5^th International Conference on HIV/AIDS, STDs and STIs November 13-14, 2017 Las Vegas, Nevada, USA (Venue: Renaissance Las Vegas Hotel)

Xingdong Ye has his passion in improving the health and wellbeing, graduated from Jiangxi Gannan School of Medicine, China in 1988, and got his Master's degree in Sun Yatsum Medical University, Guangzhou in 1995, engaged in the prevention and treatment of syphilis. More than 100 professional academic papers had been published in the past decades and he has put forward to the prevention and control of syphilis in Guangzhou with his proposal entiled “1234” basic strategies after finishing the Guangzhou municipal major project on syphilis control, and reported application of nested quantitative PCR in detecting TP DNA in the diagnosis of syphilis from various biological samples for the first time.

Though finding of T. palladium in dark field microscope or positive specific and nonspecific T. pallidium antibody was enough to make a diagnosis of syphilis, determination of early infection was a challenge at present. Polymerase chain reaction (PCR) was essential for syphilis diagnosis for those with negative serum antibody and organism as well. We reported that detection limit was 2 TP /ml for nest-real time-PCR (NR-PCR) (Fig.1), the present work is to evaluate application of NR-PCR in the detection of TP DNA from various biological samples of syphilitic patients. A total of 923 various samples including tissue swabs, serum the whole blood, earlobe blood and CSF were collected from 576 patients. Of those, 43 swabs from early syphilis lesions were detected for TP DNA by both Nest PCR (nPCR) and NR-PCR, the sensitivity of TP DNA detection by nPCR and NR-PCR was 79% (34/43), 72% (31/43) respectively, kappa was .81. The TP DNA positive rate for earlobe blood collected from latent syphilis and neurosyphilis were 70.3%, 26.7% respectively, and a significant difference was observed (P<0.01). TP DNA positive rate detected by NR PCR for swabs, serum, whole blood collected during initiate visit was 84.2%, 66.9%, 42.4% respectively. In patients with positive TPPA, the sensitivity, specificity, positive predictive value, negative predictive value for NR PCR in detecting TP DNA in blood of primary stage was 72.5%, 75%, 99.6%, 2.9% respectively, and Youden index 0.48, kappa value 0.024 (Table 1), least agreement was shown between NR PCR and syphilitic serological results in making syphilis diagnosis (P<0.03). It was concluded that the TP DNA positive rate for different samples group in various type syphilis was different from each other when detected by NR-PCR, and there is less agreement between syphilitic serology diagnosis and NR-PCR in making syphilis diagnosis. They can be independently used clinically.

M Shakirzyanova is a licensed Medical Laboratory Scientist with a PhD in Microbiology and a research background in Virology, Molecular Biology and Microbiology. During her Post-doctoral Fellowship, she studied HIV transmission and monitored SAIDS in monkey (Indian Rhesus Macaque) model. She conducted analysis of the co-receptor switch in R5-tropic SHIV-infected macaques. She has expertise in protocol development, reporting, and analysis of experimental data. Her current research is monitoring of HIV-1 drug resistance in HIV-1 positive patients on anti-retroviral therapy.

Statement of the Problem: Integrase strand transfer inhibitors together with protease and reverse transcriptase inhibitors are the drugs recommended by NIH for pre- and post- HIV-1 exposure prophylaxis. As part of the Ending the AIDS Epidemic (ETE) initiative in New York State, the NYC Public Health Laboratory has validated the ViroSeq HIV-1 Integrase Genotyping Assay for detection of the drug resistance mutations in the HIV-1 integrase gene. This assay allows us to provide the clinicians with complete drug resistance information. Meanwhile, the sequence data allows performing the phylogenetic analysis of virus from newly infected patients and following up of incident cases that may be out of care. Methods: RNA was isolated manually from plasma samples (provided by NYC VA Hospital and Sonic Reference Laboratory Austin, TX), or recombinant viruses’ supernatants (Harvard Medical School). The viral DNA was amplified by RT-PCR, quantified on agarose gel, purified, and used for cycle sequencing PCR. The sequencing was performed on ABI3500 genetic analyzer. Results: The limit of detection results were generated with four randomly chosen supernatants diluted at several levels with negative human plasma. The LOD was 500 gene copies per mL (cp/ml) for two of the supernatants (Y143C; V151I and L74M, V151I, N155H), 1000 gene cp/ml for one (G140S; Q148H; V151I), and 2500 gene cp/ml for another one (V151I, N155H and G163R). The reproducibility was performed with virus harboring E92Q/N155H/V151I mutations. All sequencing results showed the same mutations at different dilution levels, which confirmed the high reproducibility of the assay. Blinded sample validation was performed on 40 samples. All of drug resistance mutations revealed in our study was matched with the keys provided by the supplier of the samples. Conclusion: ViroSeq HIV-1 Integrase Genotyping Assay detects integrase resistant mutations with the reasonable analytical sensitivity, and the high reproducibility and 100% accuracy.

