Publications by authors named "Emma Spencer"

50 Publications

Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences.

J Rural Health 2021 Dec 3. Epub 2021 Dec 3.

HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, Tallahassee, Florida, USA.

Purpose: To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability.

Methods: Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed.

Findings: The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01).

Conclusions: In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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http://dx.doi.org/10.1111/jrh.12636DOI Listing
December 2021

Circulating protein carbonyls are specifically elevated in critically ill patients with pneumonia relative to other sources of sepsis.

Free Radic Biol Med 2021 Nov 21. Epub 2021 Nov 21.

Department of Pathology and Biomedical Science, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand. Electronic address:

Background: Septic shock is a life-threatening dysregulated response to severe infection and is associated with elevated oxidative stress. We aimed to assess protein carbonyls in critically ill patients with different sources of sepsis and determine the effect of vitamin C intervention on protein carbonyl concentrations.

Methods: Critically ill patients with septic shock (n = 40) were recruited, and sources of sepsis and ICU severity scores were recorded. The patients were randomised to receive either intravenous vitamin C (100 mg/kg body weight/day) or placebo infusions. Blood samples were collected at baseline and daily for up to three days for measurement of cell counts, vitamin C concentrations, protein carbonyls, C-reactive protein, and myeloperoxidase concentrations.

Results: Protein carbonyl concentrations increased 2.2-fold in the cohort over the duration of the study (from 169 to 369 pmol/mg protein; p = 0.03). There were significant correlations between protein carbonyl concentrations and ICU severity scores (APACHE III r = 0.47 and SOFA r = 0.37; p < 0.05) at baseline. At study admission, the patients with pneumonia had nearly 3-fold higher protein carbonyl concentrations relative to the patients with other sources of sepsis (435 vs 157 pmol/mg protein, p < 0.0001). The septic patients had deficient vitamin C status at baseline (9.8 ± 1.4 μmol/L). This increased to 456 ± 90 μmol/L following three days of intravenous vitamin C intervention. Vitamin C intervention did not attenuate the increase in protein carbonyl concentrations.

Conclusions: Circulating protein carbonyls are specifically elevated in critically ill patients with pneumonia relative to other sources of sepsis. The reasons for this are currently unclear and may indicate a mechanism unique to pulmonary sources of sepsis. Intravenous vitamin C administration did not attenuate the increase in protein carbonyls over time.
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http://dx.doi.org/10.1016/j.freeradbiomed.2021.11.029DOI Listing
November 2021

Neutrophils Isolated from Septic Patients Exhibit Elevated Uptake of Vitamin C and Normal Intracellular Concentrations despite a Low Vitamin C Milieu.

Antioxidants (Basel) 2021 Oct 13;10(10). Epub 2021 Oct 13.

Department of Intensive Care Medicine, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand.

Vitamin C (ascorbate) plays an important role in neutrophil function and is accumulated by the cells either directly via vitamin C transporters (SVCT) or indirectly following oxidation to dehydroascorbic acid. Septic patients are known to have significantly depleted plasma ascorbate status, but little is known about the ascorbate content of their circulating cells. Therefore, we assessed the ascorbate concentrations of plasma, leukocytes and erythrocytes from septic patients and compared these to healthy controls. Non-fasting blood samples were collected from healthy volunteers ( = 20) and critically ill patients with sepsis ( = 18). The ascorbate content of the plasma and isolated neutrophils and erythrocytes was measured using HPLC and plasma myeloperoxidase concentrations were determined using ELISA. Ex vivo uptake of ascorbate and dehydroascorbic acid by neutrophils from septic patients was also assessed. Neutrophils isolated from septic patients had comparable intracellular ascorbate content to healthy volunteers (0.33 vs. 0.35 nmol/10 cells, > 0.05), despite significantly lower plasma concentrations than the healthy controls (14 vs. 88 µmol/L, < 0.001). In contrast, erythrocytes from septic patients had significantly lower intracellular ascorbate content than healthy controls (30 vs. 69 µmol/L, = 0.002), although this was 2.2-fold higher than the matched plasma concentrations in the patients ( = 0.008). Higher concentrations of myeloperoxidase, a source of reactive oxygen species, were observed in the septic patients relative to healthy controls (194 vs. 14 mg/mL, < 0.0001). In contrast to neutrophils from healthy volunteers, the neutrophils from septic patients demonstrated elevated uptake of extracellular ascorbate. Overall, neutrophils from septic patients exhibited comparable intracellular ascorbate content to those from healthy controls, despite the patients presenting with hypovitaminosis C. The mechanisms involved are currently uncertain, but could include increased generation of dehydroascorbic acid in septic patients, enhanced basal activation of their neutrophils or upregulation of their vitamin C transporters.
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http://dx.doi.org/10.3390/antiox10101607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533547PMC
October 2021

SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study.

PLoS One 2021 7;16(9):e0255401. Epub 2021 Sep 7.

Australian Government Department of Health, Canberra, Australian Capital Territory, Australia.

Background: Prolonged periods of confined living on a cruise ship increase the risk for respiratory disease transmission. We describe the epidemiology and clinical characteristics of a SARS-CoV-2 outbreak in Australian passengers on the Diamond Princess cruise ship and provide recommendations to mitigate future cruise ship outbreaks.

Methods: We conducted a retrospective cohort study of Australian passengers who travelled on the Diamond Princess from 20 January until 4 February 2020 and were either hospitalised, remained in Japan or repatriated. The main outcome measures included an epidemic curve, demographics, symptoms, clinical and radiological signs, risk factors and length of time to clear infection.

