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Inspire : Vol 6, Issue 7, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• Centre for Impact | Way forward
• 3rd European Congress of Clinical Microbiology & Infectious Diseases (ECCMID)
• 60th annual European Renal Association (ERA) Congress
• CPSP Provincial Faculty Member
• Smoking cessation skills building workshop
• World No-Tobacco Day
• Employee of the Month - Shahzad Vasaya
• Featured Faculty – Dr Sana Sheikh– Faculty member – Data Science Team
• Poem Section
• What Academics are Reading?
• Publications

Syringe Service Programs In Indiana: Moving Past The “Moral” Concerns Of Harm Reduction Towards Effective Legislation, Steven Nisi

Indiana Journal of Law and Social Equality

No abstract provided.

An Old Illness: How The United States Uses Racist And Xenophobic Ideas About Disease To Exclude Haitian Migrants During The Covid-19 Pandemic, Emily Mcconnville

Indiana Journal of Law and Social Equality

No abstract provided.

Microalbuminuria In Perinatally Hiv-Infected Children And Adolescents In The United States, Roukaya Al Hammoud, Anupama Kalaskar, Gilhen Rodriguez, Gabriela Del Bianco, Cynthia Bell, James R Murphy, Gloria P Heresi

Faculty, Staff and Student Publications

Background: The kidney is a common target for human immunodeficiency virus (HIV), making renal disease a common noninfectious complication of HIV. Microalbuminuria is an important marker that can detect early renal damage. Timely detection of microalbuminuria is important to initiate renal management and stop the progression of renal dysfunction in people with HIV. Limited data are available about renal abnormalities in people with perinatal HIV infection. The objective of this study was to determine the prevalence of microalbuminuria in a cohort of perinatally HIV-infected children and young adults receiving combination antiretroviral therapy and investigate correlations between microalbuminuria and clinical and …

Designing A Local Policy To Reduce Hiv In Mexico City, Mayar Al Mohajer

Faculty, Staff and Students Publications

The Joint United Nations Program on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (Joint United Nations Program on HIV/AIDS, UNAIDS) has recommended 90-90-90 goals to increase the number of patients who are aware of their status, on antiretroviral therapy, and have undetectable viral loads. Mexico City has made several achievements to aid in prevention, early diagnosis, and treatment; however, the incidence of HIV has not decreased over the past decade. This article reviews global initiatives that were successful in achieving some or all these metrics and provide a road map for Mexico to reach the desired goals.

Stranger Iggs: Beneficial And Detrimental Sides Of Immunoglobulin G Subclasses, Sweta Shrestha

Dartmouth College Ph.D Dissertations

Understanding antibody responses across various immunological conditions can provide valuable insights for the advancement of therapeutic as well as prophylactic interventions. IgG subclass responses, in particular, have garnered the most attention because of their potential role in disease outcomes and treatment efficacy. The four IgG subclasses differ in their hinge region and “constant region” and these differences in turn modulate their antibody functions. Some subclasses demonstrate robust antibody effector functions, while others exhibit diminished effector functions. The consequences of these differences can either be advantageous or disadvantageous, contingent upon the specific context in which they occur.

This thesis explores the …

Tenofovir Induced Hypokalaemia - A Case Report, Ankisha Gupta, Kiran P. K, Rajendra Prasad S

Digital Journal of Clinical Medicine

Tenofovir, an important medication for HIV/AIDS, carries the risk of hypokalemia in patients receiving treatment. Factors such as dietary deficits, vomiting, or diarrhea further increase this risk. Tenofovir acts as a mitochondrial toxin by inhibiting the DNA polymerase gamma enzyme, crucial for mitochondrial DNA replication. Consequently, ATP generation is depleted through the aerobic pathway, leading to dysfunction in the proximal tubule. This dysfunction manifests as renal acidosis type 2, which involves reduced bicarbonate excretion by the proximal tubule, resulting in renal bicarbonate wasting and decreased serum bicarbonate levels. Consequently, the lumen of the distal nephron becomes negatively charged, leading to …

