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1.
Int J Environ Res Public Health ; 19(12)2022 Jun 08.
Article in English | MEDLINE | ID: covidwho-1884176

ABSTRACT

(1) Aims: This study explored the mechanism by which exposure to different information sources on social media influences Chinese parents' intention to vaccinate their children against COVID-19. (2) Methods: We developed a research framework based on the Stimulus-Organism-Response (SOR) theory to illustrate how exposure to information sources on social media increases vaccine confidence and, as a result, parents' intentions regarding pediatric vaccination. The partial least square structural equation modeling (PLS-SEM) method was used to test the data collected through an online survey (687 valid samples). (3) Results: The government approval of vaccines fuels vaccination confidence and acts as a mediator between (a) mass media, government new media, and key opinion leaders, and (b) perceived effectiveness and side effects (safety) of vaccines. (4) Conclusions: The mass media, government new media, and key opinion leaders are crucial sources for encouraging parents to vaccinate their children since they boost the vaccination trust. The focus of COVID-19 vaccination promotion should be to strengthen parents' trust in the government, combined with publicizing the effectiveness and side effects (safety) of vaccines.

2.
JMIR Public Health Surveill ; 8(6): e37479, 2022 06 07.
Article in English | MEDLINE | ID: covidwho-1883841

ABSTRACT

BACKGROUND: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. OBJECTIVE: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19-related service interruptions. METHODS: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included "telemedicine," "telehealth," "mobile health," "eHealth," "mHealth," "telecommunication," "social media," "mobile device," and "internet," among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies' methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. RESULTS: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. CONCLUSIONS: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses.


Subject(s)
COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Pandemics/prevention & control , Public Health , SARS-CoV-2
3.
Sage Open ; 12(2):13, 2022.
Article in English | English Web of Science | ID: covidwho-1883493

ABSTRACT

In the context of no prescriptive medications and lack of sufficient vaccine, COVID-19 preventive behaviors were a top priority, particularly for developing countries. This study aimed to determine how the media influenced preventive behaviors of Vietnamese people against COVID-19. A mixed method was conducted, including qualitative research by a focus group with 11 participants and quantitative research by cross-section with 609 respondents. The results showed that media exposure was directly associated with increased perceived severity, perceived vulnerability, perceived self-efficacy, and knowledge about COVID-19 and indirectly associated with COVID-19 preventive behaviors. There were slight differences in the impacts of media on mediating constructs and preventive behaviors by generation, and no significant differences among subgroups by gender, place of residence, and educational level. This finding offered some implications that communication practice should specifically prioritize improving knowledge on COVID-19, its severity and vulnerability. Furthermore, public awareness towards threat appraisal, coping appraisal, and active conduction COVID-19 preventive behaviors.

4.
Journal of Industrial Integration and Management-Innovation and Entrepreneurship ; 07(02):183-202, 2022.
Article in English | English Web of Science | ID: covidwho-1883313

ABSTRACT

Virtual reality (VR) has applications in cardiology to create enhancement, thereby improving the quality of associated planning, treatment and surgery. The need is to study different applications of this technology in the field of cardiology. We have studied research papers on VR and its applications in cardiology through a detailed bibliometric analysis. The study identified five significant steps for proper implementation of this technology in cardiology. Some challenges are to be undertaken by using this technology, and they can provide some benefits;thus, authors contemplate extensive research and development. This study also identifies 10 major VR technology applications in cardiology and provided a brief description. This innovative technology helps a heart surgeon to perform complex heart surgery effectively. Thus, VR applications have the potential for improving decision-making, which helps save human life. VR plays a significant role in the development of a surgical procedure. This technology undertakes 3D heart model information in full colour, which helps to analyze the overall heart vane, blockage and blood flow. With the help of this digital technology, a surgeon can improve the accuracy of heart surgery, and he can simulate the surgery. A surgeon can undertake surgery in a virtual environment on a virtual patient. The unique purpose of this technology is to practice pre-operatively on the specific circumstance. A cardiologist can also check the proper status of inner and outer heart wall layer. Thus, by using this 3D information, the surgeon can now interact with heart data/information without any physical touch. This technology opens a new opportunity to improve the heart surgery and development in cardiovascular treatment to improve patient outcome.