Results: Among 223 Australian passengers, 56 were confirmed SARS-CoV-2 positive. Forty-nine cases had data available and of these over 70% had symptoms consistent with COVID-19. Of symptomatic cases, 17% showed signs and symptoms before the ship implemented quarantine and a further two-thirds had symptoms within one incubation period of quarantine commencing. Prior to ship-based quarantine, exposure to a close contact or cabin mate later confirmed SARS-CoV-2 positive was associated with a 3.78 fold (95% CI, 2.24-6.37) higher risk of COVID-19 acquisition compared to non-exposed passengers. Exposure to a positive cabin mate during the ship's quarantine carried a relative risk of 6.18 (95% CI, 1.96-19.46) of developing COVID-19. Persistently asymptomatic cases represented 29% of total cases. The median time to the first of two consecutive negative PCR-based SARS-CoV-2 assays was 13 days for asymptomatic cases and 19 days for symptomatic cases (p = 0.002).

Conclusion: Ship based quarantine was effective at reducing transmission of SARS-CoV-2 amongst Australian passengers, but the risk of infection was higher if an individual shared a cabin or was a close contact of a confirmed case. Managing COVID-19 in cruise ship passengers is challenging and requires enhanced health measures and access to onshore quarantine and isolation facilities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255401PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423262PMC
September 2021

Functional traits driving species role in the structure of terrestrial vertebrate scavenger networks.

Ecology 2021 12 28;102(12):e03519. Epub 2021 Sep 28.

North Carolina Zoo, 4401 Zoo Parkway, Asheboro, North Carolina, 27205, USA.

Species assemblages often have a non-random nested organization, which in vertebrate scavenger (carrion-consuming) assemblages is thought to be driven by facilitation in competitive environments. However, not all scavenger species play the same role in maintaining assemblage structure, as some species are obligate scavengers (i.e., vultures) and others are facultative, scavenging opportunistically. We used a database with 177 vertebrate scavenger species from 53 assemblages in 22 countries across five continents to identify which functional traits of scavenger species are key to maintaining the scavenging network structure. We used network analyses to relate ten traits hypothesized to affect assemblage structure with the "role" of each species in the scavenging assemblage in which it appeared. We characterized the role of a species in terms of both the proportion of monitored carcasses on which that species scavenged, or scavenging breadth (i.e., the species "normalized degree"), and the role of that species in the nested structure of the assemblage (i.e., the species "paired nested degree"), therefore identifying possible facilitative interactions among species. We found that species with high olfactory acuity, social foragers, and obligate scavengers had the widest scavenging breadth. We also found that social foragers had a large paired nested degree in scavenger assemblages, probably because their presence is easier to detect by other species to signal carcass occurrence. Our study highlights differences in the functional roles of scavenger species and can be used to identify key species for targeted conservation to maintain the ecological function of scavenger assemblages.
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http://dx.doi.org/10.1002/ecy.3519DOI Listing
December 2021

The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation.

Lancet Infect Dis 2021 Dec 22;21(12):1737-1746. Epub 2021 Jul 22.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia.

Background: The global distribution of melioidosis is under considerable scrutiny, with both unmasking of endemic disease in African and Pacific nations and evidence of more recent dispersal in the Americas. Because of the high incidence of disease in tropical northern Australia, The Darwin Prospective Melioidosis Study commenced in October, 1989. We present epidemiology, clinical features, outcomes, and bacterial genomics from this 30-year study, highlighting changes in the past decade.

Methods: The present study was a prospective analysis of epidemiological, clinical, and laboratory data for all culture-confirmed melioidosis cases from the tropical Northern Territory of Australia from Oct 1, 1989, until Sept 30, 2019. Cases were identified on the basis of culture-confirmed melioidosis, a laboratory-notifiable disease in the Northern Territory of Australia. Patients who were culture-positive were included in the study. Multivariable analysis determined predictors of clinical presentations and outcome. Incidence, survival, and cluster analyses were facilitated by population and rainfall data and genotyping of Burkholderia pseudomallei, including multilocus sequence typing and whole-genome sequencing.

Findings: There were 1148 individuals with culture-confirmed melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38-60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) Indigenous Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified risk. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100 000 people; the highest annual incidence in Indigenous Australians was 103·6 per 100 000 in 2011-12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the past 5 years. Genotyping of B pseudomallei confirmed case clusters linked to environmental sources and defined evolving and new sequence types.

Interpretation: Melioidosis is an opportunistic infection with a diverse spectrum of clinical presentations and severity. With early diagnosis, specific antimicrobial therapy, and state-of-the-art intensive care, mortality can be reduced to less than 10%. However, mortality remains much higher in the many endemic regions where health resources remain scarce. Genotyping of B pseudomallei informs evolving local and global epidemiology.

Funding: The Australian National Health and Medical Research Council.
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http://dx.doi.org/10.1016/S1473-3099(21)00022-0DOI Listing
December 2021

The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation.

Lancet Infect Dis 2021 Dec 22;21(12):1737-1746. Epub 2021 Jul 22.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia.

Background: The global distribution of melioidosis is under considerable scrutiny, with both unmasking of endemic disease in African and Pacific nations and evidence of more recent dispersal in the Americas. Because of the high incidence of disease in tropical northern Australia, The Darwin Prospective Melioidosis Study commenced in October, 1989. We present epidemiology, clinical features, outcomes, and bacterial genomics from this 30-year study, highlighting changes in the past decade.

