A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol.

BACKGROUND: People who inject drugs living with HIV (PWIDLH) suffer the lowest rates of HIV viral suppression due to episodic injection drug use and poor mental health coupled with poor retention in HIV care. Approximately 44% of PWIDLH along the US-Mexico border are retained in care and only 24% are virally suppressed. This underserved region faces a potential explosion of transmission of HIV due to highly prevalent injection drug use. This protocol describes an optimization trial to promote sustained viral suppression among Spanish-speaking Latinx PWIDLH. METHODS: The multiphase optimization strategy (MOST) is an engineering-inspired framework for designing and building optimized interventions and guides this intervention. The primary aim is to conduct a 24 factorial experiment in which participants are randomized to one of 16 intervention conditions, with each condition comprising a different combination of four behavioral intervention components. The components are peer support for methadone uptake and persistence; behavioral activation therapy for depression; Life-Steps medication adherence counseling; and patient navigation for HIV care. Participants will complete a baseline survey, undergo intervention, and then return for 3-,6-,9-, and 12-month follow-up assessments. The primary outcome is sustained viral suppression, defined as viral loads of < 40 copies per mL at 6-,9-, and 12-month follow-up assessments. Results will yield effect sizes for each component and each additive and interactive combination of components. The research team and partners will make decisions about what constitutes the optimized multi-component intervention by judging the observed effect sizes, interactions, and statistical significance against real-world implementation constraints. The secondary aims are to test mediators and moderators of the component-to-outcome relationship at the 6-month follow-up assessment. DISCUSSION: We are testing well-studied and available intervention components to support PWIDLH to reduce drug use and improve their mental health and engagement in HIV care. The intervention design will allow for a better understanding of how these components work in combination and can be optimized for the setting. TRIAL REGISTRATION: This project was registered at clinicaltrials.gov (NCT05377463) on May 17th, 2022.

Detección de cepas de Neisseria meningitidis con susceptibilidad intermedia a la penicilina

Se estudiaron 166 cepas de Neisseria meningitidis, serogrupo B, aisladas de enfermos procedentes de todo el país y recibidas en la Laboratorio Nacional de Referencia de Meningococo del Instituto Perdro Kourí, en el período comprendido desde enero de 1989 hasta mayo de 1995. Se determinó la susceptibilidad antimicrobiana a la penicilina por el método de dillución en placas de agar (concentración mínima inhibitoria) y el método de difusión, utilizando discos de 2 U de penicilina. El 56 y 44 porciento de las cepas resultaron sensibles y con susceptibilidad inter,edia, respectivamente, por el método de concentración mínima inhibitoria. Por el método de difusión encontramos 44 porciento de cepas sensibles y 56 porciento de cepas con susceptibilidad intermedia. No se encontraron cepas de meningococo resistentes a la penicililna, ni cepas productoras de ß-lactamasa (AU)