5.
Ieee Transactions on Computational Social Systems ; : 11, 2022.
Article in English | English Web of Science | ID: covidwho-1883142

ABSTRACT

Users online tend to consume information adhering to their system of beliefs and ignore dissenting information. During the COVID-19 pandemic, users get exposed to a massive amount of information about a new topic having a high level of uncertainty. In this article, we analyze two social media that enforced opposite moderation methods, Twitter and Gab, to assess the interplay between news consumption and content regulation concerning COVID-19. We compare the two platforms on about three million pieces of content, analyzing user interaction with respect to news articles. We first describe users' consumption patterns on the two platforms focusing on the political leaning of news outlets. Finally, we characterize the echo chamber effect by modeling the dynamics of users' interaction networks. Our results show that the presence of moderation pursued by Twitter produces a significant reduction of questionable content, with a consequent affiliation toward reliable sources in terms of engagement and comments. Conversely, the lack of clear regulation on Gab results in the tendency of the user to engage with both types of content, showing a slight preference for the questionable ones which may account for a dissing/endorsement behavior. Twitter users show segregation toward reliable content with a uniform narrative. Gab, instead, offers a more heterogeneous structure where users, independent of their leaning, follow people who are slightly polarized toward questionable news.

6.
Ieee Journal of Selected Topics in Signal Processing ; 16(2):289-299, 2022.
Article in English | English Web of Science | ID: covidwho-1883129

ABSTRACT

As we transition away from pandemic-induced isolation and social distancing, there is a need to estimate the risk of exposure in built environments. We propose a novel metric to quantify social distancing and the potential risk of exposure to airborne diseases in an indoor setting, which scales with distance and the number of people present. The risk of exposure metric is designed to incorporate the dynamics of particle movement in an enclosed set of rooms for people at different immunity levels, susceptibility due to age, background infection rates, intrinsic individual risk factors (e.g., comorbidities), mask-wearing levels, the half-life of the virus and ventilation rate in the environment. The model parameters have been selected for COVID-19, although the modeling framework applies to other airborne diseases. The performance of the metric is tested using simulations of a real physical environment, combining models for walking, path length dynamics, and air-conditioning replacement action. We have also created a visualization tool to help identify high-risk areas in the built environment. The resulting software framework is being used to help with planning movement and scheduling in a clinical environment ahead of reopening of the facility, for deciding the maximum time within an environment that is safe for a given number of people, for air replacement settings on air-conditioning and heating systems, and for mask-wearing policies. The framework can also be used for identifying locations where foot traffic might create high-risk zones and for planning timetabled transitions of groups of people between activities in different spaces. Moreover, when coupled with individual-level location tracking (via radio-frequency tagging, for example), the exposure risk metric can be used in real-time to estimate the risk of exposure to the coronavirus or other airborne illnesses, and intervene through air-conditioning action modification, changes in timetabling of group activities, mask-wearing policies, or restricting the number of individuals entering a given room/space. All software are provided online under an open-source license.

7.
Transportation Research Part D-Transport and Environment ; 106:16, 2022.
Article in English | English Web of Science | ID: covidwho-1882579

ABSTRACT

From an environmental equity perspective, the aim of this paper is twofold. First, we want to verify to what extent vulnerable population groups resided in areas exposed to high levels of aircraft noise before and during the COVID-19 pandemic (2019 and 2020) in the Montre acute accent al census metropolitan area. Second, we want to identify whether the use of an aircraft noise indicator rather than another generates significant variations in the results and consequently in terms of affected areas and populations.With the IMPACT web-application, we model aircraft noise contours from three cumulative (Lden, Ldn, Laeq,24h) and a single-event (LAmax) metrics. The model's input data are retrieved by a website for flight tracking. Next, four variables are extracted from the 2016 Statistics Canada census at a fine scale level (dissemination areas): that is, the percentages of low-income individuals, visible minorities, children under 15 years old, and individuals aged 65 and over.The results show a significant drop in population exposed to aircraft noise in 2020 compared to 2019. In addition, the estimates of populations impacted by aircraft noise differ from one indicator to the next. The logistic regression models indicate that the inequities are inconsistent between cumulative and single-event metrics.

