Homelessness and housing assistance among persons with HIV, and associations with HIV care and viral suppression, New York City 2018.

OBJECTIVES: To measure housing assistance and homelessness among persons living with HIV (PLWH) and their association with health. METHODS: Exposure categories were: experiencing homelessness (per emergency shelter use or self-report), receiving housing assistance (per housing subsidy) without homelessness, or neither homelessness nor receiving housing assistance. Outcomes were: engagement (≥1 visit) and retention (≥2 visits ≥90 days apart) in HIV-related medical care and one-time (latest viral load) and durable (≥1 viral load test, all suppressed) HIV viral suppression (<200 copies/mL). Among PLWH in New York City (NYC), we calculated and conducted modified Poisson regressions of the four outcomes according to exposure category. RESULTS: During 2018, 45% of NYC's 84,053 PLWH received housing assistance, and 8% experienced homelessness. Relative to homelessness, receipt of assistance without homelessness was associated with 3-7% higher adjusted relative risk (ARR) of engagement and retention in care and 31-64% higher ARR of one-time and durable viral suppression. Relative to not receiving assistance, receipt of assistance without homelessness was associated with 6-18% higher ARR of care and 2-5% lower ARR of viral suppression. CONCLUSIONS: Programs promoting housing stability may support HIV care and viral suppression, particularly if preventing homelessness. These may help improve HIV care and suppression rates.

Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017.

Objectives. To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017.Methods. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]).Results. The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers. Long-term SPH and REN consumers had better engagement in care, viral suppression, and CD4 count than controls at both first and second year after enrollment, but the effect did not grow bigger from year 1 to 2. HPA consumers did not have better outcomes than controls regardless of enrollment length.Conclusions. Longer enrollment with timely housing placement and a higher number and more types of services are associated with better HIV health outcomes for low-income persons living with HIV with unmet housing needs.

Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder.

Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g., rental assistance, supportive housing) and unstable (e.g., emergency shelter) government-subsidized housing. Sequence analysis identified a "quick stable housing" pattern for 67% of persons placed by this program within 2 years, vs. 28% of unplaced. Compared with unplaced persons not achieving stable housing quickly, persons quickly achieving stable housing were more likely to engage in care, whether placed (per Poisson regression, ARR: 1.14;95% CI 1.09-1.20) or unplaced (1.19;1.13-1.25) by this program, and to be virally suppressed, whether placed (1.22;1.03-1.44) or unplaced (1.26, 1.03-1.56) by this program. Housing programs can help homeless PLWH secure stable housing quickly, manage their infection, and prevent transmission.

RESUMEN: Unas 958 personas de bajos recursos y quienes viven con VIH y enfermedades mentales o bien presentan problemas de abuso de sustancias solicitaron a un programa de vivienda complementada con servicios de apoyo. Entre ellas, se evaluó los impactos de la colocación en viviendas sobre la estabilidad en la misma, así como la participación en los cuidados médicos para el VIH, y la supresión de la carga viral. Las bases de datos administrativas y del registro de vigilancia brindaron información médica y domiciliar, incluyendo información sobre vivienda estable (por ejemplo, asistencia de pago de renta a largo plazo, o vivienda complementada con servicios de apoyo) y vivienda inestable (por ejemplo, alojamiento de emergencia temporal) subsidiada por el gobierno. El método "análisis de secuencia" permitió identificar una pauta caracterizada por estabilidad domiciliar conseguida de modo ligero (es decir, de forma oportuna) en el 67% de las personas quienes fueron colocadas por este programa dentro de un lapso de dos años, comparado con 28% de las personas quienes no fueron colocadas. En comparación con las personas quienes no fueron colocadas y no lograron estabilidad de vivienda de modo ligero, las personas quienes lograron estabilidad de vivienda de modo ligero tuvieron una mayor probabilidad de participar en cuidados médicos, ya sea que fueran colocadas (según regresión de Poisson, cociente de riesgo ajustado: 1.14; intervalo de confianza de 95%: 1.09-1.20) o no fueran colocadas (1.19, 1.13-1.25) por este programa, así como de lograr la supresión de la carga viral, ya sea que fueran colocadas (1.22, 1.03-1.44) o no fueran colocadas (1.26, 1.03-1.56) por este programa. Los programas que facilitan la colocación en o el pago de vivienda y apoyo en el mismo pueden ayudar a las personas con VIH y sin hogar obtener vivienda estable de modo ligero, controlar su infección, y prevenir la transmisión.

