Browsing by Author "University of Pittsburgh Graduate School of Public Health"

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    Acceptability of Pre-Exposure Prophylaxis among Men Who Have Sex with Men and Transgender Women in Northern Thailand
    (2013-10-08) Daniel Yang; Chonlisa Chariyalertsak; Antika Wongthanee; Surinda Kawichai; Kriengkrai Yotruean; Pongpun Saokhieo; Thomas Guadamuz; Voravit Suwanvanichkij; Chris Beyrer; Suwat Chariyalertsak; University of California, San Francisco; Johns Hopkins Bloomberg School of Public Health; Chiang Mai University; Thailand Ministry of Public Health; Mahidol University; University of Pittsburgh Graduate School of Public Health
    Background:Northern Thailand has a high burden HIV epidemic among MSM and TG. Oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine has demonstrated efficacy in preventing HIV among MSM and TG in Chiang Mai, Thailand. Determinants of PrEP acceptability are needed to gauge the potential uptake of this prevention strategy.Methods:From January to February 2012, 238 MSM and TG participants, who self-reported as HIV-uninfected or of unknown status, completed a self-administered survey on hand-held computers. Participants were recruited by venue-day-time sampling and asked to rate their likelihood of using oral PrEP for HIV prevention with an efficacy of 50%. PrEP acceptability was defined as being "very likely" to use PrEP. Odds ratios and 95% CIs were calculated to identify correlates of acceptability.Results:131 MSM and 107 TG responded, with mean ages of 23.7 and 21.8, respectively. 24% of MSM engaged primarily in receptive anal sex vs. 74% of TG. 21% of MSM and 44% of TG reported regular medication use. Prior awareness of PrEP was high at 66% among both MSM and TG respondents. 41% of MSM and 37% of TG were "very likely" to use PrEP. Among MSM, factors associated with PrEP acceptability included a prior history of STIs (AOR 4.6; 95%CIs 1.7-12.6), previous HIV testing (AOR 2.4 95%CIs 1.1-5.3), regularly planned sex (AOR 2.8 95%CIs 1.1-7.2), and infrequent sex (AOR 2.9 95%CIs 1.3-6.3). Among TG, factors associated with acceptability included prior awareness of PrEP (AOR 3.3; 95%CIs 1.2-9.0) and having private insurance (AOR 5.0; 95%CIs 1.3-19.0).Conclusion:MSM and TG in Northern Thailand are distinct groups in terms of sexual behaviors, patterns of medication use, and correlates of PrEP acceptability. Efforts to maximize PrEP uptake should include expanded HIV testing services and the provision of financial subsidies to reduce the cost of PrEP. © 2013 Yang et al.
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    Community-Based Interventions to Improve and Sustain Antiretroviral Therapy Adherence, Retention in HIV Care and Clinical Outcomes in Low- and Middle-Income Countries for Achieving the UNAIDS 90-90-90 Targets
    (2016-10-01) Jean B. Nachega; Olatunji Adetokunboh; Olalekan A. Uthman; Amy W. Knowlton; Frederick L. Altice; Mauro Schechter; Omar Galárraga; Elvin Geng; Karl Peltzer; Larry W. Chang; Gilles Van Cutsem; Shabbar S. Jaffar; Nathan Ford; Claude A. Mellins; Robert H. Remien; Edward J. Mills; University of Pittsburgh Graduate School of Public Health; Universiteit Stellenbosch; Johns Hopkins University; Warwick Medical School; Yale University School of Medicine; Projeto Praça Onze; Brown University; University of California, San Francisco; Mahidol University; University of Limpopo; Human Sciences Research Council of South Africa; Médecins Sans Frontières; Liverpool School of Tropical Medicine; Organisation Mondiale de la Sante; Columbia University in the City of New York; New York State Psychiatric Institute; Precision Global Health
    © 2016, Springer Science+Business Media New York. Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched four electronic databases for all available randomized controlled trials (RCTs) and comparative cohort studies in LMICs comparing community versus health facility-based interventions. Relative risks (RRs) for pre-defined adherence, treatment engagement (linkage and retention in care), and relevant clinical outcomes were pooled using random effect models. Eleven cohort studies and eleven RCTs (N = 97,657) were included. Meta-analysis of the included RCTs comparing community- versus health facility-based interventions found comparable outcomes in terms of ART adherence (RR = 1.02, 95 % CI 0.99 to 1.04), virologic suppression (RR = 1.00, 95 % CI 0.98 to 1.03), and all-cause mortality (RR = 0.93, 95 % CI 0.73 to 1.18). The result of pooled analysis from the RCTs (RR = 1.03, 95 % CI 1.01 to 1.06) and cohort studies (RR = 1.09, 95 % CI 1.03 to 1.15) found that participants assigned to community-based interventions had statistically significantly higher rates of treatment engagement. Two studies found community-based ART delivery model either cost-saving or cost-effective. Community- versus facility-based models of ART delivery resulted in at least comparable outcomes for clinically stable HIV-infected patients on treatment in LMICs and are likely to be cost-effective.
