Implementing Assisted Partner Services to HIV Test and Treat Men and their Female Sexual Partners: A Study Protocol (Preprint)

BACKGROUND Despite the effective scale-up of HIV testing and treatment programs worldwide, only 75% of persons living with HIV (PLWH) globally know their status, with lower rates among men. This highlights the importance of implementing HIV testing and linkage interventions with high uptake in this population group. In a cluster randomized controlled trial conducted between 2013 and 2015, our team found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH, safely reached more at-risk individuals to conduct testing compared to client referral alone. However, more data is needed to assess APS implementation in a real-world setting. OBJECTIVE This study evaluates the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya. METHODS In a collaboration between the University of Washington and PATH, we are integrating APS into 31 health facilities in Western Kenya and enrolling female index clients newly diagnosed with HIV who receive APS, their male sexual partners, and female sexual partners of the male sexual partners who test HIV positive. Female index clients and all sexual partners testing HIV-positive will be followed up at 6 weeks, 6 months, and 12 months to assess linkage to care, antiretroviral therapy (ART) initiation, and HIV viral load suppression. We will evaluate acceptability, fidelity and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and sub-county level policymakers responsible for HIV testing services. Facility health staff providing HIV testing services and APS, in addition to staff working with the study project team will also be interviewed. We will also conduct direct observations of facility infrastructure and clinic procedures, and extract data from facility and county/national databases. RESULTS As of March 2020, we have recruited 1724 index clients, 3201 male partners, and 1585 female partners. We have completed all recruitment for this study and have completed all 6-week (99%), 6-month (97%) and 12-month (91%) follow-up visits. Preliminary analyses demonstrate that through scaling-up APS, facilities are able to identify 12-18 new HIV-positive males for every 100 men contacted and tested. We are now in the process of completing the remaining follow-up interviews and building a self-testing component of the study as an adaptation to the COVID-19 pandemic. CONCLUSIONS Results will be used to bridge the gap between clinical research findings and everyday practice, and provide guidance on optimal strategies for APS integration into HIV service delivery. CLINICALTRIAL N/A

Performance of In Silico Prediction Tools for the Detection of Germline Copy Number Variations in Cancer Predisposition Genes in 4208 Female Index Patients with Familial Breast and Ovarian Cancer

The identification of germline copy number variants (CNVs) by targeted next-generation sequencing (NGS) frequently relies on in silico CNV prediction tools with unknown sensitivities. We investigated the performances of four in silico CNV prediction tools, including one commercial (Sophia Genetics DDM) and three non-commercial tools (ExomeDepth, GATK gCNV, panelcn.MOPS) in 17 cancer predisposition genes in 4208 female index patients with familial breast and/or ovarian cancer (BC/OC). CNV predictions were verified via multiplex ligation-dependent probe amplification. We identified 77 CNVs in 76 out of 4208 patients (1.81%); 33 CNVs were identified in genes other than BRCA1/2, mostly in ATM, CHEK2, and RAD51C and less frequently in BARD1, MLH1, MSH2, PALB2, PMS2, RAD51D, and TP53. The Sophia Genetics DDM software showed the highest sensitivity; six CNVs were missed by at least one of the non-commercial tools. The positive predictive values ranged from 5.9% (74/1249) for panelcn.MOPS to 79.1% (72/91) for ExomeDepth. Verification of in silico predicted CNVs is required due to high frequencies of false positive predictions, particularly affecting target regions at the extremes of the GC content or target length distributions. CNV detection should not be restricted to BRCA1/2 due to the relevant proportion of CNVs in further BC/OC predisposition genes.