Methods: The present study was a prospective analysis of epidemiological, clinical, and laboratory data for all culture-confirmed melioidosis cases from the tropical Northern Territory of Australia from Oct 1, 1989, until Sept 30, 2019. Cases were identified on the basis of culture-confirmed melioidosis, a laboratory-notifiable disease in the Northern Territory of Australia. Patients who were culture-positive were included in the study. Multivariable analysis determined predictors of clinical presentations and outcome. Incidence, survival, and cluster analyses were facilitated by population and rainfall data and genotyping of Burkholderia pseudomallei, including multilocus sequence typing and whole-genome sequencing.

Findings: There were 1148 individuals with culture-confirmed melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38-60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) Indigenous Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified risk. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100 000 people; the highest annual incidence in Indigenous Australians was 103·6 per 100 000 in 2011-12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the past 5 years. Genotyping of B pseudomallei confirmed case clusters linked to environmental sources and defined evolving and new sequence types.

Interpretation: Melioidosis is an opportunistic infection with a diverse spectrum of clinical presentations and severity. With early diagnosis, specific antimicrobial therapy, and state-of-the-art intensive care, mortality can be reduced to less than 10%. However, mortality remains much higher in the many endemic regions where health resources remain scarce. Genotyping of B pseudomallei informs evolving local and global epidemiology.

Funding: The Australian National Health and Medical Research Council.
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http://dx.doi.org/10.1016/S1473-3099(21)00022-0DOI Listing
December 2021

Defining the optimal cut-point of self-reported ART adherence to achieve viral suppression in the era of contemporary HIV therapy: a cross-sectional study.

AIDS Res Ther 2021 06 26;18(1):36. Epub 2021 Jun 26.

SHARC Center for Translational HIV Research, University of Florida, 2004 Mowry Road, Gainesville, 32610, USA.

Background: When considering adherence to antiretroviral therapy (ART) for HIV, many different cut-points are used. The primary goals of this study were to identify a level of self-reported medication adherence that best distinguished HIV viral suppression from non-suppression, and to compare the ability of a single-item and a 3-item adherence questionnaire to predict HIV viral suppression.

Methods: This cross-sectional analysis included 380 persons with HIV (PWH) from the Florida Cohort study who completed a self-reported ART adherence measure within 30-days of having an HIV viral load test. We used Receiver Operating Characteristic (ROC) curve analyses and ROCContrast to compare the ability of a single-item and a 3-item self-reported adherence measure to predict HIV viral suppression (defined as ≤ 200 copies/mL). We used the Youden index and chi square statistics to assess specific cut-points, and repeated the analysis with a different definition of HIV viral suppression (≤ 1000 copies/mL).

Results: The mean percent adherence was 92.4% using the single-item score and 90.4% using the 3-item score; 81.6% had viral suppression. The areas under the curve for the single-item and 3-item adherence measures were generally poor overall and not significantly different from each other (0.589 and 0.580, p = 0.67). The Youden index identified cut-points of 93% and 89% as maximizing the sensitivity and specificity for the single-item and 3-item measures, respectively, whereas a cut-point of 80% on the single-item measure was best able to discriminate those with viral suppression (58% vs. 84%, p < 0.001). Results were similar with viral suppression defined as ≤ 1000 copies/mL.

Conclusions: In this sample of PWH, a single question on medication adherence was as good as a 3-item questionnaire in predicting HIV viral suppression, although neither had good discriminatory ability. A cut-point close to 90% adherence maximized sensitivity and specificity, although viral suppression was very similar for nearly all measures above 80%.
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http://dx.doi.org/10.1186/s12981-021-00358-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234726PMC
June 2021

Monitoring the dead as an ecosystem indicator.

Ecol Evol 2021 Jun 1;11(11):5844-5856. Epub 2021 May 1.

School of Science Federation University Australia Mt Helen VIC Australia.

Dead animal biomass (carrion) is present in all terrestrial ecosystems, and its consumption, decomposition, and dispersal can have measurable effects on vertebrates, invertebrates, microbes, parasites, plants, and soil. But despite the number of studies examining the influence of carrion on food webs, there has been no attempt to identify how general ecological processes around carrion might be used as an ecosystem indicator. We suggest that knowledge of scavenging and decomposition rates, scavenger diversity, abundance, and behavior around carrion, along with assessments of vegetation, soil, microbe, and parasite presence, can be used individually or in combination to understand food web dynamics. Monitoring carrion could also assist comparisons of ecosystem processes among terrestrial landscapes and biomes. Although there is outstanding research needed to fully integrate carrion ecology and monitoring into ecosystem management, we see great potential in using carrion as an ecosystem indicator of an intact and functional food web.
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http://dx.doi.org/10.1002/ece3.7542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207411PMC
June 2021

Incarceration History and HIV Care Among Individuals Living with HIV in Florida, 2014-2018.

AIDS Behav 2021 Oct 6;25(10):3137-3144. Epub 2021 May 6.

Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA.

The present study examines the HIV continuum of care outcomes among people living with HIV (PLWH) who have either recent (< 12-months) or distal (> 12-months) incarceration history compared to those without an incarceration history. A self-administered survey (as part of the Florida Cohort Study (n = 932)) was used to collect data on demographic information, linkage to care, retention in care, HIV medication adherence, viral suppression, and incarceration history. Those with recent incarceration history were least likely to report HIV medication adherence greater than or equal to 95% of the time (χ = 8.79; p = 0.0124), always take their medications as directed (χ = 15.29; p = 0.0005), and to have durable viral suppression (χ = 16.65; p = 0.0002) compared to those distally or never incarcerated. In multivariable analyses, those never and distally incarcerated had greater odds of care linkage ([vs recently incarcerated] AOR = 2.58; CI: 1.31, 5.07; p = 0.0063, AOR = 2.09; CI: 1.11, 3.95; p = 0.0228, respectively). Those never incarcerated had greater odds of taking ART as directed ([vs recently incarcerated] AOR = 2.53; CI: 1.23 - 5.19; p = 0.0116). PLWH with an incarceration history may need more on-going monitoring and follow-up HIV care than those without previous incarceration regardless of when incarceration occurred.
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http://dx.doi.org/10.1007/s10461-021-03250-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419071PMC
October 2021

Peroxiredoxin 2 oxidation reveals hydrogen peroxide generation within erythrocytes during high-dose vitamin C administration.

