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Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

IntroductionAlthough HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations.MethodsWe pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations.ResultsOf 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs.ConclusionsThis study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.

After severe neurocognitive decline developed in an otherwise healthy 63-year-old man, brain magnetic resonance imaging showed eosinophilic meningoencephalitis and enhancing lesions. The patient tested positive for antibodies to Baylisascaris spp. roundworms, was treated with albendazole and dexamethasone, and showed improvement after 3 months. Baylisascariasis should be considered for all patients with eosinophilic meningitis.

ObjectiveIdentification of a particular cause of meningoencephalitis can be challenging owing to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. Metagenomic deep sequencing (MDS) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis.MethodsWe present the case of a 74-year-old woman with endophthalmitis followed by meningoencephalitis. MDS of her cerebrospinal fluid (CSF) was performed to identify an infectious agent.ResultsSequences aligning to Balamuthia mandrillaris ribosomal RNA genes were identified in the CSF by MDS. Polymerase chain reaction subsequently confirmed the presence of B. mandrillaris in CSF, brain tissue, and vitreous fluid from the patient's infected eye. B. mandrillaris serology and immunohistochemistry for free-living amoebas on the brain biopsy tissue were positive.InterpretationThe diagnosis was made using MDS after the patient had been hospitalized for several weeks and subjected to costly and invasive testing. MDS is a powerful diagnostic tool with the potential for rapid and unbiased pathogen identification leading to early therapeutic targeting.

The article discusses the importance of Programme Science in the President's Emergency Plan For AIDS Relief (PEPFAR) and its role in achieving the UNAIDS targets and ending the HIV pandemic by 2030. Programme Science emphasizes the need for context-specific evidence and ongoing knowledge to inform programmatic decisions. The article highlights the challenges faced by PEPFAR, such as reaching populations not effectively covered by existing services and supporting continuity of care for people living with HIV. It also emphasizes the need to address system-level challenges and integrate HIV services into primary care systems. The article calls for the integration of science into program planning and execution and the empowerment of HIV programs to use Programme Science to improve programs. PEPFAR is planning future initiatives to contribute to Programme Science and encourages others to do the same. The article concludes by emphasizing the importance of evidence-based policies and strategies tailored to different communities and regions. [Extracted from the article]

Author(s): Elvin H. Geng 1,*, Michael J. A. Reid 2,3, Eric Goosby 2,3, Quarraisha Abdool-Karim 4,5 Many problems underscored by the Coronavirus Disease 2019 (COVID-19) pandemic, and highlighted in other [...]

During the past 15 years, researchers have shown a renewed interest in the study of the Plasmodium parasites that infect orangutans. Most recently, studies examined the phylogenetic relationships and divergence dates of these parasites in orangutans using complete mitochondrial DNA genomes. Questions regarding the dating of these parasites, however, remain. In the present study, we provide a new calibration model for dating the origins of Plasmodium parasites in orangutans using a modified date range for the origin of macaques in Asia. Our Bayesian phylogenetic analyses of complete Plasmodium sp. mitochondrial DNA genomes inferred two clades of plasmodia in orangutans (Pongo 1 and Pongo 2), and that these clades likely represent the previously identified species Plasmodium pitheci and Plasmodium silvaticum. However, we cannot identify which Pongo clade is representative of the morphologically described species. The most recent common ancestor of both Pongo sp. plasmodia, Plasmodium. hylobati, and Plasmodium. inui dates to 3–3.16 million years ago (mya) (95% highest posterior density [HPD]: 2.09–4.08 mya). The Pongo 1 parasite diversified 0.33–0.36 mya (95% HPD: 0.12–0.63), while the Pongo 2 parasite diversified 1.15–1.22 mya (95% HPD: 0.63–1.82 mya). It now seems likely that the monkey Plasmodium (P. inui) is the result of a host switch event from the Pongo 2 parasite to sympatric monkeys, or P. hylobati. Our new estimates for the divergence of orangutan malaria parasites, and subsequent diversification, are all several hundred thousand years later than previous Bayesian estimates. RESEARCH HIGHLIGHTS: We provide a complete history of the discovery and study of the plasmodia found in orangutans including morphological and phylogenetic studies.Our interpretation of the phylogenetic results of Bayesian and maximum parsimony analyses on complete mitochondrial DNA sequences of plasmodia isolated from orangutans seems to indicate the presence of two species.Using two newly created models we date the origins of the two orangutan plasmodia clades. Our Pongo 1 clade dates to between 0.63 and 0.12 3–3.16 million years ago (mya), while our Pongo 2 clade is older dating to 1.82–0.63 mya. [ABSTRACT FROM AUTHOR]

We evaluated the impact of language concordance—clinician or public health worker fluency in a patient's primary language—on coronavirus disease 2019 (COVID-19) contact tracing outcomes among 2668 Spanish-speaking adults in San Francisco. Language concordance was associated with 20% greater odds of COVID-19 testing and 53% greater odds of support service referrals. [ABSTRACT FROM AUTHOR]

The article discusses the efforts of the President's Emergency Plan for AIDS Relief (PEPFAR) in combating the global HIV pandemic. PEPFAR, along with partner governments and organizations, has saved millions of lives and made progress towards achieving the UNAIDS "95-95-95 targets" in sub-Saharan Africa. The article emphasizes the need for transformative political leadership, sustained financial commitment, and program innovation to sustain the HIV/AIDS response. It also highlights the importance of addressing knowledge gaps and integrating HIV services with other healthcare needs, such as hypertension and mental health. PEPFAR remains committed to supporting partner countries in achieving these goals. [Extracted from the article]