Mirjam-Colette Kempf

Objective: This study examined whether attendance at online digital health research appointments in the American Women Assessing Risk Epidemiologically (AWARE) study was associated with (1) participant age, (2) scheduling factors (time of day, day of week, month), (3) appointment confirmation, and (4) HIV behavioral risk factors. Materials and Methods: We analyzed scheduling and eligibility screening data from AWARE, a 24-month U.S.-based longitudinal digital cohort of cisgender women at elevated likelihood of HIV seroconversion. Participant demographic and behavioral data were merged with the study team’s Outlook calendar. Chi-square tests and logistic regression models assessed associations between appointment attendance and participant characteristics and scheduling factors. Results: Women aged ≥50 years had higher odds of missing baseline visits compared to those aged 20-29 years (44.7% vs 32.3%). Appointments scheduled at 2:00 pm (45.7%), 4:00 pm (45.2%), and 8:00 am (40.2%) had higher no-show rates than other times. No-show rates were lowest on Fridays (30.2%) and during March (27.7%) and June (25.2%). Confirming appointments 24 hours in advance significantly reduced no-shows compared to no confirmation (19.0% vs 51.6%). Histories of having been physically hurt (44.2% vs 32.1%), forced to have sexual activities (41.8% vs 34.1%) and incarcerated (39.3% vs 33.4%) were also associated with higher no-show rates. Similar patterns were observed for rescheduled visits. Conclusion: Attendance in digital research was influenced by age, scheduling, and structural vulnerabilities. Incorporating digital access support into study design and grant budgets may reduce disparities, improve retention, and enhance efficiency.

We used 2020–2022 data from the MACS/WIHS Combined Cohort Study (MWCCS) of 1689 women with and without HIV to identify latent health behavior classes (HBCs) underlying covariation in diet, physical inactivity, and substance use. We tested if HBCs predicted key mental and physical health outcomes, including depression and metabolic syndrome (MetS), at a 1-year follow-up. A latent class analysis yielded three HBCs: (1) Class 1: Healthiest, (2) Class 2: Poor Diet with Substance Use, and (3) Class 3: Physical Inactivity and Poor Diet with Low Substance Use. Women with older age, higher income, and HIV had greater odds of being in Class 1. Class 2 had the highest odds of elevated depressive symptoms when controlling for age, income, menopause stage, and HIV status. Although Class 3 had the highest odds of MetS, the association between HBC and MetS was nonsignificant. Findings suggest complex health behavior patterns predict depressive symptoms.

Supplementary Table S1 lists all genetic variants (SNPs) in the candidate genese associated with pre-cancer.

Background:Cervical cancer oncogenesis starts with human papillomavirus (HPV) cell entry after binding to host cell surface receptors; however, the mechanism is not fully known. We examined polymorphisms in receptor genes hypothesized to be necessary for HPV cell entry and assessed their associations with clinical progression to precancer.Methods:African American women (N = 1,728) from the MACS/WIHS Combined Cohort Study were included. Two case–control study designs were used—cases with histology-based precancer (CIN3+) and controls without; and cases with cytology-based precancer [high-grade squamous intraepithelial lesions (HSIL)] and controls without. SNPs in candidate genes (SDC1, SDC2, SDC3, SDC4, GPC1, GPC2, GPC3, GPC4, GPC5, GPC6, and ITGA6) were genotyped using an Illumina Omni2.5-quad beadchip. Logistic regression was used to assess the associations in all participants and by HPV genotypes, after adjusting for age, human immunodeficiency virus serostatus, CD4 T cells, and three principal components for ancestry.Results:Minor alleles in SNPs rs77122854 (SDC3), rs73971695, rs79336862 (ITGA6), rs57528020, rs201337456, rs11987725 (SDC2), rs115880588, rs115738853, and rs9301825 (GPC5) were associated with increased odds of both CIN3+ and HSIL, whereas, rs35927186 (GPC5) was found to decrease the odds for both outcomes (P value ≤ 0.01). Among those infected with Alpha-9 HPV types, rs722377 (SDC3), rs16860468, rs2356798 (ITGA6), rs11987725 (SDC2), and rs3848051 (GPC5) were associated with increased odds of both precancer outcomes.Conclusions:Polymorphisms in genes that encode binding receptors for HPV cell entry may play a role in cervical precancer progression.Impact:Our findings are hypothesis generating and support further exploration of mechanisms of HPV entry genes that may help prevent progression to cervical precancer.

