Emily Cherenack, PhD

Recent Intravaginal Practices are Associated with Altered Accuracy of Tests for Bacterial Vaginosis, but do not Completely Interfere with Tests for Semen Exposure: Implications for HIV Prevention Research

Emily M. Cherenack, Nicholas F. Nogueira, Yue Pan, Patricia Raccamarich, Gray Kelsey, Margarita Avila, Courtney A. Broedlow, Deborah L. Jones, Nichole R. Klatt, Maria L. Alcaide

- University of Miami Miller School of Medicine, Miami, FL (Cherenack, Nogueira, Pan, Raccamarich, Kelsey, Avila, Jones, Alcaide)
- University of Minnesota, Minneapolis, MN (Broedlow, Klatt)

 

Intravaginal practices (IVPs) include douching and the introduction of products inside the vagina for perceived hygiene purposes. IVPs are common among sexually active women and may contribute to bacterial vaginosis (BV), a condition known to increase HIV acquisition risk. It is unknown if IVPs impact the performance of vaginal assays used in HIV prevention research.

This study enrolled 444 sexually active women of reproductive age without HIV in Miami, Florida, a city with high rates of HIV transmission. Survey and vaginal biospecimen data were collected to assess IVPs in the three days preceding biospecimen collection, examine the association between IVPs and concordance between clinical measures of BV by Amsel Criteria and Nugent Scoring, and investigate the ability to detect semen via prostate specific antigen (PSA) tests among women with recent IVPs.

IVPs in the past three days were reported by 14% (n = 60) of all women, 16% of women with BV (n = 34), and 43% (n = 25) of women with condomless intercourse in the past three days. About half of women (49%, n = 216) were diagnosed with BV per Nugent Scoring (38%, n = 170) and/or Amsel Criteria (45%, n = 198), including 34% (n = 152) positive on both, 10% (n = 46) just Amsel positive, and 4% (n = 18) just Nugent positive. When comparing Amsel Criteria to the gold standard of Nugent Scoring, women with recent IVPs showed lower accuracy (78% vs. 86%), higher sensitivity (95% vs. 88%), and lower specificity (68% vs. 84%) than women without recent IVPs. Half (47%, n = 209) of women never used condoms in the past month; 28% (n = 58) of these participants had intercourse in the past three days, and 8% (n = 17) had detectable PSA. IVPs were reported by 41% (n = 7/17) with detectable PSA.

Women with recent IVPs show decreased accuracy of clinical measures for BV. Although recent IVPs are common among women reporting intercourse, PSA tests can detect semen despite recent IVPs. Results highlight the importance of including IVP assessments in HIV prevention research for women.

A More Positive Attitude Towards One’s Own Aging is Associated with Better Physical Functioning Among Women Living with HIV

Emily M. Cherenack, Theodora F. Brophy, Margarita Avila Max, Alicia Graubard-Silebi, Nicholas F. Nogueira, Daniel Westreich, Elizabeth F. Topper, Deborah Konkle-Parker, Aadia Rana, Seble Kassaye, Anandi N. Sheth, Deborah L. Jones, Maria L. Alcaide

University of Miami Miller School of Medicine, Miami, FL (Cherenack, Brophy, Max, Graubard-Silebi, Nogueira, Jones, Alcaide);
University of North Carolina at Chapel Hill, Chapel Hill, NC (Westreich);
John Hopkins University, Baltimore, MD (Topper);
Georgetown University, Washington, DC (Kassaye);
University of Alabama at Birmingham, Birmingham, AL (Rana);
Emory University School of Medicine, Atlanta, GA (Sheth);
University of Mississippi Medical Center, Jackson, MS (Konkle-Parker);

 

A more positive attitude towards one’s own aging (ATA) is associated with better health in the general population, but little is known about ATA among reproductive-age women living with HIV (WLWH). Investigating the association of ATA with health outcomes, such as physical functioning, and resources that could be provided in HIV clinics, such as health-related social support (HRSS), is an essential step in the development of psychosocial interventions to improve ATA and health among WLWH. This analysis tested the hypotheses that HRSS among WLWH is associated with ATA, and ATA is associated with physical functioning, independently and when controlling for theoretically selected covariates.

Baseline data from 2021-2022 were collected in the ongoing Study of Treatment and Reproductive Outcomes enrolling women 18- to 45-years-old with and without HIV across the southern US. Interviewer-administered surveys included validated measures of age, ATA, HRSS, impact of health on physical functioning, and past-year hospitalization for medical illness. Current pregnancy, HIV, and CD4+ T-cell count were biologically confirmed. ATA was compared across HIV and pregnancy status. Among non-pregnant WLWH, regressions examined the association of HRSS with ATA and of ATA with physical functioning and CD4+ Count independently and controlling for age and hospitalization in both models and HRSS in the model for physical functioning.

We enrolled 279 eligible participants (Mean age=37 years, 86% Black, 5% pregnant, 80% WLWH). ATA did not differ by age, HIV, or pregnancy. In bivariate correlations, ATA, but not age, correlated with HRSS (r=0.46) and physical functioning (r=0.36). After restricting the sample to 201 non-pregnant WLWH, greater HRSS was associated with more positive ATA (Adj R2=0.19, β-unadjusted=0.4, p-unadjusted< 0.001), and ATA was positively associated with physical functioning (Adj R2=0.13, β-unadjusted=0.3, p-unadjusted<0.001). Both associations remained significant at p-adjusted<0.001 after controlling for covariates. ATA was not associated with CD4+ Count.


 

ATA was associated with HRSS and physical functioning among WLWH. Although causality cannot be inferred, this provides preliminary evidence that longitudinal and experimental research is warranted to examine causal associations between HRSS, ATA, and physical functioning, with the long-term goal of developing interventions to improve aging experiences among WLWH.