Predicting Hiv Vaccine-Mediated Protection Level To Identify Immune Correlates Using Positive Unlabeled Learning, Shiwei Xu

Dartmouth College Ph.D Dissertations

The development of a vaccine for Human Immunodeficiency Virus type 1 (HIV-1) is a crucial step in preventing the global spread of AIDS. To ensure the progress and effectiveness of this vaccine, it is essential to establish efficient biotechnology platforms and data mining methods. These methods would help identify immune characteristics that distinguish individuals with varying levels of vaccine-induced protection and determine the underlying factors that contribute to protection against HIV acquisition. While previous studies have focused on identifying immune markers associated with infection outcomes among vaccinated patients, it is important to acknowledge the limitations of traditional case-control analytical protocols …

Assessing The Contributions Of Modifiable Risk Factors To Serious Falls And Fragility Fractures Among Older Persons Living With Hiv, Julie A Womack, Terrence E Murphy, Linda Leo-Summers, Jonathan Bates, Samah Jarad, Thomas M Gill, Evelyn Hsieh, Maria C Rodriguez-Barradas, Phyllis C Tien, Michael T Yin, Cynthia A Brandt, Amy C Justice

Faculty, Staff and Students Publications

BACKGROUND: Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown.

METHODS: We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine-learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within …

Protocol For Developing A Personalised Prediction Model For Viral Suppression Among Under-Represented Populations In The Context Of The Covid-19 Pandemic, Jiajia Zhang Ph.D., Xueying Yang Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Bankole Olatosi Ph.D.

Faculty Publications

Introduction Sustained viral suppression, an indicator of long-term treatment success and mortality reduction, is one of four strategic areas of the 'Ending the HIV Epidemic' federal campaign launched in 2019. Under-represented populations, like racial or ethnic minority populations, sexual and gender minority groups, and socioeconomically disadvantaged populations, are disproportionately affected by HIV and experience a more striking virological failure. The COVID-19 pandemic might magnify the risk of incomplete viral suppression among under-represented people living with HIV (PLWH) due to interruptions in healthcare access and other worsened socioeconomic and environmental conditions. However, biomedical research rarely includes under-represented populations, resulting in biased …

Improved Tracking And Referrals For Vision And Dental Care For Patients With Hiv, Kory Tillery, Michelle Iandiorio

Quality Improvement/Patient Safety Symposium

BACKGROUND

Regular vision and dental care are important components of healthcare for persons with HIV (PWH). HIV infection is associated with a wide array of complications for both ocular and oral health regardless of severity of HIV disease. Ocular disease can range from opportunistic or associated infections (i.e cytomegalovirus retinitis, ocular syphilis); to inflammatory or degenerative disease (i.e retinal vasculopathy, optic neuropathy), or drug effects. Oral disease similarly encompasses infectious and noninfectious etiologies, including opportunistic infections (i.e., candidiasis, oral hairy leukoplakia), comorbid infections (i.e. herpes simplex virus, human papilloma virus, periodontitis/gingivitis), or inflammatory conditions (i.e. salivary gland disease). The Health …

Noninvasive Screening Of Nonalcoholic Fatty Liver Disease Among People Living With Hiv, Essi M. Havor

Dissertations and Theses (Open Access)

Background: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects up to 75% of people living with HIV (PLWH). Given the high HIV prevalence in Houston and Harris County, knowledge of the prevalence of NAFLD in PLWH is needed to inform prevention efforts. In addition, such knowledge is required to raise awareness among at-risk individuals and healthcare professionals.