8.
Public Health Rep ; : 333549221099533, 2022 Jun 08.
Article in English | MEDLINE | ID: covidwho-1883402

ABSTRACT

The swift global spread of COVID-19 prompted public health authorities to explore digital technologies to aid in contact tracing for infection control. Exposure notification, a mobile device-based technology that notifies individuals of potential exposure to COVID-19 without requiring personally identifiable information, has been broadly favored because of its relative ease of use, scalability, and protection of personal privacy. Although several exposure notification protocols were developed, a partnership between Google and Apple led to the development of the most widely implemented exposure notification protocol in the world, including in the United States. In this article, we first describe the development of the Google Apple Exposure Notification (GAEN) protocol, noting the value of the discourse among software developers and public health authorities concerning the protocol's design and features. We track states' deployment of GAEN mobile applications (apps) and population-level adoption rates, finding the nationwide rollout of GAEN apps to be more fragmented than anticipated. We then discuss how the limited data collected from these apps make assessments of their effectiveness challenging. Finally, we consider the importance of the federal government playing a greater role in GAEN's early development, emphasize the power of public-private partnerships, and highlight the overriding importance of public messaging over technological details.

9.
Gondwana Res ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1882044

ABSTRACT

Environmental selenium (Se) distribution in the US is uneven, yet US residents appear to have a relatively narrow range of serum Se concentrations, according to the NHANES III survey data; this is probably due to the modern food-distribution system. In the US, Se concentration in alfalfa leaves has been used as a proxy for regional Se exposure (low, medium or high, corresponding to ≤ 0.05, 0.06-0.10 and ≥ 0.11 ppm respectively). Se in plants, soil, water, and bacteria can be transformed into volatile dimethyldiselenide, which can be inhaled and excreted via the lung. Hence, pulmonary Se exposure may be different in states with different atmospheric Se levels. We found a significantly higher death rate from COVID-19 in low-Se states than in medium-Se or high-Se states, though the case densities of these states were not significantly different. Because inhaled dimethyldiselenide is a potent inducer of nuclear-factor erythroid 2 p45-related factor 2 (Nrf2), exposure to higher atmospheric dimethyldiselenide may increase Nrf2-dependent antioxidant defences, reducing the activation of NFκB by SARS-CoV-2 in the lung, thereby decreasing cytokine activation and COVID-19 severity. Atmospheric dimethyldiselenide may thereby play a role in COVID-19 mortality, although the extent of its involvement is unclear. Synopsis Loss of pulmonary dimethydiselenide via exhalation may help explain a significantly higher death rate from COVID-19 in states with low environmental (atmospheric) Se concentrations.

10.
Topics in Antiviral Medicine ; 30(1 SUPPL):381, 2022.
Article in English | EMBASE | ID: covidwho-1881032

ABSTRACT

Background: China implemented strict lockdowns to contain COVID-19 at the early stage. We aimed to evaluate the impact of COVID-19 on HIV care continuum in China. Methods: Anonymized programmatic data on HIV care continuum between 1 January 2017 and 31 December 2020 were collected from seven provincial and municipal centers for disease control and prevention and eight major infectious disease hospitals specialized in HIV care in various regions in China. We performed interrupted time series analysis to characterize temporal trend in monthly numbers of HIV tests, HIV diagnosis, HIV antiretroviral therapy (ART) initiations, ART collections, and HIV post-exposure prophylaxis (PEP) prescriptions before, during and after the national lockdown period (23 January to 7 April 2020). We used Poisson segmented regression models to estimate the immediate impact of the lockdown on these outcomes, as well as post-lockdown trends. Results: During the study period, we recorded 1,101,686 HIV tests, 69,659 HIV diagnoses, 63,458 ART initiations, 1,593,490 ART collections, and 16,780 PEP prescriptions. A median of 789 (IQR 367-975), 409 (278-626), and 1045 (524-1262) HIV tests per day were recorded before, during and after lockdown. Lockdown was associated with 32.8% decrease in HIV testing in January 2020, the first month after lockdown (incidence rate ratio [IRR] 0.672;95% confidence interval [CI] 0.585-0.772). Daily HIV diagnoses decreased from a median of 50 (7-76) before lockdown, to 23 (6-46) during lockdown, and back to 48 (12-74) after lockdown, with an estimated 27.1% decrease in January 2020 (0.729, 0.599-0.887). There was no marked change in the number of ART initiation and ART collection during the lockdown, but the number of ART collection was lower than the expected level by the end of December 2020 (0.761, 0.659-0.879). The number of monthly PEP prescriptions decreased significantly during the lockdown (0.362, 0.220-0.595) and still had not recovered to the expected level by the end of December 2020 (0.456, 0.362-0.574). With the ease of restrictions, HIV testing (slope change 1.067/month, 1.048-1.086) and PEP prescriptions (1.077/month, 1.016-1.142) showed a significant increasing trend. Conclusion: ART initiation and ART collection generally remained stable during the lockdown, but HIV testing, HIV diagnosis and PEP prescription were affected. ART collection and PEP prescriptions have not recovered to expected levels in the eighth month after the suspension of lockdown.