Multilevel Factors Associated with a Lack of Viral Suppression Among Persons Living with HIV in a Federally Funded Housing Program.

Persons with HIV who are receiving housing services often have high rates of engagement in care, yet many are not virally suppressed. We linked data from the New York City Housing Opportunities for Persons with AIDS (HOPWA) program to electronically reported laboratory tests from the HIV surveillance registry to examine factors associated with a lack of viral suppression. Of 1491 HOPWA consumers, 523 (35.1%) were not durably suppressed, and 253 (17.0%) were unsuppressed at their last viral load test. Substance use, age < 27 years, and emergency housing all independently predicted lack of durable viral suppression and lack of viral suppression at last viral load test.

Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone.

PURPOSE: Transarterial chemoembolization is accepted therapy for hepatocellular carcinoma (HCC). No randomized trial has demonstrated superiority of chemoembolization compared with embolization, and the role of chemotherapy remains unclear. This randomized trial compares the outcome of embolization using microspheres alone with chemoembolization using doxorubicin-eluting microspheres. MATERIALS AND METHODS: At a single tertiary referral center, patients with HCC were randomly assigned to embolization with microspheres alone (Bead Block [BB]) or loaded with doxorubicin 150 mg (LC Bead [LCB]). Random assignment was stratified by number of embolizations to complete treatment, and assignments were generated by permuted blocks in the institutional database. The primary end point was response according to RECIST 1.0 (Response Evaluation Criteria in Solid Tumors) using multiphase computed tomography 2 to 3 weeks post-treatment and then at quarterly intervals, with the reviewer blinded to treatment allocation. Secondary objectives included safety and tolerability, time to progression, progression-free survival, and overall survival. This trial is currently closed to accrual. RESULTS: Between December 2007 and April 2012, 101 patients were randomly assigned: 51 to BB and 50 to LCB. Demographics were comparable: median age, 67 years; 77% male; and 22% Barcelona Clinic Liver Cancer stage A and 78% stage B or C. Adverse events occurred with similar frequency in both groups: BB, 19 of 51 patients (38%); LCB, 20 of 50 patients (40%; P = .48), with no difference in RECIST response: BB, 5.9% versus LCB, 6.0% (difference, -0.1%; 95% CI, -9% to 9%). Median PFS was 6.2 versus 2.8 months (hazard ratio, 1.36; 95% CI, 0.91 to 2.05; P = .11), and overall survival, 19.6 versus 20.8 months (hazard ratio, 1.11; 95% CI, 0.71 to 1.76; P = .64) for BB and LCB, respectively. CONCLUSION: There was no apparent difference between the treatment arms. These results challenge the use of doxorubicin-eluting beads for chemoembolization of HCC.

Interreader and inter-test agreement in assessing treatment response following transarterial embolization for hepatocellular carcinoma.

PURPOSE: To evaluate interreader and inter-test agreement in applying size- and necrosis-based response assessment criteria after transarterial embolization (TAE) for hepatocellular carcinoma (HCC), applying two different methods of European Association for the Study of the Liver (EASL) criteria. METHODS: Seventy-four patients (median age, 67 years) from a prospectively accrued study population were included in this retrospective study. Four radiologists independently evaluated CT data at 2-3 (1st follow-up, FU) and 10-12 (2nd FU) weeks after TAE and assessed treatment response using size-based (WHO, RECIST) and necrosis-based (mRECIST, EASL) criteria. Enhancing tissue was bidimensionally measured (EASLmeas) and also visually estimated (EASLest). Interreader and inter-test agreements were assessed using intraclass correlation coefficient (ICC) and κ statistics. RESULTS: Interreader agreement for all response assessment methods ranged from moderate to substantial (κ = 0.578-0.700) at 1st FU and was substantial (κ = 0.716-0.780) at 2nd FU. Inter-test agreement was substantial between WHO and RECIST (κ = 0.610-0.799, 1st FU; κ = 0.655-0.782, 2nd FU) and excellent between EASLmeas and EASLest (κ = 0.899-0.918, 1st FU; κ = 0.843-0.877, 2nd FU). CONCLUSION: Size- and necrosis-based criteria both show moderate to excellent interreader agreement in evaluating treatment response after TAE for HCC. Inter-test agreement regarding EASLmeas and EASLest was excellent, suggesting that either may be used. KEY POINTS: • Applying EASL criteria, visual estimation and bidimensional measurements show comparable interreader agreement. • EASL meas and EASL est show substantial interreader agreement for treatment response in HCC. • Agreement was excellent for EASL meas and EASL est after TAE of HCC. • Visual estimation of enhancement is adequate to assess treatment response of HCC.