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    Decay and persistence of maternal dengue antibodies among infants in Bangkok
    (2011-08-01) Willem G. Van Panhuis; Christine Luxemburger; Krisana Pengsaa; Kriengsak Limkittikul; Arunee Sabchareon; Jean Lang; Anna P. Durbin; Derek A.T. Cummings; University of Pittsburgh Graduate School of Public Health; Sanofi Pasteur SA; Mahidol University; Sanofi Pasteur; Johns Hopkins Bloomberg School of Public Health
    Maternal dengue antibodies are important in determining the optimal age of dengue vaccination, but no study has quantified the heterogeneity of antibody decay and persistence in infants. We used longitudinal regression methods and survival analysis to measure decay and persistence times of serotype-specific neutralizing antibodies in 139 infants in Bangkok. A biphasic decay pattern was found with half-life times of 24-29 days between birth and 3 months and 44-150 days after 3 months. Atypical decay rates were found in 17% of infants for dengue virus-1 and-4. Median persistence times of plaque reduction neutralization tests > 10 ranged from 6 to 9 months. Persistence times for individuals could not be predicted based on antibody values at birth. Vaccination against dengue before 12 months of age would be ineffective if maternal antibodies at plaque reduction neutralization test levels below 80 interfere with vaccine uptake. Projections of average antibody persistence based on values at birth should be avoided in studies on dengue pathogenesis in infants. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.
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    Eroding gains in safe sex behavior, HIV/AIDS knowledge, and risk perceptions among royal Thai Navy conscripts after 28 years of the aids epidemic in Thailand
    (2014-01-01) Nuntawun Yuntadilok; Rattana Timmuang; Somkid Timsard; Thomas E. Guadamuz; Elsa Heylen; Jeffrey Mandel; Maria L. Ekstrand; Mahidol University; Hua Chiew Chalermprakiet University; Division of Preventive Medicine; University of Pittsburgh Graduate School of Public Health; UCSF Center for AIDS Prevention Studies; University of California, San Francisco
    Despite extensive early prevention efforts, recent surveys suggest that sexual risk taking may again be on the rise in Thailand. The present cross-sectional study surveyed 3,299 recruits in the Thai Navy in 2010, to examine their rates and correlates of consistent condom use. Most participants were aged 21-22 years, unmarried, and had a secondary education. Almost half were employed in labor/agriculture. Only 17 % of sexually experienced recruits were consistent condom users, and 53 % reported multiple sex partners in the past 3 months. In multiple logistic regression, residence in the Northeast (AOR 1.47), age (AOR 1.43), being single (AOR 2.13), non-MSM status (AOR 1.41), voluntary testing (AOR 1.24), and condom use at first sex (AOR 4.29) were significantly associated with consistent condom use. These findings suggest gaps in Thailand's condom campaign targeting both sexually experienced and inexperienced youth. Interventions targeting naval recruits may benefit from including sex education in the training curriculum, building drillmasters' capacities to facilitate sex education/counseling, and creating a supportive environment with better access to condoms. © Springer Science+Business Media New York 2013.
