John Lucian Davis

Background: The Ending the HIV Epidemic (EHE) initiative remains a national priority in the United States, aiming to reduce new HIV infections by 90% by 2030. As we cross the initiative’s midpoint, there is renewed commitment to strengthening the HIV workforce’s capacity to plan, implement, and sustain effective HIV prevention, treatment, and care interventions. Despite substantial improvement in HIV outcomes, uneven implementation of evidence-based interventions reflects persistent gaps between available evidence and its translation into locally actionable practice. Achieving EHE goals requires tailoring implementation to the diverse sociostructural conditions shaping HIV outcomes across jurisdictions. Research increasingly highlights the value of integrated, contextual data to strengthen public health decision-making. Linking indicators spanning multiple conceptual domains across various geographic levels can support a robust understanding of the distinct drivers of HIV outcomes, yet existing data systems remain fragmented. A harmonized, multisource, multilevel database is therefore essential to support targeted, needs-based, and data-driven implementation under the EHE initiative. We present a reproducible protocol detailing the transferable methodology of building and maintaining such a resource. Objective: This project aims to (1) build a high-quality contextual database integrating multiple data sources using transparent, replicable, and updatable methods and (2) develop and document systematic workflows for ongoing updates and quality assurance (QA) and support future use aligned with open-science frameworks and standard data practices. Methods: This project will follow best practices in data architecture, acquisition, standardization, and QA. For objective 1, we will integrate data across multiple geographic levels (eg, ZIP code, county) for 2020-2025, with measures categorized into conceptual domains (eg, epidemiologic and sociodemographic) guided by established theoretical frameworks. For objective 2, we will develop a tiered data structure using a GitHub repository to store documentation, processing scripts, and QA logs aligning with open science practices. Construction and QA methods were informed by targeted PubMed literature reviews. Data sources include existing data repositories, literature-identified datasets, and gray literature with consistent formatting and permissive terms of use suitable for web scraping. Stakeholder engagement will span all phases of database development, informing variable selection, usability, and validation to enable iterative refinement and revision. Results: Funding was obtained in August 2025. Literature reviews from October to November 2025 informed the database construction methods, source identification, and protocol development. Data acquisition, standardization, and QA began in May 2026, with acquisition remaining iterative. Cross-source integration, final QA checks, and dashboard development are expected to conclude in October 2026. Study results are anticipated for publication in summer 2027. Conclusions: This protocol will provide a reproducible, transferable model for building and maintaining a contextual data resource that could support public health planning and advance implementation science through more context-responsive decision-making under the EHE initiative.

Bubble continuous positive airway pressure (bCPAP) is a low-cost respiratory support device that has demonstrated different outcomes for children with severe pneumonia in different settings. Some differences in outcomes may be attributable to implementation factors (e.g., patient monitoring and feeding practices). We aimed to characterize bCPAP reach, implementation fidelity, and safety outcomes for children with severe pneumonia in Pakistan. We conducted a prospective cohort study at Aga Khan University Hospital and Abbasi Shaheed Hospital from February through May 2025. We enrolled children 1–59 months who met WHO criteria for severe pneumonia within 24 hours of presentation to the emergency department. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, or death. We reported the proportion of children receiving bCPAP (“reach”) and constructed a mixed-effects, multinomial logistic regression model with robust standard errors to report: fidelity (child location in a highly monitored area, continuous monitoring, avoidance of unplanned disruptions to bCPAP, and avoidance of oral feeding); safety (aspiration events and pneumothorax); bCPAP failure (death, respiratory support escalation, or leaving against medical advice); and in-hospital mortality. Of 165 children with severe pneumonia, 88 (53%) received bCPAP over 141 bCPAP days. The average predicted probabilities (95% CI) of our fidelity measures were: 85% (78–92%) for location in a highly monitored area; 56% (51–60%) for continuous monitoring; 66% (57–75%) for continuous bCPAP without disruptions; 46% (36–55%) for avoidance of oral feeding while on bCPAP. Among children receiving bCPAP, 9 (10%) experienced an aspiration event, 1 (2.2%) experienced a pneumothorax; 19 (22%) experienced bCPAP treatment failure. One child (1.1%) died; 6 (6.8%) required respiratory support escalation; 14 (16%) left against medical advice. We identified several gaps in bCPAP reach and fidelity. These may be modifiable by individual- and team-targeted strategies to reduce bCPAP-related complications and pneumonia-related child deaths.