Specific Aims: This cross-sectional study aimed (1) to examine the demographic, behavioral, clinical, and psychosocial characteristics of PLWH in Houston/Harris County, Texas, and to estimate the prevalence of NAFLD, (2) to determine factors associated with the severity of NAFLD, and (3) to identify specific …

Shortening Of Telomeres Caused By Bacterial Lipopolysaccharides In Hiv-1 Exposed Human Oral Keratinocytes, Daphne Alcala Zúñiga

Theses and Dissertations

The Human Immunodeficiency Virus-1 (HIV-1) continues to affect many individuals around the globe. Although people with HIV (PWH) have longer life expectancies because of modern treatments, they continue to exhibit comorbidities that are signs of premature aging compared to healthy individuals. The significance of the oral microbiome during HIV-1 infection has become of interest as chronic inflammatory conditions, such as periodontitis, have shed light on the detrimental effects of chronic inflammation. HIV-1 infection can promote dysbiosis, an imbalance of the oral microbiota, which in turn promotes the growth of opportunistic microorganisms such as P. gingivalis. This overpopulation enhances pathogenicity through …

Medication Compliance And Decreases In Viral Load Status In Patients With Hiv, Tangela Woodland- Ballard

Doctor of Nursing Practice Projects

Background: The human immunodeficiency virus (HIV) epidemic has been a worldwide challenge for several decades. Proper medication adherence, following the Centers for Disease Control guidelines, has proven effective in decreasing patients’ viral load, thus improving their quality of life, and reducing the spread of the disease. The current literature identifies a lack of knowledge, support, and resources as barriers to medication compliance.

Purpose: To increase medication compliance among persons with HIV.

Methods: This evidence-based practice project utilized the Modified Morisky Scale to help minority HIV patients adhere to strict medication regimens. Repeated measures analysis of variance was conducted to …

The Comorbidity Of Depression And Neurocognitive Disorder In Persons With Hiv Infection: Call For Investigation And Treatment, Karl Goodkin, Teresa H. Evering, Albert M. Anderson, Ann Ragin, Cynthia L. Monaco, Christina Gavegnano, Ryan J. Avery, Sean B. Rourke, Lucette A. Cysique, Bruce J. Brew

School of Medicine Publications

Depression and neurocognitive disorder continue to be the major neuropsychiatric disorders affecting persons with HIV (PWH). The prevalence of major depressive disorder is two to fourfold higher among PWH than the general population (∼6.7%). Prevalence estimates of neurocognitive disorder among PWH range from 25 to over 47% – depending upon the definition used (which is currently evolving), the size of the test battery employed, and the demographic and HIV disease characteristics of the participants included, such as age range and sex distribution. Both major depressive disorder and neurocognitive disorder also result in substantial morbidity and premature mortality. However, though anticipated …

Independent Effects Of Hiv And Antiretroviral Therapy On The Oral Microbiome Identified By Multivariate Analyses, Clifford J. Beall, Elizabeth A. Lilly, Carolina Granada, Kelly Treas, Kenneth R. Dubois, Shahr B. Hashmi, Jose A. Vazquez, Michael E. Hagensee, Ann L. Griffen, Eugene J. Leys, Paul L. Fidel

School of Dentistry Faculty Publications

The oral microbiome is an important predictor of health and disease. We recently reported significant yet modest effects of HIV under highly active antiretroviral therapy (ART) on the oral microbiome (bacterial and fungal) in a large cohort of HIV-positive (HIV+) and matched HIV-negative (HIV-) individuals. As it was unclear whether ART added to or masked further effects of HIV on the oral microbiome, the present study aimed to analyze the effects of HIV and ART independently, which also included HIV- subjects on preexposure prophylaxis (PrEP) therapy. Cross-sectional analyses of the effect of HIV devoid of ART (HIV+ ART- versus matched …

Smoking Prevalence Amongst People Living With Hiv In Western Jamaica, D Aguilera, B Rinola, S Tundealao, R Klaff, M Aung, M Johnson-Campbell, P Jolly, I Tamí-Maury

GW Research Showcase 2021-2026

No abstract provided.

A Randomized Clinical Trial Of Transgender Women Switching To B/F/Taf: The (Mo)Betta Trial, Jordan E Lake, Ana N Hyatt, Han Feng, Paula Debroy, Aaren Kettelhut, Hongyu Miao, Liming Peng, Shalender Bhasin, Susan Bell, Nahid Rianon, Todd T Brown, Nicholas T Funderburg

Faculty, Staff and Student Publications

Background: Cardiometabolic disease in transgender women (TW) is affected by gender-affirming hormonal therapies (GAHTs), HIV, and antiretroviral therapy (ART). We evaluated the 48-week safety/tolerability of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) vs continued ART in TW on GAHT.