Redox Biol 2021 07 17;43:101980. Epub 2021 Apr 17.

Centre for Free Radical Research, Department of Pathology & Biomedical Science, University of Otago, Christchurch, New Zealand. Electronic address:

Intravenous infusion of high dose (>10 g) vitamin C (IVC) is a common alternative cancer therapy. IVC results in millimolar levels of circulating ascorbate, which is proposed to generate cytotoxic quantities of HO in the presence of transition metal ions. In this study we report on the in vitro and in vivo effects of millimolar ascorbate on erythrocytes. Addition of ascorbate to whole blood increased erythrocyte intracellular ascorbate approximately 35-fold. Within 10 min of ascorbate addition, we detected increased oxidation of erythrocyte peroxiredoxin 2 (Prx2), a major thiol antioxidant protein and a sensitive marker of HO production. Up to 50% of Prx2 was present in the oxidised form after 60 min. The presence of extracellular catalase, removal of plasma or the addition of a metal chelator did not prevent ascorbate-induced Prx2 oxidation, suggesting that the HO responsible for Prx2 oxidation was generated within the erythrocyte. Ascorbate is known to increase the rate of haemoglobin autoxidation and HO production. Through spectral monitoring of oxidised haemoglobin we estimated a generation rate of 15 μM HO/min inside erythrocytes. We also investigated changes in erythrocyte ascorbate concentration and Prx2 oxidation following IVC infusion in a cohort of patients with cancer. Plasma ascorbate levels ranged from 7.8 to 35 mM immediately post infusion, while erythrocyte ascorbate levels reached 1.5-3.4 mM 4 h after beginning infusion. Transient oxidation of erythrocyte Prx2 was observed. We conclude that erythrocytes accumulate ascorbate during IVC infusion, providing a significant reservoir of ascorbate, and this ascorbate increases HO generation within the cells. The consequence of increased erythrocyte Prx2 oxidation warrants further investigation.
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http://dx.doi.org/10.1016/j.redox.2021.101980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099772PMC
July 2021

SARS-COV-2 ANTIBODY PREVALENCE AMONG HEALTHCARE WORKERS AND FIRST RESPONDERS, FLORIDA, MAY-JUNE 2020.

Fla Public Health Rev 2021 Feb;18(1):1-10

Florida Department of Health, Tallahassee, FL.

Background: The SARS-CoV-2 virus responsible for severe respiratory infection associated with coronavirus disease 2019 (COVID-19) was first confirmed in Florida on March 1, 2020. Responding to the pandemic, multi-agency collaborative partnerships put in place actions integrating point-of-care antibody testing at established large-scale COVID-19 testing sites where the baseline seropositivity of COVID-19 in health care workers and first responders in Florida at the start of the pandemic was established.

Purpose: Determine the seropositivity of healthcare workers and first responders at five drive thru testing sites using a rapid SARS-CoV-2 antibody test in Florida from May 6 through June 3, 2020.

Methods: The first drive-thru SARS-CoV-2 antibody test site was opened at Miami Hard Rock Stadium, May 6, 2020. Testing expanded to three additional sites on May 9, 2020: Jacksonville, Orlando, and Palm Beach. The fifth and final site, Miami Beach, began testing on May 21, 2020. Healthcare workers and first responder's self-seeking SARS-CoV-2 testing were designated for antibody testing and completed a laboratory collection form onsite for the point-of-care test. All testing was performed on whole blood specimens (obtained by venipuncture) using the Cellex Inc. qSARS-CoV-2 IgG/IgM Rapid Test. Seropositivity was assessed by univariate analysis and by logistic regression including the covariates age, sex, race/ethnicity, and testing location.

Results And Discussion: As of June 3, 2020, of 5,779 healthcare workers and first responders tested, 4.1% were seropositive (range 2.6-8.2%). SARS-COV-2 antibody tests had higher odds of being positive for persons testing at the Miami Hard Rock Stadium (aOR 2.24 [95% C.I. 1.48-3.39]), persons of Haitian/Creole ethnicity (aOR 3.28 [95% C.I. 1.23-8.72]), Hispanic/Latino(a) ethnicity (aOR 2.17 [95% C.I. 1.50-3.13], and Black non-Hispanic persons (aOR 1.63 [95% C.I. 1.08-2.46]). SARS-COV-2 antibody prevalence among first responders and healthcare workers in five sites in Florida varied by race and ethnicity and by testing location.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040388PMC
February 2021

An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs.

Int J Drug Policy 2021 08 31;94:103194. Epub 2021 Mar 31.

Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Background: People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored.

Methods: We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%.

Results: In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point.

Conclusion: Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
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http://dx.doi.org/10.1016/j.drugpo.2021.103194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608566PMC
August 2021

Pre-exposure Prophylaxis Use and Detected Sexually Transmitted Infections Among Men Who Have Sex With Men in the United States-National HIV Behavioral Surveillance, 5 US Cities, 2017.

J Acquir Immune Defic Syndr 2020 12;85(4):430-435

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background: Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) may be at high risk for bacterial sexually transmitted infections (STIs). We examined the prevalence of extragenital gonorrhea and chlamydia by PrEP status among a multisite sample of US MSM.

