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Carvalho TMDS, Laurindo PDSDODC, de Araújo DO, Fonseca RRDS, Laurentino RV, Monteiro JC, Feitosa RNM, da Costa FAM, dos Santos LM, Oliveira-Filho AB, Machado LFA. Exposure to Treponema pallidum among Female Sex Workers: A Retrospective Study Conducted in the State of Pará, Brazilian Amazon. Pathogens 2024; 13:559. [PMID: 39057786 PMCID: PMC11279634 DOI: 10.3390/pathogens13070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Syphilis remains a significant global public health issue, and female sex workers (FSWs) are highly vulnerable to the etiological agent of this disease. This study aimed to describe the prevalence of exposure to Treponema pallidum, as well as the vulnerability factors among FSWs in the state of Pará, Brazilian Amazon. METHODS A cross-sectional, retrospective study involving 360 FSWs from five cities in Pará was conducted from 2005 to 2007. Blood samples were collected for treponemal and non-treponemal testing, and epidemiological information was obtained through interviews. RESULTS The exposure rate to T. pallidum was 37.7% (136/360), and the majority of FSWs had serological results indicating past exposure (21.1%). Among the FSWs exposed to T. pallidum, most of them were single, aged 23 to 42 years old, had less than 8 years of schooling, and had a family income of between 1 and 3 minimum wages. They reported using condoms during sexual intercourse and had no history of sexually transmitted infection (STI). Furthermore, many of the FSWs exposed to T. pallidum reported having more than 20 sexual partners per month, and had partners from other Brazilian states, but not from other countries. An age over 42 years and a reduced level of education were factors associated with exposure to T. pallidum. Finally, a high rate of exposure to T. pallidum among FSWs in the Brazilian state of Pará (from 2005 to 2007) was detected. In later years, epidemiological studies conducted with FSWs recorded that this rate remained high. Measures to control, treat, and prevent syphilis among FSWs were necessary between 2005 and 2007, and they are still imperative today. Actions related to educational programs and STI control, treatment, and prevention measures contained in Brazilian policies aimed at women's health have not changed the vulnerability scenario of FSWs regarding their exposure to T. pallidum, even after 16 years, and must be reviewed and adapted to the conditions of the Brazilian Amazon.
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Affiliation(s)
- Thaís Mayara da Silva Carvalho
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (T.M.d.S.C.); (P.d.S.d.O.d.C.L.); (D.O.d.A.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Paula do Socorro de Oliveira da Costa Laurindo
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (T.M.d.S.C.); (P.d.S.d.O.d.C.L.); (D.O.d.A.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Diogo Oliveira de Araújo
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (T.M.d.S.C.); (P.d.S.d.O.d.C.L.); (D.O.d.A.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Ricardo Roberto de Souza Fonseca
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Rogério Valois Laurentino
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Jacqueline Cortinhas Monteiro
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Rosimar Neris Mantins Feitosa
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Fernando Augusto Miranda da Costa
- Bacteriology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (F.A.M.d.C.); (L.M.d.S.)
| | - Leonardo Miranda dos Santos
- Bacteriology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (F.A.M.d.C.); (L.M.d.S.)
| | - Aldemir Branco Oliveira-Filho
- Study and Research Group on Vulnerable Populations, Institute for Coastal Studies, Federal University of Pará, Bragança 68600-000, PA, Brazil;
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (T.M.d.S.C.); (P.d.S.d.O.d.C.L.); (D.O.d.A.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
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Gunn HJ, Rezvan PH, Fernández MI, Comulada WS. How to apply variable selection machine learning algorithms with multiply imputed data: A missing discussion. Psychol Methods 2023; 28:452-471. [PMID: 35113633 PMCID: PMC10117422 DOI: 10.1037/met0000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychological researchers often use standard linear regression to identify relevant predictors of an outcome of interest, but challenges emerge with incomplete data and growing numbers of candidate predictors. Regularization methods like the LASSO can reduce the risk of overfitting, increase model interpretability, and improve prediction in future samples; however, handling missing data when using regularization-based variable selection methods is complicated. Using listwise deletion or an ad hoc imputation strategy to deal with missing data when using regularization methods can lead to loss of precision, substantial bias, and a reduction in predictive ability. In this tutorial, we describe three approaches for fitting a LASSO when using multiple imputation to handle missing data and illustrate how to implement these approaches in practice with an applied example. We discuss implications of each approach and describe additional research that would help solidify recommendations for best practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Heather J. Gunn
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States
| | - Panteha Hayati Rezvan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Cyrus E, Lama JR, Sanchez J, Sullivan DS, Leon S, Villaran MV, Vagenas P, Vu D, Coudray M, Altice FL. Substance use and other correlates of HIV infection among transwomen and men who have sex with men in Perú: Implications for targeted HIV prevention strategies for transwomen. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001464. [PMID: 36962933 PMCID: PMC10022005 DOI: 10.1371/journal.pgph.0001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023]
Abstract
