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Duncan Short,1 Xueqi Wang,2 Shivali Suri,3 Thomas K Hsu,2 Bryn Jones,1 Rob J Fredericksen,4 Heidi M Crane,4 Alexandra Musten,5 Jean Bacon,5 Yongwei Wang,2 Kevin A Gough,3 Moti Ramgopal,6 Jeff Berry,7 William B Lober4 1ViiV Healthcare, Brentford, UK; 2ViiV Healthcare, Durham, NC, USA; 3St Michael’s Hospital, Toronto, ON, Canada; 4Center for AIDS Research, University of Washington, Seattle, WA, USA; 5Ontario HIV Treatment Network, Toronto, ON, Canada; 6Midway Specialty Care Center, Fort Pierce, FL, USA; 7TPAN, Chicago, IL, USACorrespondence: Duncan Short, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK, Tel +44 7827 282971, Email duncan.x.short@viivhealthcare.comPurpose: Use of patient-reported outcomes assessments (PROs) can improve patient–provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics.Patients and Methods: Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting < 95% or < 80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses.Results: Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported < 95% and < 80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with < 95% and < 80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51– 4.56] and 4.26 [2.82– 6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2.76 [1.91– 4.00] and 3.28 [1.95– 5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of < 95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511– 0.997]); no other factors were associated with < 95% or < 80% adherence.Conclusion: These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.Keywords: patient satisfaction, antiretroviral therapy, highly active, treatment adherence, implementation science, quality of life

Abstract A critical goal for ecologists is understanding how ongoing local and global species losses will affect ecosystem functions and services. Diversity–functioning relationships, which are well‐characterized in primary producer communities, are much less consistently predictable for ecosystem functions involving two or more trophic levels, particularly in situations where multiple species in one trophic level impact functional outcomes at another trophic level. This is particularly relevant to pollination functioning, given ongoing pollinator declines and the value of understanding pollination functioning for single plant species like crops or threatened plants. We used spatially replicated, controlled single‐pollinator‐species removal experiments to assess how changes in bumble bee species richness impacted the production of fertilized seeds in a perennial herb—Delphinium barbeyi—in the Rocky Mountains of Colorado, USA. To improve predictability, we also assessed how traits and abundances in the plant and bumble bee communities were related to D. barbeyi reproductive success. We hypothesized that trait‐matching between pollinator proboscis length and D. barbeyi's nectar spurs would produce a greater number of fertilized seeds, while morphological similarity within the floral community would dilute pollination services. We found that the effects of pollinator removal differed depending on the behavioral patterns of pollinators and compositional features of the plant and pollinator communities. While pollinator floral fidelity generally increased D. barbeyi seed production, that positive effect was primarily evident when more than half of the Bombus community was experimentally removed. Similarly, communities comprising primarily long‐tongued bees were most beneficial to D. barbeyi seed production in tandem with a strong removal. Finally, we observed contrasting effects of morphological similarity in the plant community, with evidence of both competition and facilitation among plants. These results offer an example of the complex dynamics underlying ecosystem function in multitrophic systems and demonstrate that community context can impact diversity–functioning relationships between trophic levels.

Abstract Molecular identification of mixed‐species pollen samples has a range of applications in various fields of research. To date, such molecular identification has primarily been carried out via amplicon sequencing, but whole‐genome shotgun (WGS) sequencing of pollen DNA has potential advantages, including (1) more genetic information per sample and (2) the potential for better quantitative matching. In this study, we tested the performance of WGS sequencing methodology and publicly available reference sequences in identifying species and quantifying their relative abundance in pollen mock communities. Using mock communities previously analyzed with DNA metabarcoding, we sequenced approximately 200Mbp for each sample using Illumina HiSeq and MiSeq. Taxonomic identifications were based on the Kraken k‐mer identification method with reference libraries constructed from full‐genome and short read archive data from the NCBI database. We found WGS to be a reliable method for taxonomic identification of pollen with near 100% identification of species in mixtures but generating higher rates of false positives (reads not identified to the correct taxon at the required taxonomic level) relative to rbcL and ITS2 amplicon sequencing. For quantification of relative species abundance, WGS data provided a stronger correlation between pollen grain proportion and sequence read proportion, but diverged more from a 1:1 relationship, likely due to the higher rate of false positives. Currently, a limitation of WGS‐based pollen identification is the lack of representation of plant diversity in publicly available genome databases. As databases improve and costs drop, we expect that eventually genomics methods will become the methods of choice for species identification and quantification of mixed‐species pollen samples.

