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BACKGROUND: Alcohol use disorders (AUD) are common in men who have sex with men (MSM) and transgender women (TGW) in Peru and undermine antiretroviral therapy (ART) adherence. Oral naltrexone (NTX) is an evidenced-based treatment for AUD that has not been assessed in co-treating AUD in MSM/TGW with HIV. SETTING AND DESIGN: A two-site, randomized, double-blind, placebo-controlled trial among MSM/TGW with AUD and newly diagnosed with HIV in Lima, Peru. METHODS: Newly diagnosed MSM/TGW with AUD were prescribed a single-treatment regimen of EFV/TDF/FTC from 2014-2015 and randomized 2:1 to oral NTX (N=103) or placebo (N=53) for 24 weeks. Primary and secondary outcomes were proportion achieving viral suppression (VS: HIV-1 RNA

Machine learning algorithms can sometimes exacerbate health disparities based on ethnicity, gender, and other factors. There has been limited work at exploring potential biases within algorithms deployed on a small scale, and/or within minoritized communities. Understanding the nature of potential biases may improve the prediction of various health outcomes. As a case study, we used data from a sample of 539 young adults from minoritized communities who engaged in nonmedical use of prescription opioids and/or heroin. We addressed the indicated issues through the following contributions: 1) Using machine learning techniques, we predicted a range of opioid use outcomes for participants in our dataset; 2) We assessed if algorithms trained only on a majority sub-sample (e.g., Non-Hispanic/Latino, male), could accurately predict opioid use outcomes for a minoritized sub-sample (e.g., Latino, female). Results indicated that models trained on a random sample of our data could predict a range of opioid use outcomes with high precision. However, we noted a decrease in precision when we trained our models on data from a majority sub-sample, and tested these models on a minoritized sub-sample. We posit that a range of cultural factors and systemic forms of discrimination are not captured by data from majority sub-samples. Broadly, for predictions to be valid, models should be trained on data that includes adequate representation of the groups of people about whom predictions will be made. Stakeholders may utilize our findings to mitigate biases in models for predicting opioid use outcomes within minoritized communities.

Supplemental material, sj-docx-1-tva-10.1177_15248380231176062 for Misogynistic Extremism: A Scoping Review by Robin O’Hanlon, Frederick L. Altice, Roy Ka-Wei Lee, Jack LaViolette, Gloria Mark, Orestis Papakyriakopoulos, Koustuv Saha, Munmun De Choudhury and Navin Kumar in Trauma, Violence, & Abuse

The use of pre-exposure prophylaxis (PrEP) for HIV prevention within the U.S. military is low. Implementing preference-based alternative modalities of PrEP delivery, however, can be an innovative strategy to address the specific barriers to PrEP uptake among military MSM. We sought to identify population-based, segment-specific preferences for longer-acting and alternative PrEP delivery modalities to guide patient-centered strategies to optimize uptake within military-serving healthcare systems. HIV-negative military men who have sex with men (MSM) completed an anonymous, adaptive choice-based conjoint (ACBC) analysis survey consisting of five key attributes of interest (dosing method, provider type, visit location, lab work evaluation location, and dispensing venue). Relative importance and part-worth utility scores were generated using Hierarchical Bayes (HB) estimation, and cluster ensemble analysis grouped participants into “phenotype” segments by preference similarity. The randomized first-choice model was then used to examine changes in program interest rates among segments through market simulation. The 429 participants were segmented into five preference groups. The dosing method attribute was found to be the most important to nearly all segments. Simulations revealed that PrEP program interest among two segments with low interest levels increased when smartphone, civilian-based, and long-acting injectable PrEP options were involved. Findings also suggested a need for clinics to be responsive and sensitive to sexual practices, risk perception, and functional PrEP knowledge. Responsiveness to segment-specific preferences in the design of military PrEP programs and acting on the importance of clinical relationships within the context of PrEP engagement within a military setting may contribute to increasing PrEP uptake.

Additional file 1. Appendix. Detailed description of covariates, supplementary analyses not shown in main text, and raw data on cause of death classification.

Additional file 1 Supplementary Table A���C.

Additional file 1: NGT focus group guide.

Additional file 1.