Methods: MSM aged ≥18 years were recruited through venue-based sampling to participate in the 2017 National HIV Behavioral Surveillance. In 5 cities (San Francisco, Washington DC, New York City, Miami, and Houston), participants completed a questionnaire, HIV testing, and pharyngeal and rectal STI specimen self-collection. We measured prevalence of pharyngeal and rectal gonorrhea and chlamydia among self-reported non-HIV-positive MSM who reported using or not using PrEP in the previous 12 months.

Results: Overall, 29.6% (481/1627) of non-HIV-positive MSM reported PrEP use in the past year. MSM who reported PrEP use were more likely to have any STI (ie, extragenital gonorrhea and/or chlamydia) than MSM not on PrEP [14.6% vs. 12.0%, adjusted prevalence ratio (aPR) = 1.5, 95% confidence interval (CI) : 1.1 to 2.0], reflecting differences in rectal chlamydia prevalence (8.7% vs. 6.0%, aPR = 1.6, 95% CI: 1.1 to 2.4). PrEP use was not associated with pharyngeal chlamydia, pharyngeal gonorrhea, or rectal gonorrhea.

Conclusions: The prevalence of extragenital STI was high for both MSM on PrEP and those not on PrEP in the past year. MSM on PrEP were more likely to have rectal chlamydia but not pharyngeal STIs or rectal gonorrhea. Our findings support regular STI testing at exposed anatomic sites as recommended for sexually active MSM, including those on PrEP.
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http://dx.doi.org/10.1097/QAI.0000000000002482DOI Listing
December 2020

Positive Association of Ascorbate and Inverse Association of Urate with Cognitive Function in People with Parkinson's Disease.

Antioxidants (Basel) 2020 Sep 23;9(10). Epub 2020 Sep 23.

Nutrition in Medicine Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.

Oxidative stress is thought to contribute to the aetiology of neurological disorders such as Parkinson's disease. Ascorbate (vitamin C) is a potent antioxidant and is associated with neurological and cognitive function. In this study we assessed the ascorbate status of a cohort of people with Parkinson's disease ( = 215), aged 50-90 years, compared with a cohort of age matched healthy controls ( = 48). The study sample's cognitive status ranged from normal to mild cognitive impairment and dementia. There was no difference between the Parkinson's disease and healthy control groups with respect to mean ascorbate status, however, a higher proportion of participants with Parkinson's disease had hypovitaminosis C (i.e., <23 μmol/L) compared with healthy controls (20% vs. 8%, respectively). Within the Parkinson's disease group, Montreal Cognitive Assessment (MoCA) scores correlated positively with ascorbate concentrations, with higher ascorbate status associated with better cognitive function ( = 0.14, = 0.045). Participants with hypovitaminosis C had significantly lower MoCA scores relative to participants with ascorbate concentrations >23 µmol/L ( = 0.014). Ascorbate concentrations were significantly lower in the cognitively impaired subgroup compared with the normal cognition subgroup in the Parkinson's disease cohort ( = 0.03). In contrast, urate showed an inverse correlation with cognitive function ( = -0.19, = 0.007), with higher urate concentrations observed in the cognitively impaired subgroup compared with the normal cognition subgroup ( = 0.015). There was an inverse association between ascorbate status and urate concentrations ( = -0.15, = 0.017). Plasma protein carbonyls, a measure of systemic oxidative stress, were not significantly different between the Parkinson's disease cohort and healthy controls, and there was no association with cognitive function ( = 0.09, = 0.19) or with ascorbate status ( = -0.05, = 0.45). Overall, our study showed ascorbate status was positively associated with cognitive function in Parkinson's disease, suggesting that longitudinal studies investigating the temporal sequence of cognitive decline and ascorbate status are warranted.
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http://dx.doi.org/10.3390/antiox9100906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598173PMC
September 2020

KiwiC for Vitality: Results of a Randomized Placebo-Controlled Trial Testing the Effects of Kiwifruit or Vitamin C Tablets on Vitality in Adults with Low Vitamin C Levels.

Nutrients 2020 Sep 22;12(9). Epub 2020 Sep 22.

Centre for Free Radical Research, Department of Pathology and Biomedical Science, University of Otago, Christchurch 8140, New Zealand.

Consumption of vitamin C-rich fruit and vegetables has been associated with greater feelings of vitality. However, these associations have rarely been tested in randomized controlled trials. The aim of the current study was to test the effects of eating a vitamin C-rich food (kiwifruit) on subjective vitality and whether effects are driven by vitamin C. Young adults ( = 167, 61.1% female, aged 18-35) with plasma vitamin C <40 µmol/L were randomized into three intervention conditions: kiwifruit (2 SunGold™ kiwifruit/day), vitamin C (250 mg tablet/day), placebo (1 tablet/day). The trial consisted of a two-week lead-in, four-week intervention, and two-week washout. Plasma vitamin C and vitality questionnaires (total mood disturbance, fatigue, and well-being) were measured fortnightly. Self-reported sleep quality and physical activity were measured every second day through smartphone surveys. Nutritional confounds were assessed using a three-day food diary during each study phase. Plasma vitamin C reached saturation levels within two weeks for the kiwifruit and vitamin C groups. Participants consuming kiwifruit showed significantly improved mood and well-being during the intervention period; improvements in well-being were sustained during washout. Decreased fatigue and increased well-being were observed following intake of vitamin C alone, but only for participants with consistently low vitamin C levels during lead-in. Diet records showed that participants consuming kiwifruit reduced their fat intake during the intervention period. Intervention effects remained significant when adjusting for age and ethnicity, and were not explained by sleep quality, physical activity, BMI, or other dietary patterns, including fat intake. There were no changes in plasma vitamin C status or vitality in the placebo group. Whole food consumption of kiwifruit improved subjective vitality in adults with low vitamin C status. Similar, but not identical, changes were found for vitamin C tablets suggesting that additional properties of kiwifruit may contribute to improved vitality.
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http://dx.doi.org/10.3390/nu12092898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551849PMC
September 2020

Syphilitic Reinfections During the Same Pregnancy-Florida, 2018.