Prevalência de disfunção sexual em idosas participantes de grupos de convivência no município de Natal/RN

Introdução: Alterações no ciclo de resposta sexual podem caracterizar uma disfunção, a mulher idosa tende a passar por um tempo considerável no período do climatério onde ocorrem modificações orgânicas na mulher e na sua resposta sexual. Objetivo: Verificar a prevalência de disfunções sexuais (DS) em mulheres idosas residentes do Município de Natal/RN. Metodologia: Estudo transversal, com amostra de 34 mulheres idosas com vida sexual ativa participantes de grupos de convivência. Utilizou-se questionário estruturado e Function Sexual Female Index (FSFI). A análise estatística foi realizada através da análise descritiva e a analise bivariada, por meio do teste Qui-quadrado de Pearson e Exato de Fisher. Resultados: Verificou-se uma prevalência de DS de 79,4%. As análises das variáveis não apresentaram associação estatisticamente significativa. Conclusão: Observa-se alta prevalência de DS nas idosas, o que evidencia a necessidade de implantação de novas práticas de atuação que visem à prevenção e tratamento da DS nessa faixa etária.

Crotalaria ochroleuca Susceptibility to Heterodera glycines Races

The aim of the study is to assess Crotalaria ochroleuca susceptibility to six Heterodera glycines races. To this, C. ochroleuca seedlings and two soybean cultivars were transplanted and individually inoculated with nematode races 1, 2, 3, 5, 6 and 14. Plants were collected and assessed 30 and 60 days after inoculation. Crotalaria ochroleuca reduced the number of females and the total number of eggs of the races 1, 2, 5 and 6. The reproduction of race 3 in crotalaria was equal to that of soybean cultivars in both assessment periods, whereas race 14 only reduced the reproduction in crotalaria to 60 days. Races 1 and 6 (30th day) and races 6 and 14 (60th day) showed number of eggs female-1 smaller than the controls. According to female index (FI), C. ochroleuca was resistant to races 1, 2 and 5, susceptible to race 3, and showed varying reactions to races 6 and 14.

Infectivity ofMycobacterium tuberculosisGenotypes and Outcome of Contact Investigation in Classroom in Guangxi, China

Objective. To evaluate the infectivity ofMycobacterium tuberculosis(M.tb) genotypes of index cases in the classroom of adolescent schools in Guangxi, China.Methods. Adolescent school tuberculosis (TB) contact investigations were conducted for all reported index TB cases from November 2016 to December 2017 in Guangxi, China. Genotypes of index cases and contact cases were identified by 15-loci mycobacterial interspersed repetitive units–variable number tandem repeat and spoligotyping. Outcome variable was 5 levels’ order of tuberculin skin test (TST) results to new active TB [0-5 mm, 6-9 mm, 10-14 mm, ≥ 15 mm (without TB), and ≥15 mm (with TB)]. Multivariate ordered logistic regression analysis was performed to evaluate the independent effect of genotypes of index case on contact screening outcome.Results. Beijing genotype occurred more commonly in female index patients. One genotypic cluster of two index cases and one cluster of two contact cases were detected. The association between infectivity of Beijing genotype of index cases and outcome of contact investigation was statistically significant in univariate analysis but no so after adjustment for characteristics of contacts and sex of index cases (P value=0.057). Female index cases increased the chance for TB infection/being active TB among contacts (ordinal odds ratio = 1.39, 95% confidence interval: 1.21, 1.60). Contacts who studied in the middle school, who with non-Han ethnicity and who without BCG scar had increased risk for TB infection/being active TB.Conclusion. There was not enough evidence from our data to support that Beijing strains were more infective than non-Beijing strains in TB transmission in school setting.

Reproduction of Soybean Cyst Nematode on Dry Bean Cultivars Over Multiple Generations