Michelle Nguyen is an undergraduate student at Trinity University interested in studying the cultural and structural determinants that increases one’s risk behavior in contracting HIV. She believes that by studying these areas, the stigmatizing effects that arise from one’s social settings can be addressed and targeted in a manner that appeal to the individual, which includes the cultural environment in which they reside. By altering one’s perception of HIV as a taboo subject that should be hidden, individuals may be more likely to disclose their status (if they are positive) and regularly get tested for HIV (if they are negative/uncertain), lowering theirs and their partner’s vulnerability to HIV. Because prevention strategies are fashioned and implemented within certain political landscapes, successful prevention programs should aim to change the social context in which the affected individual experiences inequality and discrimination.

The experiences of individuals living with HIV/AIDS are strongly affected by and shaped through misconceptions, stigma, discrimination, and the cultural/ social determinants surrounding this pandemic. The limited knowledge and silence surrounding HIV/AIDS often cause hesitation when it comes to disclosing one’s status, seeking treatment, and maintaining care, fueling further feelings of negativity and self-stigma. Likewise, the social meaning and cultural context surrounding HIV/AIDS can lead to risky behavior and increase one’s exposure to HIV. This study seeks to better understand ways in which individuals with HIV are stigmatized and discriminated against. It includes a literature review regarding HIV-related stigma and original research drawing on ethnographic research, client interactions, and interviews with 40 participants. Purposive sampling was used to recruit participants who previously received an HIV test and were willing to share their perceptions, experiences, feelings, and thoughts about HIV/AIDS. This data illustrates that stigma manifests itself in highly variable ways and that everyone’s experiences differ depending on their support systems.

Eveline Ndii Kalomo is an Assistant Professor at Wichita State, School of Social Work. She teaches various courses in social work for students both in the undergraduate and graduate programs. Her research interests are intersections of HIV/AIDS and, kinship caregiving, population aging, gerontology, mental health, intimate partner violence, substance abuse, children’s mental health and educational outcomes. She has expertise and passion in improving the health and well-being of individuals and families affected by HIV and AIDS in Africa. Her research area stemmed from her extensive experience working with families and children affected by AIDS in Namibia.

Statement of the Problem: In sub-Saharan Africa, the advent for the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) had dramatically altered the nature of informal caregiving. Countries in this region are faced with the challenge of providing care and support to people living HIV and AIDS (PLWHA) at home. Scholars assert that many caregivers are predominately older women, living below the poverty line, experiencing financial and psychological strain. To understand the psychological well-being of these caregivers, studies have examined factors such as (physical, social, and mental well-being of caregivers, and HIV-related stigma) influencing the quality of life of family members caring for PLWHA. However, little is known about this phenomenon in Namibia, one of the top five countries in the world with the highest AIDS prevalence rates. Thus, this study explored the relationship between HIV-related stigma, depression, and food security on caregiver burden. Methodology: A purposive sampling method was used to recruit a sample of 97 caregivers who were caring for a family member living with AIDS. Findings: The average age of the caregivers was 45.6 years (SD=9.3), a majority (88.7%) were female. 85% had a chronic illness that prevented them from working. Correlation analysis showed that caregiver burden was significantly negatively associated with their quality of life (Pearson correlation=-0.38, p<0.000). Caregiving burden was positively associated with their depression level (Pearson correlation=0.38, p<0.000). After controlling for caregiver socio-demographics, household hunger, and HIV-related stigma, caregiver burden was still significantly related with their quality of life (β=-0.18, p=0.001) and depression level (β=0.16, p=0.001). Conclusion & Recommendations: Findings underscore the complex nature of HIV/AIDS caregiving. Further research is needed to examine the stress process of caregiving among HIV-affected families.