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    Evidence of association of APOE with age-related macular degeneration - a pooled analysis of 15 studies
    (2011-12-01) Gareth J. Mckay; Chris C. Patterson; Usha Chakravarthy; Shilpa Dasari; Caroline C. Klaver; Johannes R. Vingerling; Lintje Ho; Paulus T.V.M. de Jong; Astrid E. Fletcher; Ian S. Young; Johan H. Seland; Mati Rahu; Gisele Soubrane; Laura Tomazzoli; Fotis Topouzis; Jesus Vioque; Aroon D. Hingorani; Reecha Sofat; Michael Dean; Julie Sawitzke; Johanna M. Seddon; Inga Peter; Andrew R. Webster; Anthony T. Moore; John R.W. Yates; Valentina Cipriani; Lars G. Fritsche; Bernhard H.F. Weber; Claudia N. Keilhauer; Andrew J. Lotery; Sarah Ennis; Michael L. Klein; Peter J. Francis; Dwight Stambolian; Anton Orlin; Michael B. Gorin; Daniel E. Weeks; Chia Ling Kuo; Anand Swaroop; Mohammad Othman; Atsuhiro Kanda; Wei Chen; Goncalo R. Abecasis; Alan F. Wright; Caroline Hayward; Paul N. Baird; Robyn H. Guymer; John Attia; Ammarin Thakkinstian; Giuliana Silvestri; Queen's University Belfast; Erasmus University Medical Center; Netherlands Institute for Neuroscience NIN - KNAW; Academic Medical Centre, University of Amsterdam; London School of Hygiene & Tropical Medicine; Stavanger University Hospital; Tervise Arengu Instituut; Universitaire de Creteil; Clinica Oculistica; Aristotle University of Thessaloniki; Universidad Miguel Hernandez de Elche; CIBERESP; UCL; National Cancer Institute at Frederick; Tufts University School of Medicine; Tufts Medical Center; Icahn School of Medicine at Mount Sinai; UCL Institute of Ophthalmology; Moorfields Eye Hospital NHS Foundation Trust; University of Cambridge; Universitat Regensburg; Universitatsklinikum Wurzburg; University of Southampton; Southampton General Hospital; OHSU School of Medicine; University of Pennsylvania; David Geffen School of Medicine at UCLA; University of Pittsburgh Graduate School of Public Health; The University of the Michigan Kellogg Eye Center; National Eye Institute; University of Michigan School of Public Health; Western General Hospital; University of Melbourne; University of Newcastle, Australia; John Hunter Hospital; Mahidol University
    Age-related macular degeneration (AMD) is the most common cause of incurable visual impairment in high-income countries. Previous studies report inconsistent associations between AMD and apolipoprotein E (APOE), a lipid transport protein involved in low-density cholesterol modulation. Potential interaction between APOE and sex, and smoking status has been reported. We present a pooled analysis (n = 21,160) demonstrating associations between late AMD and APOε4 (odds ratio [OR] = 0.72 per haplotype; confidence interval [CI] : 0.65-0.74; P = 4.41×10 -11 ) and APOε2 (OR = 1.83 for homozygote carriers; CI: 1.04-3.23; P = 0.04), following adjustment for age group and sex within each study and smoking status. No evidence of interaction between APOE and sex or smoking was found. Ever smokers had significant increased risk relative to never smokers for both neovascular (OR = 1.54; CI: 1.38-1.72; P = 2.8×10 -15 ) and atrophic (OR = 1.38; CI: 1.18-1.61; P = 3.37×10 -5 ) AMD but not early AMD (OR = 0.94; CI: 0.86-1.03; P = 0.16), implicating smoking as a major contributing factor to disease progression from early signs to the visually disabling late forms. Extended haplotype analysis incorporating rs405509 did not identify additional risks beyond ε2 and ε4 haplotypes. Our expanded analysis substantially improves our understanding of the association between the APOE locus and AMD. It further provides evidence supporting the role of cholesterol modulation, and low-density cholesterol specifically, in AMD disease etiology. © 2011 Wiley Periodicals, Inc.
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    Factors associated with unprotected receptive anal intercourse with internal ejaculation among men who have sex with men in a large internet sample from asia
    (2012-10-01) Sin How Lim; Thomas E. Guadamuz; Chongyi Wei; Roy Chan; Stuart Koe; University of Malaya; Mahidol University; University of Pittsburgh Graduate School of Public Health; National Skin Centre, Singapore; Asia Pacific Coalition on Male Sexual Health (APCOM)
    We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n = 10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5 % had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR = 1.53, 95 % CI: 1.28, 1.83; AOR = 1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR = 1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR = 2.85, CI: 2.48, 3.27; AOR = 2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR = 1.39, 95 % CI: 1.08, 1.81), higher perception of HIV risk (AOR = 1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR = 1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR = 1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention. © Springer Science+Business Media, LLC 2012.