11.
Topics in Antiviral Medicine ; 30(1 SUPPL):373, 2022.
Article in English | EMBASE | ID: covidwho-1880996

ABSTRACT

Background: HIV prevalence in 15-64-year-olds in Migori County remains high at 13%, nearly 2.7 times higher than the national prevalence (4.9%) and 28% of all new HIV infections were among adolescent 10-19 years, while 52% were young people age 15-24 years. LVCT Health STEPS project implemented the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program in 12 wards in Migori County with a goal of reducing new HIV infections among adolescent girls and young women (AGYW) aged 10-24 years. A combination of evidence-based behavioral, structural, and biomedical interventions were delivered through the safe space (SS) model. Methods: The DREAMS program mobilized, screened for HIV vulnerability, enrolled and offered services to eligible AGYW between June 2017 and June 2021. Mentors, facilitators, and health service providers were trained and engaged to provide mandatory primary and need-based secondary interventions in community spaces considered to be safe from harassment, where AGYW could have fun, relax, display talents, and express themselves. AGYW were segmented based on age categories, geographic location, marital, and schooling status. Due to COVID-19 pandemic, AGYW participation was reduced from 30 to 15 and SS held in open spaces while observing ministry of health protocols. Service completion data was uploaded in DREAMS database, exported, and analysed in Excel. Results: By June 2021, 1,206 SS were established. A total of 52,477 AGYW were screened for vulnerability and 93% (47,587) enrolled in DREAMS. Majority, 83% (39,603) were active at SS and received primary age-based interventions including: 96% (38,064) gender-based violence (GBV) screening, 98% (38,960) financial literacy training, 97% (38,283) school/community-based HIV and violence prevention intervention. Of the 30,759 AGYW eligible for HIV testing services (HTS), 95% received HTS, 98% (30,067) PrEP education, 99% (30,356) contraceptive method mix education, 99% (30,318) condom education and 79% (9,388) received entrepreneurship training. AGYW were prioritized for secondary interventions. Of 2,339 eligible for PrEP, 89% were initiated, among 5,097 sexually active, 99% received contraceptives. Additionally, 92% (17,778) were supported on education subsidy and 60% (7,718) on economic strengthening, and of those disclosing GBV, 100% (16,560) received post violence care. Conclusion: Safe spaces are platforms for scaling up comprehensive HIV prevention interventions among AGYW.

12.
Topics in Antiviral Medicine ; 30(1 SUPPL):337-338, 2022.
Article in English | EMBASE | ID: covidwho-1880981

ABSTRACT

Background: Although cisgender MSM (cis-MSM) and transgender women (TGW) suffer the highest burden due to the HIV epidemic in Latin America (LA), PrEP implementation is limited. ImPrEP was an implementation study to assess safety and feasibility of same-day PrEP initiation (daily-oral TDF/FTC) for cis-MSM and TGW vulnerable to HIV infection in Brazil, Peru and Mexico;results on factors associated with long-term PrEP engagement (LTPE) and HIV incidence are reported here. Methods: Eligible cis-MSM and TWG (HIV-negative, ≥18 years-old, reporting 1+ risk criteria) were screened and enrolled on the same-day, receiving a 30-day PrEP supply. Follow-up visits were scheduled at week 4 after enrollment and quarterly thereafter. Main outcomes were LTPE (3+ follow-up visits within 52 weeks of enrollment) and HIV incidence. A multivariable model controlling for country, education, gender, substance use, STIs, and self-reported adherence is presented. Results: From March 2018-June 2021, 9522 participants were enrolled (Brazil: 3928, Mexico: 3301, Peru: 2293), with 12348.92 person-years (PY) follow-up;follow-up time accrued for LTPE analysis affected by Covid-19 restrictions was shorter in Brazil than in Mexico and Peru. Overall, 26% were aged 18-24, 94.3% cis-MSM, 5.7% TGW, 73.2% non-white and 76.0% >secondary education;92.8% reported condomless anal sex (CAS), 17.3% sex-work, 57.8% had >5 sex partners. Overall, 8.8% attended only the enrollment visit and 68.2% showed LTPE (Brazil:80.1%;Mexico:67.2%;Peru:45.0%). Participants aged 18-24 years (aOR 0.53[95%CI:0.46-0.62]), 10 sex partners (aOR 1.48[95%CI:1.28-1.70]), reporting receptive CAS (aOR 1.24[95%CI:1.12-1.39]), complete adherence at week-4 (aOR:3.11[95%CI:2.79-3.45]) and CAS with HIV+ partner (aOR:1.48[95%CI:1.28-1.71]) were more likely. HIV incidence was 0.84/100 PY (95% CI:0.69-1.02), higher in Peru, among TGW and 18-24 years-old participants. Conclusion: Same-day PrEP is feasible and safe among cis-MSM and TGW in LA. Overall LTPE was high;COVID-19 restrictive measures may partially explain the differences across countries. Social and structural levels of HIV risk need to be addressed for full PrEP benefits realization.

