Breast Cancer Among Transgender and Nonbinary Patients: Paradigms for Improving Data Collection and Inclusion in Breast Imaging Settings.

Breast cancer incidence among transgender and nonbinary (TGNB) individuals is not well characterized owing to the absence of robust data collection among this patient population. Consequently, breast cancer risks are largely unknown, and screening guidelines are not based on robust evidence. Additionally, TGNB patients experience barriers to access health care. A first step in improving data collection, research, and ultimately care of TGNB individuals is the identification of group members and demonstration to patients that our breast imaging centers are champions of LGBTQ+ health. At our institution, patients who present for breast imaging complete an iPad-administered breast imaging history and breast cancer risk assessment survey. Using the modified Tyrer-Cuzick model, the lifetime risk of developing breast cancer is estimated, and additional key history that may impact breast care and future breast imaging is collected. Under the previous clinic workflow, patients are identified as either "male" or "female" and complete a corresponding gender-specific survey. To improve care, we revised the survey using gender-inclusive language and developed four versions to allow patients to separately self-report their sex assigned at birth and gender identity. Relevant queries relating to hormone use and gender-affirming chest/breast surgery that are concordant with six gender-identity groups were added. Long-term collection of these inclusive data by imaging centers has the potential to enhance the data set available to improve breast care and better understand breast cancer risk and outcomes among TGNB populations.

Cross-cultural adaptation and psychometric properties of the Herth Hope Index in Kinyarwanda: adapting a positive psychosocial tool for healthcare recipients and providers in the Rwandan setting.

BACKGROUND: The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. METHODS: A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n = 43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n = 206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach's alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. RESULTS: The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (α = 0.85) and test-retest reliability (r = 0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square = 1.53; root mean square error of approximation = 0.05; standardized root mean square residual = 0.05; comparative fit index = 0.96; Tucker-Lewis Index = 0.95). CONCLUSION: This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.

Dendritic cells efficiently transmit HIV to T Cells in a tenofovir and raltegravir insensitive manner.

Dendritic cell (DC)-to-T cell transmission is an example of infection in trans, in which the cell transmitting the virus is itself uninfected. During this mode of DC-to-T cell transmission, uninfected DCs concentrate infectious virions, contact T cells and transmit these virions to target cells. Here, we investigated the efficiency of DC-to-T cell transmission on the number of cells infected and the sensitivity of this type of transmission to the antiretroviral drugs tenofovir (TFV) and raltegravir (RAL). We observed activated monocyte-derived and myeloid DCs amplified T cell infection, which resulted in drug insensitivity. This drug insensitivity was dependent on cell-to-cell contact and ratio of DCs to T cells in coculture. DC-mediated amplification of HIV-1 infection was efficient regardless of virus tropism or origin. The DC-to-T cell transmission of the T/F strain CH077.t/2627 was relatively insensitive to TFV compared to DC-free T cell infection. The input of virus modulated the drug sensitivity of DC-to-T cell infection, but not T cell infection by cell-free virus. At high viral inputs, DC-to-T cell transmission reduced the sensitivity of infection to TFV. Transmission of HIV by DCs in trans may have important implications for viral persistence in vivo in environments, where residual replication may persist in the face of antiretroviral therapy.