Public Health Commons^™

A Healthy Dietary Pattern With A Low Inflammatory Potential Reduces The Risk Of Gestational Diabetes Mellitus, Lotta Pajunen, Liisa Korkalo, Noora Houttu, Outi Pellonperä, Kati Mokkala, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Tero Vahlberg, Kristina Tertti, Kirsi Laitinen

Faculty Publications

Purpose An optimal diet for lowering the risk of gestational diabetes mellitus (GDM) is still to be defined, but may comprise of nutrient intakes, dietary patterns, diet quality, and eating frequency. This study was designed to investigate the contribution of diet in developing GDM in a comprehensive way. Methods The dietary intake of overweight or obese women, a risk group for GDM (n = 351), was assessed using 3-day food diaries and diet quality questionnaires in early pregnancy. Eating frequency and nutrient intakes were calculated, and dietary patterns identified using principal component analysis. The inflammatory potential of the diet was …

The Indonesian Strategy To Achieve Universal Health Coverage Through National Health Insurance System: Challenges In Human Resources, Atikah Adyas

Kesmas

Many countries are currently trying to achieve universal health insurance coverage in order to provide health protection for their population. Indonesia has received a strong political commitment to implement national health insurance including government support to finance the poor. The implementation of comprehensive national health insurance requires human resources, each of which has a role in fighting for noble goals for the welfare of all people. This paper is taken from the experience of Indonesia and several other countries as well as guidelines that can be used in exploring the role of human resources for the success of the implementation …

Mental Fatigue And Its Associated Factors Among Coal Mining Workers After One Year Of The Covid-19 Pandemic In Indonesia, Hendra Djamalus, Budi Utomo, I Made Djaja, Sjahrul M. Nasri

Kesmas

Mental fatigue among coal mining operators was related to driving activities that require high concentration. This study aimed to determine factors that contributed to mental fatigue among coal mine operators in Indonesia, specifically in Kalimantan and Sumatra, after a one-year COVID-19 pandemic. This cross-sectional study was conducted among 480 operators from two companies and seven sites. A self-administrated questionnaire in the Google Form was used to measure mental fatigue, the non-work-related factors (age, education, marital status, residence, and stress level), and work-related factors (working periods, shift pattern, type of shift, and work area in mining). The data analyzed using Chi-square …

The Covid-19 Pandemic: Role Of Coping Humor And Internal Health Locus Of Control On Social Dysfunction And Anxiety & Depression, Muhammad Arief Sumantri, Zahrani Zahrani, Hilda Rosa Ainiyah, Azmul Fuady Idham

Kesmas

The concerns about the impact of social distancing on mental health have been widely discussed. This study aimed to know the predictive effect of coping humor and Internal Health Locus of Control (Internal HLoC) on social dysfunction and anxiety & depression during the implementation of the COVID-19 social distancing agenda. This study was also intended to assess the effect of humor content on coping humor. A quantitative approach was used as the method ofthe study with 243 online-recruited participants, and a PLS-SEM analysis was applied to find out the predictive effect in this study. The results and conclusions showed that …

Breastfeeding Knowledge And Behavior In Lactational Amenorrhea Method (Lam) As A Natural Contraceptive, Mufdlilah Mufdlilah, Reza Bintangdari Johan, Sri Ratna Ningsih

Kesmas

The lactational amenorrhea method (LAM) is a natural contraceptive that is highly effective after the three essential criteria are fulfilled. However, there is a significantly low adoption resulting from poor knowledge and correct practices. This study aimed to determine the correlation between knowledge and behavior of breastfeeding mothers on breastfeeding as a natural contraceptive. This was an analytic observational study with a cross-sectional design involving 89 breastfeeding mothers and was performed from January to March 2018. Furthermore, data were collected using a questionnaire, and the results showed knowledge of breastfeeding mothers to be good (59.6%) and not good (51.7%). However, …

Integrated Model Of A Family Approach And Local Support In Tuberculosis Case Finding Efforts In People With Hiv/Aids, Erni Astutik, Chatarina Umbul Wahyuni, Imelda F E Manurung, Geofrey Ssekalembe