Eveline Ndii Kalomo is an Assistant Professor at Wichita State, School of Social Work. She teaches various courses in social work for students both in the undergraduate and graduate programs. Her research interests are intersections of HIV/AIDS and, kinship caregiving, population aging, gerontology, mental health, intimate partner violence, substance abuse, children’s mental health and educational outcomes. She has expertise and passion in improving the health and well-being of individuals and families affected by HIV and AIDS in Africa. Her research area stemmed from her extensive experience working with families and children affected by AIDS in Namibia.

Statement of the Problem: People living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) face enormous challenges including HIV-related stigma and mental health issues. Studies have documented that people living with HIV and AIDS (PLWHA) are at greater risk for experiencing, judgmental attitudes from health care providers, stigma and discrimination, and often, refusal of services. Researchers have reported that HIV-related stigma has been linked with many mental health conditions including depression, poor self-esteem, anxiety, generalized stress and poor social supports. Given the far-reaching social and mental health impacts of HIV-related stigma on PLWHA, unfortunately, however, little is known about this phenomenon among people living in Namibia. This study is one of the first studies conducted in Namibia, one of the top five countries in the world with the highest AIDS prevalence rates. The purpose of this study was to examine the association between HIV-related stigma and its association with depression, self-esteem, and social support as it is perceived and experienced by PLWHA in rural northern Namibia. Methodology: A purposive sampling was used to recruit a total of 124 men and women living with HIV/AIDS in the Katima Mulilo. Participants were recruited as they came for their routine follow-up for HIV care. A cross-sectional survey was used to collect information on demographics, self-esteem, social support, HIV-related stigma, and depression. Findings: Correlation analysis revealed that HIV-related stigma, self-esteem, and social support were all significantly correlated with depression. Further, Ordinary Least Squares (OLS) regression analysis indicated that HIV-related stigma was the largest risk factor and self-esteem was the largest protective factor with respect to depressive symptoms. Conclusions & Recommendations: There is a need for appropriate assessment and interventions for psychosocial distress among PLWHA. Helping professionals should design evidence-based interventions that address individual and societal challenges that impact PLWHA.

Jeff K H Cheung, MD, FACEP, FASAM, is a graduate of Mount Sinai School of Medicine. He was trained in Emergency Medicine at Lincoln Medical and Mental Health Center in the Bronx, New York. He recently accepted the position of Interfaith Medical Center’s Chairman of Emergency Medicine.

Statement of the Problem: Interfaith Medical Center’s (IMC) Emergency Room lacked a systematic process to ensure that newly diagnosed HIV+ patients were linked to care. The lack of defined policies and procedures to test and treat HIV+ patients was compounded by the high rate of socio-economic factors affecting the patient population. Through a FOCUS grant, in January 2015 IMC implemented an improved system for conducting HIV testing in the ED and linking newly diagnosed patients to follow up care. Findings: Interfaith Medical Center’s FOCUS program has conducted a retrospective study of patients initiating emergency department care where routine HIV testing was conducted from January 2015 to March 2017. The purpose of this study was to evaluate the increase in newly HIV diagnosed patients resulting from the routine HIV testing in the emergency department and the efforts of the HIV clinical linkage to care team. Prior to routine HIV testing, IMC’s emergency department only tested on average 100 patients during January 2014 to December 2014. During the study period; IMC has performed 10,520 4th generation HIV tests. Additionally, IMC was able to scale up HIV screening from year one to year two of the study. From January 2015 to Dec 2015 a total of 3,546 HIV tests were conducted. HIV testing almost doubled in year two increasing numbers to 6,974 tests. From January 2015 to December 2015, IMC diagnosed 19 new HIV positives and linked 14 to care (68%). From January 2016 to March 2017, IMC diagnosed 22 new HIV positives and linked 19 to care (72%). Conclusion & Significance: While the use of this model successfully identified patients with undiagnosed HIV infection in the ED, and enabled scale up of routine HIV screening in an emergency department setting innovative testing approaches, such as routine, non-targeted screening, are necessary to effectively diagnose new HIV cases and link those patients to regular HIV medical care. Recommendations: In summary, routine HIV testing at Interfaith Medical Center Emergency Department has increased the number of new HIV cases identified. The steps that we undertook-i.e. EMR updates, updating polices, administrative support, training, lab procedures for notification, lab testing updates all aided in the increase of HIV Testing and linkage to care.