BACKGROUND The Ending the HIV Epidemic (EHE) initiative remains a national priority in the United States (U.S.), aiming to reduce new HIV infections by 90% by 2030. As we cross the initiative’s midpoint, there has been a renewed commitment to strengthening the HIV workforce’s capacity to plan, implement, and sustain effective HIV prevention, treatment, and care interventions. Despite substantial improvements in HIV outcomes, uneven implementation of evidence-based interventions reflects persistent gaps between available evidence and its translation into locally actionable practice. Achieving EHE goals requires tailoring implementation to the diverse epidemiological, social, and structural conditions shaping HIV outcomes across jurisdictions. Research increasingly highlights the value of integrated, contextual data to strengthen public health decision-making. Linking indicators spanning multiple conceptual domains across regional, local and individual levels can support a more robust understanding of the distinct drivers of HIV outcomes, yet existing data systems remain fragmented across domains and scales. A harmonized, multisource, multilevel database is therefore essential to support targeted, needs-based and data-driven implementation under the EHE initiative. OBJECTIVE This project has two objectives: (1) to build a high-quality contextual database integrating multiple sources of public data using transparent, replicable, and updateable methods, and (2) to develop and document systematic workflows for ongoing database updates, quality assurance, and to support future use aligned with open-science frameworks and standard data practices. METHODS This project will follow best practices in data architecture, acquisition, standardization, and quality assurance. For Objective 1, we will integrate data across multiple geographic levels (e.g., ZIP code, county) for the years 2020-2025, with measures categorized into conceptual domains (e.g., epidemiologic, sociodemographic) guided by established theoretical frameworks to facilitate future analyses. For Objective 2, we will develop a tiered data structure to enable transparent and reproducible data management, using a GitHub repository to store all documentation, processing scripts, and quality assurance logs to align with open science practices. Database construction and quality assurance methods were informed by targeted literature reviews in PubMed. Data sources will be identified from three inputs: existing data repositories, datasets identified through targeted literature reviews, and reports or grey-literature with consistent formatting and permissive terms of use suitable for web scraping. Stakeholder engagement will be integrated through all phases of database development, informing variable selection, usability, and validation to enable iterative refinement and revision. RESULTS Literature reviews were conducted from October to November of 2025, to inform database construction methods, source identification, and protocol development. Data acquisition will begin in May 2026. CONCLUSIONS This contextual database will provide a reproducible and scalable data resource to support public health planning and advance implementation science by enabling more context-responsive decision-making under the EHE initiative.

Bubble continuous positive airway pressure (bCPAP) is a low-cost respiratory support device that has demonstrated different outcomes for children with severe pneumonia in different settings. Some differences in outcomes may be attributable to implementation factors (e.g., patient monitoring and feeding practices). We aimed to characterize bCPAP reach, implementation fidelity, and safety outcomes for children with severe pneumonia in Pakistan. We conducted a prospective cohort study at Aga Khan University Hospital and Abbasi Shaheed Hospital from February through May 2025. We enrolled children 1–59 months who met WHO criteria for severe pneumonia within 24 hours of presentation to the emergency department. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, or death. We reported the proportion of children receiving bCPAP (“reach”) and constructed a mixed-effects, multinomial logistic regression model with robust standard errors to report: fidelity (child location in a highly monitored area, continuous monitoring, avoidance of unplanned disruptions to bCPAP, and avoidance of oral feeding); safety (aspiration events and pneumothorax); bCPAP failure (death, respiratory support escalation, or leaving against medical advice); and in-hospital mortality. Of 165 children with severe pneumonia, 88 (53%) received bCPAP over 141 bCPAP days. The average predicted probabilities (95% CI) of our fidelity measures were: 85% (78-92%) for location in a highly monitored area; 56% (51-60%) for continuous monitoring; 66% (57-75%) for continuous bCPAP without disruptions; 46% (36-55%) for avoidance of oral feeding while on bCPAP. Among children receiving bCPAP, 9 (10%) experienced an aspiration event, 1 (2.2%) experienced a pneumothorax; 19 (22%) experienced bCPAP treatment failure. One child (1.1%) died; 6 (6.8%) required respiratory support escalation; 14 (16%) left against medical advice. We identified several gaps in bCPAP reach and fidelity. These may be modifiable by individual-and team-targeted strategies to reduce bCPAP-related complications and pneumonia-related child deaths.