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    Healthcare workers’ perceptions of an organizational quality assurance program implemented in a resource-limited setting: A qualitative study
    (2018-07-07) Hiroko Henker; Shivani Fox-Lewis; Navy Tep; Dary Vanna; Sreymom Pol; Claudia Turner; Mahidol University; Nuffield Department of Clinical Medicine; University of Pittsburgh Graduate School of Public Health; Cambodia Oxford Medical Research Unit; Angkor Hospital for Children
    © 2018 The Author(s). Background: There is increasing awareness of the need to implement quality assurance programs in developing countries. Healthcare staff are the primary drivers of improving the quality of care, but little is known about how they perceive quality assurance programs in resource-limited settings. This study aims to evaluate healthcare workers’ perceptions of the organizational quality assurance program (OQA) at Angkor Hospital for Children (AHC), Cambodia. The OQA nvolves regular data collection and monitoring of quality indicators, to assess whether agreed quality standards are being met. Methods: This qualitative study consisted of four focus group discussions (FGDs) with 29 hospital staff (convenience sampling) from medical, nursing and non-medical departments. Staff members’ understanding of quality assurance and perceptions of the strengths and weaknesses of the OQA were explored. Thematic content analysis was used to identify key themes. Results: Participants emphasized that quality indicators must include physical and psychological well-being. Strengths of the OQA included shared understanding amongst all groups of participants of its goals, committed leadership, that it was locally-relevant and that target indicators were developed from a “ground-up” approach. On-going challenges included that there was a gap in understanding of the OQA processes and overall running of the OQA across the organization between managers and staff. Conclusion: The introduction of the OQA at AHC has been well-received by staff members. Overall, the program is perceived to be valuable. Healthcare provision in resource-limited settings increasingly needs to demonstrate quality assurance. The model of OQA developed at AHC is one way to achieve this.
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    Hemozoin differentially regulates proinflammatory cytokine production in human immunodeficiency virus-seropositive and -seronegative women with placental malaria
    (2004-12-01) Julie M. Moore; Sujittra Chaisavaneeyakorn; Douglas J. Perkins; Caroline Othoro; Juliana Otieno; Bernard L. Nahlen; Ya Ping Shi; Venkatachalam Udhayakumar; The University of Georgia; National Center for Infectious Diseases; Mahidol University; University of Pittsburgh Graduate School of Public Health; Kenya Medical Research Institute; New Nyanza Provincial General Hospital; Organisation Mondiale de la Sante
    Pregnant women are at an increased risk for malarial infection. Plasmodinm falciparum accumulates in the placenta and is associated with dysregulated immune function and poor birth outcomes. Malarial pigment (hemozoin) also accumulates in the placenta and may modulate local immune function. In this study, the impact of hemozoin on cytokine production by intervillous blood mononuclear cells from malaria-infected placentas was investigated. There was a dose-dependent, suppressive effect of hemozoin on production of gamma interferon (IFN-γ), with less of an effect on tumor necrosis factor alpha (TNF-α) and interleukin-10, in human immunodeficiency virus-seronegative (HIV-) women. In contrast, IFN-γ and TNF-α production tended to increase in HIV-seropositive women with increasing hemozoin levels. Production patterns of cytokines, especially IFN-γ in HIV- women, followed different trends as a function of parasite density and hemozoin level. The findings suggest that the influences of hemozoin accumulation and high-density parasitemia on placental cytokine production are not equivalent and may involve different mechanisms, all of which may operate differently in the context of HIV infection. Cytokine production dysregulated by accumulation of hemozoin or high-density parasitemia may induce pathology and impair protective immunity in HIV-infected and -uninfected women.