Given widespread concerns over human-mediated bee declines in abundance and species richness, conservation efforts are increasingly focused on maintaining natural habitats to support bee diversity in otherwise resource-poor environments. However, natural habitat patches can vary in composition, impacting landscape-level heterogeneity and affecting plant-pollinator interactions. Plant-pollinator networks, especially those based on pollen loads, can provide valuable insight into mutualistic relationships, such as revealing the degree of pollination specialization in a community; yet, local and landscape drivers of these network indices remain understudied within urbanizing landscapes. Beyond networks, analyzing pollen collection can reveal key information about species-level pollen preferences, providing plant restoration information for urban ecosystems. Through bee collection, vegetation surveys, and pollen load identification across ~350 km of urban habitat, we studied the impact of local and landscape-level management on plant-pollinator networks. We also quantified pollinator preferences for plants within urban grasslands. Bees exhibited higher foraging specialization with increasing habitat heterogeneity and visited fewer flowering species (decreased generality) with increasing semi-natural habitat cover. We also found strong pollinator species-specific flower foraging preferences, particularly for Asteraceae plants. We posit that maintaining native forbs and supporting landscape-level natural habitat cover and heterogeneity can provide pollinators with critical food resources across urbanizing ecosystems.

Given ongoing pollinator declines, it is important to understand the dynamics of linked extinctions of plants driven by pollinator extinctions. Topological robustness models focused on this question suggest relatively high robustness of plant species to pollinator species extinctions. Still, existing robustness models typically assume that all interactions in plant-pollinator networks are positive, which is clearly not always the case. For example, many pollinators remove floral resources without transferring pollen, or even damage floral structures in the case of nectar robbing. Here we introduce antagonistic interactions into plant-pollinator networks and assess the resilience of plant communities to pollinator species losses. Incorporating antagonistic interactions leads to lower network robustness, i.e. an increased rate of plant species loss (as compared to networks with only mutualistic interactions) in empirical plant-pollinator networks. In conjunction with extinction order, the addition of increasingly antagonistic interactions was idiosyncratic in that it did not always magnify the effects of extinction order across the three networks. These results underscore the importance of considering the full spectrum of interaction outcomes when assessing robustness to coextinctions in plant-pollinator networks, as well as other ecological systems.

Managed honey bee (Apis mellifera) colonies are kept at much greater densities than naturally occurring feral or wild colonies, which may have detrimental effects on colony health and survival, disease spread, and drifting behavior (bee movement between natal and non-natal colonies). We assessed the effects of a straightforward apiary management intervention (altering the density and visual appearance of colonies) on colony health. Specifically, we established three "high density / high drift" ("HD") and three "low density / low drift" ("LD") apiary configurations, each consisting of eight bee colonies. Hives in the HD apiary configuration were of the same color and placed 1m apart in a single linear array, while hives in the LD apiary configuration were placed 10m apart at different heights, facing outwards in a circle, and made visually distinctive with colors and symbols to reduce accidental drift between colonies. We investigated disease transmission and dynamics between the apiary configurations by clearing all colonies of the parasitic mite Varroa destructor, and subsequently inoculating two randomly-chosen colonies per apiary with controlled mite doses. We monitored the colonies for two years and found that the LD apiary configuration had significantly greater honey production and reduced overwinter mortality. Inoculation and apiary management intervention interacted to affect brood mite levels, with the highest levels in the inoculated colonies in the HD configuration. Finally, foragers were more than three times more likely to drift in the HD apiary configurations. Our results suggest that a relatively straightforward management change-placing colonies in low-density visually complex circles rather than high-density visually similar linear arrays-can provide meaningful benefits to the health and productivity of managed honey bee colonies.

In recent years, FAES breeders have joined forces with FAES molecular geneticists. Molecular genetics can make breeding programs more efficient, accelerate progress in breeding, and enable the introduction of novel traits. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag224

Forage improvement research at the FAES traces to its earliest days – the first forage grass variety was released in 1892, and the first forage legume variety was released in 1896. By 1915, almost 1700 plant introductions had been tested and evaluated as potential new varieties. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

The Cooperative Forest Genetics Research Program (CFGRP), founded in 1953 by geneticists Tom Perry and Ray Goddard, is a cooperative organization composed of FAES scientists working together with private industries and state agencies to develop genetically improved varieties of slash pine (Pinus elliottii), loblolly pine (P. taeda), longleaf pine (P. palustris) and sand pine (P. clausa). Through faster growth and greater disease resistance, plantations of improved southern pine yield up to 45 percent more usable wood per acre at harvest than the unimproved plantations. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

Lisianthus (Eustoma grandiflorum) is a relatively new cut flower. Sakata Seed Company was the first to offer lisianthus as a new cut flower in the United States in the early 1980s. Growers and consumers alike were anxious to try lisianthus because it has elegant and beautiful flowers in 15 colors, the flowers have a long vase life, and there are few “blue” flowers available in the cut flower market. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag222

