A behavioral cascade of HIV seroadaptation among US men who have sex with men in the era of PrEP and U=U

ABSTRACTSeroadaptive behaviors help to reduce HIV risk for some men who have sex with men (MSM), and have been well documented in a range of MSM populations. Advancements in biomedical prevention have changed the contexts in which seroadaptive behaviors occur. We thus sought to estimate and compare the prevalence of four stages of the “seroadaptive cascade” in the recent era: knowledge of own serostatus, knowledge of partner serostatus; serosorting (matching by status), and condomless anal intercourse. Serosorting overall appeared to remain common, especially with casual and one-time partners. Although PrEP use did not impact status discussion, it did impact serosorting and the likelihood of having condomless anal intercourse. For respondents not diagnosed with HIV and not on PrEP, condomless anal intercourse occurred in just over half of relationships with partners who were not on treatment. Biomedical prevention has intertwined with rather than supplanted seroadaptive behaviors, while contexts involving neither persist.

The Impact of Lacking Guideline on the Prescription of Nonoccupational Postexposure Prophylaxis among HIV Medical Care Providers: National Internet-based Observational Study in China (Preprint)

BACKGROUND Nonoccupational postexposure prophylaxis (nPEP) is an effective HIV biomedical prevention strategy. While previously nPEP guidelines for HIV were mainly released in developed countries, little is known on the perception, attitude, and practice of nPEP in HIV medical care providers in developing countries. OBJECTIVE We aimed to assess the nPEP perception and prescribing practice among HIV medical care providers in China. METHODS HIV medical care providers were recruited in China during May to June 2019, through an online survey regarding nPEP-related knowledge, attitudes, and clinical prescription experiences. Multivariable logistic regression was performed to identify factors associated with prescribing nPEP among HIV medical care providers. RESULTS Totally, 777 eligible participants participated in this study, who are from 133 cities in 31 provinces in China. Of the participants, only 39.8% (309/777) understood nPEP well. Overall, 53.3% (414/777) of participants once prescribed nPEP, among whom 38.9% (161/414) encountered barriers in the prescription process. HIV medical care providers who working in a specialized infectious disease hospital (vs. general hospital: adjusted odds ratio (aOR), 2.50; 95% confidence interval (CI), 1.86–3.35), and having previously prescribed occupational PEP (oPEP, aOR, 4.55; 95% CI, 3.08–6.73), had a significantly positive association with prescribing nPEP; however, self-reported having no oPEP guideline in place (aOR, 0.53; 95% CI, 0.36–0.79), as well as believing nPEP may promote HIV high-risk behavior (aOR, 0.52; 95% CI, 0.36–0.76) or result in HIV drug resistance (aOR, 0.53; 95% CI, 0.36–0.77) among key populations, were negatively associated with nPEP prescription behavior. CONCLUSIONS HIV medical care providers have a poor nPEP perception and an inadequate proportion of prescribing, which may impede the smooth implementation of nPEP to prevent HIV infection. The development of a national nPEP guideline would improve the situation.

Designing preclinical perceptibility measures to evaluate topical vaginal gel formulations relating user sensory perceptions and experiences to formulation properties

The effectiveness of any biomedical prevention technology relies on both biological efficacy and behavioraladherence. Microbicide trials have been hampered by low adherence, limiting the ability to draw meaningfulconclusions about product effectiveness. Central to this problem may be an inadequate conceptualization of howproduct properties themselves impact user experience and adherence. Our goal is to expand the current microbicidedevelopment framework to include product ‘‘perceptibility,’’ the objective measurement of user sensoryperceptions (i.e., sensations) and experiences of formulation performance during use. For vaginal gels, a setof biophysical properties, including rheological properties and measures of spreading and retention, may criticallyimpact user experiences. Project LINK sought to characterize the user experience in this regard, and tovalidate measures of user sensory perceptions and experiences (USPEs) using four prototype topical vaginal gelformulations designed for pericoital use. Perceptibility scales captured a range of USPEs during the productapplication process (five scales), ambulation after product insertion (six scales), and during sexual activity (eightscales). Comparative statistical analyses provided empirical support for hypothesized relationships between gelproperties, spreading performance, and the user experience. Project LINK provides preliminary evidence for theutility of evaluating USPEs, introducing a paradigm shift in the field of microbicide formulation design. Wepropose that these user sensory perceptions and experiences initiate cognitive processes in users resulting inproduct choice and willingness-to-use. By understanding the impact of USPEs on that process, formulationdevelopment can optimize both drug delivery and adherence.

Immunochromatographic assays for COVID-19 epidemiological screening: our experience

In March 2020, the World Health Organization (WHO) declared a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the absence of effective treatment or biomedical prevention, understanding potential post infection immunity has important implications for epidemiologic assessments. For this reason, increasing number of in vitro diagnostic companies are developing serological assays to detect antibodies against SARS-CoV-2, but most of them lack the validation by third parties in relation to their quality, limiting their usefulness. We submitted to serological screening by two different immunochromatographic (IC) rapid testing for detection of IgG and IgM against SARS-CoV-2, 151 asymptomatic or minimally symptomatic healthcare workers previously tested positive for SARS-CoV-2 RT-PCR in order to evaluate the performance of rapid assays. Results showed discrepancies between molecular and IC results, and an inconsistency of immunoglobulins positivity patterns when compared to ELISA/CLIA results, highlighting the absolute necessity of assays performance validation before their marketing and use, in order to avoid errors in the results evaluation at both clinical and epidemiological level.

We have a duty to eradicate HIV in the community, in the world' : successful PrEP use among black men who have sex with men

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] Black men who have sex with men (BMSM) have a 50% lifetime risk of HIV infection. The HIV epidemic continues to be a perplexing health issue, despite the availability of a highly effective biomedical prevention strategy. Pre-exposure prophylaxis (PrEP) uptake is suboptimal among BMSM: a priority population that accounts for over one fourth of all new HIV diagnoses in the United States. Most research endeavors have focused on identifying barriers to PrEP with less emphasis on facilitators of PrEP uptake. This qualitative study was undertaken to gain a better understanding about the factors that motivate BMSM to seek PrEP and the strategies that resulted in successful uptake. In-depth individual interviews were conducted with Midwestern BMSM (n=12) who were successfully taking PrEP for over one year. The men were sophisticated, privately insured healthcare consumers and yet, the overarching theme that emerged from the data was that obtaining PrEP was a "long, hard road". Facilitators to PrEP access included having an important person, insight into the roles of stigma, sexual partner mistrust, and the desire to be a part of something bigger than oneself. Also prevalent in the data were descriptions about barriers to PrEP access. Men in this study felt strongly that HIV prevention is everyone's responsibility. Findings have important implications for research and clinical practice. Strategies that can decrease healthcare system barriers and help simplify the process to access PrEP are greatly needed.