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    HIV Disclosure and sexual transmission behaviors among an internet sample of HIV-positive men who have sex with men in Asia: Implications for prevention with positives
    (2012-10-01) Chongyi Wei; Sin How Lim; Thomas E. Guadamuz; Stuart Koe; University of Pittsburgh Graduate School of Public Health; National University of Singapore; Mahidol University; Asia Pacific Coalition on Male Sexual Health (APCOM)
    The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A crosssectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men. © Springer Science+Business Media, LLC 2011.
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    Mortality among foreign nationals in chiang mai city, Thailand, 2010 to 2011
    (2012-12-01) Vichan Pawun; Surasing Visrutaratna; Kumnuan Ungchusak; Suteerat Mahasing; Chosita Khumtalord; Siriying Tipsriraj; Chalermpol Chenwittaya; Thomas E. Guadamuz; Stephen R. Wisniewski; Thailand Ministry of Public Health; University of Pittsburgh Graduate School of Public Health; Office of Disease Prevention and Control; Mahidol University
    Background. Up to 65% of travelers to less developed countries report health problems while traveling. International travel is an increasing concern for health practitioners. To date, there have not been any published analyses of mortality amongst foreign nationals visiting Thailand. Our objectives are to examine the magnitude and characterize the deaths among foreign nationals in Chiang Mai, a popular tourist province in Thailand. Methods. The study commenced with a review of the Thai death registration. Death certificates were retrieved, reviewed, and classified by the causes of death. Basic statistics and proportionate mortality ratio (PMR) were used to describe the pattern of deaths. Standardized mortality ratio (SMR) was used to assess the excess mortality risk among foreign nationals. Results. Between January 1, 2010 andMay 31, 2011, there were 1,295 registered deaths in ChiangMai City, of which 102 records (7.9%) were foreign nationals. Median age of decedents was 64 years (range 14-102 y). Female-to-male ratio was 1 : 5.4. The highest mortality was among Europeans (45.1%). Most of the deaths were natural causes (89.2%) including 36 cardiac diseases (PMR=35.3) and 20 malignancy diseases (PMR=19.6). Deaths due to external causes were low. The SMRs range between 0.15 and 0.30. Conclusion. Communicable diseases and injuries were not the leading causes of death among foreign nationals visiting Chiang Mai, Thailand. It is essential that travelers are aware of mortality risk associated with their underlying diseases and that they are properly prepared to handle them while traveling. © 2012 International Society of Travel Medicine, 1195-1982.
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    Patterns and levels of illicit drug use among men who have sex with men in Asia
    (2012-01-01) Chongyi Wei; Thomas E. Guadamuz; Sin How Lim; Yongxu Huang; Stuart Koe; University of Pittsburgh Graduate School of Public Health; Mahidol University; National University of Singapore; Asia Pacific Coalition on Male Sexual Health (APCOM)
    Background: The emergence of gay communities in Asia may predispose men who have sex with men (MSM) to drug use. We describe patterns and levels of illicit drug use, and characteristics of stimulant drug users among MSM in Asia. Methods: A cross-sectional Internet-based survey was conducted among 10,861 participants recruited through online methods. Pearson's chi-square tests were used to compare patterns of drug use by participants' HIV status. Multivariable logistic regression analysis was conducted to identify significant correlates of stimulant drug use. Results: Overall, 16.7% of participants reported recreational drug use in the past 6 months. Ecstasy (8.1%) and Viagra (7.9%) were the most prevalent drugs being used. HIV-positive MSM reported significantly higher levels of individual drug use and polydrug use compared to HIV-negative/unknown MSM. Being gay (AOR = 1.62, 95% CI: 1.28, 2.05), having casual male partners only or having both casual and regular partners (AOR = 2.05, 95% CI: 1.66, 2.53; AOR = 2.97, 95% CI: 2.39, 3.69), HIV-positive status (AOR = 4.54, 95% CI: 3.63, 5.69), sex work (AOR = 1.52, 95% CI: 1.19, 1.93), and having more gay friends (" Some" vs. "A few/None" AOR = 1.98, 95% CI: 1.62, 2.43; "Most/All" vs. "A few/None" AOR = 4.59, 95% CI: 3.77, 5.59) were independently associated with stimulant drug use. Conclusions: Our findings point to the urgency of incorporating substance use prevention and treatment into current HIV prevention activities in Asia, which must use a harm reduction approach and galvanize dignity. © 2011 Elsevier Ireland Ltd.