Background: Stigma is a barrier to human immunodeficiency virus (HIV) care among women with HIV (WWH) in the United States (US). We estimated associations between latent stigma profiles and HIV outcomes among WWH in the Women's Interagency HIV Study. Methods: From 2018 to 2019, participants (N = 1407) completed semi-annual assessments on sociodemographics, substance use, HIV-related, anticipated, and race-related stigma in healthcare, and suboptimal antiretroviral therapy adherence (<95%), and underwent HIV RNA testing. Latent profile analysis and multinomial logistic regression were used to examine adjusted associations between profiles and several covariates. Structural equation modeling estimated longitudinal associations between profiles, suboptimal adherence, and viral nonsuppression (HIV-1 RNA ≥20 copies/mL). Results: We identified 3 profiles: high stigma (3%), low stigma (86%), and anticipated stigma (11%). Membership in the high stigma profile was greater for Black WWH who use drugs (adjusted odds ratio [aOR], 3.6 [95% confidence interval {CI}, 1.1–12.1]), non-Black WWH who use drugs (aOR, 4.8 [95% CI, 1.3–18]), and those who reported suboptimal adherence (aOR, 2.2 [95% CI, 1–4.8]), drug use (aOR, 2.6 [95% CI, 1.3–5.1]), noninjection drug use (aOR, 2.2 [95% CI, 1.1–4.4]), opioid use treatment (aOR, 4.07 [95% CI, 1.47–11.26]), depression (aOR, 5.8 [95% CI, 2.8–11.9]), stress (aOR, 1.09 [95% CI, 1.05–1.1]), and high post-traumatic stress disorder (aOR, 10.6 [95% CI, 4.3–25.7]). In the longitudinal model, suboptimal adherence was lowest for the low stigma profile and predicted future viral nonsuppression. Conclusions: Reducing stigma and integrating HIV, substance use, and mental health treatment is crucial for improving health outcomes among US WWH.

Relationship dynamics can influence sexual health outcomes and may affect engagement with HIV prevention strategies. This qualitative study explored how women's perceived relationship dynamics impacted their HIV prevention strategies, including condom and Pre-Exposure Prophylaxis (PrEP) use, and HIV testing. Semi-structured interviews were conducted with 34 women at higher risk of HIV acquisition and 40 women living with HIV in the USA, recruited through social media and health clinics. Interviews were audio recorded, professionally transcribed, and analysed using content analysis to identify themes. Participants identified trust, infidelity, and communication as the most salient aspects of their relationships that impacted HIV prevention. Trust fostered emotional security, while infidelity heightened uncertainty about partners' HIV status. Barriers to open communication with partners hindered women from prioritising their health. Participants recommended routine HIV testing with partners, open discussions about sexual health history, and PrEP to protect their health within relationships. The study offers valuable insights to inform the design of tailored HIV prevention strategies for women.

Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women’s health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable—in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial—the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed—electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976

Supplementary Table S1 lists all genetic variants (SNPs) in the candidate genese associated with pre-cancer.

Supplementary Table S1 lists all genetic variants (SNPs) in the candidate genese associated with pre-cancer.

Background: Cervical cancer oncogenesis starts with human papillomavirus (HPV) cell entry after binding to host cell surface receptors; however, the mechanism is not fully known. We examined polymorphisms in receptor genes hypothesized to be necessary for HPV cell entry and assessed their associations with clinical progression to pre-cancer. Methods: African-American women (N=1728) from the MACS/WIHS Combined Cohort Study were included. Two case-control study designs were used - cases with histology-based pre-cancer (CIN3+) and controls without; and cases with cytology-based pre-cancer (HSIL) and controls without. Single nucleotide polymorphisms (SNPs) in candidate genes (SDC1, SDC2, SDC3, SDC4, GPC1, GPC2, GPC3, GPC4, GPC5, GPC6 and ITGA6) were genotyped using an Illumina Omni2.5-quad beadchip. Logistic regression was used to assess the associations in all participants and by HPV genotypes, after adjusting for age, HIV-serostatus, CD4 T-cells, and three principal components for ancestry. Results: Minor alleles in SNPs rs77122854 (SDC3), rs73971695, rs79336862 (ITGA6), rs57528020, rs201337456, rs11987725 (SDC2), rs115880588, rs115738853 and rs9301825 (GPC5) were associated with increased odds of both CIN3+ and HSIL, whereas, rs35927186 (GPC5) was found to decrease the odds for both outcomes (p-value≤0.01). Among those infected with Alpha-9 HPV types, rs722377 (SDC3), rs16860468, rs2356798 (ITGA6), rs11987725 (SDC2), and rs3848051 (GPC5) were associated with increased odds of both pre-cancer outcomes. Conclusions: Polymorphisms in genes that encode binding receptors for HPV cell entry may play a role in cervical pre-cancer progression. Impact: Our findings are hypothesis generating and support further exploration of mechanisms of HPV entry genes that may help prevent progression to cervical pre-cancer.