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Over the past 10 years, sexually transmitted infections (STIs) have seen a significant resurgence in the United States despite the availability of effective treatments and reliable prevention methods. Rhode Island has experienced a similar uptick in the incidence of syphilis, chlamydia and gonorrhea, with many cases occurring among gay, bisexual, men who have sex with men (GBMSM), which coincides with a recent concerning rise in congenital syphilis cases. We reviewed the most recent STI trends for the state of Rhode Island in 2022. During this year, 6,883 cases of STIs were reported to the Department of Health (N=5,199 chlamydia, 1,444 gonorrhea, and 240 infectious syphilis cases). Compared to 2012, this represented a 21%, 185%, and 253% increase in chlamydia, gonorrhea, and syphilis infections, respectively. Since 2020, eight cases of congenital syphilis have been reported. Prior to 2020, no cases of congenital syphilis were reported since 2009. This resurgence is mainly attributed to shifting social and behavioral trends, particularly among younger individuals and shared sexual networks across diverse groups.1 Further efforts and resources are needed to effectively address these concerning trends in STIs.

Background: Human immunodeficiency virus (HIV) remains a global challenge and novel measures for transmission disruption are needed. Contact tracing is limited by reluctance or inability of newly diagnosed individuals to name at-risk contacts. Molecular cluster analysis is mostly used for outbreak investigations, and its role in routine public health activities remains uncertain., Methods: We conducted a 2-year prospective statewide study in Rhode Island to evaluate integration of HIV cluster analyses into routine contact tracing, by attempting to reinterview all new diagnoses who clustered, notifying them of clustering, and evaluating benefits of this strategy. Clustering was compared between a phylogenetic ensemble versus distance-based HIV-TRACE., Results: Of 100 new diagnoses during 2021-2022, 52 individuals clustered, of whom only 31% were reinterviewed. Reinterviewing did not improve contact tracing beyond initial interviews, and the study was stopped early for futility. Clustering concordance within the phylogenetic ensemble was high (88%-89%), but lower (74%) for HIV-TRACE. Despite hypothesis rejection, we established a public health-academic partnership, developed a bioinformatics pipeline enabling near real-time cluster analysis, and identified gaps and unique opportunities for intervention., Conclusions: Attempting to reinterview all statewide new HIV diagnoses in molecular clusters showed no evidence of improving contact tracing. However, a strong academic-public health partnership enabled near real-time, longitudinal integration of molecular cluster analysis into routine public health activities, and identified barriers and opportunities tailoring data-driven approaches to unique individual and community characteristics, guiding future work on optimal use of molecular epidemiology to disrupt HIV transmission., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Molecular HIV cluster data can guide public health responses towards ending the HIV epidemic. Currently, real-time data integration, analysis, and interpretation are challenging, leading to a delayed public health response. We present a comprehensive methodology for addressing these challenges through data integration, analysis, and reporting. We integrated heterogeneous data sources across systems and developed an open-source, automatic bioinformatics pipeline that provides molecular HIV cluster data to inform public health responses to new statewide HIV-1 diagnoses, overcoming data management, computational, and analytical challenges. We demonstrate implementation of this pipeline in a statewide HIV epidemic and use it to compare the impact of specific phylogenetic and distance-only methods and datasets on molecular HIV cluster analyses. The pipeline was applied to 18 monthly datasets generated between January 2020 and June 2022 in Rhode Island, USA, that provide statewide molecular HIV data to support routine public health case management by a multi-disciplinary team. The resulting cluster analyses and near-real-time reporting guided public health actions in 37 phylogenetically clustered cases out of 57 new HIV-1 diagnoses. Of the 37, only 21 (57%) clustered by distance-only methods. Through a unique academic-public health partnership, an automated open-source pipeline was developed and applied to prospective, routine analysis of statewide molecular HIV data in near-real-time. This collaboration informed public health actions to optimize disruption of HIV transmission.