Patient perspectives and preferences for communication of medical imaging risks in a cancer care setting.

PURPOSE: To identify opportunities for improving patient-centered communication about diagnostic imaging tests that involve the use of radiation in a cancer care setting. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Patient knowledge, information sources, and communication preferences were assessed in six focus groups during 2012. The groups consisted of patients undergoing treatment for metastatic colorectal carcinoma, women treated within the past 6 months for early-stage breast carcinoma, men undergoing surveillance after testicular cancer treatment, parents of patients treated for stage I-III neuroblastoma, patients in a thoracic oncology survivorship program, and participants in a lung cancer screening program. A multidisciplinary research team performed thematic content analysis of focus group transcripts. High-level findings were summarized during consensus conferences. RESULTS: Although they were aware of the long-term risk of cancer from exposure to ionizing radiation, most participants reported that their health care provider did not initiate discussion about benefits and risks of radiation from imaging tests. Most patients obtained information by means of self-directed internet searches. Participants expressed gratitude for tests ("That CT saved my daughter's life," "I'd rather have the radiation dosage than being opened up"), yet they expressed concern about having to initiate discussions ("If you don't ask, nobody is going to tell you anything") and the desire to be offered information concerning the rationale for ordering specific imaging examinations, intervals for follow-up imaging, and testing alternatives. Participants believed that such information should be available routinely and that conversation with their personal physician or endorsed, readily available reference materials were ideal methods for information exchange. Understanding imaging radiation risks and active participation in decision making about imaging were especially important to cancer survivors. CONCLUSION: A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that involve the use of radiation.

Mechanistic investigation of the reaction of epoxides with heterocumulenes catalysed by a bimetallic aluminium salen complex.

The bimetallic aluminium(salen) complex [(Al(salen))2O] is known to catalyse the reaction between epoxides and heterocumulenes (carbon dioxide, carbon disulfide and isocyanates) leading to five-membered ring heterocycles. Despite their apparent similarities, these three reactions have very different mechanistic features, and a kinetic study of oxazolidinone synthesis combined with previous kinetic work on cyclic carbonate and cyclic dithiocarbonate synthesis showed that all three reactions follow different rate equations. An NMR study of [Al(salen)]2O and phenylisocyanate provided evidence for an interaction between them, consistent with the rate equation data. A variable-temperature kinetics study on all three reactions showed that cyclic carbonate synthesis had a lower enthalpy of activation and a more negative entropy of activation than the other two heterocycle syntheses. The kinetic study was extended to oxazolidinone synthesis catalysed by the monometallic complex Al(salen)Cl, and this reaction was found to have a much less negative entropy of activation than any reaction catalysed by [Al(salen)]2O, a result that can be explained by the partial dissociation of an oligomeric Al(salen)Cl complex. A mechanistic rationale for all of the results is presented in terms of [Al(salen)]2O being able to function as a Lewis acid and/or a Lewis base, depending upon the susceptibility of the heterocumulene to reaction with nucleophiles.

Oxa-thia-, oxa-selena and crown ether macrocyclic complexes of tin(II) tetrafluoroborate and hexafluorophosphate--synthesis, properties and structures.