Background: Low adherence to tuberculosis (TB) treatment remains a major driver of adverse health outcomes in high-burden countries. While guidelines recommend routine client education, its effectiveness and the knowledge constructs that influence adherence remain poorly defined. Methods: We conducted a prospective cohort study of adults (≥18 years) initiating treatment for drug-susceptible TB in Kampala, Uganda. We assessed clients’ TB knowledge before and after routine education and at the two-week, two-month, and five-month follow-up visits. We recorded self-reported seven-day medication adherence at each visit and final treatment outcomes. We used paired t-tests to compare knowledge scores (0–100) before and after education. We constructed multivariable Poisson and logistic regression models to examine the association of knowledge with the outcomes of nonadherence and WHO-defined treatment success. Results: We enrolled 80 participants (28% female; 36% living with HIV). Overall TB knowledge scores increased by 25 points (95% CI 22–28), from 53 to 78, yet only 9% achieved TB literacy (an overall TB knowledge score ≥90) after TB education, peaking at 18% at two weeks, before declining to just 3.6% at five months. Each 10-point increase in post-education knowledge was associated with a reduction in nonadherence of 15% (IRR ^0.1 0.85; 95% CI 0.72–1.00, p = 0.048) at the two-week visit and 32% (IRR ^0.1 0.68; 95% CI 0.50–0.89, p = 0.005) at the two-month visit. Ultimately, 71% completed treatment, but knowledge was not a significant predictor of treatment success (OR = 1.77, 95% CI 0.01–314.6, p = 0.83). Conclusions: Routine client education significantly increased TB knowledge, yet less than 10% achieved TB literacy. Post-education knowledge was independently associated with better early adherence, highlighting the need for more robust education interventions to optimize TB treatment outcomes.

Background: Rapid, accurate, nonsputum tests are needed to close gaps in tuberculosis (TB) detection. We evaluated the diagnostic performance of molecular testing on saliva and oral swabs. Methods: We conducted a nested case–control study with 1:1 incidence-density sampling within a prospective cohort of adults and children undergoing evaluation for pulmonary TB at primary care centers in Colombia (July 2023–August 2024). Participants provided a sputum sample for liquid mycobacterial culture and paired saliva and nylon-flocked oral swabs for storage at −80°C. A microbiologist blinded to clinical and culture data performed Xpert MTB/RIF Ultra on thawed saliva and on swab eluate, each mixed 1:1 with sample reagent. We calculated the sensitivity and specificity of saliva and swab against sputum culture and compared them using McNemar's test. Results: Among 648 enrolled participants, we tested saliva and swabs from all 95 individuals with culture-confirmed TB and 95 matched culture-negative controls (n = 190). Saliva sensitivity was 90.5% (95% confidence interval [CI], 82.8–95.6), and specificity was 95.8% (95% CI, 89.6–98.8). Swab sensitivity was 71.6% (95% CI, 61.4–80.4), and specificity was 99% (95% CI, 94.3–100). Saliva sensitivity exceeded that of swab by an absolute difference of 18.9% (95% CI, +10.0 to +27.9, P < .001), but there was no significant difference in specificity (−3.2%, 95% CI, −7.7 to +1.4, P = .25). Over 95% of participants found saliva and swab collection procedures acceptable. Conclusions: Both saliva and swabs were highly sensitive and specific for culture-confirmed pulmonary TB. Saliva sensitivity exceeded the World Health Organization's ≥80% target for a low-complexity, nonsputum TB diagnostic test.