Objectives: Molecular epidemiology is a powerful tool to characterize HIV epidemics and prioritize public health interventions. Typically, HIV clusters are assumed to have uniform patterns over time. We hypothesized that assessment of cluster evolution would reveal distinct cluster behavior, possibly improving molecular epidemic characterization, towards disrupting HIV transmission., Design: Retrospective cohort., Methods: Annual phylogenies were inferred by cumulative aggregation of all available HIV-1 pol sequences of individuals with HIV-1 in Rhode Island (RI) between 1990 and 2020, representing a statewide epidemic. Molecular clusters were detected in annual phylogenies by strict and relaxed cluster definition criteria, and the impact of annual newly-diagnosed HIV-1 cases to the structure of individual clusters was examined over time., Results: Of 2153 individuals, 31% (strict criteria) - 47% (relaxed criteria) clustered. Longitudinal tracking of individual clusters identified three cluster types: normal, semi-normal and abnormal. Normal clusters (83-87% of all identified clusters) showed predicted growing/plateauing dynamics, with approximately three-fold higher growth rates in large (15-18%) vs. small (∼5%) clusters. Semi-normal clusters (1-2% of all clusters) temporarily fluctuated in size and composition. Abnormal clusters (11-16% of all clusters) demonstrated collapses and re-arrangements over time. Borderline values of cluster-defining parameters explained dynamics of non-normal clusters., Conclusions: Comprehensive tracing of molecular HIV clusters over time in a statewide epidemic identified distinct cluster types, likely missed in cross-sectional analyses, demonstrating that not all clusters are equal. This knowledge challenges current perceptions of consistent cluster behavior over time and could improve molecular surveillance of local HIV epidemics to better inform public health strategies., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: HIV continues to have great impact on millions of lives. Novel methods are needed to disrupt HIV transmission networks. In the USA, public health departments routinely conduct contact tracing and partner services and interview newly HIV-diagnosed index cases to obtain information on social networks and guide prevention interventions. Sequence clustering methods able to infer HIV networks have been used to investigate and halt outbreaks. Incorporation of such methods into routine, not only outbreak-driven, contact tracing and partner services holds promise for further disruption of HIV transmissions., Methods and Analysis: Building on a strong academic-public health collaboration in Rhode Island, we designed and have implemented a state-wide prospective study to evaluate an intervention that incorporates real-time HIV molecular clustering information with routine contact tracing and partner services. We present the rationale and study design of our approach to integrate sequence clustering methods into routine public health interventions as well as related important ethical considerations. This prospective study addresses key questions about the benefit of incorporating a clustering analysis triggered intervention into the routine workflow of public health departments, going beyond outbreak-only circumstances. By developing an intervention triggered by, and incorporating information from, viral sequence clustering analysis, and evaluating it with a novel design that avoids randomisation while allowing for methods comparison, we are confident that this study will inform how viral sequence clustering analysis can be routinely integrated into public health to support the ending of the HIV pandemic in the USA and beyond., Ethics and Dissemination: The study was approved by both the Lifespan and Rhode Island Department of Health Human Subjects Research Institutional Review Boards and study results will be published in peer-reviewed journals., Competing Interests: Competing interests: MH reports fees from Competition Economics and The Miriam Hospital for consulting, outside the submitted work. RK reports receiving a research grant from Gilead Sciences for work that is not related to HIV or this paper., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: External carotid artery originated superior thyroid artery are frequently documented in classical anatomical, surgical and radiological textbooks. Knowledge of anatomical variations, proper identification of superior thyroid arteries is very important to avoid major complications during and after neck surgeries. The aim of the study is to find out the prevalence of right superior thyroid artery originating from right external carotid artery in cadavers of a Medical College in Nepal., Methods: A descriptive cross-sectional study was carried out at the department of anatomy in Universal College of Medical Sciences, Bhairahawa, Nepal from October 2020 to January 2021 after ethical clearance from the same institution (IRC UCMS, Ref: UCMS/IRC/078/20). Variations in origin of superior thyroid arteries were observed, recorded and photographed. Convenient sampling method was used. Data was analyzed using Microsoft Excel 2016. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage., Results: Out of 30 right superior thyroid arteries of 30 cadavers, 27 (90%) at 90% Confidence Interval (80.22-96.44) originates from right external carotid artery., Conclusions: In our study we observed that almost nine tenths of right superior thyroid arteries originated from the right external carotid artery which was relatively high in comparison to other studies. Thus, Extensive knowledge of variations in origin of superior thyroid artery is important for surgeons prior to various interventional surgeries.