Today, the sweet corn industry is one of the most robust vegetable industries in Florida, and nationally, sweet corn is ranked second in consumption after tomato. Florida production uses about two dozen hybrids derived from about six different breeding programs. Over the years, the FAES breeding program has contributed an array of products, including hybrids and inbreds, along with germplasm that serves as the raw material for the development of future hybrids. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag214

In 2000, Florida produced 450,000 acres of sugarcane with an estimated value of $750 million. Canal Point clones occupied 75% of Florida's sugarcane area, accounting for $560 million in farm income. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

Plant breeding and plant molecular genetics are critical to helping solve the agricultural challenges of the future. New varieties will continue to help reduce the amount of pesticides, fertilizers and energy used in farming. Higher yields will help to feed the world’s increasing population as well as reduce the amount of land and water needed. Healthier and better-tasting foods will benefit consumers. FAES scientists continue to work for farmers and consumers to improve plant production and our quality of life. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

Grain crops are widely grown in the Southeast for forage production, grain, and cover crops. They provide green livestock forage during the late fall, winter and early spring months when permanent pastures are generally dormant and nonproductive. Many successful varieties of grain have been released by the FAES Grain Breeding Team. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag217

There are more than four million acres of managed turfgrass in Florida, with 75 percent of these in residential lawns. Several warm-season turf species are important for use in Florida. The decision of which turfgrass species to use is based on the desired maintenance effort and geographic location within the state. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag220

Foliage breeding began in 1976 at FAES with Jake Henny and Gary Wilfret focusing on members of the family Araceae (referred to as aroids) and Caladium, respectively. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag221

The peanut originated in South America, and today it is widely grown for oil, roasted nuts, peanut butter and other products. Research on peanut breeding at FAES dates back to 1920. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag216

The program at FAES has provided improvements that have allowed tomato to be grown successfully in Florida and it has had a significant impact on production worldwide. Major achievements in the breeding program have been the development of disease-resistant varieties and the improvement of fruit quality. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag213

FAES leased a tract of land near Leesburg, Florida in 1930 for watermelon research. Emphasis in the early years of the program was resistance to Fusarium wilt, and many crosses and selections were made with the objective of developing new, wilt-resistant varieties. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

Until the 1980s, nearly all research effort was focused on development of disease-resistant bunch grape varieties. In the late 1970s, muscadine breeding began to be emphasized. Developments of biotechnological procedures to facilitate genetic improvement of grape began at the Leesburg site in 1984 and continue at Apopka, Florida. The program has been responsible for a number of pivotal technological advances for grape and has been awarded two U.S. patents for work in genetic transformation. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

The FAES team of citrus scientists has been recognized by the Florida citrus industry as an invaluable resource. In an integrated project funded by the industry, the labs are working together to address the most serious threats to the citrus industry. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag211

After several years and cycles of crossing and selection, Paul Lyrene developed today’s newer commercial varieties of blueberries, which have larger berries, stronger bushes and higher yields. These new berries also ripen earlier and are easier to pick and ship. Today’s varieties have made Florida blueberry production what it is today – a crop that sells 4 million pounds per year, with a farm-gate value of $20 million. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag206

Tropical pumpkin (Cucurbita moschata Duchesne), also known as calabaza, calabash, auyama, ayote, or zapallo, is a species of pumpkin that is grown throughout the tropics and subtropics. Tropical pumpkins are a valuable source of dietary carotenoids that have a major role in nutrition as provitamin A and antioxidants. Carotenoid concentrations in tropical pumpkin compare favorably with those in butternut squash. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003.

Florida tropical fruit industry acreage has fluctuated during the past 70 years due to natural disasters, foreign competition and changes in the U.S. demographics. Today, there are about 16,000 acres in cultivation, with an economic impact of over $137 million annually. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. Circular 1440/AG210: New Plants for Florida: Tropical Fruit (ufl.edu)

The Florida strawberry industry has continued to grow. There are now approximately 7,000 acres in production, with a crop value approaching $200 million. This growth is being fueled, in part, by new variety releases from the FAES breeding program. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag207

This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag204

New plants developed at the Florida Agricultural Experiment Station (FAES) have been vital to the state’s agricultural industries and to consumers here and throughout the country and the world. New crop varieties are developed through research led and conducted by plant breeders with cooperation from scientists in other agricultural disciplines. These varieties may have higher yield; they may be more resistant to pests, or they may be healthier for consumers. Almost every crop variety grown in Florida came from plant breeding programs at FAES. This document is part of Circular 1440, a publication of the Florida Agricultural Experiment Station, the Agronomy Department and IFAS Communication Services, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date August 2003. Originally published as a booklet by IFAS Communication Services June 2003. https://edis.ifas.ufl.edu/ag205

