The gender of PrEP: Transgender men negotiating legitimacy in France.

Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the "interpretative descriptive" method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.

Indigenous Transmission of Mycobacterium africanum in Canada: A Case Series and Cluster Analysis.

Mycobacterium africanum is an important cause of human tuberculosis and is found almost exclusively in West Africa. We identified a cluster of patients in Montreal, Canada, with M africanum disease that share identical genotypic signatures by mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing and a putative epidemiological link, thus providing evidence of possible local transmission of M africanum in Montreal over a 10-year period.

Burden of HIV and tuberculosis co-infection in Montreal, Quebec.

OBJECTIVE: Define the burden of HIV-TB co-infection and predictors of HIV screening among incident TB cases. METHODS: Analysis of surveillance data on TB incident cases reported to Montreal's Public Health Department from 2004 to 2009. Among all reported TB cases, proportions of cases with HIV testing and HIV infection were calculated by patient characteristics. A test for linear trends was performed on the annual proportions of HIV-tested and HIV-positive cases. Adjusted odds ratios (AOR) for HIV testing at time of TB diagnosis were computed. RESULTS: A total of 778 incident TB cases were included in the analysis. HIV testing was reported for 50.8% (n=395) of cases. The proportion of HIV-tested cases increased significantly from 43% in 2004 to 70% in 2009. HIV-TB co-infection was found in 9.3% of patients with reported HIV status or in 4.2% of the overall cohort. HIV prevalence was high in men, individuals aged 40-59, those originating from Sub-Saharan Africa and the Caribbean, and the homeless. Multivariate analysis revealed that HIV testing at time of TB diagnosis was performed mainly for subjects born in the Caribbean, Central or South America, or Sub-Saharan Africa, those with pulmonary disease, and injection drug users. CONCLUSIONS: Although reporting of HIV testing among incident TB patients increased, targeted HIV testing still occurs. HIV prevalence in TB cases remained stable during the study period; however, it may be underestimated due to missed opportunities for HIV testing and under-reporting.

Completion rates of treatment for latent tuberculosis infection in Quebec, Canada from 2006 to 2010.

OBJECTIVE: Treatment of latent TB infection (LTBI) in high-risk populations has been identified as a priority activity for reducing TB incidence. Treatment completion rates are usually far from the 80% target. The objective of this study was to evaluate the proportion of individuals who obtained enough medication for standard LTBI treatment. METHODS: Using the Régie de l'assurance maladie du Québec database, we extracted data on all prescriptions filled as part of the free anti-tuberculosis medication program. We calculated the proportion of patients who had obtained at least 270 doses among patients who had started treatment with isoniazid (INH), and the proportion of patients who had obtained at least 120 doses among patients who had started treatment with rifampin (RMP). RESULTS: Among the 2,895 patients who had started INH, 907 (31.3%) obtained at least 270 doses. Among the 373 patients who had started RMP, 242 (64.9%) obtained at least 120 doses. Women were more likely to stop INH treatment before acquiring 270 doses of the medication than men (hazard ratio [HR] = 1.08; 95% confidence interval [CI]: 1.01-1.17). CONCLUSION: Only 31.3% of patients who started treatment with INH had procured at least 270 doses. Completion rates are far below target values.

A case of active tuberculosis in a cabin crew: the results of contact tracing.

INTRODUCTION: Transmission of communicable diseases on board aircraft is of considerable concern for passengers and aircrew. Previously published estimates of risk of tuberculosis (TB) transmission have been highly variable. Furthermore, very few studies have been published for active TB in aircrew. METHODS: The public health authorities advised the Medical Advisor of an airline that a cabin crewmember had been diagnosed with active TB. Contact tracing was done for the cabin crew who worked with the index case for more than 8 h. Cabin crewmembers were divided in two groups according to their exposure and had one tuberculin skin test (TST) more than 8 wk after the last exposure. Those with a TST > or = 5 mm have been recommended to have a QuantiFERON-TB Gold In-Tube (QFT) assay. RESULTS: Among the 56 identified contacts, 32 agreed to be evaluated, of whom 6 (19%) had a TST > or = 5 mm. Of those six, four underwent a QFT with one positive result. None had active TB. The percentages of positives in the two exposure groups were similar. All the positive contacts were born in Canada in the period when the childhood Bacille Calmette-Guérin (BCG) vaccination program was in effect. DISCUSSION: The same percentage of positives in the two exposure groups, the proportion of positive contacts below the expected rate in Canadians, and the high proportion of QFT negative among the TST positive contacts suggest that transmission of TB to the cabin crew is unlikely.

Tuberculosis and homelessness in Montreal: a retrospective cohort study.

