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The US faces substantial demographic and geographic disparities in both HIV burden and access to pre-exposure prophylaxis (PrEP), an effective strategy to prevent HIV acquisition. Long-acting cabotegravir (CAB) is a novel, injectable PrEP option which demonstrated superior reduction in risk of HIV acquisition compared to daily-oral PrEP in the HPTN083 trial. We modelled the impact of increased PrEP initiations and the introduction of long-acting CAB on HIV incidence among men who have sex with men (MSM) in Atlanta, Georgia, a population with a high burden of HIV. The Georgia Department of Public Health has set an ambitious 25% HIV incidence reduction target, which could be reached with a daily-oral PrEP coverage of 42.2%. However, the target could be achieved at lower levels of PrEP coverage (34.6%) if a mix of PrEP modalities was used, such as an equal split of long-acting CAB PrEP and daily-oral PrEP. Our results clearly demonstrate that broadening access to new PrEP options has the potential to facilitate the achievement of public health HIV incidence reduction goals at plausible levels of PrEP coverage. [ABSTRACT FROM AUTHOR]

Unsafe hospital wastewater (HWW) is a significant concern, especially in low-and middle-income countries (LMICs) where the health impact is often underreported. Socio-technical systems (STS) theory, which examines the interplay between social and technical elements within complex systems, is widely used in developed countries but rarely applied in LMIC hospitals. STS theory was employed to evaluate the social and technical aspects of HWW treatment and management in Dhaka City, alongside a comprehensive assessment of WWT processes. A mixed-methods approach was used, combining quantitative (structured observations) and qualitative interviews. Structured observations assessed the availability and functionality of WWT systems in selected hospitals. The fieldworkers conducted 30 key-informant interviews across 13 hospitals, including 21 respondents from government and nine from private hospitals. The respondents were cleaners, key health professionals, and public works department (PWD) engineers. We also analyzed relevant government reports and policies. Among the hospitals surveyed, 10 had some form of WWT system, while the remaining three lacked any treatment infrastructure. Of those with WWT, seven utilized anaerobic baffled reactors and three had septic tanks. Interviews revealed that hospital authorities prioritize patient care and medical equipment maintenance over WWT, with limited understanding among hospital staff regarding WWT. PWD-engineers reported frequent staff shortages and bureaucratic delays, affecting the efficiency of WWT system repairs and desludging. Our study identified significant gaps in WWT in Dhaka hospitals, including the limited use of adequate treatment technologies, poor wastewater management knowledge, and many systems in disrepair, leading to hazardous liquid being discharged directly into the environment. The STS approach highlighted the need for policy formulation for HWW regulation, government leadership, adequate financing, technical assistance, and staff capacity building. Addressing these issues comprehensively can lead to safer and more sustainable wastewater management practices in HCFs, ultimately benefiting public health and the environment. [ABSTRACT FROM AUTHOR]

We investigated men who have sex with men's (MSM) location preferences for long-acting injectable pre-exposure prophylaxis (LA-PrEP). MSM (n = 1076) who completed the 2021 American Men's Internet Survey, were currently prescribed oral PrEP, and expressed LA-PrEP interest reported location preferences for receiving LA-PrEP: healthcare provider (HCP) setting, pharmacy, or at-home. HCP settings were preferred by 60% of participants; 26% preferred home and 14% preferred pharmacy. In adjusted models, high healthcare stigma was associated with preferring pharmacy and at-home versus HCP, while high friends/family stigma was associated with preferring HCP settings versus pharmacy. Healthcare access history was associated with preference for HCP setting versus home. Being 25 to 29 or 30 to 29 years old versus 40+ was associated with preferring HCP versus home. Private insurance was associated with location preferences. Findings support the need for multiple LA-PrEP service locations to best reach MSM and highlight multiple complex factors that influence such preferences. Plain Language Summary: Location Preferences for Receiving Long-Acting Injectable Pre-Exposure Prophylaxis (LA-Prep) among Men who have Sex with Men (MSM) We investigated location preferences among men who have sex with men (MSM) for receiving long-acting injectable pre-exposure prophylaxis (LA-PrEP), a medication approved to prevent human immunodeficiency virus (HIV). MSM (n = 1076) who completed the 2021 American Men's Internet Survey, were currently prescribed oral PrEP, and expressed interest in switching to LA-PrEP reported preferences for where they would like to receive LA-PrEP. Responses included healthcare provider (HCP) setting, pharmacy, or at-home. HCP settings were preferred among 60% of MSM; 26% preferred home, and 14% preferred pharmacy. In adjusted models, high healthcare stigma was associated with preferring pharmacy and at-home over HCP setting, while high friends/family stigma was associated with preferring HCP settings over pharmacy. Healthcare access history was associated with preference for HCP setting over home. Being younger (25-29 or 30-29 vs 40+ years old) was associated with preferring HCP over home. Private insurance was associated with various location preferences. Findings support the need for multiple LA-PrEP service location options to best reach MSM and highlight multiple complex factors that influence their preferences. [ABSTRACT FROM AUTHOR]

Biological treatment with a stable activated sludge process, followed by chemical treatment is one of the potential and accepted cyanide remediation processes for coke plant wastewater treatment. Biologically treated coke plant wastewater contains free cyanide above permissible limit. Presently, chemical treatment with NaOCl is being used to attenuate free cyanide below permissible limit in biologically treated water. This process increases the TDS and colour content in discharge water. Ca(OCl)2 can be used as an alternative to NaOCl for cyanide remediation in biologically treated coke plant wastewater without increasing TDS. In the present work, cyanide removal efficiency of NaOCl and Ca(OCl)2 for real coke plant wastewater after biological treatment has been studied. Optimisation of chemical dosage, treatment time and pH study has been done for Ca(OCl)2 and NaOCl treatment. It was found that up to 90% of free cyanide removal could be achieved through Ca(OCl)2 treatment without increasing the TDS value. In addition, more than 50% colour of the wastewater was removed. pH elevation step required in NaOCl treatment can be eliminated in Ca(OCl)2 treatment, thereby reducing caustic consumption. The study indicated that the use of Ca(OCl)2 is economically more viable than that of NaOCl in cyanide treatment. [ABSTRACT FROM AUTHOR]

Purpose: Two-drug regimens (2DR) may address drug–drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load < 50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race. Methods: From the OPERA® cohort, people with HIV with a viral load < 50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥ 50 copies/mL), confirmed virologic failure (2 viral loads ≥ 200 copies/mL or discontinuation after 1 viral load ≥ 200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race. Results: The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤ 5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related reasons (viremia, adverse diagnosis, side effect, lab abnormality). For all outcomes, incidence rates were comparable across strata of age, sex, and race. Conclusion: This descriptive study demonstrates that DTG/3TC 2DR is an effective and well-tolerated treatment option for people with HIV with a viral load < 50 copies/mL at switch, regardless of their age, sex, or race. [ABSTRACT FROM AUTHOR]