Associations Between HIV and Severe Mpox in an Atlanta Cohort

BACKGROUND

In the Southeastern United States, the 2022 mpox outbreak disproportionately impacted people who are black and people with HIV (PWH).

METHODS

We analyzed a cohort of 395 individuals diagnosed with mpox across 3 health care systems in Atlanta, Georgia between 1 June 2022 and 7 October 2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the US Centers for Disease Control and Prevention definition) and, among PWH, the associations between CD4+ T-cell count and HIV load with severe mpox.

RESULTS

Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV load, 90 (35.0%) had > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% confidence interval [CI], 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV load > 200 copies/mL had 2.10 (95% CI, 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T-cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis.

CONCLUSIONS

PWH with nonsuppressed HIV loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with nonsuppressed HIV loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.

Identifying knowledge practices in an infodemic era: Rediscovering the professional identities of LIS professionals in an infodiverse environment

The professional identity of librarians is established with regard to the current understanding of their knowledge practices. The global phenomenon of false and untrustworthy information circulating on social media platforms paints a new issue that librarians must conquer. Messages, content, news, and information on the web make it challenging for librarians to educate users as to where the sources come from and the need to evaluate for credibility and trustworthiness. During the pandemic, and with a surge of information disorders on social media, the World Health Organization recommended building resilience to misinform-ation and engaging and empowering communities to take positive action. This research seeks to explore the relationship between professional identities and the participation of librarians in an infodiverse environment, specifically by exploring how Filipino librarians applied aspects of their knowledge practices to the evaluation of social media health information during the pandemic.

Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population

Simple Summary

Liver cancer incidence in the United States is higher among African Americans compared to White Americans. The determinants of racial disparities in liver cancer incidence are not clear. Using data from White and African Americans from low socioeconomic backgrounds, we compared the prevalence of known liver cancer risk factors by race and assessed factors associated with liver cancer incidence. Understanding liver cancer risk differences can assist prevention strategies that target people at high risk, potentially based on risk factors that differ by race.

Abstract

The purpose of this study was to examine differences in risk factors associated with hepatocellular carcinoma (HCC) among White and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC-adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for White and African Americans, separately. There were 294 incident HCC. The incidence rate ratio for HCC was higher (IRR = 1.4, 95%CI: 1.1–1.9) in African Americans compared to White Americans. White Americans saw a stronger association between self-reported hepatitis C virus (aHR = 19.24, 95%CI: 10.58–35.00) and diabetes (aHR = 3.55, 95%CI: 1.96–6.43) for the development of HCC compared to African Americans (aHR = 7.73, 95%CI: 5.71–10.47 and aHR = 1.48, 95%CI: 1.06–2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR = 2.91, 95%CI: 1.87–4.52) and heavy alcohol consumption (aHR = 1.59, 95%CI: 1.19–2.11) were significantly associated with HCC risk among African Americans only. In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among White and African Americans.

Environmental Conditions, Ignition Type, and Air Quality Impacts of Wildfires in the Southeastern and Western United States

This research contrasts the environmental conditions, meteorological drivers, and air quality impacts of human- and lightning-ignited wildfires in the southeastern and western United States, the two continental U.S. regions with the most wildfire burn area. We use the Fire Program Analysis Wildfire Occurrence Data (FPA FOD) to determine wildfire abundance and ignition sources between 1992 and 2015. We investigate specific ecoregions within these two U.S. regions and find that in the majority of ecoregions, annual lightning- and human-ignited wildfire burn area have similar relationships with key meteorological parameters. We investigate the fuel moisture values where wildfires occur segregated by ignition type and show that within a given ecoregion, the differences in median fuel moisture between ignition types are generally smaller than the differences between ecoregions. Our results suggest that annual wildfire burn area for human- and lightning-ignited wildfires within a given ecoregion are modulated by environmental conditions, and climate change may similarly impact wildfires of both ignition types. Finally, we estimate fine particulate matter emissions for Fire Program Analysis Wildfire Occurrence Data wildfires using the Fire INventory from NCAR model framework. We show that emissions of fine particulate matter from human-ignited wildfires is significant and of a similar total magnitude between the west and southeastern United States. Additionally, the west and southeast have a similar number of wildfires associated with National Weather Service air quality smoke forecasts.

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.

Occupational heat-related illness emergency department visits and inpatient hospitalizations in the southeast region, 2007-2011

BACKGROUND

Heat-related illness (HRI) is an occupational health risk for many outdoor, and some indoor, workers.

METHODS

Emergency department (ED) and inpatient hospitalization (IH) data for 2007-2011 from nine southeast states were analyzed to identify occupational HRI numbers and rates, demographic characteristics, and co-morbid conditions.

RESULTS

There were 8,315 occupational HRI ED visits (6.5/100,000 workers) and 1,051 IHs (0.61/100,000) in the southeast over the study period. Out-of-state residents comprised 8% of ED visits and 12% of IHs. Rates for both, ED visits and IHs were significantly elevated in males and blacks. Younger workers had elevated rates for ED visits, while older workers had higher IH rates.

CONCLUSIONS

This is the first study to evaluate occupational HRI ED visits and IHs in the southeast region and indicates the need for enhanced heat-stress prevention policies in the southeast. Findings from this study can be used to direct state health department tracking and evaluation of occupational HRI.

What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary Care Physicians in the Southeastern United States

The Centers for Disease Control and Prevention have recommended routinely testing patients (aged 13-64) for HIV since 2006. However, many physicians do not routinely test. From January 2011 to March 2012, we conducted 18 in-depth individual interviews and explored primary care physicians' perceptions of barriers and facilitators to implementing routine HIV testing in North Carolina. Physicians' comments were categorized thematically and fell into 5 groups: policy, community, practice, physician, and patient. Lack of universal reimbursement was identified as the major policy barrier. Participants believed endorsement from the United States Preventive Services Tasks Force would facilitate adoption of routine HIV testing policies. Physicians reported HIV/AIDS stigma, socially conservative communities, lack of confidentiality, and rural geography as community barriers. Physicians believed public HIV testing campaigns would legitimize testing and decrease stigma in communities. Physicians cited time constraints and competing clinical priorities as physician barriers that could be overcome by delegating testing to nursing staff. HIV test refusal, low HIV risk perception, and stigma emerged as patient barriers. Physicians recommended adoption of routine HIV testing for all patients to facilitate and destigmatize testing. Physicians continue to experience a variety of barriers when implementing routine HIV testing in primary care settings. Our findings support multilevel approaches to enhance physician routine HIV testing in primary care settings.

What do men who serve as lay health advisers really do?: Immigrant Latino men share their experiences as Navegantes to prevent HIV

HoMBReS was a lay health adviser (LHA) intervention designed to reduce sexual risk among recently arrived, nonEnglish-speaking Latino men who were members of a multicounty soccer league in central NC. Our community-based participatory research (CBPR) partnership collected, analyzed, and interpreted qualitative life-story narratives to characterize the roles of male LHAs known as Navegantes. Nine Navegantes were interviewed. Their mean age was 39 years (range: 26-62 years); six were from Mexico and three from El Salvador. Navegantes described the function and facilitators of serving as LHAs and identified leverage points for future HIV and STD prevention strategies. They highlighted psychosocial and sociocultural influences on HIV risk, settings for risky behavior, and personal changes from serving as Navegantes. This study provides preliminary evidence that an LHA approach is feasible and appropriate for Latino men, and can be effective in reaching men who might otherwise be difficult to reach.