Methods: TW on GAHT and suppressive ART were randomized 1:1 to switch to B/F/TAF (Arm A) or continue current ART (Arm B). Cardiometabolic biomarkers, sex hormones, bone mineral density (BMD) and lean/fat mass by DXA scan, and hepatic fat (controlled continuation parameter [CAP]) were measured. Wilcoxon rank-sum/signed-rank and χ2 tests compared continuous and categorical variables.

Results: TW (Arm A n = 12, Arm …

Imaging Of Brain Structural And Functional Effects In People With Human Immunodeficiency Virus, Erin E O'Connor, Edith V Sullivan, Linda Chang, Dima A Hammoud, Tony W Wilson, Ann B Ragin, Christina S Meade, Jennifer Coughlin, Beau M Ances

2020-Current year OA Pubs

Before the introduction of antiretroviral therapy, human immunodeficiency virus (HIV) infection was often accompanied by central nervous system (CNS) opportunistic infections and HIV encephalopathy marked by profound structural and functional alterations detectable with neuroimaging. Treatment with antiretroviral therapy nearly eliminated CNS opportunistic infections, while neuropsychiatric impairment and peripheral nerve and organ damage have persisted among virally suppressed people with HIV (PWH), suggesting ongoing brain injury. Neuroimaging research must use methods sensitive for detecting subtle HIV-associated brain structural and functional abnormalities, while allowing for adjustments for potential confounders, such as age, sex, substance use, hepatitis C coinfection, cardiovascular risk, and others. …

Relationship Between Treatment Comorbidities And Hiv Viral Suppression Among People Who Live With Aids In Johannesburg., Nwogo Immaculata Ekeji, Tolulope A. Osoba, Hebatullah Tawfik, Mehdi Agha

Journal of Social, Behavioral, and Health Sciences

HIV has globally infected over 37.9 million people, of which 28.2 million (73%) are on antiretroviral treatment, and 66% of those on treatment are virally suppressed. In South Africa, however, low rate of viral suppression (47%) among people living with HIV is a major health problem that has continued to fuel HIV prevalence. A cross-sectional quantitative research design was used to investigate the relationship between treatment comorbidities and viral suppression among HIV-infected adults aged 18–49 who were diabetic, had cancer, or tuberculosis in Johannesburg. HIV Care Continuum formed the theoretical framework for this research. An existing HIV-infected patient de-identifiable dataset …

Hiv Screening Among Immigrants Establishing Care In Maine, 2017-2021, Elizabeth Mazzeo, Elizabeth Danielson, Benjamin Felix, Kimberly Toomire, Elizabeth Eisenhardt, Evelyn Roach, Katlyn Breton, Karen Thompson, Stephen Digiovanni, Kathleen M. Fairfield

Journal of Maine Medical Center

No abstract provided.

Cognitive And Academic Performance Of Rural Zambian Youth Exposed To Hiv, Sophie Jago, Joseph Mwaba Chirwa, Mei Tan, Philip E Thuma, Elena L Grigorenko

Faculty, Staff and Students Publications

Studies focusing on children affected by HIV have shown that they have generally lower academic performance, however, few studies separate children who are HIV exposed and infected (CHEI) and those who are HIV exposed but uninfected (CHEU). Importantly, in rural sub-Saharan Africa, the majority of studies on CHEI and CHEU examine academic performance indirectly based on cognitive test scores. Therefore, studies assessing the effects of HIV on academic achievement directly for CHEI and CHEU are needed. This article evaluates the effects of HIV-infection on cognitive and academic performance by comparing CHEI (n = 82) and CHEU (n = 1045) aged …

Understanding The Health-Related Quality Of Life Of People Living With Hiv Based On Sexual Orientation, Rico Januar Sitorus, Nyoman Yudi Antara, Reymart Sangalang, Merry Natalia Panjaitan, Nelsensius Klau Fauk

