A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial.

BACKGROUND: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. OBJECTIVE: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs' health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. METHODS: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. RESULTS: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. CONCLUSIONS: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs' health outcomes in the future. TRIAL REGISTRATION: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2614-7.

Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence.

Pregnant women in sub-Saharan Africa are at high risk of HIV acquisition and require effective methods to prevent HIV. In a cohort of pregnant women offered Pre-exposure prophylaxis (PrEP), we evaluate the relationship between internalized and anticipated stigma and PrEP initiation at first antenatal visit, 3-month continuation and adherence using multivariable logistic regression. High internalized and anticipated PrEP stigma are associated with lower PrEP care initiation at first antenatal visit (aOR internalized stigma = 0.06; 95% CI = 0.03-0.11 and aOR anticipated stigma = 0.55; 95% CI = 0.31-1.00) compared to women with low reported stigma, after controlling for covariates. Women whose partners have not been tested for HIV or whose serostatus remains unknown have 1.6-times odds of PrEP retention at 3-months compared to women whose partners have been tested (aOR = 1.60; 95% CI = 1.02-2.52) after adjusting for covariates. PrEP counseling and maternal PrEP interventions must consider individual- and relational-level interventions to overcome anticipated PrEP stigma and other barriers to PrEP initiation and adherence.

Characterizing social cohesion and gender identity as risk determinants of HIV among cisgender men who have sex with men and transgender women in Côte d'Ivoire.

PURPOSE: HIV prevalence has been previously estimated among cisgender men who have sex with men (MSM) in Côte d'Ivoire; however, limited data exist relating to the role of social cohesion and gender identity within this population. This study aims to examine these factors as risk determinants of HIV among MSM in Côte d'Ivoire. METHODS: We conducted a cross-sectional study using respondent-driven sampling for recruitment with a structured sociobehavioral instrument and testing for HIV. After respondent-driven sampling adjustment, chi-squared tests and bivariate logistic regression and multivariate logistic regression analyses were performed to characterize social and identity-based risk determinants of biologically confirmed prevalent HIV infection. RESULTS: HIV prevalence was 11.2% (n = 146/1301). Transgender woman identity was associated with higher odds of HIV compared with cisgender MSM (aOR = 3.4, 95% CI [2.0-5.8], P < .001). Having a combined social cohesion score of medium (aOR = 0.4, 95% CI [0.2-0.8], P < .01) or high (aOR = 0.2, 95% CI [0.1-0.3], P < .001) was associated with lower odds of HIV compared with a low score. CONCLUSION: These data suggest that social cohesion is a determinant of prevalent HIV infection in Côte d'Ivoire among gay men, other cisgender MSM, and transgender women. The differences in HIV burden and social cohesion between transgender women and cisgender MSM highlight the need to better target the diversity of people traditionally included in the MSM umbrella to ensure comprehensive HIV prevention and treatment interventions.

Cost-effectiveness of malaria elimination in Sampov Loun Operational District, Cambodia.

BACKGROUND: Over the past decade, Cambodia has seen a significant decline in its malaria burden. The government has established the goal of eliminating malaria in the country by 2025. With PMI/USAID support, Cambodia is implementing a package of interventions as part of its efforts. This assessment aimed to describe the cost of malaria elimination activities in Sampov Loun Operational District (OD) between July 2015 and March 2018, to describe the cost per malaria case detected under PMI programming, and to estimate the incremental cost-effectiveness of the elimination programme per Plasmodium falciparum (Pf) or P. vivax (Pv)/Pf mixed case averted under the Cambodia Malaria Elimination Programme (CMEP) and the U.S. President's Malaria Initiative. Opportunity costs of government workers were also assessed to understand the theoretical cost of sustaining this programme through government efforts alone. MATERIALS AND METHODS: We conducted an empirical micro-costing analysis based on elimination activities alone using CMEP internal project implementation data and corresponding epidemiologic data from July 2015 to March 2018 and empirical findings from implementation to date. We then constructed a cost model in Microsoft Excel using empirical data and used a cost-effectiveness decision tree to describe programme effectiveness in the first three years of implementation and to estimate efficacy for the subsequent year. RESULTS: The total cost of malaria elimination activities in Sampov Loun OD from July 2015 to March 2018 was $883,096. The cost per case of malaria detected in 2017 was $1,304. Including opportunity costs for government staff from July 2015 to March 2018, the total cost was $926,000. Under continued CMEP implementation, the projected future total cost of the program would be about $110,000 per year, or $0.64 per Sampov Loun resident. The incremental cost-effectiveness of the elimination programme was $28 for every additional Pf or Pv/Pf mix malaria case averted, compared to the no-CMEP proxy. CONCLUSION: CMEP activities are cost effective compared to the no-CMEP proxy, as shown through an incremental cost-effectiveness of $28 for every additional Pf or Pv/Pf mix malaria case averted. The total cost of the project is 0.93% of the total per capita spending on health in Cambodia and about 5% of all government health expenditure. Continuing investments in malaria will be needed at national level for stewardship and governance and at local level for ensuring programme readiness in case of malaria outbreaks.