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Although gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender women have the highest HIV burden in Latin America, pre-exposure prophylaxis (PrEP) implementation is poor. We aimed to assess the feasibility of same-day oral PrEP delivery in Brazil, Mexico, and Peru.Implementation PrEP (ImPrEP) was a prospective, single-arm, open-label, multicentre PrEP implementation study conducted in Brazil (14 sites), Mexico (four sites), and Peru (ten sites). MSM and transgender women were eligible to participate if they were aged 18 years or older, HIV-negative, and reported one or more prespecified criteria. Enrolled participants received same-day initiation of daily oral PrEP (tenofovir disoproxil fumarate [300 mg] coformulated with emtricitabine [200 mg]). Follow-up visits were scheduled at week 4 and quarterly thereafter. We used logistic regression models to identify factors associated with early loss to follow-up (not returning after enrolment), PrEP adherence (medication possession ratio ≥0·6), and long-term PrEP engagement (attending three or more visits within 52 weeks). This study is registered at the Brazilian Registry of Clinical Trials, U1111-1217-6021.From Feb 6, 2018, to June 30, 2021, 9979 participants were screened and 9509 were enrolled (Brazil n=3928, Mexico n=3288, and Peru n=2293). 543 (5·7%) participants were transgender women, 8966 (94·3%) were cisgender men, and 2481 (26·1%) were aged 18-24 years. There were 12 185·25 person-years of follow-up. 795 (8·4%) of 9509 participants had early loss to follow-up, 6477 (68·1%) of 9509 were adherent to PrEP, and 5783 (70·3%) of 8225 had long-term PrEP engagement. Transgender women (adjusted odds ratio 1·60, 95% CI 1·20-2·14), participants aged 18-24 years (1·80, 1·49-2·18), and participants with primary education (2·18, 1·29-3·68) had increased odds of early loss to follow-up. Transgender women (0·56, 0·46-0·70), participants aged 18-24 years (0·52, 0·46-0·58), and those with primary education (0·60, 0·40-0·91) had lower odds of PrEP adherence. Transgender women (0·56, 0·45-0·71), participants aged 18-24 years (0·56, 0·49-0·64), and those with secondary education (0·74, 0·68-0·86) had lower odds of long-term PrEP engagement. HIV incidence was 0·85 per 100 person-years (95% CI 0·70-1·03) and was higher for transgender women, participants from Peru, those aged 18-24 years, Black and mixed-race participants, and participants who were non-adherent to PrEP.Same-day oral PrEP is feasible for MSM and transgender women in Latin America. Social and structural determinants of HIV vulnerability need to be addressed to fully achieve the benefits of PrEP.Unitaid, WHO, and Ministries of Health in Brazil, Mexico, and Peru.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

El desarrollo de la psicología en Guatemala durante las últimas décadas se ha visto fortalecido por varios hitos en su historia como han sido los congresos, encuentros académicos y profesionales, colaboraciones internacionales y conferencias para nombrar algunos. Este número especial de nuestra revista da testimonio de uno de ellos. Gracias a la confianza, apoyo y mentoría de los grandes exponentes de las psicoterapias integrativas de América Latina y de la valiosa y comprometida colaboración de un comité organizador, pudo realizarse en Guatemala, de manera virtual con sólido apoyo tecnológico, el VIII Encuentro Latinoamericano de Psicoterapias Integrativas (ELAPSI). Si bien, el producto final fue de una excelente calidad académica, científica, profesional y sociocultural, también fue de inmenso valor el llegar a concretarlo. Desde el momento en que nos fue confiada la realización del mismo en el marco del VII Encuentro Latinoamericano que se llevó a cabo en Uruguay en 2018, sabíamos que estábamos abriendo brecha. Por primera vez, un ELAPSI sería realizado fuera de América del Sur, en donde históricamente se había congregado la comunidad académica y profesional de las psicoterapias integrativas. Por lo tanto, iniciar el proceso de organización implicaba no solo colocar a Guatemala en el mapa latinoamericano de la integración psicoterapéutica sino también consolidar un equipo organizador que representara las voces integrativas de las Américas particularmente de aquellos países donde hasta el momento estaban casi silenciadas. Los valores de solidaridad, apoyo, entusiasmo y compromiso se hicieron presentes para emprender una tarea que, aunque ambiciosa desde sus albores, fue apasionante.

