Trends in diabetes incidence and associated risk factors among people with HIV in the current treatment era.

Objective: To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH).

Design: A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018.

Methods: PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR).

Leveraging Technology and Gamification to Engage Learners in a Microbiology Curriculum in Undergraduate Medical Education.

Background: Microbiology is a critical and expansive topic that many medical schools' curriculum must teach in a constrained time frame. We implemented a microbiology question bank smart phone app enhanced with game elements and clinical pearls during a microbiology course for first-year medical students. We hypothesized that these enhancements and clinical pearls would engage the students meaningfully and increase their knowledge base.

Prevalence of and Factors Associated With Genital and Extragenital Chlamydia and Gonorrhea Among Transgender Women in HIV Care in the United States, 2005 to 2016.

Background: Data on testing rates and prevalence of and factors associated with genital and extragenital chlamydia and gonorrhea among transgender women with HIV in the United States are limited.

Methods: This retrospective cohort analysis included transgender women living with HIV enrolled in the US Centers for AIDS Research Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with chlamydia or gonorrhea testing performed in HIV clinic. The primary outcome was a positive test result for chlamydia or gonorrhea at urogenital or extragenital (rectal/pharyngeal) sites.

Prompt Outpatient Care For Older Adults Discharged From The Emergency Department Reduces Recidivism.

Introduction: Older adults present unique challenges to both emergency clinicians and health systems. These challenges are especially evident with respect to discharge after an emergency department (ED) visit as older adults are at risk for short-term, negative outcomes including repeat ED visits. The aim of this study was to evaluate characteristics and risk factors associated with repeat ED utilization by older adults.

An Integrated Hospital Protocol for Persons With Injection-Related Infections May Increase Medications for Opioid Use Disorder Use but Challenges Remain.

Background: Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge.

Methods: This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018.

Racial disparities and factors associated with prescription for smoking cessation medications among smokers receiving routine clinical care for HIV.

Factors associated with prescription of smoking cessation medication (SCM), including the impact of race, have not been well described among a large population of people living with HIV (PLWH) engaged in routine clinical care. Our study investigated whether there are racial differences between African-American and White PLWH regarding SCM prescription and sought to identify other factors associated with these prescriptions at a large HIV clinic in the Southeastern United States. Among 1899 smokers, 38.

Factors Associated with HIV Disclosure Status Among iENGAGE Cohort of New to HIV Care Patients.

HIV disclosure is an important behavior with implications for HIV treatment and prevention but understudied among new to HIV care patients who face unique challenges adjusting to a new diagnosis. This study evaluated the factors associated with HIV disclosure status and patterns of HIV disclosure among new to HIV care patients. A cross-sectional study was conducted evaluating the iENGAGE (integrating ENGagement and Adherence Goals upon Entry) cohort.

In-Hospital Illicit Drug Use and Patient-Directed Discharge: Barriers to Care for Patients With Injection-Related Infections.

Background: Hospitalized persons who inject drugs are at a greater risk of adverse hospital outcomes including discharge against medical advice, inpatient illicit drug use, overdose, and death. However, there are limited data on the frequency and outcomes of these events in the United States.

Methods: This retrospective analysis included patients with injection-related infections receiving a protocol for injection drug use (IDU) at University of Alabama at Birmingham Hospital from 2016 to 2017.

Creating and testing a GCP game in an asynchronous course environment: The game and future plans.

Introduction: The National Institute of Health has mandated good clinical practice (GCP) training for all clinical research investigators and professionals. We developed a GCP game using the Kaizen-Education platform. The GCP Kaizen game was designed to help clinical research professionals immerse themselves into applying International Conference on Harmonization GCP (R2) guidelines in the clinical research setting through case-based questions.

Transmission Risk Among Youth Living With HIV in the U.S.

Purpose: HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts.

Methods: A cohort of 600 HIV behaviorally infected youth aged 13-24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs.

Physical activity trends and metabolic health outcomes in people living with HIV in the US, 2008-2015.

Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High.

Sexually transmitted infections and sexual behaviors of men who have sex with men in an American Deep South PrEP clinic.

HIV pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition among men who have sex with men (MSM), but PrEP uptake has been associated with sexually transmitted infections (STIs). The effect of PrEP on STIs in MSM in the Deep South of the United States is unknown. We performed a retrospective analysis of adult MSM at an American Deep South PrEP clinic to calculate the prevalence and incidence rate of bacterial STIs (chlamydia, gonorrhea, and syphilis) and identify associated risk factors by linking incident STI to patient-reported outcomes; 139 MSM accessed the clinic between 2014 and 2018 with baseline bacterial STI prevalence of 11%.

Identifying Missed Opportunities for Human Immunodeficiency Virus Pre-exposure Prophylaxis During Preventive Care and Reproductive Visits in Adolescents in the Deep South.

Background: Pre-exposure prophylaxis (PrEP) for individuals at significant risk for Human Immunodeficiency Virus acquisition is approved for individuals weighing at least 35 kg by the Food and Drug Administration. This cross-sectional study analyzed indications for PrEP in a clinical setting.

