Systemic racism leads to racial/ethnic residential segregation, which can result in health inequities. We examined if the associations between residential segregation and later-life cognition and dementia differed based on segregation measure and by participant race/ethnicity. Tests of memory (n = 4616), language (n = 4333), visuospatial abilities (n = 4557), and incident dementia (n = 4556) were analyzed in older residents of Northern Manhattan, New York (mean age: 75.7 years). Segregation was measured at the block group-level using three indices: dissimilarity, isolation, and interaction. We fit multilevel linear or Cox proportional hazards models and included a race/ethnicity × segregation term to test for differential associations, adjusting for socioeconomic and health factors. Living in block groups with higher proportions of minoritized people was associated with −0.05 SD lower language scores. Living in block groups with higher potential contact between racial/ethnic groups was associated with 0.06–0.1 SD higher language scores. The findings were less pronounced for other cognitive domains and for incident dementia. Non-Hispanic Black adults were most likely to experience negative effects of neighborhood segregation on cognition (language and memory) and dementia. All indices partly capture downstream effects of structural racism (i.e., unequal distributions of wealth/resources) on cognition. Therefore, desegregation and equitable access to resources have the potential to improve later-life cognitive health.

Use of the TS-EIA may result in underdetection of primary syphilis compared with the RPR. Further evaluation of the sensitivity of the TS-EIA in high-morbidity settings is warranted before the adoption of reverse sequence screening algorithms.

Timely follow-up and rescreening improved during the study period, subsequent to implementation of electronic medical records and enhanced DIS follow-up. Even in this later period, the combination of lack of timely follow-up and rescreening resulted in 39% of patients without CDC recommended follow-up. Further efforts are needed to improve timely follow-up by patients and rescreening by clinicians.

BackgroundSerosorting, preferentially engaging in unprotected anal intercourse (UAI) with partners of the same HIV status, is practiced by some MSM as a risk reduction strategy.MethodsMay through November 2010, we assessed serosorting practices and beliefs among MSM seeking STI testing at an urban LGBT health center. We compared serosorting practices and beliefs by HIV status and partner characteristics with Pearson χ2tests. Sexual behaviours, partner characteristics, and HIV status were based on self-report.Results705 HIV-negative and 88 HIV-positive MSM completed the assessment. Median time since last HIV test was 7.5 months; nearly a third had not been tested in the last year. Overall, 53% reported no UAI, 27% reported seroconcordant UAI, and 18% reported serodiscordant UAI with last sex partner. UAI was more common with seroconcordant partners than with serodiscordant partners (55% vs 37%, p<0.001); 23% of HIV-positive and 17% of HIV-negative men reported serodiscordant UAI. 81% of men with seroconcordant partners said they knew their partner's status by getting tested together or talking with them; 5% determined partners' status indirectly and 14% did not report how they determined their partner's status. Seroconcordant UAI was more common among HIV-positive than HIV-negative men (53% vs 24%, p<0.001). Among 288 HIV-negative men reporting UAI: seroconcordant UAI was more common with main vs casual partners (76% vs 41%, p<0.001) and within monogamous vs non-monogamous relationships (69% vs 51%, p=0.003); serodiscordant UAI was more common among men with ≥3 recent sex partners vs <3 partners (50% vs 33%, p=0.005) and those who reported any anonymous sex partners vs none (53% vs 28%, p<0.001). Among men who said that they could not be talked out of safer sex with a seroconcordant partner, 10% of HIV-negative men and 16% of HIV-positive men reported serodiscordant UAI. 19% of HIV-negative men who endorsed seroconcordant partnerships reported serodiscordant UAI.ConclusionsDiscrepancies between serosorting endorsement and practice underscore the importance of assessing cognitions related to risk-taking and behaviour. High rates of partner concurrency, infrequent testing, and indirect assessment of partner serostatus may limit the effectiveness of serosorting as a risk reduction strategy, even with main partners. The contribution of serosorting to HIV transmission within primary relationships warrants further research.

Background Two trials of acyclovir (ACV) 400 mg twice daily as daily suppressive therapy against herpes simplex virus type 2 (HSV-2) proved ineffective for prevention of HIV acquisition. Explanations for this lack of efficacy are unclear. In one of these trials, HPTN 039, ACV was modestly effective in reducing genital ulcers due to HSV-2; however, there was less reduction in the frequency of genital ulcers and higher HSV-2 DNA quantity in breakthrough lesions in women from African sites than in men from US sites. Pharmacokinetic differences of ACV have been proposed as one explanatory variable for these findings. Methods Sixty-eight HIV-negative, HSV-2 seropositive women participated in a pharmacokinetic study of ACV after completion of HPTN 039 (a phase III, randomised clinical trial of daily acyclovir 400 mg p.o. twice daily). Following a single oral dose of 400 mg of acyclovir, blood was collected over an 8 h period. An LC/MS/MSbased assay determined ACV concentrations. PK parameters were estimated using non-compartmental methods. Results Sixty-six African women had complete PK data for evaluation. Mean (range) age was 36 (21e54) years and weight was 70 (40e129) kg. The geometric mean (95% CI) for PK parameter estimates were: Cmax 0.31 ug/ml (0.28, 0.34), AUC0-inf 1.59 ug*hr/ml (1.43, 1.76), Tmax 1.56 h (1.40, 1.80), and half-life 2.8 h (2.5, 3.0). This Cmax was lower than 8 comparable single dose ACV PK studies in non-African populations, mean 46% lower (range 28%e 59% lower, all p values <0.006). Similarly, AUC was lower than all other studies, mean 38% lower (range 26%e62%, all p values <0.001). In some studies, Tmax was earlier and the half-life was shorter. Subject weight did not explain the differences. Conclusion Acyclovir exposure in black African women was lower than in comparable ACV studies of non-African populations. These statistically significant differences in drug exposure (Cmax and AUC) may be clinically significant and partly explain the modest effects of ACV on HSV-2 recurrence in these African women. Results The epidemiological impact of PrEP is largely driven by programme characteristicsdcoverage, prioritisation strategy and time to scale updas well as individual's adherence behaviour. If PrEP is prioritised to key groups, it could be a cost-effective way to avert infection and save lives (up to 8% less new infections with 5% coverage). Across all our scenarios the estimated highest cost per DALY gained (US$2755) is below the WHO recommended threshold for costeffective interventions for the region (