espanolObjetivo. Evaluar las prevalencias de marcadores de infec-cion por T. pallidum en personas que viven con VIH y reciben tratamiento antirretroviral en el Programa de VIH/SIDA de la Ciudad de Mexico, asi como sus caracteristicas asociadas. Material y metodos. Se siguio el metodo del algoritmo reverso para el diagnostico de T. pallidum aplicado a 2 383 individuos VIH positivos, quienes contestaron un cuestionario sobre caracteristicas sociodemograficas, practicas sexuales, diagnostico previo de sifilis y tiempo de tratamiento anti-rretroviral. Las variables significativamente asociadas con los marcadores de sifilis se analizaron mediante un modelo de regresion logistica. Resultados. Las prevalencias de marcadores de infeccion “activa o resuelta” y “probable-mente activa” fueron 44.2 y 28.8%, respectivamente. Las caracteristicas asociadas con los marcadores fueron Clinica Especializada Condesa Iztapalapa (CECI), diagnostico previo de infeccion por sifilis, hombres que tienen sexo con hom-bres (HSH) y practicas sexuales receptivas. Conclusiones.Las prevalencias de marcadores de infeccion por T. pallidumfueron altas y estuvieron relacionadas con practicas sexuales especificas y con el diagnostico previo de sifilis, caracteristicas que requieren medidas preventivas dentro del programa. EnglishObjective. The aim of this study is to evaluate the prevalence of T. pallidum infection markers in HIV-positive individuals receiving highly active antiretroviral therapy (ART) in the Mexico City HIV/AIDS Program, as well as predictive characteristics. Materials and methods. The reverse serologic algorithm method was used for the T. pallidum diagnosis, and applied to 2 383 HIV-positive individuals. Sociodemographic characteristics, sexual practices, previous syphilis diagnosis, and length of antiretroviral treatment, were evaluated. Variables significantly associated with syphilis markers were analyzed using a logistic regression model. Results. Prevalence of “active or resolved” and “probable active” infection markers were 44.2 and 28.8%, respectively. Predictive factors were: Clinica Especializada Condesa Iztapalapa (CECI), previous syphilis diagnosis, men in who have sex with men (MSM), and receptive sex practices. Conclusions. The prevalence of T. pallidum infection markers was the highest ever reported in Mexico, and was related to specific sexual practices as well as previous syphilis diagnosis, elements which require preventive measures in the Mexico City HIV/AIDS Program.

Syphilis, a sexually transmitted infection, has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011 to 2015. Databases from the laboratory were analyzed, and the following four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH), and patients from primary care clinics (others). The diagnosis of syphilis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data were analyzed and, with follow-up information, a retrospective dynamic cohort was formed. Factors associated with the seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. A total of 81,863 baseline individuals were analyzed. The seroprevalence of syphilis was 9.9% in the VCT group, 8.2% in the PPr group, 37.0% in the PLWH group, and 8.7% in the others group; the prevalence of active syphilis was 1.7–13.1%. A total of 11,124 people were followed up. The incidence (cases per 100 person-years) was 3.5 among the VCT group, 16.0 among the PLWH group, and

Clinical supervision is an essential mechanism for training psychologists internationally. But although it is performed globally, scholarship has primarily addressed it through the lens of Western supervision practices. The authors of this manuscript aspired to an alternative lens, that of enlightened globalization (Kim and Park in Korea J 44(2):30–51, 2007), to compare supervision practices in the U.S. and six countries that have been less studied—China, Guatemala, Mexico, South Korea, Turkey, and the United Arab Emirates. Although the Guidelines for Supervision of Health Service Psychologists (American Psychological Association [APA] in http://www.apa.org/about/policy/guidelines-supervision.pdf , 2014, Am Psychol 70(1):33–46, 2015) provided the framework for examining cross-national practices, they were not imposed as standards for all but rather as a springboard for inquiry. The final comparisons addressed areas of regulation and supervisor competence, ethical and legal factors, supervisory multicultural factors, the supervisory relationship, supervisees with problems of professional competence, and assessment, evaluation, and feedback. Cultural differences identified include forms of communication (direct, implicit, explicit), the supervision hierarchy, manifestations of respect, power, and the cultural relevance of regulation, gatekeeping, evaluation, and feedback. The article concludes by using the results of these analyses to propose a definition of clinical supervision that could be appropriate for all seven countries and presumably most other countries as well.

Background: Human immunodeficiency virus (HIV) incidence should be calculated in cross-sectional studies using recent infection testing algorithms (RITA) that consider clinical variables and serological test results such as enzyme-linked immunosorbent assay (ELISA) and dried blood spot (DBS) analysis. Methods: The correlation between serum samples and DBS was evaluated using two commercial ELISA kits: SediaTM BED HIV-1 Incidence EIA (BED-Sedia) and Maxim HIV-1 Limiting Antigen Avidity (LAg-Avidity). Eight different RITAs were developed; all of them included serological assays. A combination of the variables viral load, antiretroviral therapy (ART) and CD4 count was used to build the RITAs. The sensitivity, specificity, Youden index, predictive positive value, predictive negative value, false recent rate (FRR) and false long-term rate were evaluated. Results: The correlations between serum samples and DBS were 0.990 and 0.867 for BED-Sedia and LAg-avidity, respectively. Using only serological assays, the Youden index was higher for LAg-avidity than BED-Sedia (82.1–83.0% versus 69.2–69.6%). The best RITA was ART-serology, which showed a Youden index of 91.2–93.9% and FRR of 1.8–2.2%. Conclusions: Using DBS samples to determine HIV incidence is a good tool for epidemiological surveillance. The RITA that included ART and serological tests (BED-Sedia or LAg-avidity) showed the highest sensitivity and specificity and a low FRR. Keywords: HIV serodiagnosis, Incidence, Dried blood spot testing, Serologic tests