13.
Topics in Antiviral Medicine ; 30(1 SUPPL):296, 2022.
Article in English | EMBASE | ID: covidwho-1880969

ABSTRACT

Background: There are no authorized or approved treatments in the US for COVID-19 in patients <12 years of age. SARS-CoV-2 neutralizing monoclonal antibodies bamlanivimab and etesevimab together (BAM+ETE) reduce COVID-19 related hospitalization and all-cause mortality in patients ≥12 years of age with mild to moderate COVID-19. Herein, we present the pharmacokinetic (PK), safety, and efficacy results from an open-label Phase III clinical trial addendum (BLAZE-1, NCT04427501) investigating weight-based dosing of BAM+ETE in pediatric patients at increased risk for severe COVID-19. Methods: A total of 91 pediatric patients (<18 years of age) were evaluated for PK. Pediatric patients weighing ≥40kg received 700mg BAM+1400mg ETE. Pediatric patients weighing less than 40kg received weight-based dosing to match the exposures observed in adults and adolescents (12 to <18 years of age) who received the authorized dose of 700mg BAM+1400mg ETE. Twenty additional adolescent patients (12 to <18 years of age) received BAM+ETE in controlled BLAZE-1 cohorts and were included in safety and efficacy analyses. All ambulatory patients had mild to moderate COVID-19 upon enrollment, at least one risk factor for severe COVID-19, and received treatment within 3 days of a positive SARS-CoV-2 test. The primary objective was to characterize the pharmacokinetics of weight-based dosing of BAM+ETE in pediatric patients. Results: Of the 111 pediatric patients who received BAM+ETE, the median age was 12 and age distribution was 12 to <18 (n=60), 6 to <12 (n=36), 2 to <6 (n=10), and 0 to <2 (n=5). Overall, 47.7% were female, 19.1% were Hispanic/Latino, and 62.4% were Black/African American. In patients receiving weight-based dosing, the AUC for both BAM and ETE in pediatric patients was similar (within 90% interval) to adults (Figure). For all pediatric patients, there were no reports of hospitalizations, serious adverse events, or deaths. At Day 7, pediatric patients had a change in viral load from baseline of-4.10 (normalized baseline viral load of 6.41) as compared to-3.65 (normalized baseline viral load of 6.75) in adult patients. The median time to complete symptom resolution was 5 days for all pediatric patients. Conclusion: The weight-based doses administered to pediatric patients provided similar drug exposures when compared to adult patients who received the authorized dose of 700 mg BAM+1400mg ETE. Treatment in pediatric patients was well-tolerated and resulted in favorable viral load reduction and symptom resolution.

