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To identify actionable opportunities for improving Partner Notification (PN) for HIV among men who have sex with men (MSM), we characterized the perspectives and experiences of PN among Medical Case Managers (case managers), Disease Intervention Specialists (DIS), and MSM. In partnership with an AIDS service organization and the Connecticut State Health Department, we conducted a focus group of case managers (n = 14) and in-depth interviews with DIS (n = 7) and MSM (n = 24). We found differences between MSM’s and providers’ (case managers and DIS) perspectives regarding (1) determinants of sexual risk behaviors; (2) considerations impacting HIV disclosure; and (3) barriers to trusting relationships between MSM and providers. Factors impacting MSM perspectives on PN were incompletely appreciated by both case managers and DIS. PN may be improved through improving provider understanding of the complexities for MSM regarding sexual risk behaviors and disclosure and transcending barriers to trusting relationships between MSM and providers.

Community-based participatory research (CBPR) is an important approach to inform the development and implementation of HIV/AIDS prevention and treatment strategies. However, there is a paucity of literature describing CBPR from the perspective of community-based organizations (CBOs), specifically AIDS service organizations (ASO). Focusing on the perspective of the executive director (ED) from the partnering ASO, we describe in this paper lessons learned during Project Counseling Others About Contacts and Exposures with HIV ( COACH ), a CBPR, qualitative study intended to examine perspectives and experiences of professionals and clients regarding partner notification (PN) for HIV. Specifically, we describe opportunities and challenges associated with the time investment, balancing a dual role of service provider and researcher, and partnering with the department of public health. This description of the perspective of the ED from the ASO and the associated lessons learned may inform the actions of other CBOs, including ASOs, considering partnering with academic institutions for CBPR.

Objectives: To examine sex partner meeting venues and out-of-state sex partners among men who have sex with men (MSM) with syphilis in Connecticut, a state with moderate syphilis prevalence. Goal: To better understand transmission dynamics in the current syphilis epidemic. Study Design: Review of health department records. Results: A total of 185 MSM were diagnosed with early syphilis in Connecticut from 2000 to 2005 (mean age, 36 years; 56% white, 37% HIV-positive). Fifty-two percent of cases reported meeting sex partners at venues that facilitate multiple and/or anonymous sexual encounters including gay clubs or bars (22%), Internet (18%), and adult bookstores (12%). Meeting sex partners in venues increased over time and was associated with nonmetropolitan residence of the case. Forty-three percent of cases had an out-of-state sex partner during the time in which they likely acquired their infection. Having out-of-state sex partners decreased during the study period. Throughout 2000-2005, having out-of-state sex partners was positively associated with bathhouse use and negatively associated with use of adult bookstores. Conclusions: The observed pattern of increased meeting sex partners in venues located within the state and decreased out-of-state sex partners over time is suggestive of increasing transmission within the state of Connecticut.

Objective: The objective of this study was to describe the epidemiology of early syphilis among men in Connecticut, a moderate-prevalence region, in 2004. Study Design: The authors conducted a cross-sectional analysis of health department data. Results: Fifty-five cases were reported from 25 different towns. A majority of cases (82%) were reported among men who have sex with men, and 22% reported coinfection with HIV. Spatial analysis indicated moderate clustering of cases. Approximately half of 197 reported sex partners were not from Connecticut, including 28% from New York City and 20% from other states/countries. The median distance between partners was 48 km (30 miles). Twenty-three percent of syphilis cases had both local and nonlocal partners. Conclusions: The current epidemiology of early syphilis in Connecticut is consistent with national trends. However, the dispersal of cases throughout the state and the high proportion of reported sex partners residing outside of Connecticut suggest that this state is not a core area of endemic transmission.

Understanding the efficacy and durability of heterologous immunization schedules against SARS-CoV-2 is critical, as supply demands and vaccine choices become significant issues in the global vaccination strategy. Here we characterize the neutralizing antibodies produced in two subjects who received combination immunizations against SARS-CoV-2, first with Covishield (Oxford–AstraZeneca) vaccine, followed 33 days later with a second dose (booster) shot of the Pfizer-BioNTech vaccine. Serum samples were collected 25 days following the primary vaccination and 13 days after the secondary Pfizer vaccination. Both subjects exhibited increased levels of isotype IgG and IgM antibodies directed against the entire spike protein following immunizations. These antibodies also exhibited increased reactivity with the receptor binding domain (RBD) in the spike protein and neutralized the infectivity of replicating vesicular stomatitis virus (VSV) that contains the COVID-19 coronavirus S protein gene in place of its normal G glycoprotein. This VSV pseudovirus also contains the reporter gene for enhanced green fluorescent protein (eGFP). Antibody titers against the spike protein and serum neutralization titers against the reporter virus are reported for the 2 heterologous vaccinated individuals and compared to a positive control derived from a convalescent patient and a negative control from an unexposed individual. The Pfizer-BioNTech vaccine increased antibody binding to the spike protein and RBD, and approached levels found in the convalescent positive control. Neutralizing antibodies against the VSV-S pseudovirus in the 2 subjects also approached levels in the convalescent sera. These results firmly validate the value of the Pfizer-BioNTech vaccine in boosting immunity following initial Covishield inoculation.

We gathered undergraduate enrollment data for various fields of study in natural resources (NR) at National Association of University Forest Resources Programs (NAUFRP)-member institutions dating back to 1980. We found that across all geographic regions, enrollment trends were highly cyclical, changing by nearly 50% in a decade or less. Although current aggregate enrollments are roughly equivalent to 1980 levels, student numbers have shifted from traditional consumptive NR fields such as forestry to more interdisciplinary and ecosystembased programs. Female NR enrollments have steadily increased, reaching 41% in 2012 versus 57% in the undergraduate population as a whole. Forestry, however, had the lowest female enrollment levels in 2012 at just 18%. Minority enrollment has also increased, and as of 2012 comprised about 12% of NR enrollment, up from less than 1% in 1973 but still well below the overall undergraduate level of 40%. Minority representation differs among NR fields of study, with forestry below the average. Minority enrollment in most disciplines is dominated by Hispanics, with notable exceptions being wood science/products (Asians) and recreation (blacks). The dramatic decline in forestry enrollments in both absolute numbers and as a proportion of overall NR enrollments from 1980 to 2012 may be due to a number of factors, including (1) changing public values toward forests and forestry, (2) diversification of NR degree offerings, (3) inflexible, science-based curricula associated with accreditation, certification, and federal Office of Personnel Management standards, (4) perceived lack of jobs and concern about low wages, and (5) little attraction to forestry for women and minorities, two student cohorts that have grown significantly in recent decades. These trends offer both challenges and opportunities for the future of the NR profession and forestry in particular.

Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.

Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support. This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.