Sex Transm Dis 2021 05;48(5):e52-e55

From the Centers for Disease Control and Prevention, Atlanta, GA.

Abstract: We reviewed all cases of syphilis reported among pregnant women in Florida in 2018 for syphilitic reinfection. Nineteen (7.3%) of 261 pregnant women with syphilis were reported as reinfected during the same pregnancy. Timely rescreening and treatment prevented 6 (31.6%) of 19 reinfected women from delivering infants with congenital syphilis.
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http://dx.doi.org/10.1097/OLQ.0000000000001298DOI Listing
May 2021

Employing Molecular Phylodynamic Methods to Identify and Forecast HIV Transmission Clusters in Public Health Settings: A Qualitative Study.

Viruses 2020 08 22;12(9). Epub 2020 Aug 22.

Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA.

Molecular HIV surveillance is a promising public health strategy for curbing the HIV epidemic. Clustering technologies used by health departments to date are limited in their ability to infer/forecast cluster growth trajectories. Resolution of the spatiotemporal dynamics of clusters, through phylodynamic and phylogeographic modelling, is one potential strategy to develop a forecasting tool; however, the projected utility of this approach needs assessment. Prior to incorporating novel phylodynamic-based molecular surveillance tools, we sought to identify possible issues related to their feasibility, acceptability, interpretation, and utility. Qualitative data were collected via focus groups among field experts ( = 17, 52.9% female) using semi-structured, open-ended questions. Data were coded using an iterative process, first through the development of provisional themes and subthemes, followed by independent line-by-line coding by two coders. Most participants routinely used molecular methods for HIV surveillance. All agreed that linking molecular sequences to epidemiological data is important for improving HIV surveillance. We found that, in addition to methodological challenges, a variety of implementation barriers are expected in relation to the uptake of phylodynamic methods for HIV surveillance. The participants identified several opportunities to enhance current methods, as well as increase the usability and utility of promising works-in-progress.
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http://dx.doi.org/10.3390/v12090921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551766PMC
August 2020

The effect of conservative oxygen therapy on systemic biomarkers of oxidative stress in critically ill patients.

Free Radic Biol Med 2020 11 5;160:13-18. Epub 2020 Aug 5.

Medical Research Institute of New Zealand, Wellington, New Zealand; Wellington Hospital Intensive Care Unit, Wellington, New Zealand.

Background: Supplemental oxygen is delivered to critically ill patients who require mechanical ventilation. Oxidative stress is a potential complication of oxygen therapy, resulting in damage to essential biomolecules such as proteins, lipids, and nucleic acids. Whether plasma levels of oxidative stress biomarkers vary based on how liberally oxygen therapy is applied during mechanical ventilation is unknown.

Methods: We carried out an oxidative stress substudy nested within a large multi-centre randomized controlled trial in which critically ill adults were randomized to receive either conservative oxygen therapy or standard oxygen therapy. Blood samples were collected at enrolment, and daily thereafter for up to three days. The antioxidant ascorbate (vitamin C) was assessed using HPLC with electrochemical detection and protein oxidation using a sensitive protein carbonyl ELISA. We also assessed whether critically ill patients with different disease states exhibited varying levels of oxidative stress biomarkers.

Results: A total of 125 patients were included. Mean ascorbate concentrations decreased over time (from 25 ± 9 μmol/L to 14 ± 2 μmol/L, p < 0.001), however, there was no significant difference between the conservative oxygen group and standard care (p = 0.2), despite a significantly lower partial pressure of oxygen (PaO) in the conservative oxygen group (p = 0.03). Protein carbonyl concentrations increased over time (from 208 ± 30 μmol/L to 249 ± 29 μmol/L; p = 0.016), however, there was no significant difference between the conservative and standard oxygen groups (p = 0.3). Patients with sepsis had significantly higher protein carbonyl concentrations than the other critically ill patients (293 ± 92 μmol/L vs 184 ± 24 μmol/L, p = 0.03). Within the septic subgroup, there were no significant differences in protein carbonyl concentrations between the two interventions (p = 0.4).

Conclusions: Conservative oxygen therapy does not alter systemic markers of oxidative stress in critically ill ventilated patients compared with standard oxygen therapy. Patients with sepsis exhibited elevated protein carbonyls compared with the other critically ill patients implying increased oxidative stress in this patient subgroup.
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http://dx.doi.org/10.1016/j.freeradbiomed.2020.06.018DOI Listing
November 2020

Low Vitamin C Status in Patients with Cancer Is Associated with Patient and Tumor Characteristics.

Nutrients 2020 Aug 5;12(8). Epub 2020 Aug 5.

Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch 8011, New Zealand.

Vitamin C (ascorbate) acts as an antioxidant and enzyme cofactor, and plays a vital role in human health. Vitamin C status can be affected by illness, with low levels being associated with disease due to accelerated turnover. However, robust data on the ascorbate status of patients with cancer are sparse. This study aimed to accurately measure ascorbate concentrations in plasma from patients with cancer, and determine associations with patient or tumor characteristics. We recruited 150 fasting patients with cancer (of 199 total recruited) from two cohorts, either prior to cancer surgery or during cancer chemo- or immunotherapy. A significant number of patients with cancer had inadequate plasma ascorbate concentrations. Low plasma status was more prevalent in patients undergoing cancer therapy. Ascorbate status was higher in women than in men, and exercising patients had higher levels than sedentary patients. Our study may prompt increased vigilance of ascorbate status in cancer patients.
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http://dx.doi.org/10.3390/nu12082338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468872PMC
August 2020

Sociodemographic, Ecological, and Spatiotemporal Factors Associated with Human Immunodeficiency Virus Drug Resistance in Florida: A Retrospective Analysis.