14.
Topics in Antiviral Medicine ; 30(1 SUPPL):381-382, 2022.
Article in English | EMBASE | ID: covidwho-1880955

ABSTRACT

Background: In March 2020, British Columbia (BC) declared a COVID-19-related public health emergency. Measures to limit SARS-CoV-2 transmission impacted social behaviors and disrupted healthcare access. We examined client engagement in BC's province-wide, publicly-funded HIV PrEP program before and during the COVID-19 pandemic. Methods: Using de-identified data from BC's provincial PrEP Program, we describe client engagement in the 15 months pre-(Jan 2019-Mar 2020) and during (Apr 2020-Jun 2021) the pandemic, summarized by 3-month periods. Fisher's exact, Wilcoxon rank sum test, and GEE models were used to compare median number of PrEP clients (total and new) and the proportion with PrEP dispensing and HIV testing in pre-vs during pandemic periods. We also compared these outcomes in the Apr-Jun quarter of 2019 (pre-) vs 2020 (early) and 2021 (late) pandemic. Results: A total of 7300 clients engaged with the PrEP program during the 30-month study period, with median (Q1-Q3) age 33 (27-42) years, 98% cis-male, 1% trans-female, 98% gay-bisexual-MSM (gbMSM). The median (Q1-Q3) quarterly active PrEP clients increased from 4366 (4019-4677) pre-pandemic to 4754 (4683-4784) during-pandemic (p<0.001) following program expansion late 2019, but the median (Q1-Q3) number of new clients declined from 545 (504-566) to 319 (318-320;p=0.033) and the proportion of clients with HIV testing fell from 87% (87-88%) to 82% (77-82%;p<0.001). PrEP engagement in relation to the pandemic timeline (Figure) showed a transient, early pandemic drop in new initiations and medication dispensing followed by rebound. As a proportion of all active clients, new PrEP clients in the Apr-Jun quarter dropped from 14% in 2019 to 4% in 2020 (p<0.001) and remained lower at 8% in 2021 (p<0.001). A transient decrease in the proportion of new enrolees from sexual health clinics was also observed: 54% in 2019 to 44% in 2020 (p=0.017) with rebound to 55% in 2021 (p=0.784). Similarly, clients with PrEP dispensed in this quarter fell from 75% in 2019 to 56% in 2020 (p<0.001) with partial rebound to 68% in 2021 (p<0.001). HIV testing in PrEP clients fell from 87% in 2019 to 82% in 2020 (p<0.001) and remained lower at 84% in 2021 (p<0.001). Conclusion: BC PrEP program engagement declined early in the COVID-19 pandemic, with partial rebound coinciding with the easing of public health restrictions. Ongoing clinical monitoring for PrEP remains key. Continued evaluation will facilitate understanding the pandemic impact on HIV prevention programming.

15.
Topics in Antiviral Medicine ; 30(1 SUPPL):55, 2022.
Article in English | EMBASE | ID: covidwho-1880940

ABSTRACT

Background: The number of undiagnosed persons globally remains a barrier to achieving UNAIDS 95-95-95 goals. While nearly 80% are aware of their status, there is much variability by age and geography. Many of those undiagnosed are not engaging in traditional HIV services and do not visit physical locations;novel strategies are needed to overcome structural barriers. We implemented an online, HIV self-testing (HIVST) service for vulnerable populations in India. Methods: An integrated web-based platform for HIVST www.safezindagi. net/selftesting was implemented across 24 Indian states in July 2021. Virtual outreach workers (vORWs) contacted clients on dating apps and social media platforms, provided counseling, and directed interested clients to HIVST via a platform that allowed for home delivery or pick up at a community site. HIVST could be assisted or unassisted with pre/post-test counseling from vORWS. Linkage to confirmatory testing/ART and PrEP was provided as needed. Descriptive statistics were used to characterize outcomes. Results: Between June 30-October 21, 2021, 2,234 clients registered and 1,356 (61%) clients ordered an HIVST kit. Median age of the 1,356 clients was 27 years;74% were male and 66% self-identified as MSM. Ten percent self-identified as transgender. In the prior 6 months, 67% reported condomless sex, 51% multiple partners, 13% transactional sex, 7% STIs, and 4% injection drug use. 1,190 clients (88%) received their kits within 3 days;44% used a courier service and 56% picked up from a community site. Of 1,070 (90%) results uploaded, 43 (4%) were positive with geographical variability (5 states had >4% positivity). The median age of the positive clients was 30 years and 74% were male. Of importance, 65% reported condomless sex with multiple partners in prior 6 months and none were previously tested for HIV. 19 (44%) were linked to confirmatory testing of whom 16 (84%) were confirmed positive and 14 (88%) initiated ART at public centers (see Figure). Conclusion: These data highlight the role of an HIVST platform to reach first time test-takers in a population with high risk behaviors and identified HIV burden >16 times the general population. With increasing online engagement and uptake of telemedicine globally, as well as continuing disruptions due to COVID-19, HIVST offers a critical approach to reach high-risk individuals, identify PLHIV, and link them to care and treatment.