Kesmas

Human immunodeficiency virus (HIV) infection has detrimental impacts on the lives of different population groups living with HIV, including men who have sex with men (MSM). Using the World Health Organization Quality of Life questionnaire, this study aimed to assess the health-related quality of life of men living with HIV with different sexual orientations and to determine the dominant influential factors. This cross-sectional study involved 206 men living with HIV. They were recruited from the Sriwijaya Plus Foundation and a medical facility that provided antiretroviral therapy. The data were analyzed using Chi-square and binomial logistic regression. The analysis showed that …

Improved Survival After Liver Transplantation For Patients With Human Immunodeficiency Virus (Hiv) And Hiv/Hepatitis C Virus Coinfection In The Integrase Strand Transfer Inhibitor And Direct-Acting Antiviral Eras, Jake Sheraj Jacob, Anjiya Shaikh, Karthik Goli, Nicole E Rich, Jihane N Benhammou, Aijaz Ahmed, Donghee Kim, Abbas Rana, John A Goss, Susanna Naggie, Tzu-Hao Lee, Fasiha Kanwal, George Cholankeril

Faculty, Staff and Students Publications

BACKGROUND: People with human immunodeficiency virus (HIV) with and without hepatitis C virus (HCV) coinfection had poor outcomes after liver transplant (LT). Integrase strand transfer inhibitors (INSTIs) and direct-acting antivirals (DAAs) have changed the treatment landscape for HIV and HCV, respectively, but their impact on LT outcomes remains unclear.

METHODS: This retrospective analysis of adults with HIV monoinfection (n = 246) and HIV/HCV coinfection (n = 286) who received LT compared mortality in patients with HIV who received LT before versus after approval of INSTIs and in patients with HIV/HCV coinfection who received LT before versus after approval of DAAs. …

Incidence And Clearance Of Anal Human Papillomavirus Infection In 16 164 Individuals, According To Human Immunodeficiency Virus Status, Sex, And Male Sexuality: An International Pooled Analysis Of 34 Longitudinal Studies, Feixue Wei, Marc T Goodman, Ningshao Xia, Jun Zhang, Anna R Giuliano, Gypsyamber D'Souza, Nancy A Hessol, Maarten F Schim Van Der Loeff, Jianghong Dai, Karin Neukam, Alexandra De Pokomandy, I Mary Poynten, Ronald B Geskus, Joaquin Burgos, Isabelle Etienney, Anna-Barbara Moscicki, Maria Gabriella Donà, Maura L Gillison, Alan G Nyitray, Rebecca G Nowak, Evy Yunihastuti, Huachun Zou, Carmen Hidalgo-Tenorio, Nittaya Phanuphak, Jean-Michel Molina, Alice M Schofield, Stephen Kerr, Song Fan, Yong Lu, Jason J Ong, Admire T Chikandiwa, Sirinya Teeraananchai, Nicola Squillace, Dorothy J Wiley, Joel M Palefsky, Damien Georges, Catharina J Alberts, Gary M Clifford

Faculty, Staff and Student Publications

Background: Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized.

Methods: We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their …

Sars-Cov-2-Specific T Cell And Humoral Immunity In Individuals With And Without Hiv In An African Population: A Prospective Cohort Study, Owen Ngalamika, Salum J. Lidenge, Marie Claire Mukasine, Musonda Kawimbe, Patrick Kamanzi, John R. Ngowi, Julius Mwaiselage, For Yue Tso

School of Medicine Faculty Publications

Objectives: To longitudinally compare SARS-CoV-2-specific T cell and humoral immune responses between convalescent individuals who are HIV-positive (HIV+) and HIV-negative (HIV-). Methods: We conducted enzyme-linked immunospots to determine the SARS-CoV-2-specific T cell responses to spike and nucleocapsid, membrane protein, and other open reading frame proteins (NMO), whereas an immunofluorescence assay was used to determine the humoral responses. Participants were sampled at baseline and after 8 weeks of follow-up. Results: Individuals who are HIV- had significantly more T cell responses to NMO and spike than individuals who are HIV+ at baseline, P-value = 0.026 and P-value = 0.029, respectively. At follow-up, …