Kesmas

The human immunodeficiency virus (HIV) remains a major global public health problem. People with HIV/acquired immune deficiency syndrome (AIDS) are more susceptible to opportunistic infections such as tuberculosis (TB). Therefore, families and community leaders need to help monitor people living with HIV/AIDS (PLWHA). This study aimed to analyze an integrated family approach and local support model to detect TB cases in PLWHA. This study used a case-control study in Kupang City, East Nusa Tenggara Province, in July 2020. The sample comprised 100 people (50 PLWHA with TB case and 50 controls) using total sampling and random sampling, respectively. The variables …

Predictors Of The Covid-19 Social Distancing Practice Among Undergraduate Health Students In Samarinda City, Indonesia: A Cross-Sectional Study, Siti Hadijah Aspan, Pramon Viwattanakulvanid

Kesmas

Social distancing is a health protocol recommended by the World Health Organization (WHO) for reducing the spread of COVID-19. Undergraduate health students play an important role in the dissemination of accurate information. This study identified predictors that influenced the COVID-19 social distancing practice and examined the sources of social distancing information among undergraduate health students in Samarinda City, Indonesia. This cross-sectionalonline survey study (March-April 2021) involved 422 undergraduate students from medicine, public health, and pharmacy faculties at Mulawarman University. Binary logistic regression was conducted to identify factors associated with the COVID-19 social distancing practice. The results showed that age (AOR …

Knowledge, Attitudes, And Practices Of Health Personnel In Responding To The Covid-19 Pandemic In Indonesia, Dyah Suryani, Suyitno Suyitno, Maretalinia Maretalinia, Elvi Juliansyah, Vernonia Yora Saki, Kraichat Tantrakarnapa

Kesmas

The COVID-19 pandemic, originated in China, has spread to worldwide, including Indonesia. Until July 2021, the growth rate has been gradually increasing, and cases have been found in all 34 provinces of Indonesia. This cross-sectional study aimed to investigate the knowledge, attitude, and practices (KAP) of health personnel in the primary health care towards the COVID-19 pandemic in Indonesia using online self-report questionnaire. A total of 440 respondents contributed to this online survey. The average level of KAP were 7.7 out of 10.0, 14.3 out of 15.0, and 31.9 out of 36.0, respectively. There was no significant association between respondents’ …

The Seroprevalence Of Toxoplasma Gondii In Cats At The House Of Maternal Women With Toxoplasmosis In Badung, Indonesia, Made Subrata, Nyoman Mantik Astawa, Nyoman Tigeh Suryadi, Sang Gede Purnama, Kadek Karang Agustina, Ngakan Putu Anom Harjana, Made Damriyasa

Kesmas

Toxoplasmosis is a zoonotic disease caused by infection with the parasite called Toxoplasma gondii (T. gondii). The health and social impacts of the infectionare enormous, including miscarriage, hydrocephalus, blindness, and mental retardation. The occurrence of toxoplasmosis in maternal women cannot be se parated from cats around their houses. This study aimed to determine the seroprevalence of the parasite in cats found in the human carriers residences and identify the risk factors of toxoplasmosis in maternal women in Badung District, Bali Province, Indonesia. A total of 80 cat serum samples were obtained from two residential groups, 40 from the housing where …

How Risky People Of Getting Covid-19 Based On Their Daily Activities?, Fajar Ariyanti, Mustakim Mustakim, Moch T A Al Ayubi, Desty Pratiwi Marlisman

Kesmas

In Indonesia at the end of 2020, COVID-19 cases were increasing and predicted to continue, as it had not yet passed the peak of the pandemic curve. The government had implemented mobility restrictions to reduce exposure to COVID-19. This study aimed to identify the risk of people getting COVID-19 based on their daily activities. Using a cross-sectional design, this study took 315 respondents under non-probability sampling from September to October 2020. Thedata were analyzed using the Chi-square test with α 0.05. This study showed that the risk percentage of people infected with COVID-19 based on their daily activities was 15.56% …

Performance Of A Validated Spontaneous Preterm Delivery Predictor In South Asian And Sub-Saharan African Women: A Nested Case Control Study, Rasheda Khanam, Tracy C. Fleischer, Nansi Boghossian, Imran Nisar, Usha Dhingra, Sayedur Rahman, Angela C. Fox, Muhammad Iiyas, Arup Dutta, Nurun Naher, Ashoka D. Polpitiya, Usma Mehmood, Saikat Deb, Aziz Ahmed Choudhury, Md Bahadur Badsha, Karim Muhammad, Said Mohammed Ali, Salahuddin Ahmed, Durlin E. Hickok, Najeeha Iqbal, Et. Al.