The volatile opioid epidemic is associated with higher levels of opioid use disorder (OUD) and negative health outcomes in adolescents and young adults. Medications for opioid use disorder (MOUD) demonstrate the best evidence for treating OUD. Adherence to and retention in MOUD among adolescents and young adults, however, is incompletely understood. This systematic review examines the state of the literature regarding the association of age with adherence to and retention in MOUD using methadone, buprenorphine, or naltrexone among persons aged 10 to 24 along with related facilitators and barriers. The research team searched for all studies of MOUD that examined adherence, retention, or related concepts as an outcome variable where the sample included adolescents or young adults. Search criteria generated 10,229 records, which, after removing duplicates and conducting title/abstract screening, yielded 587 studies for full-text review. Ultimately, 52 articles met inclusion criteria for abstraction and 17 were selected for qualitative coding and analysis. This review found younger age to be consistently associated with shorter retention in the published literature, although the overall quality of included studies was low. Several factors at the individual, interpersonal, and institutional levels, such as concurrent substance use, MOUD adherence, family conflict, and MOUD dosage and flexibility, were seen as playing a role in MOUD retention among adolescents and young adults. This review highlights how MOUD providers can tailor treatment to increase retention of adolescents and young adults while pointing to the need for more research explaining MOUD adherence and retention disparities in this age group. This is a pre-copyedited, author-produced PDF of an article accepted for publication in 'Epidemiologic Reviews' following peer review. The version of record [Viera, A., Bromberg, D.J., Whittaker, S., Refsland, B.M., Stanojlović, M., Nyhan, K., and Altice, F.L. (2020). Adherence to and Retention in Medications for Opioid Use Disorder among Adolescents and Young Adults. Epidemiologic Reviews.] is available online at: https://doi.org/10.1093/epirev/mxaa001. Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing help@openaccessbutton.org.

Background: Study retention is a major challenge in HIV clinical trials conducted with persons recruited from correctional facilities. Objective: To examine study retention in a trial of within-prison methadone initiation and a behavioral intervention among incarcerated men with HIV and opioid dependence in Malaysia. Methods: In this 2x2 factorial trial, 296 incarcerated men with HIV and opioid dependence were allocated to (1) an HIV risk reduction intervention, the Holistic Health Recovery Program for Malaysia (HHRP-M), (2) pre-release methadone initiation, (3) both interventions, or (4) standard care (NCT02396979). Here we estimate effects of these interventions on linkage to the study after prison release and completion of post-release study visits. Results: Most participants (68.9%) completed at least one post-release study visit but few (18.6%) completed all 12. HHRP-M was associated with a 13.5% (95% confidence interval (CI): 3.8%, 23.2%) increased probability of completing at least one post-release study visit. Although not associated with initial linkage, methadone treatment was associated with an 11% (95% CI: 2.0%, 20.6%) increased probability of completing all twelve post-release study visits. Being subject to forced relocation outside Kuala Lumpur after prison release decreased retention by 43.3% (95% CI: −51.9%, −34.8%). Conclusion: Retaining study participants in HIV clinical trials following prison release is challenging and potentially related to the broader challenges that participants experience during community reentry. Researchers conducting clinical trials with this population may want to consider methadone and HHRP as means to improve post-release retention, even in clinical trials where these interventions are not being directly evaluated.

Background The consequences of substance use disorders (SUDs) are varied and broad, affecting many sectors of society and the economy. Economic evaluation translates these consequences into dollars to examine the net economic impact of interventions for SUD, and associated conditions such as HCV and HIV. The nexus between substance use and crime makes criminal justice outcomes particularly significant for estimating the economic impact of SUD interventions, and important for data harmonization. Methods We compared baseline data collected in six NIDA-funded Seek, Test, Treat and Retain (STTR) intervention studies that enrolled HIV-infected/at-risk individuals with SUDs (total n = 3415). Criminal justice measures included contacts with the criminal justice system (e.g., arrests) and criminal offenses. The objective was to develop a list of recommended measures and methods supporting economic data harmonization opportunities in HIV and SUD research, with an initial focus on crime-related outcomes. Results Criminal justice contacts and criminal offenses were highly variable across studies. When measures grouped by offense classifications were compared, consistencies across studies emerged. Most individuals report being arrested for property or public order crimes (> 50%); the most commonly reported offenses were prostitution/pimping, larceny/shoplifting, robbery, and household burglary. Conclusions We identified four measures that are feasible and appropriate for estimating the economic consequences of SUDs/HIV/HCV: number of arrests, number of convictions, days of incarceration, and times committing criminal offenses, by type of offense. To account for extreme variation, grouping crimes by offense classification or calculating monthly averages per event allows for more meaningful comparisons across studies.