Optimal Timing Of Antiretroviral Therapy Initiation In Children And Adolescents With Human Immunodeficiency Virus-Associated Pulmonary Tuberculosis, Alexander Kay, Jose Mendez-Reyes, Tara Devezin, Meenakshi Bakaya, Teresa Steffy, Sandile Dlamini, Amos Msekandiana, Tara Ness, Jason Bacha, Pauline Amuge, Mogomotsi Matshaba, Moses Chodota, Phoebe Nyasulu, Lineo Thahane, Lumumbwa Mwita, Adeodata Kekitiinwa, Andrew Dinardo, Bhekumusa Lukhele, H Lester Kirchner, Anna Mandalakas

Faculty, Staff and Students Publications

BACKGROUND: There is insufficient evidence in children and adolescents with human immunodeficiency virus (CAHIV) to guide the timing of antiretroviral treatment (ART) initiation after starting treatment for pulmonary tuberculosis (pTB). To address this knowledge gap, we evaluated the risk of mortality associated with timing of ART initiation in ART-naive CAHIV treated for pTB.

METHODS: Data were extracted from electronic medical records of ART-naive patients, aged 0-19 years, who were treated for HIV-associated pTB at Baylor Centers of Excellence in Botswana, Eswatini, Malawi, Lesotho, Tanzania, or Uganda between 2013 and 2020. Data were analyzed against a primary outcome of all-cause mortality …

Effectiveness And Safety Of Bictegravir/Emtricitabine/Tenofovir Alafenamide In Patients With Hiv-1 Infection And Ongoing Substance Use Disorder: The Base Study, Joshua P. Havens, Sara Bares, Elizabeth Lyden, Anthony T. Podany, Kimberly Scarsi, Nada A. Fadul, Susan Swindells

Journal Articles: Infectious Diseases

BACKGROUND: People with human immunodeficiency virus (HIV) and substance use disorder (PWH/SUD) are at higher risk of nonadherence to antiretroviral therapy. Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) exhibits high rates of efficacy with a favorable adverse event profile. The BASE study (NCT03998176) is a phase 4, single-arm study evaluating the effectiveness and safety of B/F/TAF among PWH/SUD.

METHODS: Viremic (HIV RNA >1000 copies/mL) PWH/SUD initiated B/F/TAF once daily for 48 weeks (W). The primary endpoint was proportion of participants with HIV RNA/mL at W24. Secondary endpoints were proportion of participants with HIV-1 RNA/mL at W48, safety, B/F/TAF adherence (dried blood spot [DBS] concentrations …

Influence Of Stigma On Retention In Hiv Care And Adherence To Antiretroviral Therapy In Specialized Hiv Clinics Targeting Men Who Have Sex With Men And Transgender Women In Lima, Peru, David Oliveros Oliveros

Public Health Theses

HIV stigma is a social determinant of health that can influence adherence to antiretroviraltherapy (ART) and engagement in HIV care that impacts viral suppression levels for people with HIV (PWH). In Peru, a country which lags behind 95-95-95 targets for HIV outcomes, LGBTQ-affirming clinics have the potential to mitigate these negative health effects of stigma and discrimination among men who have sex with men (MSM) and transgender women (TGW), two populations that continue to be disproportionately affected by HIV. Using a validated HIV stigma scale and multivariate logistic regression models, this study assessed the magnitude and types of stigma present …

Perspectives On The Use Of Molecular Hiv Data For Public Health, Margaret Watson

College of Graduate Studies: Theses & Dissertations

Background. Effective HIV treatment and pre-exposure prophylaxis can drastically reduce the risk of acquiring HIV and prevent most future transmission, but these advances are not accessible to many who could most benefit from them. Advances in use of molecular sequence data to inform prevention efforts, paired with supportive interventions, have the potential to identify clusters of rapid HIV transmission and focus prevention resources toward areas of highest need. Although molecular cluster detection has been successfully used in other areas of public health, advocates for people with HIV have raised concerns about the application of this approach because of HIV …