16.
Topics in Antiviral Medicine ; 30(1 SUPPL):315-316, 2022.
Article in English | EMBASE | ID: covidwho-1880880

ABSTRACT

Background: In the U.S/Mexico border region, drug tourism (DT) has been linked to increased HIV risk among people who inject drugs (sharing injection equipment) and paying for sex. Sex and DT from the U.S. to Mexico drive bidirectional cross-border mobility, and have consequently played an important role in HIV spread in the border region, but prior to the COVID19 pandemic, HIV incidence remained <2 per 100 person years (PY). We assessed HIV incidence and associated risk factors among PWID during the COVID-19 pandemic. Methods: Participants are from La Frontera, a longitudinal study of PWID aged ≥18 from 3 groups: PWID who injected drugs in Tijuana ≤24 months ago but live in San Diego (SD DTs), and non-drug tourist (NDT) PWID, who live in SD county or Tijuana (TJ) but have never used illicit drugs across the border. Beginning in Oct/2020, participants underwent surveys and provided samples for HIV and SARS-CoV-2 serology every 6 months, and an egocentric social network (SN) survey. HIV prevalence, bivariate incidence-density rates, incident rate-ratios (IRR), and exact 95% confidence intervals (CI) were calculated for independent variables between baseline and follow-up. Results: To date, among 611 participants at baseline, HIV prevalence was 7.6% (SD DT: 3.8%, SD NDT: 3.5%, TJ NDT: 15.8%). Of the HIV-PWID returning for their 6 months visit thus far (n=286;93% follow-up), eight HIV seroconversions occurred during 118 PY of follow-up (Incidence: 13.53/100PY;95% CI: 5.84-26.66). Although not significant, incidence was notably higher among TJ NDT (19.9/100PY vs 1.82/100 PY SD DT vs 0 SD NDT;IRR 10.94, 95% CI 0.35, 22.59 TJ NDT vs SD DT), those who shared syringes/works with a network member (30.34/100PY vs. 7.31/100PY;IRR 4.15, 95% CI 0.37,9.19) and non-heterosexual participants (29.31/100PY vs 5.38/100PY;IRR 4.67, 95% CI 0.39, 9.67). Conclusion: Preliminary HIV incidence rates among PWID in the U.S./Mexico border region during the pandemic are high, and suggest a new HIV outbreak among PWID residing in TJ. Mobile harm reduction services providing syringes and HIV testing, as well as coordination with the municipal HIV program to allow for ART initiation and PrEP are urgently needed to prevent a continuing outbreak.

17.
Topics in Antiviral Medicine ; 30(1 SUPPL):350-351, 2022.
Article in English | EMBASE | ID: covidwho-1880844

ABSTRACT

Background: The impact of COVID-19 mitigation measures on STI transmission and racial disparities remains unknown. The objectives were to examine trends in sex and drug risk behaviors, access to sexual health services and STI positivity overall and by race during-compared to pre-pandemic among urban sexual minorities (MSM). Methods: Sexually-active MSM aged 18-45 years were administered a behavioral survey and STI testing at three-month intervals. Participants completing > one during-pandemic (April-December 2020) and one pre-pandemic study visit (before March 13, 2020) occurring < six months apart were included. Generalized estimating equations with modified Poisson regression models compared outcomes during-compared to pre-pandemic visits. Results: Among 231 MSM, reports of > three sex partners declined [adjusted Prevalence Ratio (aPR): pandemic-1(p1) 0.68, 95% CI (0.54-0.86);pandemic-2(p2) 0.65 (0.51-0.84);pandemic-3(p3) 0.57 (0.43-0.75)];similar findings were observed among Black and non-Black MSM. Black, but not non-Black MSM, reported sustained decreases in substance use (aPR: p1 0.90 (0.79-1.03);p2 0.74 (0.62-0.89);p3 0.82 (0.67-0.99)], and increased HIV/PrEP care engagement [aPR: p1 1.20 (1.07-1.34);p2 1.24 (1.11-1.39);p3 1.30 (1.16-1.47)]. Reported STI testing (overall and by race) decreased [aPR: p1 0.68 (0.57-0.81);p2 0.78 (0.67-0.92)], then rebounded [aPR: p3 1.01 (0.87-1.18)]. Overall, neither chlamydia [aPR: p2 1.62 (0.75-3.46);p3 1.13 (0.24-1.27)] nor gonorrhea [aPR: p2 0.87 (0.46-1.62) p3 0.56 (0.24-1.27)] positivity significantly changed during vs. pre-pandemic. Conclusion: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared to pre-pandemic. Findings underscore the urgent need for novel strategies to deliver STI prevention services without in-person interactions among MSM.