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    The Potential Role of Circuit Parties in the Spread of HIV Among Men Who Have Sex with Men in Asia: A Call for Targeted Prevention
    (2014-01-01) Doug H. Cheung; Sin How Lim; Thomas E. Guadamuz; Stuart Koe; Chongyi Wei; UCSF Center for AIDS Prevention Studies; Harvard School of Public Health; University of Malaya; University of Pittsburgh Graduate School of Public Health; Mahidol University; ICM Pharma Pte Ltd; University of California, San Francisco
    © 2014, Springer Science+Business Media New York. We postulated that the growing popularity of circuit parties may play a role in the escalating HIV prevalence among men who have sex with men (MSM) in Asia. The present study is the first to characterize the sociodemographic and HIV-related behavioral factors of circuit party attendees living in Asia. We analyzed a subset of data from the Asia Internet MSM Sex Survey conducted from January 1 to February 28, 2010. Inclusion criteria included: being biologically male, aged 18 years or above, self-reported sex with another man, and reported international travel in the past 6 months (N = 6,094). From our multivariable logistic regression model, participants’ resident country with low HIV prevalence (among MSM) (AOR 1.59, 95 % CI 1.27–2.00) and country of destination with high HIV prevalence were independently associated with higher odds of circuit party attendance (AOR 1.32, 95 % CI 1.14–1.53) during international travel. Statistical interaction indicated circuit party attendees were likely to have traveled from low HIV prevalence (among MSM) countries to high HIV prevalence countries (AOR 1.40, 95 % CI 1.20–1.64). Other independent correlates included unprotected anal sex with a male casual sex partner and recreational drug use during travel. HIV and STI prevention focusing on circuit party attendees may have a pivotal role on the spread of the HIV epidemics among MSM in Asia.
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    Preparing for introduction of a dengue vaccine: Recommendations from the 1st Dengue v2V Asia-Pacific Meeting
    (2011-11-28) Sai Kit Lam; Donald Burke; Maria Rosario Capeding; Chee Keong Chong; Laurent Coudeville; Jeremy Farrar; Duane Gubler; Sri Rezeki Hadinegoro; Jeffrey Hanna; Jean Lang; Han Lim Lee; Yee Sin Leo; Chan Quang Luong; Richard Mahoney; John Mcbride; Jorge Mendez-Galvan; Lee Ching Ng; Suchitra Nimmannitya; Eng Eong Ooi; Donald Shepard; Jaco Smit; Rémy Teyssou; Laurent Thomas; Joseph Torresi; Pedro Vasconcelos; Dewa Nyoman Wirawan; Sutee Yoksan; University of Malaya; University of Pittsburgh Graduate School of Public Health; Gokila; Kementerian Kesihatan Malaysia; Sanofi Pasteur; University of Oxford; National University of Singapore; Ministry of Health, Republic of Indonesia; Tropical Population Health Unit; Institute for Medical Research Kuala Lumpur; Tan Tock Seng Hospital; Pasteur Institute in Ho Chi Minh City; International Vaccine Institute, Seoul; James Cook University, Australia; Hospital Infantil de Mexico Federico Gomez; National Environmental Authority; Thailand Ministry of Public Health; Brandeis University; Emergency Network at the University Hospital of Fort-de-France; Austin Center for Infection Research; Instituto Evandro Chagas; School of Public; Mahidol University
    Infection with dengue virus is a major public health problem in the Asia-Pacific region and throughout tropical and sub-tropical regions of the world. Vaccination represents a major opportunity to control dengue and several candidate vaccines are in development. Experts in dengue and in vaccine introduction gathered for a two day meeting during which they examined the challenges inherent to the introduction of a dengue vaccine into the national immunisation programmes of countries of the Asia-Pacific. The aim was to develop a series of recommendations to reduce the delay between vaccine licensure and vaccine introduction. Major recommendations arising from the meeting included: ascertaining and publicising the full burden and cost of dengue; changing the perception of dengue in non-endemic countries to help generate global support for dengue vaccination; ensuring high quality active surveillance systems and diagnostics; and identifying sustainable sources of funding, both to support vaccine introduction and to maintain the vaccination programme. The attendees at the meeting were in agreement that with the introduction of an effective vaccine, dengue is a disease that could be controlled, and that in order to ensure a vaccine is introduced as rapidly as possible, there is a need to start preparing now. © 2011 Elsevier Ltd.