The reactions of Sn(BF4)2 and Sn(PF6)2 with crown ethers and oxa-thia- or oxa-selena-macrocycles are complex, with examples of fragmentation of the fluoroanions, and cleavage of the ligands observed, in addition to adduct formation. The reaction of Sn(BF4)2 with 15-crown-5 or 18-crown-6 produced the sandwich complex [Sn(15-crown-5)2][BF4]2 with 10-coordinate tin, and [Sn(18-crown-6)(H2O)][BF4]2·2H2O which has an hexagonal pyramidal tin centre with two long contacts to lattice water molecules (overall 7 + 2 coordination). [Sn(18-crown-6)(PF6)][PF6] is formed from 18-crown-6 and Sn(PF6)2, but the hexafluorophosphate ions hydrolyse readily in these systems to produce F(-) which coordinates to the tin to produce [Sn(18-crown-6)F][PF6], which can also be made directly from Sn(PF6)2, 18-crown-6 and KF in MeCN. The structure contains a hexagonal pyramidal coordinated Sn(II) cation with an apical fluoride. The oxa-thia macrocycle [18]aneO4S2 forms [Sn([18]aneO4S2)(H2O)2(PF6)][PF6], from which some crystals of composition [Sn([18]aneO4S2)(H2O)2(PF6)]2[PF6][F] were obtained. The cation contains an approximately planar O4S2 coordinated macrocycle, with two coordinated water molecules on one side of the plane and a weakly bound (κ(2)) PF6(-) group on the opposite face, and with the fluoride ion hydrogen bonded to the coordinated water molecules. In contrast, the oxa-selena macrocycle, [18]aneO4Se2, produces an anhydrous complex [Sn([18]aneO4Se2)(PF6)2] which probably contains coordinated anions, although it decomposes quite rapidly in solution, depositing elemental Se, and hence crystals for an X-ray study were not obtained. Reacting Sn(BF4)2 and [18]aneO4Se2 or [18]aneO4S2 also causes rapid decomposition, but from the latter reaction crystals of the 1,2-ethanediol complex [Sn([18]aneO4S2){C2H4(OH)2}][BF4]2 were isolated. The structure reveals the coordinated macrocycle and a chelating diol, with the O-H protons of the latter hydrogen bonded to the [BF4](-) anions. This is a very rare, structurally authenticated example of ring opening/cleavage of an oxa-thia macrocycle. The new complexes were characterised by microanalysis, IR, (1)H, (19)F{(1)H} and (31)P{(1)H} NMR spectroscopy as appropriate, and X-ray structures are reported for [Sn(15-crown-5)2][BF4]3[H3O]·H2O, [Sn(18-crown-6)(H2O)][BF4]2·2H2O, [Sn(18-crown-6)F][PF6], [Sn([18]aneO4S2)(H2O)2(PF6)]2[PF6][F] and [Sn([18]aneO4S2){C2H4(OH)2}][BF4]2. The complexes are compared and contrasted with chloro-tin(II) complexes of crown ethers, germanium(II) and lead(II) analogues.

Influence of temperature and pressure on cyclic carbonate synthesis catalyzed by bimetallic aluminum complexes and application to overall syn-bis-hydroxylation of alkenes.

The effect of moderate temperatures (22-100 °C) and pressures (1-10 bar) on the synthesis of cyclic carbonates from epoxides and carbon dioxide catalyzed by a combination of bimetallic aluminum complexes and tetrabutylammonium bromide is investigated. The combined bimetallic complex and tetrabutylammonium bromide catalyst system is shown to be an order of magnitude more active than the use of tetrabutylammonium bromide alone at all temperatures and pressures studied. At the higher temperatures and pressures used, disubstituted epoxides become substrates for the reaction and it is shown that reactions proceed with retention of the epoxide stereochemistry. This allowed a route for the overall syn-bis-hydroxylation of alkenes to be developed without the use of hazardous metal based reagents. At higher pressures it is also possible to use compressed air as the carbon dioxide source.

Proline-catalysed amination reactions in cyclic carbonate solvents.

Propylene carbonate is shown to be an environmentally friendly and sustainable replacement for dichloromethane and acetonitrile in proline-catalysed a-hydrazinations of aldehydes and ketones. Enantioselectivities comparable to those obtained in conventional solvents or ionic liquids can be obtained, even when using a lower catalyst loading.