Infectious diseases are a major threat to both managed and wild pollinators. One key question is how the movement or transplantation of honeybee colonies under different management regimes affects honeybee disease epidemiology. We opportunistically examined any persistent effect of colony management history following relocation by characterising the virus abundances of honeybee colonies from three management histories, representing different management histories: feral, low-intensity management, and high-intensity "industrial" management. The colonies had been maintained for one year under the same approximate 'common garden' condition. Colonies in this observational study differed in their virus abundances according to management history, with the feral population history showing qualitatively different viral abundance patterns compared to colonies from the two managed population management histories; for example, higher abundance of sacbrood virus but lower abundances of various paralysis viruses. Colonies from the high-intensity management history exhibited higher viral abundances for all viruses than colonies from the low-intensity management history. Our results provide evidence that management history has persistent impacts on honeybee disease epidemiology, suggesting that apicultural intensification could be majorly impacting on pollinator health, justifying much more substantial investigation.

Earth system models predict that increases in atmospheric and soil dryness will reduce photosynthesis in the Amazon rainforest, with large implications for the global carbon cycle. Using in situ observations, solar-induced fluorescence, and nonlinear machine learning techniques, we show that, in reality, this is not necessarily the case: In many of the wettest parts of this region, photosynthesis and biomass tend to increase with increased atmospheric dryness, despite the associated reductions in canopy conductance to CO2 These results can be largely explained by changes in canopy properties, specifically, new leaves flushed during the dry season have higher photosynthetic capacity than the leaves they replace, compensating for the negative stomatal response to increased dryness. As atmospheric dryness will increase with climate change, our study highlights the importance of reframing how we represent the response of ecosystem photosynthesis to atmospheric dryness in very wet regions, to accurately quantify the land carbon sink.

BackgroundAtrial fibrillation (AF) adversely impacts health-related quality of life (hrQoL). While some patients demonstrate improvements in hrQoL, the factors associated with large improvements in hrQoL are not well described.MethodsWe assessed factors associated with a 1-year increase in the Atrial Fibrillation Effect on Quality-of-Life score of 1 SD (≥18 points; 3× clinically important difference), among outpatients in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation I registry.ResultsOverall, 28% (181/636) of patients had such a hrQoL improvement. Compared with patients not showing large hrQoL improvement, they were of similar age (median 73 versus 74, P=0.3), equally likely to be female (44% versus 48%, P=0.3), but more likely to have newly diagnosed AF at baseline (18% versus 8%; P=0.0004), prior antiarrhythmic drug use (52% versus 40%, P=0.005), baseline antiarrhythmic drug use (34.8% versus 26.8%, P=0.045), and more likely to undergo AF-related procedures during follow-up (AF ablation: 6.6% versus 2.0%, P=0.003; cardioversion: 12.2% versus 5.9%, P=0.008). In multivariable analysis, a history of alcohol abuse (adjusted OR, 2.41; P=0.01) and increased baseline diastolic blood pressure (adjusted OR, 1.23 per 10-point increase and >65 mm Hg; P=0.04) were associated with large improvements in hrQoL at 1 year, whereas patients with prior stroke/transient ischemic attack, chronic obstructive pulmonary disease, and peripheral arterial disease were less likely to improve (P

PurposeThe Anal Cancer HSIL Outcomes Research (ANCHOR) trial aims to determine whether treating precancerous anal high-grade squamous intraepithelial lesions (HSIL), versus active surveillance, is effective in reducing anal cancer incidence in HIV-infected individuals. We evaluated the reliability (i.e., internal consistency, test-retest) and between-group stability of a 25-item ANCHOR Health-Related Symptom Index (A-HRSI).MethodsANCHOR participants at least 1-month post-randomization to treatment or active surveillance completed the A-HRSI via telephone. Participants were contacted 7-10 days later to complete the A-HRSI and a participant global impression of change (PGIC) item.ResultsParticipants (n = 100) were enrolled (mean age = 51.4, 79% cisgender-male, 73% African American, 9% Hispanic) from five ANCHOR sites. Cronbach's α was good for the physical symptoms (0.82) domain and fair for the physical impacts (0.79) and psychological symptoms (0.73) domains. Intraclass correlation coefficients were good for each of respective domains (i.e., 0.80, 0.85, and 0.82). There were no significant differences in PGIC between the treatment (n = 56) and active surveillance (n = 44) groups (F(1,98) = 2.03, p = 0.16).ConclusionsThe A-HRSI is able to reliably assess participant-reported symptoms and impacts of anal HSIL across a 7-10 days of timeframe. Future work will involve the establishment of construct and discriminant validity prior to inclusion in the full ANCHOR trial.