J Infect Dis 2021 03;223(5):866-875

Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA.

Background: Persons living with human immunodeficiency virus (HIV) with resistance to antiretroviral therapy are vulnerable to adverse HIV-related health outcomes and can contribute to transmission of HIV drug resistance (HIVDR) when nonvirally suppressed. The degree to which HIVDR contributes to disease burden in Florida-the US state with the highest HIV incidence- is unknown.

Methods: We explored sociodemographic, ecological, and spatiotemporal associations of HIVDR. HIV-1 sequences (n = 34 447) collected during 2012-2017 were obtained from the Florida Department of Health. HIVDR was categorized by resistance class, including resistance to nucleoside reverse-transcriptase , nonnucleoside reverse-transcriptase , protease , and integrase inhibitors. Multidrug resistance and transmitted drug resistance were also evaluated. Multivariable fixed-effects logistic regression models were fitted to associate individual- and county-level sociodemographic and ecological health indicators with HIVDR.

Results: The HIVDR prevalence was 19.2% (nucleoside reverse-transcriptase inhibitor resistance), 29.7% (nonnucleoside reverse-transcriptase inhibitor resistance), 6.6% (protease inhibitor resistance), 23.5% (transmitted drug resistance), 13.2% (multidrug resistance), and 8.2% (integrase strand transfer inhibitor resistance), with significant variation by Florida county. Individuals who were older, black, or acquired HIV through mother-to-child transmission had significantly higher odds of HIVDR. HIVDR was linked to counties with lower socioeconomic status, higher rates of unemployment, and poor mental health.

Conclusions: Our findings indicate that HIVDR prevalence is higher in Florida than aggregate North American estimates with significant geographic and socioecological heterogeneity.
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http://dx.doi.org/10.1093/infdis/jiaa413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938178PMC
March 2021

Health Care-Specific Enacted HIV-Related Stigma's Association with Antiretroviral Therapy Adherence and Viral Suppression Among People Living with HIV in Florida.

AIDS Patient Care STDS 2020 07;34(7):316-326

Department of Epidemiology, Florida International University, Miami, Florida, USA.

Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample ( = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95),  = 0.198; AOR = 1.17, CI: (0.65-2.11),  = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42),  = 0.702; AOR = 1.16, CI: (0.64-2.13),  = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20),  = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92),  = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.
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http://dx.doi.org/10.1089/apc.2020.0031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370977PMC
July 2020

Patients Undergoing Myeloablative Chemotherapy and Hematopoietic Stem Cell Transplantation Exhibit Depleted Vitamin C Status in Association with Febrile Neutropenia.

Nutrients 2020 Jun 24;12(6). Epub 2020 Jun 24.

The Infection Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.

Patients undergoing myeloablative chemotherapy and hematopoietic stem cell transplantation (HSCT) experience profound neutropenia and vulnerability to infection. Previous research has indicated that patients with infections have depleted vitamin C status. In this study, we recruited 38 patients with hematopoietic cancer who were undergoing conditioning chemotherapy and HSCT. Blood samples were collected prior to transplantation, at one week, two weeks and four weeks following transplantation. Vitamin C status and biomarkers of inflammation (C-reactive protein) and oxidative stress (protein carbonyls and thiobarbituric acid reactive substances) were assessed in association with febrile neutropenia. The vitamin C status of the study participants decreased from 44 ± 7 µmol/L to 29 ± 5 µmol/L by week one ( = 0.001) and 19 ± 6 µmol/L by week two ( < 0.001), by which time all of the participants had undergone a febrile episode. By week four, vitamin C status had increased to 37 ± 10 µmol/L ( = 0.1). Pre-transplantation, the cohort comprised 19% with hypovitaminosis C (i.e., <23 µmol/L) and 8% with deficiency (i.e., <11 µmol/L). At week one, those with hypovitaminosis C had increased to 38%, and at week two, 72% had hypovitaminosis C, and 34% had outright deficiency. C-reactive protein concentrations increased from 3.5 ± 1.8 mg/L to 20 ± 11 mg/L at week one ( = 0.002), and 119 ± 25 mg/L at week two ( < 0.001), corresponding to the development of febrile neutropenia in the patients. By week four, these values had dropped to 17 ± 8 mg/L ( < 0.001). There was a significant inverse correlation between C-reactive protein concentrations and vitamin C status ( = -0.424, < 0.001). Lipid oxidation (thiobarbituric acid reactive substances (TBARS)) increased significantly from 2.0 ± 0.3 µmol/L at baseline to 3.3 ± 0.6 µmol/L by week one ( < 0.001), and remained elevated at week two ( = 0.003), returning to baseline concentrations by week four ( = 0.3). Overall, the lowest mean vitamin C values (recorded at week two) corresponded with the highest mean C-reactive protein values and lowest mean neutrophil counts. Thus, depleted vitamin C status in the HSCT patients coincides with febrile neutropenia and elevated inflammation and oxidative stress.
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http://dx.doi.org/10.3390/nu12061879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353216PMC
June 2020

Opening the lines of communication: towards shared decision making and improved end-of-life care in the Top End.

Med J Aust 2020 07 21;213(1):10-11.e1. Epub 2020 Jun 21.

Royal Darwin Hospital, Darwin, NT.