Faculty Publications

Objectives

To address the disproportionate burden of preterm birth (PTB) in low- and middle-income countries, this study aimed to (1) verify the performance of the United States-validated spontaneous PTB (sPTB) predictor, comprised of the IBP4/SHBG protein ratio, in subjects from Bangladesh, Pakistan and Tanzania enrolled in the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, and (2) discover biomarkers that improve performance of IBP4/SHBG in the AMANHI cohort.

Study design

The performance of the IBP4/SHBG biomarker was first evaluated in a nested case control validation study, then utilized in a follow-on discovery study performed on the same samples. …

Statistical Analysis Based On Adaptive Progressive Hybrid Censored Data From Lomax Distribution, Amal Helu, Hani Samawi

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

In this article, we consider statistical inferences about the unknown parameters of the Lomax distribution basedon the Adaptive Type-II Progressive Hybrid censoring scheme, this scheme can save both the total test time and the cost induced by the failure of the units and increases the efficiency of statistical analysis. The estimation of the parameters is derived using the maximum likelihood (MLE) and the Bayesian procedures. The Bayesian estimators are obtained based on the symmetric and asymmetric loss functions. There are no explicit forms for the Bayesian estimators, therefore, we propose Lindley’s approximation method to compute the Bayesian estimators. A comparison …

Aggregating Twitter Text Through Generalized Linear Regression Models For Tweet Popularity Prediction And Automatic Topic Classification, Chen Mo, Jingjing Yin, Isaac Chun-Hai Fung, Zion Tse

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Social media platforms have become accessible resources for health data analysis. However, the advanced computational techniques involved in big data text mining and analysis are challenging for public health data analysts to apply. This study proposes and explores the feasibility of a novel yet straightforward method by regressing the outcome of interest on the aggregated influence scores for association and/or classification analyses based on generalized linear models. The method reduces the document term matrix by transforming text data into a continuous summary score, thereby reducing the data dimension substantially and easing the data sparsity issue of the term matrix. To …

Causal Effects On Low Apgar At 5-Min And Stillbirth In A Malaria Maternal–Fetal Health Outcome Investigation: A Large Perinatal Surveillance Study In The Brazilian Amazon, Julio Abel Seijas-Chávez, Melissa Nolan Ph.D., Mph, Mary K. Lynn, Maria José Francalino Da Rocha, Muana Da Costa Araújo, Fernando Luiz Affonso Fonseca, Gabriel Zorello Laporta

Faculty Publications

Background

Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality of Cruzeiro do Sul, Acre state, Brazilian Amazon. The research questions are: what are the causal effects of low birth weight on low Apgar at 5-min and of perinatal anaemia on stillbirth?

Methods

From November 2018 to October 2019, pregnant women of ≥ 22 weeks or puerperal mothers, who delivered at the referral maternity hospital (Juruá Women and Children’s Hospital), …

The Dietary Inflammatory Index Is Not Associated With Gut Permeability Or Biomarkers Of Systemic Inflammation In Hiv Immunologic Non-Responders, Fat Malazogu, Rodney K. Rousseau, Nitin Shivappa Mbbs, Mph, Ph.D., Sanja Huibner, Sharon L. Walmsley, Colin M. Kovacs, Erika Benko, Robert J. Reinhard, Ron Rosenes, James R. Hébert, Rupert Kaul