Methods: There were 429 charts reviewed from adolescents between 15 and 21 years old seen for preventive care visits at an adolescent primary care center in the Deep South during a 1-year timeframe.

Peripheral CD4 T follicular cells induced by a conjugated pneumococcal vaccine correlate with enhanced opsonophagocytic antibody responses in younger individuals.

Background: PCV13 (conjugated polysaccharide) and PPSV23 (polysaccharide only) are two licensed vaccines targeting S. pneumoniae. The role of CD4 T-cell responses in pneumococcal vaccines among healthy participants and their impact on antibodies is not yet known.

Obesity Affects the Association of Bioelectrical Impedance Phase Angle With Mortality in People Living With HIV.

Bioelectrical impedance analysis phase angle (BIA-PA) is a valid indicator of mortality risk in people living with HIV; however, it is not known whether BIA-PA is valid for people living with HIV who are overweight or obese. We assessed whether BIA-PA differentially predicted mortality by body mass index category in participants receiving clinical care at a single site between 2000 and 2012. Change in BIA-PA from the highest versus last available phase angle was assessed using multivariate logistic regression models.

Intersecting Epidemics: Incident Syphilis and Drug Use in Women Living With Human Immunodeficiency Virus in the United States (2005-2016).

Background: Rates of early syphilis in US women are steadily increasing, but predictors of infection in this group are not clearly defined.

Methods: This retrospective analysis focused on women enrolled in the US CFAR Network of Integrated Clinical Systems cohort between January 2005 and December 2016 with syphilis testing performed. The primary outcome of incident syphilis infection was defined serologically as a newly positive test with positive confirmatory testing after a negative test or a 2-dilution increase in rapid plasma regain titer.

Mental health disorders and alcohol use are associated with increased likelihood of smoking relapse among people living with HIV attending routine clinical care.

Background: People living with HIV (PLWH) have a high level of interest in quitting smoking, but only a small proportion have sustainable abstinence 6 months after cessation. Few investigations have focused on relapse to smoking among PLWH. In this investigation, we evaluated the prevalence of relapse after smoking cessation and the characteristics associated with smoking relapse using a retrospective, longitudinal cohort of PLWH during an eight-year observation.

Are missed- and kept-visit measures capturing different aspects of retention in HIV primary care?

The literature recognizes six measures of retention in care, an integral component of the HIV Continuum of Care. Given prior research showing that different retention measures are differentially associated with HIV health outcomes (e.g.

Assessing a novel way to measure three common rehabilitation outcome measures using a custom mobile phone application.

Background: Clinicians often use thirty-second-sit (chair)-to-stand (30CST), timed-up-and-go (TUG), and the five-times-sit-to-stand (5xSTS) since these outcome measures (OMs) are sensitive for strength, balance and mobility.

Research Question: The purpose of this study was to validate a custom smart phone application (App) that can remotely assess the 30CST, TUG, and 5xSTS.

Methods: Thirty-one healthy adults (range: 22-55 y; 54.

Ryan White HIV/AIDS program recipients more likely than non-recipients to be retained in care using six different retention measures.

Retention in care (RiC) is crucial for maintaining HIV health. We examined the relationship between receipt of Ryan White HIV/AIDS Program (RWHAP) supplementary services and six different measures of RiC among 2,288 adults living with HIV who received HIV primary care services at a large, academically-affiliated HIV/AIDS clinic in the southeastern United States in 2016. The independent variable of interest was RWHAP supplementary services, which referred to whether patients received documented non-medical wraparound supplementary services.

Predictors of smoking cessation among people living with HIV receiving routine clinical care.

People living with HIV (PLWH) have a higher prevalence of smoking and are less likely to quit smoking than the general population. Few studies involving a large sample of PLWH receiving routine care have evaluated factors associated with smoking cessation. This retrospective longitudinal cohort study evaluated factors associated with smoking cessation among PLWH from 2007 to 2018.

Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus.

Background: To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality.

Methods: The sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems.

Evolution of HIV-1 drug resistance after virological failure of first-line antiretroviral therapy in Lusaka, Zambia.

Background: HIV viral load (VL) and resistance testing are limited in sub-Saharan Africa, so individuals may have prolonged time on failing first-line antiretroviral therapy (ART). Our objective was to describe the evolution of drug resistance mutations among adults failing first-line ART in Zambia.

Methods: We analysed data from a trial of VL monitoring in Lusaka, Zambia.

A Measure to Assess HIV Treatment Readiness among Adolescents and Young Adults.

HIV infections among adolescents and young adults continue to grow and clinical guidelines recommend the immediate start of life-saving antiretroviral therapy (ART). Unfortunately, suboptimal medication adherence among youth is common and can lead to poorer health outcomes as well as onward transmission of HIV to sexual partners. Clinical tools to assess treatment readiness are needed and can assist with adherence intervention strategies for youth.

Assessing a novel way to measure step count while walking using a custom mobile phone application.

Introduction: Walking speed has been associated with many clinical outcomes (e.g., frailty, mortality, joint replacement need, etc.