18.
Topics in Antiviral Medicine ; 30(1 SUPPL):4, 2022.
Article in English | EMBASE | ID: covidwho-1880744

ABSTRACT

Sharp declines in the incidence of hepatitis C virus (HCV) have coincided with unrestricted access to direct-acting antivirals (DAA) against HCV, particularly among PLHIV in clinical care. However, rates of HCV reinfection are still high among specific key populations at risk of or living with HIV. This presentation begins with a case highlighting one individual's experience with PrEP use and HCV re-infection. An overview is then provided of the most recent data on the risk of HCV primary and re-infection among key populations, focusing on MSM and PWID. The potential effect of COVID-19 restrictions on HCV infection rates is also addressed. Issues regarding the role of testing, early diagnosis, and treatment in the acute phase of HCV infection, as well as the implications surrounding chemsex, are explored and recommendations for a comprehensive strategy to prevent new HCV infections are provided.

19.
Topics in Antiviral Medicine ; 30(1 SUPPL):282, 2022.
Article in English | EMBASE | ID: covidwho-1880721

ABSTRACT

Background: Ensuring adolescents and young people (AYP) have access to comprehensive sexual and reproductive health services (SRHS), including HIV testing and prevention, is critical if we are to reduce HIV incidence and improve wellbeing. Following HPTN 071 (PopART) in Zambia, AYP stated that they needed improved access to SRHS and that these services should be provided from locations other than the health facility. The Yathu Yathu ("For us, by us") trial was co-developed from this request. We report on a secondary outcome of this trial, coverage of 6 predefined key SRHS (HIV testing, ART initiation, PrEP initiation, condom collection, VMMC and hormonal contraception) by trial arm Methods: Yathu Yathu is a cluster randomized trial conducted 2019-2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones which were randomly allocated to the Yathu Yathu intervention (YY) or standard of care (SoC) arms. In intervention zones, a YY hub, staffed by supervised peers, provided SRHS. In both arms, a census was conducted in 2019 where AYP (15-24 years) were invited to participate in the trial. Each was offered a Yathu Yathu card, which allowed them to collect "prevention points" for accessing SRHS at the health facility (SoC arm) or at the hub and health facility (YY arm). In both arms, points could be exchanged for health rewards, thus acting as an incentive to access services and as a tool to record service use. We use this YY card data to assess coverage of key SRHS Results: Of the 40,864 AYP enumerated, 29,370 (71.9%) consented to participate and accepted a Yathu Yathu card (14, 872, 71.6% YY arm, 14,498, 72.2% SoC arm). In the YY arm, 9493/14878 (63.8%) accessed at least one key service compared to 775/14498 (5.4%) in the SoC arm (adj RR 12.5;95%CI 9.9-15.8, p<0.001). Results were similar by age and sex (Table 1). The median number of visits in the YY arm was 1 (IQR 0-31) compared to 0 (IQR 0-0) in SoC. Of those accessing any service, HIV testing was the most common service in both arms (8841/9493 (93.1%) and 568/775 (73.3%), respectively) followed by collection of condoms (4701/9493 (49.5%) and 386/775 (49.8%) respectively) Conclusion: The Yathu Yathu intervention increased uptake of key SRHS, especially HIV testing. While YY hubs closed for 3months during COVID-19, health facility attendance may have also decreased thus affecting the difference in coverage. Nonetheless, our findings demonstrate the potential of peer-led community hubs to increase coverage of SRHS.

20.
Psychol Res Behav Manag ; 15: 1411-1421, 2022.
Article in English | MEDLINE | ID: covidwho-1881326

ABSTRACT

Background/Purpose: In the context of COVID-19 lockdowns, extant research suggests that secondary coping (a strategy aimed at adjusting oneself self to the stressor) is more robustly associated with better mental health than primary coping (a strategy aimed at adjusting the stressor to oneself). We investigated whether these findings are generalizable to Spain-one of the most severely affected countries at that time. We also tested whether the link between secondary coping and mental health (as measured by anxiety) can be accounted for by how individuals perceive the COVID-19 impact (ie, perceived life changes and personal global impact) and how frequently they use traditional and social media to check COVID-19-related information. Methods: A diverse community sample (N = 408), collected during the first lockdown in Spain (early April 2020), completed a multi-measure online survey including the targeted variables. Results: Secondary coping outperformed primary coping in predicting reduced anxiety during the lockdown in Spain. Moreover, lower perceived life changes from COVID-19 and reduced personal global impact from COVID-19 both mediated the negative secondary coping-anxiety relationship. No indirect effects emerged for either conventional or social media exposure. Conclusion: These results (a) strengthen the cross-cultural validity of the link between secondary coping and anxiety and (b) advance our understanding of the psychological mechanisms underlying this association.

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