Faculty Publications

Immunologic non-responders (INRs) are a subset of individuals living with HIV who have suboptimal blood CD4+ T cell recovery despite effective antiretroviral therapy (ART). They are at an increased risk of serious non-AIDS co-morbidities and death, and demonstrate enhanced systemic immune activation. In other populations diet has been correlated with markers of systemic inflammation through the Diet Inflammatory Index (DII), but this association has not been studied in persons living with HIV (PLWH). Blood was collected from 28 INR PLWH with a blood CD4+ T cell count <350/μL despite ≥2 years of effective ART. Participants completed a Canadian Diet History Questionnaire, and their responses were used to calculate the DII. Plasma inflammatory markers (IFNγ, TNF, IL-6, sVCAM, D-dimer, sCD14 and CRP) were assayed by ELISA, cellular immune activation (HLA-DR and CD38 on CD4+ and CD8+ T cells) was quantified using flow cytometry, and small bowel permeability assessed by calculation of the urine LacMan ratio after drinking a mix of lactulose and mannitol. Participants were a median age of 57 years, had been on effective ART for 15 years, and the median DII was −1.91 (range of −3.78 to +2.23). No correlation was observed between DII and plasma markers of inflammation, levels of T cell activation, gut permeability, or the biomarker of bacterial translocation sCD14. Self-reported alcohol intake, a potential confounder of the relationship between diet and inflammatory biomarkers, was also not associated with systemic inflammation or gut permeability. Our findings suggest that other mechanisms, rather than diet, are likely to be the major driver of systemic inflammation in INR individuals.

Class Imbalance In Out-Of-Distribution Datasets: Improving The Robustness Of The Textcnn For The Classification Of Rare Cancer Types, Kevin De Angeli, Shang Gao, Ioana Danciu, Eric B. Durbin, Xiao Cheng Wu, Antoinette Stroup, Jennifer Doherty, Stephen Schwartz, Charles Wiggins, Mark Damesyn, Linda Coyle, Lynne Penberthy, Georgia D. Tourassi, Hong Jun Yoon

School of Public Health Faculty Publications

In the last decade, the widespread adoption of electronic health record documentation has created huge opportunities for information mining. Natural language processing (NLP) techniques using machine and deep learning are becoming increasingly widespread for information extraction tasks from unstructured clinical notes. Disparities in performance when deploying machine learning models in the real world have recently received considerable attention. In the clinical NLP domain, the robustness of convolutional neural networks (CNNs) for classifying cancer pathology reports under natural distribution shifts remains understudied. In this research, we aim to quantify and improve the performance of the CNN for text classification on out-of-distribution …

Association Between Diet Quality Indices And Incidence Of Type 2 Diabetes In The Melbourne Collaborative Cohort Study, Allison M. Hodge, Md Nazmul Karim, James Hébert Scd, Nitin Shivappa Mbbs, Mph, Ph.D., Barbora De Courten

Faculty Publications

Type 2 diabetes mellitus is a common condition whose incidence is increasing worldwide, and for which obesity and diet are important risk factors. The aim of this study was to assess the association of three diet quality scores with diabetes risk and how much of the association was mediated through body size. The Melbourne Collaborative Cohort Study recruited 41,513 men and women aged 40–69 years during 1990–1994. At baseline, data were collected on lifestyle and diet, anthropometric measures were performed. Incident diabetes was assessed by self-report at follow-up surveys in 1994–1998 and 2003–2007. The associations between the dietary inflammatory index …

A Community-Based Management Of Covid-19 In A Mobile Container Unit, Elena Petrova, Timothy Farinholt, Tejas P Joshi, Hannah Moreno, Mayar Al Mohajer, Shital M Patel, Joseph Petrosino, Sharmila Anandasabapathy

Faculty, Staff and Students Publications

Vaccine uptake is a multifactor measure of successful immunization outcomes that includes access to healthcare and vaccine hesitancy for both healthcare workers and communities. The present coronavirus disease (COVID-19) pandemic has highlighted the need for novel strategies to expand vaccine coverage in underserved regions. Mobile clinics hold the promise of ameliorating such inequities, although there is a paucity of studies that validate environmental infection in such facilities. Here, we describe community-based management of COVID-19 through a Smart Pod mobile clinic deployed in an underserved community area in the United States (Aldine, Harris County, TX, USA). In particular, we validate infection …