Background: Mongolia is experiencing a rapid epidemiologic transition in which high burdens of micronutrient malnutrition, infection, and cardiometabolic disease are simultaneously prevalent. This cross-sectional study sought to understand how nutritional, lifestyle, and cardiometabolic risk factors are distributed among a population at high-risk for tuberculosis (TB), comprising household contacts (HHCs) and healthcare workers, (HCWs) in Ulaanbaatar, Mongolia, and how these factors are associated with TB infection. Methods: A total of 196 HHCs and 241 HCWs were assessed for latent TB infection (LTBI) using the QuantiFERON-TB Gold Plus (QFT-Plus) assay and for diabetes using fingerprick samples for fasting blood glucose. Participants also underwent assessments of their diet and physical activity, nicotine dependence, body mass index, and serum 25(OH)D concentration. We examined associations between assessed risk factors and LTBI using multivariate logistic regression. Results: The prevalence of LTBI was 47% for both HHCs and HCWs. A total of 54% percent of HHCs and 68% of HCWs had low physical activity levels; 63% of HHCs and 95% of HCWs were overweight or obese; 7% of HHCs and 4% of HCWs had impaired or diabetic fasting blood glucose [FBG]; and 49% of HHCs and 70% of HCWs were vitamin D deficient. In a multivariable analysis of HHCs, LTBI was independently associated with lower serum [25(OH)D], and the odds ratio (OR) was 3.18 (95% CI 1.38–7.79; p = 0.009). In contrast, the probability of LTBI did not differ significantly between vitamin D-deficient and non-deficient HCWs, and the OR was 0.89 (95% CI 0.59–1.37; p = 0.42). In a pooled analysis of HHCs and HCWs, the probability of LTBI did not significantly differ between vitamin D-deficient vs. non-deficient participants. The association between serum [25(OH)D] and LTBI among HHCs and HCWs was significantly modified by fasting blood glucose (FBG), such that a lower vitamin D status was significantly more common among those in the highest tertile of FBG than among those in the lowest tertile of FBG. Conclusions: Nutritional, lifestyle, and cardiometabolic risk factors are highly prevalent among HHCs and HCWs with TB in Ulaanbaatar, Mongolia. These findings underscore the importance of simultaneously controlling TB infection, malnutrition, and cardiometabolic risks among HHCs and HCWs to reduce the disease burden in Mongolia.

Mycobacterium tuberculosis ( Mtb ) is a major threat to global health, and there is an urgent need for affordable, simple tuberculosis (TB) diagnosis in underresourced areas. Here, we combine recombinase polymerase amplification with Cas13a and Cas12a detection to create two parallelized one-pot assays that detect two conserved elements of Mtb ( IS6110 and IS1081 ) and a human DNA internal control. These assays are compatible with lateral flow and can be readily lyophilized. Our final assay showed a limit of detection of 69.0 CFU per milliliter for Mtb H37Rv and 80.5 CFU per milliliter for Mycobacterium bovis BCG in spiked sputum, with no cross-reactivity to diverse bacterial or fungal isolates. Clinical tests on 13 blinded sputum samples revealed 100% (six of six) sensitivity and 100% (seven of seven) specificity compared to culture. SHINE-TB streamlines TB diagnosis from sample to answer by combining amplification and detection while being compatible with lateral flow and lyophilization.

Background: Because of the association of mental health and substance use disorders with higher HIV mortality and decreased retention in care, we investigated their frequency and impact on tuberculosis preventive therapy (TPT) adherence and completion among people with HIV (PWHIV) initiating TPT. Methods: We conducted a prospective, longitudinal cohort study with a nested mixed methods study in 2 Johannesburg, South Africa, facilities. Participants were PWHIV on antiretroviral therapy initiating TPT between August and December 2023. We measured TPT adherence and completion with electronic medication boxes. We used validated tools to measure symptoms of anxiety, depression, alcohol use, and other substance use at enrollment and 12 weeks. We constructed multivariable regression models to determine associations of these variables with TPT adherence and completion, adjusting for age, sex, and time on antiretroviral therapy. We interviewed participants about mental health and experiences with TPT and analyzed responses using deductive content analysis. Results: Among 224 PWHIV, 111 (50%) completed TPT. Eighty-one (36%) screened positive for depression symptoms and 63 (28%) for anxiety symptoms. Seventy-six (34%) reported unhealthy alcohol use and 60 (27%) tobacco use. Using multivariable models adjusting for confounders, only depression symptoms were significantly and negatively associated with adherence (9% fewer doses; 95% confidence interval, .4–16; P = .032) and completion (odds ratio, 0.48; 95% confidence interval, .26–.90; P = .021). Participant narratives highlighted the negative influence of mental health on adherence and the need for social and psychological support services. Conclusions: Symptoms of depression, anxiety, unhealthy alcohol use, and tobacco use were common among PWHIV initiating TPT. Depression symptoms were strongly and independently associated with TPT nonadherence and noncompletion.