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    Psychosocial Health Conditions and HIV Prevalence and Incidence in a Cohort of Men Who have Sex with Men in Bangkok, Thailand: Evidence of a Syndemic Effect
    (2014-01-01) T. E. Guadamuz; K. McCarthy; W. Wimonsate; W. Thienkrua; A. Varangrat; S. Chaikummao; A. Sangiamkittikul; R. D. Stall; F. van Griensven; Mahidol University; University of Pittsburgh Graduate School of Public Health; Thailand Ministry of Public Health; The HIV Netherlands Australia Thailand Research Collaboration; University of California, San Francisco
    © 2014, Springer Science+Business Media New York. Men who have sex with men (MSM) in Bangkok may experience multiple psychosocial health conditions, such as substance use, suicidality, and a history of sexual abuse. These factors may contribute to HIV vulnerability in a syndemic way. A syndemic is defined as a number of synergistically interacting health conditions producing excess disease in a population. The objective of this study is to examine whether psychosocial health conditions among MSM have a syndemic association with HIV prevalence and HIV incidence. To do this, we evaluated psychosocial health conditions and their associations with unprotected sex, HIV prevalence and HIV incidence in a cohort of Thai MSM (N = 1,292). There was a positive and significant association between the number of psychosocial health conditions and increased levels of unprotected sex and HIV prevalence at study baseline. The number of psychosocial health conditions at baseline was also associated with increased HIV incidence during follow-up (no conditions, HIV incidence = 15.3 %; one to three conditions, 23.7 %; four to five conditions, 33.2 %). The number of psychosocial health conditions was positively associated with HIV risk behavior and HIV prevalence and incidence. Prevention efforts among MSM need to address the existence of multiple psychosocial health conditions and their synergy to effectively decrease the spread of HIV infection.
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    Recommended reporting items for epidemic forecasting and prediction research: The EPIFORGE 2020 guidelines
    (2021-10-01) Simon Pollett; Michael A. Johansson; Nicholas G. Reich; David Brett-Major; Sara Y. Del Valle; Srinivasan Venkatramanan; Rachel Lowe; Travis Porco; Irina Maljkovic Berry; Alina Deshpande; Moritz U.G. Kraemer; David L. Blazes; Wirichada Pan-Ngum; Alessandro Vespigiani; Suzanne E. Mate; Sheetal P. Silal; Sasikiran Kandula; Rachel Sippy; Talia M. Quandelacy; Jeffrey J. Morgan; Jacob Ball; Lindsay C. Morton; Benjamin M. Althouse; Julie Pavlin; Wilbert van Panhuis; Steven Riley; Matthew Biggerstaff; Cecile Viboud; Oliver Brady; Caitlin Rivers; Institute for Disease Modeling; Instituto de Salud Global de Barcelona; National Center for Emerging and Zoonotic Infectious Diseases; Milken Institute School of Public Health; London School of Hygiene & Tropical Medicine; Northeastern University; Fogarty International Center (FIC); University of Oxford; University of California, San Francisco; Bill and Melinda Gates Foundation; University of Virginia; Centers for Disease Control and Prevention; Catholic University of America; Imperial College Faculty of Medicine; SUNY Upstate Medical University; National Academies of Sciences, Engineering, and Medicine; University of Nebraska Medical Center; University of Washington; University of Massachusetts Amherst; Walter Reed Army Institute of Research; Mailman School of Public Health; Mahidol University; Nuffield Department of Medicine; Johns Hopkins Bloomberg School of Public Health; Los Alamos National Laboratory; University of Pittsburgh Graduate School of Public Health; New Mexico State University; University of Cape Town; U.S. Army Public Health Center; Armed Forces Health Surveillance Center
    Background The importance of infectious disease epidemic forecasting and prediction research is underscored by decades of communicable disease outbreaks, including COVID-19. Unlike other fields of medical research, such as clinical trials and systematic reviews, no reporting guidelines exist for reporting epidemic forecasting and prediction research despite their utility. We therefore developed the EPIFORGE checklist, a guideline for standardized reporting of epidemic forecasting research. Methods and findings We developed this checklist using a best-practice process for development of reporting guidelines, involving a Delphi process and broad consultation with an international panel of infectious disease modelers and model end users. The objectives of these guidelines are to improve the consistency, reproducibility, comparability, and quality of epidemic forecasting reporting. The guidelines are not designed to advise scientists on how to perform epidemic forecasting and prediction research, but rather to serve as a standard for reporting critical methodological details of such studies. Conclusions These guidelines have been submitted to the EQUATOR network, in addition to hosting by other dedicated webpages to facilitate feedback and journal endorsement.
