Longitudinal Trends in Physical Activity Among Older Adults With and Without HIV in Uganda.

Introduction: Physical Activity (PA) and its links to frailty, quality of life (QoL), and other comorbidities in older Ugandans living with HIV remain under-explored.

Methods: We analyzed data from three annual assessments of older people living with HIV (PLWH) and age- and sex-similar people not living with HIV (PnLWH). We fitted linear generalized estimating equations (GEE) regression models to estimate the correlates of PA, including demographics, frailty, QoL, HIV, and other comorbidities.

Uptake of HIV pre-exposure prophylaxis and contraception in South African hair salons: a study protocol for a pilot cluster randomised controlled trial.

Introduction: Young women are disproportionately affected by HIV in South Africa and have a high incidence of unintended pregnancies. Access to sexual and reproductive health (SRH) services, including HIV pre-exposure prophylaxis (PrEP), contraception and screening for seally transmitted infections (STIs), remains limited in South Africa, in part due to inadequate infrastructure and individual barriers to care. Integrated, community-based SRH services have the potential to overcome barriers to clinic-based care for women at risk of HIV, unintended pregnancy and STIs.

Cross-modal contrastive learning for unified placenta analysis using photographs.

The placenta is vital to maternal and child health but often overlooked in pregnancy studies. Addressing the need for a more accessible and cost-effective method of placental assessment, our study introduces a computational tool designed for the analysis of placental photographs. Leveraging images and pathology reports collected from sites in the United States and Uganda over a 12-year period, we developed a cross-modal contrastive learning algorithm consisting of pre-alignment, distillation, and retrieval modules.

User-centered adaption of , A novel mhealth application integrating medication reminders with virtual peer support and social/financial incentives to improve medication adherence.

Youth living with HIV (YLWH) have high rates of virologic failure due to medication non-adherence. is a novel, gamified mobile health (mHealth) application designed with user-centered principles to improve medication adherence by integrating medication reminders with social and financial incentives, virtual peer social support and early clinic outreach for non-adherent YLWH in Nigeria. Focus Group Discussions (FGDs) were conducted to identify reactions to key prototype features (user interface, medication reminders, incentives, and peer support), facilitators and barriers to app use, and how well the app would meet adherence needs.

TB or not TB? Development and validation of a clinical decision support system to inform airborne isolation requirements in the evaluation of suspected tuberculosis.

Background: The study objective was to develop and validate a clinical decision support system (CDSS) to guide clinicians through the diagnostic evaluation of hospitalized individuals with suspected pulmonary tuberculosis (TB) in low-prevalence settings.

Methods: The "TBorNotTB" CDSS was developed using a modified Delphi method. The CDSS assigns points based on epidemiologic risk factors, TB history, symptoms, chest imaging, and sputum/bronchoscopy results.

Plasma Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Biomarkers of Cognitive Decline in People Living with HIV.

Background: This study examined the relationship between neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) and cognition in people living with HIV (PLWH) at baseline and over time.

Methods: Plasma and clinical data were available from PLWH aged ≥45 years with HIV RNA <200 copies/mL enrolled in the AIDS Clinical Trials Group HAILO cohort study. We measured plasma NfL and GFAP using a single molecule array platform.

The impact of tobacco smoking and smoking cessation on lung cancer and stroke incidence among people with HIV on antiretroviral therapy in South Africa: a simulation modeling study.

Introduction: With declining HIV-related mortality, over 20% of people with HIV (PWH) in South Africa are now over age 50 years, and tobacco-related non-communicable disease burden is increasing. We quantified the impact of smoking and smoking cessation on lung cancer and stroke incidence among PWH in South Africa.

Methods: Using a microsimulation model, we simulated 18 cohorts of initially virologically suppressed PWH over their lifetime, categorised by sex, initial age (35 years/45 years/55 years) and smoking status (current/former/never).

Cost-effectiveness of viral load testing for transitioning antiretroviral therapy-experienced children to dolutegravir in South Africa: a modelling analysis.

Background: For children with HIV on antiretroviral therapy (ART), transitioning to dolutegravir-containing regimens is recommended. The aim of this study was to assess whether introducing viral load testing to inform new nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) for children with HIV and viraemia alongside dolutegravir-based ART is beneficial and of good economic value.

Methods: We used the Cost-Effectiveness of Preventing AIDS Complications-Pediatric model to project clinical and cost implications of three strategies among a simulated cohort of South African children aged 8 years with HIV receiving abacavir-lamivudine-efavirenz: (1) continue current ART (no dolutegravir; abacavir-lamivudine-efavirenz); (2) transition all children with HIV to dolutegravir, keeping current NRTIs (dolutegravir; abacavir-lamivudine-dolutegravir); or (3) transition to dolutegravir based on viral load testing (viral load plus dolutegravir), keeping current NRTIs if virologically suppressed (abacavir-lamivudine-dolutegravir, 70% of cohort) or switching abacavir to zidovudine (zidovudine) if viraemic (zidovudine-lamivudine-dolutegravir, 30%).