Background. Patients exposed to hepatitis C virus (HCV) may develop chronic infection with viremia. The diagnosis of this condition requires the use of several laboratory tests in algorithms tailored to the population and resources available for each laboratory. Aim. We compared the diagnostic efficacy of two diagnostic algorithms for the identification of viremic patients with HCV. One based on confirmation of reactive antibody results with molecular techniques (reverse transcription polymerase chain reaction, RTPCR) and the other based on the use of a new HCV core antigen test (HCV Ag). Material and methods. We measured levels of anti-HCV, HCV Ag and viral load (trough RT-PCR) in parallel, in 211 samples (53 antibody positive, 158 antibody negative). Using the three results available for each sample we simulated the diagnostic performance of the two algorithms and compared them to the results of RT-PCR as gold standard. Results. Both algorithms showed a high degree of concordance for viremic patients. The percentage of correctly classified patients was 99.05% for the algorithm based on RT-PCR and 98.10% for the HCV Ag algorithm. The HCV core Ag test showed a clinical sensitivity of 0.917 and showed a good correlation to the results of molecular biology. Spearman rank correlation coefficient (ρ) of 0.97 (95% CI 0.95 to 0.99, p < 0.0001). Conclusion. An algorithm incorporating HCV Ag as confirmatory test for anti-HCV results is a feasible alternative to the use of molecular techniques in laboratories that do not have access to them or require faster turn around times.

Objective: To describe results of HIV, sexually transmitted diseases (STI) and CD4 counts at the HIV-specialized Condesa Clinic (CC) in Mexico City. Materials and methods: Individuals who requested voluntary counseling and testing at CC were studied. We identified antibodies against HIV, syphilis, hepatitis C, and hepatitis B HBsAg. CD4 cell counts and viral load of HIV positive individuals were also obtained. Late HIV infection diagnosis was established if CD4 counts were lower than 200 cells/μL. Results: Global seroprevalence of HIV, syphilis, HBsAg, and anti HCV markers was of 20.1, 6, 1 and 1, respectively. Men displayed higher seroprevalence of infection markers than women. Among men, HIV infection was related to age and with all STI markers. Late HIV diagnosis was 31.8%. The risk of late HIV diagnosis was higher among women and it increased as age increased. Conclusions: Differences between genders regarding HIV and STIs prevalence as well as risk factors for HIV infection and late HIV diagnosis were observed.

Background We have previously found that psoriatic patients have IgG autoantibodies that recognize lesions but not autologous normal skin. The reactivity of the autoantibodies can be adsorbed with streptococcal antigens. Methods IgG antibodies were determined by immunoblot and ELISA to streptococcal antigens and by ELISA to the recombinants HSP60Sp, HSP70Sp, HSP60Ec and HSP60Hu, in plaque (PP) and guttate (GP) psoriasis patients, in healthy subjects (HC) and in individuals with streptococcal throat infections and high ASO titers, but without history of dermatological disease (ISp). Results We found by immunoblot that the IgG response to 71-, 60-, and 14-kDa protein fractions of Streptococcus pyogenes is important in psoriasis. We also found by ELISA that the response to the rHSP60Sp in PP was higher than in all the other three groups studied (P

Background Vascular endothelial growth factor (VEGF)-transgenic mice develop psoriasiform plaques that resemble human psoriasis, demonstrating that VEGF is an important factor in the development of psoriasis. In human keratinocytes, VEGF is regulated by human cathelicidin LL37, and the expression of this peptide, as well as interleukin-13 receptor-alpha1 (IL-13Rα1) and VEGF, is increased in psoriatic skin. Peptidoglycan (PGN) stimulates innate immunity, inducing cytokines and antimicrobial peptides (cathelicidins), but PGN can also activate psoriatic T-helper-1 (Th1) lymphocytes. As neither the bacterial component that induces LL37 and VEGF expression nor the function of IL-13 in keratinocytes has been clarified, the role of PGN in the induction of these molecules was evaluated in this work. Methods HaCaT keratinocytes were treated with PGN from Staphylococcus aureus, recombinant VEGF (rVEGF), and recombinant IL-13 (rIL-13). The mRNA expression of LL37, VEGF, and IL-13 was evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR), and VEGF and IL-13 production was measured by enzyme-linked immunosorbent assay (ELISA). Results Keratinocytes treated with PGN show increased expression of LL37 at 24 h, VEGF at 36 h, and IL-13 at 72 h post-treatment. Anti-Toll-like receptor 2 (anti-TLR2) antibody blocked the production of these molecules. LL37 and VEGF expression in keratinocytes treated with PGN was dose dependent. rVEGF induced IL-13 production and rIL-13 induced VEGF production at 36 h. The anti-Flt-1 antibody blocked IL-13 expression. Conclusions These results suggest that PGN from S. aureus can induce LL37 and VEGF expression in keratinocytes, and that this VEGF production can be amplified by subsequent IL-13 overproduction.