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    Sexual transmission behaviors and serodiscordant partnerships among HIV-positive men who have sex with men in Asia
    (2012-04-01) Chongyi Wei; Thomas E. Guadamuz; Sin How Lim; Stuart Koe; University of Pittsburgh Graduate School of Public Health; Mahidol University; National University of Singapore; Asia Pacific Coalition on Male Sexual Health (APCOM)
    We described sexual transmission behaviors and serodiscordant partnerships among an online sample of HIV-positive men who have sex with men (N = 416) in Asia. High rates of unprotected anal intercourse (74.8%), serodiscordant partnerships (68.5%), and unprotected sex within serodiscordant partnerships (∼60.0%) were reported. Increased number of partners, meeting partners on the Internet, drug use before sex, and not knowing ones viral load were associated with unprotected anal intercourse. Efforts to develop and scale up biomedical and behavioral interventions for HIV-positive men who have sex with men in Asia are needed. © 2012 Public Health Agency of Canada and Government of Canada All rights reserved.
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    'She met her (boy)friend online': negotiating gender identity and sexuality among young Thai women in online space
    (2013-11-01) Pimpawun Boonmongkon; Timo T. Ojanen; Ronnapoom Samakkeekarom; Nattharat Samoh; Rachawadee Iamsilpa; Soifa Topananan; Mudjalin Cholratana; Thomas E. Guadamuz; Mahidol University; University of Pittsburgh Graduate School of Public Health
    This paper focuses on the experiences of women 15-24 years old living in one suburban district in Bangkok. Its objectives are to analyse processes of building and negotiating social identity and femininity in online spaces by young women; the ways in which young women express their sexuality using online technologies; connections between the 'online' and 'offline' worlds in terms of emotions as well as social and sexual networks; and traditional values regarding female sexuality reproduced through online media and how young women negotiate and resist these. Content and narrative analyses were conducted using qualitative data from 9 focus-group discussions and 14 narrative interviews. Findings indicated that the online media serve as tools that help young women develop and express their gender identities. Mobile phones and the Internet facilitate communication in order to express love, responsibility, intimacy and sexual desires. Discourse on women's chastity, which puts pressure on women to maintain their virginity, still influences online and mobile contents, messages and images among young women. However, women also exerted agency in negotiating and expressing their sexuality, both online and offline. © 2013 © 2013 Taylor & Francis.
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    Suboptimal HIV Testing Uptake among Men Who Engage in Commercial Sex Work with Men in Asia
    (2016-12-01) Harry Jin; MacKey Reuel Friedman; Sin How Lim; Thomas E. Guadamuz; Chongyi Wei; San Francisco Department of Public Health; University of Pittsburgh Graduate School of Public Health; University of Malaya; Mahidol University; University of California, San Francisco
    © 2016, Mary Ann Liebert, Inc. Purpose: Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia. Methods: The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred and seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included in this analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year. Results: About half (48.6%) of the participants had been tested for HIV at least once within the past year, and 30.5% had never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested. Conclusion: While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.
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    Virtual Versus Physical Spaces: Which Facilitates Greater HIV Risk Taking Among Men Who Have Sex with Men in East and South-East Asia?
    (2014-08-01) Chongyi Wei; Sin How Lim; Thomas E. Guadamuz; Stuart Koe; University of California, San Francisco; University of Malaya; University of Pittsburgh Graduate School of Public Health; Mahidol University; ICM Pharma Pte Ltd
    © 2013, Springer Science+Business Media New York. Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.