The Acute And Persisting Impact Of Covid-19 On Trajectories Of Adolescent Depression: Sex Differences And Social Connectedness, Sabrina R. Liu, Elyssia Poggi Davis, Anton M. Palma, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Background

The COVID-19 era is a time of unprecedented stress, and there is widespread concern regarding its short- and long-term mental health impact. Adolescence is a sensitive period for the emergence of latent psychopathology vulnerabilities, often activated by environmental stressors. The present study examined COVID-19′s impact on adolescent depression and possible influences of different domains of social connectedness (loneliness, social media use, social video game time, degree of social activity participation).

Methods

A community sample of 175 adolescents (51% boys, mean age = 16.01 years) completed questionnaires once before and twice during the COVID-19 pandemic. Piecewise growth modeling examined the …

Posttranslational Modifications In Pd-L1 Turnover And Function: From Cradle To Grave, Xinfang Yu, Wei Li, Ken H Young, Yong Li

Faculty, Staff and Students Publications

Programmed death-ligand 1 (PD-L1) is one of the most classic immune checkpoint molecules. Cancer cells express PD-L1 to inhibit the activity of effector T cells' cytotoxicity through programmed death 1 (PD-1) engagement in exposure to inflammatory cytokines. PD-L1 expression levels on cancer cells might affect the clinical response to anti-PD-1/PD-L1 therapies. Hence, understanding molecular mechanisms for regulating PD-L1 expression is essential for improving the clinical response rate and efficacy of PD-1/PD-L1 blockade. Posttranslational modifications (PTMs), including phosphorylation, glycosylation, ubiquitination, and acetylation, regulate PD-L1 stability, cellular translocation, and interaction with its receptor. A coordinated positive and negative regulation via PTMs is …

A 6-Cpg Validated Methylation Risk Score Model For Metabolic Syndrome: The Hypergen And Goldn Studies, Bertha A. Hidalgo, Bre Minniefield, Amit Patki, Rikki Tanner, Minoo Bagheri, Hemant K. Tiwari, Donna K. Arnett, Marguerite Ryan Irvin

Epidemiology and Environmental Health Faculty Publications

There has been great interest in genetic risk prediction using risk scores in recent years, however, the utility of scores developed in European populations and later applied to non-European populations has not been successful. The goal of this study was to create a methylation risk score (MRS) for metabolic syndrome (MetS), demonstrating the utility of MRS across race groups using cross-sectional data from the Hypertension Genetic Epidemiology Network (HyperGEN, N = 614 African Americans (AA)) and the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN, N = 995 European Americans (EA)). To demonstrate this, we first selected cytosine-guanine dinucleotides …

Model-Based Evaluation Of The Implementation Of Sti Screening Among Men Who Have Sex With Men In Tokyo, Nao Yamamoto

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Machine Learning-Based Risk Factor Analysis And Prevalence Prediction Of Intestinal Parasitic Infections, Ahmet Ay

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Estimation Analysis For The Seir Model With Stochastic Perturbation For The Covid-19 Outbreak In Bogotá, Viswanathan Arunachalam, Andres Rios-Gutierrez

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Statistical Modeling Of Sars-Cov-2 Mutation In The U.S., Yuru Jing, Angela Antonou

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Association Between Neighborhood Social Deprivation And Stage At Diagnosis Among Breast Cancer Patients In South Carolina, Oluwole Adeyemi Babatunde, Whitney Zahnd Ph.D., Jan Eberth Ph.D., Andrew B. Lawson, Swann Arp Adams, Eric Adjei Boakye, Melanie S. Jefferson, Caitlin G. Allen, John L. Pearce, Hong Li, Chanita Hughes Halbert

Faculty Publications

The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions—the social deprivation index (SDI). Data were analyzed using chi-square tests, Student’s t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients …

Genomics Of Postprandial Lipidomics In The Genetics Of Lipid-Lowering Drugs And Diet Network Study, Marguerite R. Irvin, May E. Montasser, Tobias Kind, Sili Fan, Dinesh K. Barupal, Amit Patki, Rikki M. Tanner, Nicole D. Armstrong, Kathleen A. Ryan, Steven A. Claas, Jeffrey R. O’Connell, Hemant K. Tiwari, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Postprandial lipemia (PPL) is an important risk factor for cardiovascular disease. Inter-individual variation in the dietary response to a meal is known to be influenced by genetic factors, yet genes that dictate variation in postprandial lipids are not completely characterized. Genetic studies of the plasma lipidome can help to better understand postprandial metabolism by isolating lipid molecular species which are more closely related to the genome. We measured the plasma lipidome at fasting and 6 h after a standardized high-fat meal in 668 participants from the Genetics of Lipid-Lowering Drugs and Diet Network study (GOLDN) using ultra-performance liquid chromatography coupled …

Childbirth Educators’ Role Regarding Pregnant Women And Cervical Cancer Prevention, Olufunmiso Oyetunde Asamu, Hadi Danawi

Journal of Excellence in Nursing and Healthcare Practice

Childbirth educators play an important role in educating pregnant women regarding their health. They bridge the gap between pregnant women and healthcare providers. A paucity of information exists on the benefits that pregnant women derive from interactions with childbirth educators regarding early cervical cancer detection. The purpose of our cross-sectional study was to investigate the association among education during early pregnancy offered by the childbirth educators, access to childbirth educators, availability of childbirth educators in the United States and survival from cervical cancer. Secondary data from the Surveillance, Epidemiology, and End Results (SEER) on 520,153 women were analyzed using logistic …

Efficacy Of The Mrna-1273 Sars-Cov-2 Vaccine At Completion Of Blinded Phase, Hana M El Sahly, Lindsey R Baden, Brandon Essink, Susanne Doblecki-Lewis, Judith M Martin, Evan J Anderson, Thomas B Campbell, Jesse Clark, Lisa A Jackson, Carl J Fichtenbaum, Marcus Zervos, Bruce Rankin, Frank Eder, Gregory Feldman, Christina Kennelly, Laurie Han-Conrad, Michael Levin, Kathleen M Neuzil, Lawrence Corey, Peter Gilbert, Holly Janes, Dean Follmann, Mary Marovich, Laura Polakowski, John R Mascola, Julie E Ledgerwood, Barney S Graham, Allison August, Heather Clouting, Weiping Deng, Shu Han, Brett Leav, Deb Manzo, Rolando Pajon, Florian Schödel, Joanne E Tomassini, Honghong Zhou, Jacqueline Miller

Faculty, Staff and Students Publications

BACKGROUND: At interim analysis in a phase 3, observer-blinded, placebo-controlled clinical trial, the mRNA-1273 vaccine showed 94.1% efficacy in preventing coronavirus disease 2019 (Covid-19). After emergency use of the vaccine was authorized, the protocol was amended to include an open-label phase. Final analyses of efficacy and safety data from the blinded phase of the trial are reported.

METHODS: We enrolled volunteers who were at high risk for Covid-19 or its complications; participants were randomly assigned in a 1:1 ratio to receive two intramuscular injections of mRNA-1273 (100 μg) or placebo, 28 days apart, at 99 centers across the United States. …

Anal Human Papillomavirus Infection Among Men Who Have Sex With Men And Transgender Women Living With And Without Hiv In Pakistan: Findings From A Cross-Sectional Study, Muslima Ejaz, Soren Andersson, Salma Batool, Tazeen Saeed Ali, Anna Mia Ekström

Community Health Sciences

Objectives: The aim of this study was to determine the prevalence of infection, genotypes and risk factors for human papillomavirus (HPV) among men who have sex with men (MSM) and transgender women living with and without HIV in Pakistan. Anal infection with HPV is very common worldwide among MSM, particularly among MSM living with HIV. The high prevalence of HIV among MSM and male-to-female transgendered individuals in Pakistan is a significant health concern since access to screening and health-seeking is often delayed in this stigmatised key population.
Design: This cross-sectional study was conducted between March 2016 and November 2017.
Participants, …