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http://dx.doi.org/10.5694/mja2.50656DOI Listing
July 2020

Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida.

AIDS Behav 2021 Jan;25(1):93-103

Department of Epidemiology, Florida International University, 11200 SW 8th St. AHC5-505, Miami, FL, 33199, USA.

Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI]  3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.
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http://dx.doi.org/10.1007/s10461-020-02948-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749818PMC
January 2021

Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015-2017.

AIDS Care 2021 01 28;33(1):131-135. Epub 2020 May 28.

Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.

The study objective was to classify women with newly diagnosed HIV into patterns of retention in care (≥2 HIV care visits ≥3 months apart) and viral suppression over time and identify factors associated with class membership. Florida HIV/AIDS surveillance data were used to conduct Latent Class Analysis to classify women into patterns, and multinomial regression was used to compare the prevalence of class membership by demographic and clinical factors. Four classes were selected based on model fit parameters: (Class 1) consistently retained and suppressed (>90% probability of being retained and suppressed), (Class 2) not consistently retained or suppressed (≤10% probability of being retained and suppressed), (Class 3) increasingly retained and suppressed, and (Class 4) decreasingly retained and suppressed. The proportion of women in each class was 48.6%, 24.9%, 14.3%, and 12.2%, respectively. Women aged 25-34 compared to 35-49 years old, injection drug use mode of exposure, US born, and not linked to care three months post-diagnosis had a lower prevalence of belonging to the consistently retained and suppressed class. Findings may be useful in tailoring and targeting interventions to increase the prevalence of women who are consistently retained in care and virally suppressed.
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http://dx.doi.org/10.1080/09540121.2020.1771264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704763PMC
January 2021

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015-2016.

BMC Public Health 2020 May 19;20(1):723. Epub 2020 May 19.

Center for Latin American Studies, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville, FL, USA.

Background: Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma.

Methods: We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale.

Results: Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined.

Conclusions: The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.
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http://dx.doi.org/10.1186/s12889-020-08891-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236917PMC
May 2020

Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress.

Nutrients 2020 May 6;12(5). Epub 2020 May 6.

The Infection Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand.

Pneumonia is a severe lower respiratory tract infection that is a common complication and a major cause of mortality of the vitamin C-deficiency disease scurvy. This suggests an important link between vitamin C status and lower respiratory tract infections. Due to the paucity of information on the vitamin C status of patients with pneumonia, we assessed the vitamin C status of 50 patients with community-acquired pneumonia and compared these with 50 healthy community controls. The pneumonia cohort comprised 44 patients recruited through the Acute Medical Assessment Unit (AMAU) and 6 patients recruited through the Intensive Care Unit (ICU); mean age 68 ± 17 years, 54% male. Clinical, microbiological and hematological parameters were recorded. Blood samples were tested for vitamin C status using HPLC with electrochemical detection and protein carbonyl concentrations, an established marker of oxidative stress, using ELISA. Patients with pneumonia had depleted vitamin C status compared with healthy controls (23 ± 14 µmol/L vs. 56 ± 24 µmol/L, < 0.001). The more severe patients in the ICU had significantly lower vitamin C status than those recruited through AMAU (11 ± 3 µmol/L vs. 24 ± 14 µmol/L, = 0.02). The pneumonia cohort comprised 62% with hypovitaminosis C and 22% with deficiency, compared with only 8% hypovitaminosis C and no cases of deficiency in the healthy controls. The pneumonia cohort also exhibited significantly elevated protein carbonyl concentrations compared with the healthy controls ( < 0.001), indicating enhanced oxidative stress in the patients. We were able to collect subsequent samples from 28% of the cohort (mean 2.7 ± 1.7 days; range 1-7 days). These showed no significant differences in vitamin C status or protein carbonyl concentrations compared with baseline values ( = 0.6). Overall, the depleted vitamin C status and elevated oxidative stress observed in the patients with pneumonia indicates an enhanced requirement for the vitamin during their illness. Therefore, these patients would likely benefit from additional vitamin C supplementation to restore their blood and tissue levels to optimal. This may decrease excessive oxidative stress and aid in their recovery.
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http://dx.doi.org/10.3390/nu12051318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284353PMC
May 2020

The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

AIDS Care 2021 04 3;33(4):516-524. Epub 2020 Apr 3.

Department of Epidemiology, University of Florida, Gainesville, FL, USA.

In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.
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http://dx.doi.org/10.1080/09540121.2020.1748867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541483PMC
April 2021

Estimating the size of HIV-negative MSM population that would benefit from pre-exposure prophylaxis in Florida.

Ann Epidemiol 2020 04 14;44:52-56. Epub 2020 Feb 14.

Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami; Research Center in Minority Institutions, Florida International University, Miami.

Purpose: This study aimed to estimate the size of the population of men who have sex with men (MSM) in Florida with high-risk behaviors that would indicate eligibility for pre-exposure prophylaxis (PrEP) use.

Methods: Three methods were used to estimate the MSM population. Estimates from the three methods were averaged, and the number of MSM living with HIV in each zone improvement plan (ZIP) code was subtracted.

Results: The average MSM estimate was 1-2184 men (1.5-22.9%) by ZIP code. The size of the MSM population with indications for PrEP use was highest when using estimates of MSM with more than one sex partner in the past year obtained from the National HIV Behavioral Surveillance system and lowest when the MSM estimate was multiplied by 24.7% (percentage of MSM with PrEP indications from other studies).

Conclusion: Areas with high numbers of MSM with PrEP indications could be targeted with information to reduce HIV acquisition.
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http://dx.doi.org/10.1016/j.annepidem.2020.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190453PMC
April 2020
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