BACKGROUND: Montreal is Canada's second-largest city, where mean annual tuberculosis (TB) incidence from 1996 to 2007 was 8.9/100,000. The objectives of this study were to describe the epidemiology of TB among homeless persons in Montreal and assess patterns of transmission and sharing of key locations. METHODS: We reviewed demographic, clinical, and microbiologic data for all active TB cases reported in Montreal from 1996 to 2007 and identified persons who were homeless in the year prior to TB diagnosis. We genotyped all available Mycobacterium tuberculosis isolates by IS6110 restriction fragment length polymorphism (IS6110-RFLP) and spoligotyping, and used a geographic information system to identify potential locations for transmission between persons with matching isolates. RESULTS: There were 20 cases of TB in homeless persons, out of 1823 total reported from 1996-2007. 17/20 were Canadian-born, including 5 Aboriginals. Homeless persons were more likely than non-homeless persons to have pulmonary TB (20/20), smear-positive disease (17/20, odds ratio (OR) = 5.7, 95% confidence interval (CI): 1.7-20), HIV co-infection (12/20, OR = 14, 95%CI: 4.8-40), and a history of substance use. The median duration from symptom onset to diagnosis was 61 days for homeless persons vs. 28 days for non-homeless persons (P = 0.022). Eleven homeless persons with TB belonged to genotype-defined clusters (OR = 5.4, 95%CI: 2.2-13), and ten potential locations for transmission were identified, including health care facilities, homeless shelters/drop-in centres, and an Aboriginal community centre. CONCLUSIONS: TB cases among homeless persons in Montreal raise concerns about delayed diagnosis and ongoing local transmission.

Trends in duration of hospitalization for patients with tuberculosis in Montreal, Canada from 1993 to 2007.

OBJECTIVE: To study the trend of hospital stays for patients diagnosed with pulmonary TB in Montreal from 1993 to 2007. METHODS: From the registry of hospital discharge summary information, we selected first hospitalizations for patients with a diagnosis of TB, and from the reportable diseases registry, patients with culture positive pulmonary TB. We linked the selected cases, using the first 3 characters of postal code of residence, sex and age. From the linked cases, we included those for whom date of patient's admission to hospital (from the former registry) was similar to the date of notification to the public health department (from the latter registry), while allowing for an appropriate variation. RESULTS: Among the 563 linked cases, the median duration of hospitalization was 17.0 days. Duration of hospitalization did not significantly decrease during the study period. Cases with positive sputum smear were more likely to stay in hospital > or = 14 days compared to those without one (OR = 1.90, 95% CI: 1.34-2.70). TB cases > or = 50 years of age remained in hospital longer than those between 18-49 years of age (OR = 1.66, 95% CI: 1.15-2.40). CONCLUSION: For 63.9% (360) of the cases studied, the duration of hospitalization was > or = 14 days, which is consistent with the minimum recommended hospital stay for patients with pulmonary TB in Canada. Further studies are necessary to examine the impact of discharging hospitalized TB patients before 14 days of hospital stay on the risk of TB transmission in the community.

Varicella vaccination for grades 4 and 5 students: from theory to practice.

BACKGROUND: In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme. OBJECTIVES: To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme. METHODS: The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003. RESULTS: Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years. CONCLUSION: Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.

Hospitalisations for gastroenteritis: the role of rotavirus.

To determine the proportion of hospitalisations for gastroenteritis caused by rotavirus, we tested for rotavirus stool samples of all children under the age of five hospitalised for gastroenteritis between 1 December 1999 and 30 May 2000 in seven community and specialised hospitals in Quebec. Of 944 children hospitalised, 565 (59.9%) were screened for rotavirus and 405 (71.7%) tested positive. From December to April, the proportion of positive results rose from 51.6 to 78.1%. Compared with children whose test results were negative, children who tested positive presented vomiting more frequently upon admission (88.9 versus 60.4%) and needed IV fluids in greater proportion (94.1 versus 78.0%), but spent less time in hospital (2.8 versus 3.3 days). Aside from dehydration, no complications were noted. In Quebec, a large majority of winter and spring hospitalisations for gastroenteritis in children is attributable to rotavirus.

The effectiveness of serogroup C meningococcal vaccine estimated from routine surveillance data.

Serogroup C meningococcal vaccine effectiveness was estimated from routine surveillance data, based on a comparison of the proportion of vaccine and non-vaccine serogroups in vaccinated and unvaccinated reported cases. Between 1 April 1993 and 31 March 1998, 109 eligible cases were reported. Among the 54 cases caused by serogroup C, 38 had been vaccinated. Among the 55 cases caused by non-vaccine serogroups, 49 had been vaccinated. Vaccine effectiveness was estimated at 71% (95% CI: 21-89%), a value similar to that obtained in the same population by a cohort study. Effectiveness was lower in children immunized before the age of 10. This demonstrates that meningococcal vaccine effectiveness can be estimated from information obtained routinely from cases only, as an alternative to the more expensive cohort or case-control designs.