Characterization of HIV risk factors among transwomen and men who have sex with men (MSM) should be assessed separately and independently. However, due to several constraints, these populations continue to be conflated in clinical research and data. There are limited datasets globally powered to make such comparisons. The study aimed to use one of the largest surveys of transwomen and MSM in Latin America to determine differences in HIV risk and related correlates between the two populations. Secondary data analysis was completed using a cross-sectional biobehavioral survey of 4413 MSM and 714 transwomen living in Perú. Chi Square analysis of selected HIV correlates was conducted to examine differences between transwomen and MSM. Additionally, stratified binary logistic regression was used to split data for further comparative analyses of correlates associated with transwomen and MSM separately. HIV prevalence among transwomen was two-fold greater than among MSM (14.9% vs. 7.0%, p<0.001). Transwomen had a higher prevalence of most HIV risk factors assessed, including presence of alcohol dependence (16.4% vs. 19.0%; p < .001) and drug use in the past 3 months (17.0% vs. 14.9%). MSM were more likely to use marijuana (68.0% vs. 50.0%, p < .001), and transwomen were more likely to engage in inhaled cocaine use (70.0% vs. 51.1%, p < .001). The regression exposed differences in correlates driving sub-epidemics in transwomen vs. MSM, with a trend of substance use increasing HIV risk for transwomen only. Transwomen were more likely to be HIV-infected and had different risk factors from MSM. Targeted prevention strategies are needed for transwomen that are at highest risk. Additionally, further research is needed to determine if these observations in Perú regarding substance use patterns and the role of substance use in HIV risk relate to other trans populations globally.
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Affiliation(s)
- Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States of America
- Department of Global Health, Yale School of Public Health, New Haven, CT, United States of America
| | - Javier R Lama
- Associación Civil Impacta Salud y Educación (IMPACTA), Lima, Perú
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Daniell S Sullivan
- College of Medicine, Univeristy of Central Florida, Orlando, FL, United States of America
| | | | - Manuel V Villaran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Panagiotis Vagenas
- Berkeley Research Development Office, University of California Berkeley, Berkeley, CA, United States of America
| | - David Vu
- College of Medicine, Univeristy of Central Florida, Orlando, FL, United States of America
| | - Makella Coudray
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States of America
| | - Frederick L Altice
- Department of Global Health, Yale School of Public Health, New Haven, CT, United States of America
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Sued O, Cahn P. Latin America Priorities after 40 years of the beginning of the HIV pandemic. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100024. [PMID: 36776757 PMCID: PMC9904065 DOI: 10.1016/j.lana.2021.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 06/18/2023]
Affiliation(s)
| | - Pedro Cahn
- Corresponding author: Pedro Cahn; MD, PhD., Fundación Huésped, Buenos Aires, Argentina
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Delfosse A, Bouscaren N, Dupin N, Jaubert J, Tran PL, Saint Pastou C, Manaquin R, Poubeau P, Gerardin P, Bertolotti A. High prevalence of syphilis in women, minors and precarious patients: a cross-sectional study in a Reunion Island sexually transmitted infection clinic, 2017-2020. J Eur Acad Dermatol Venereol 2021; 35:2287-2292. [PMID: 34331780 DOI: 10.1111/jdv.17572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high-income countries and remains at endemic levels in low- and middle-income countries. This trend, however, has not been observed in Reunion Island. OBJECTIVES To determine the prevalence, clinical characteristics and risk factors of syphilis in at-risk patients visiting the South Reunion STI clinic in Reunion Island. METHODS This monocentric cross-sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self-administered questionnaire. RESULTS Over the 3-year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n = 195, 95% CI, 6.50-8.65%) in the overall study population, 11.76% (n = 18, 95% CI, 6.97-18.59%) in minors (aged under 18 years) and 36.36% (n = 16, 95% CI, 21-59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10-3.11], being MSM (aPR 2.87, 95% CI, 1.71-4.80), being aged under 18 years (aPR 3.54, 95% CI, 1.90-6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11-4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42-4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). CONCLUSIONS These findings suggest a high prevalence of syphilis in at-risk patients visiting our STI clinic. Unlike the situation in other high-income countries, the people most at risk of syphilis in Reunion Island are local-born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island.
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Affiliation(s)
- A Delfosse
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - N Bouscaren
- Inserm CIC1410, CHU Réunion, Saint Pierre, France
| | - N Dupin
- Service de Dermatologie, Hôpital Cochin, AP-HP, CNR de la syphilis, Institut Cochin, U1016, Université Paris Descartes, Paris, France
| | - J Jaubert
- Laboratoire de Microbiologie, CHU Réunion, Saint Pierre, France
| | - P L Tran
- Service de Gynécologie Obstétrique, CHU Réunion, Saint Pierre, France
| | - C Saint Pastou
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - R Manaquin
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - P Poubeau
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - P Gerardin
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France
| | - A Bertolotti
- Service des Maladies Infectieuses - Dermatologie, CHU Réunion, Saint Pierre, France.,Inserm CIC1410, CHU Réunion, Saint Pierre, France
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