Phaseolus vulgaris is a host of soybean cyst nematode (SCN; Heterodera glycines), a pathogen recently introduced into the major dry bean production area of North Dakota and northern Minnesota. The nematode reproduces less on most bean classes compared with soybean but can reduce plant growth and seed yield. An important question is the following: will SCN adapt to dry bean and, over time, increase in ability to reproduce on roots? To answer this question, the following experiments were conducted with cultivars from three bean classes. The cultivars ‘Premiere’ and ‘Cirrus’ (navy), ‘Buster’ and ‘Othello’ (pinto), and ‘Eclipse’ and ‘Jaguar’ (black) were grown in “Cone-tainers” in sand in plastic pots immersed in a water bath at 27°C in the greenhouse. Seedlings were inoculated with 2,000 eggs per plant of SCN HG 0 and cysts were harvested and counted after 40 days. The eggs were immediately extracted from those cysts and seedlings were inoculated again and grown for 40 days using the same methods. Soybean ‘Lee 74’ was used as a control. A female index (number of cysts produced on the test plant divided by the number of cysts produced on Lee 74) was calculated for each bean cultivar after each period of 40 days. This procedure was repeated until eight generations of eggs were completed and then the experiment was repeated. There was no significant (P ≤ 0.05) change over time in the female index on the six bean cultivars. Therefore, there was no evidence that SCN HG 0 was increasing reproduction on dry bean cultivars during two 11-month periods of continual reproduction of HG 0 on roots.

Evaluation of Northern-Grown Crops as Hosts of Soybean Cyst Nematode

Sixty-two cultivars/varieties of thirteen crops grown in the northern Great Plains were evaluated for suitability as hosts of the soybean cyst nematode (SCN; Heterodera glycines Ichinohe) (HG type 0) using soybean Lee 74 as the susceptible host. “Cone-tainers” with autoclaved sand were infested with 2,000 eggs placed into a 2-cm × 1-cm hole and then a 3-day-old germinated seed was placed in the hole. “Cone-tainers” were placed in sand in plastic pots immersed in a water bath at 27°C in the greenhouse. Plants were harvested after 30 days, and females were extracted and counted. A female index (FI = the average number of females on the test plant divided by the average number of females on soybean Lee 74 times 100) was calculated for each cultivar to assess host suitability to the nematode. FI's ≥ 10 indicated a suitable host. Canola, clover, lentil, and sunflower were nonhosts (no evidence of reproduction), while borage, camelina, chickpea, crambe, cuphea, field pea, nyjer, and safflower were poor hosts for SCN with FI's less than 8. Lupines were the only suitable host with FI's of 42 to 57. This is the first report of reproduction of SCN on chickpea, crambe, cuphea, and nyjer. Accepted for publication 2 December 2009. Published 15 March 2010.

Influence of Soybean Cropping Sequences on Seed Yield and Female Index of the Soybean Cyst Nematode

Several soybean (Glycine max) cropping sequences were planted for 12 years in a field that, at the beginning of the test, was infested with race 14 of the soybean cyst nematode, Heterodera glycines. Continuous soybean cropping sequences included H. glycines-susceptible cultivars Forrest, J82-21, Peking × Centennial breeding line, and moderately resistant cultivars Bedford and J81-116. Forrest treated with aldicarb or pentachloronitrobenzene (PCNB) plus metalaxyl and resistant breeding line JS83-236 followed by resistant cultivars Cordell and Hartwig were additional continuous soybean sequences. Rotations included two sequences each of Bedford with J81-116 or J82-21, and three sequences of Bedford with corn (Zea mays) and susceptible Essex soybean. Rotations of Bedford, corn, and Essex had 12-year mean yields significantly greater than continuous Bedford or Forrest. The female index (FI) of H. glycines on five cultivars and lines was used to bioassay changes in parasitic potential in each cropping sequence. The FI on Bedford bioassay plants increased significantly over time for all field treatments involving Bedford. When J82-21 was the bioassay plant, FI decreased significantly in treatments involving Bedford. There were no significant changes in FI for any treatment when Forrest, J81-16, and Peking were used as bioassays. Rotations of soybean cultivars with different sources of resistance and rotations of resistant and susceptible cultivars with a nonhost crop were not successful practices to manage the nematode's ability to parasitize the resistant cultivar Bedford. However, rotation of resistant and susceptible cultivars with a nonhost crop produced greater mean soybean yields and slowed the shift toward greater parasitism of the resistant cultivar sufficiently to warrant adoption of this practice.