Using Joint Longitudinal and Time-to-Event Models to Improve the Parameterization of Chronic Disease Microsimulation Models: an Application to Cardiovascular Disease.

Background: Chronic disease microsimulation models often simulate disease incidence as a function of risk factors that evolve over time (e.g., blood pressure increasing with age) in order to facilitate decision analyses of different disease screening and prevention strategies.

Tuberculosis Preventive Treatment for Pregnant People With Human Immunodeficiency Virus in South Africa: A Modeling Analysis of Clinical Benefits and Risks.

Background: Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH.

Methods: We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis).

A Qualitative Assessment of South Africa's Central Chronic Medication Dispensing and Distribution Program for Differentiated Antiretroviral Therapy Delivery in Umlazi Township, South Africa: Client Perspectives after 12 Months of Participation.

South Africa's Central Chronic Medicine Dispensing and Distribution (CCMDD) program provides community-based medication delivery for clinically stable people with HIV (PWH) on antiretroviral therapy (ART). To evaluate CCMDD implementation, we conducted semi-structured interviews with 60 PWH enrolled in CCMDD for at least 12 months. In a directed content analysis based on the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework, key themes were compared with qualitative data collected from PWH enrolling in CCMDD at an earlier time-point.

Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa.

Background: It is unclear how rising obesity among people with HIV (PWH) impacts their risk of type 2 diabetes mellitus (diabetes). We examined associations between HIV, prevalent diabetes and adiposity among South African PWH and their peers without HIV (PWOH).

Methods: HIV status was ascertained by antibody testing.

Disparities in Tobacco Smoking and Risk of Cardiovascular Disease in People With Low Socioeconomic Status or Serious Psychological Distress: A Simulation Analysis.

Introduction: High tobacco smoking prevalence in people with low SES or serious psychological distress in the U.S. may increase cardiovascular disease risk among these marginalized subpopulations.

Racial and Ethnic Disparities in Hepatitis C Care in Reproductive-Aged Women With Opioid Use Disorder.

Background: In the United States, hepatitis C virus (HCV) diagnoses among reproductive-aged women are increasing amidst the ongoing opioid and drug overdose epidemic. While previous studies document racial and ethnic disparities in HCV testing and treatment in largely male populations, to our knowledge no national studies analyze these outcomes in reproductive-aged women with opioid use disorder (OUD).

Methods: We analyzed data from a cohort of reproductive-aged women (aged 15-44 years) with diagnosed OUD captured in the TriNetX Research Network, a network of electronic health records from across the United States.

Impact of postpartum maternal fever or hypothermia on newborn and early infant illness and death in Southwestern Uganda.

Background: Deaths occurring during the neonatal period contribute close to half of under-five mortality rate (U5MR); over 80% of these deaths occur in low- and middle-income countries (LMICs). Poor maternal antepartum and perinatal health predisposes newborns to low birth weight (LBW), birth asphyxia, and infections which increase the newborn's risk of death.

Methods: The objective of the study was to assess the association between abnormal postpartum maternal temperature and early infant outcomes, specifically illness requiring hospitalisation or leading to death between birth and six weeks' age.

Public Health Impact of FDA's Request for Additional Safety Data on Cytisine for Tobacco Cessation.

Importance: No new tobacco cessation medication has been licensed in the US since 2006. Cytisine, a plant-based partial agonist of nicotinic acetylcholine receptors, has demonstrated safety and efficacy in several randomized clinical trials and is currently available in many countries. However, the drug is not commercially available in the US.

Racial and Ethnic Disparities in Testing of Hepatitis C Virus-Exposed Children Across the United States.

Background: Despite rising hepatitis C virus (HCV) prevalence among pregnant individuals in the United States, HCV testing among exposed infants remains low. Although recent guidelines recommend early ribonucleic acid (RNA) testing for HCV-exposed children to help improve testing rates, national studies describing factors associated with HCV testing and the type of testing completed are lacking.

Methods: In this retrospective national study, we characterized HCV testing and care among HCV-exposed infants born between 2010 and 2020 captured in the electronic health record-based TriNetX Research Network.

Prevalence and Correlates of Frailty Among Older People With and Without HIV in Rural Uganda.

Background: The relationship between HIV and frailty, a predictor of poor outcomes in the face of stressors, remains unknown in older people in sub-Saharan Africa.

Methods: We analyzed data from the Quality of Life and Ageing with HIV in Rural Uganda cohort study to estimate the prevalence and correlates of frailty among older people with HIV (PWH) on long-term antiretroviral therapy and among age- and sex-matched HIV-uninfected comparators. Frailty was defined as a self-report of 3 or 4 (and pre-frailty as 1 or 2) of the following phenotypic variables: weight loss, exhaustion, low activity, and slowness.