Papers by Carlos F. Caceres
BMC Health Services Research, Dec 1, 2021
Aids and Behavior, Jan 8, 2018
Aids and Behavior, Nov 30, 2018
BMC Infectious Diseases
BackgroundDespite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increa... more BackgroundDespite efforts to stop HIV epidemic in Latin America, new HIV cases continue to increase in the region especially among young MSM (YMSM). This study aims to assess if sociodemographic characteristics are associated with self-reported HIV positive status among YMSM from three Latin American countries.MethodsCross-sectional web-based survey advertised on dating apps (Grindr and Hornet) and Facebook in Brazil, Mexico and Peru. For this analysis, we included YMSM aged 18–24 years who self-reported their HIV status. We used multivariable logistic regression models for each country separately to verify if sociodemographic characteristics (race, education and income) were associated with HIV self-reported status after adjusting for behavior characteristics (sexual attraction and steady partner).ResultsAmong 43,687 MSM who initiated the questionnaire, 27,318 (62.5%) reported their HIV status; 7001 (25.6%) of whom were YMSM. Most YMSM (83.4%) reported an HIV test in the past year,...
PLOS ONE, 2021
Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazi... more Introduction PrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting awareness of 65% among gay, bisexual and other men who have sex with men (MSM). We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among MSM from these countries. Methods This was a secondary analysis of a web-based survey advertised on social media platforms from March-June 2018 in Brazil, Mexico and Peru. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, who lived in these countries, and provided informed consent. Higher risk of HIV infection was defined as having 10 or more points in the HIV Risk Index for MSM (HIRI-MSM). We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk for HIV and PrEP awareness. Results After exclusions, 19,457 MSM were included in this anal...
JMIR Public Health and Surveillance, 2019
Journal of Translational Medicine, 2019
Background: Current syphilis tests cannot distinguish between active and past syphilis among pati... more Background: Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast rapid plasma reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis. Methods: We collected quarterly serum samples from participants at risk for incident syphilis in a prospective cohort study of men and male-to-female transgender women. We defined incident syphilis as a new RPR titer ≥ 1:8 or a fourfold increase from a prior RPR titer and a positive Treponema pallidum particle agglutination assay. We measured cytokine expression using a 63-multiplex bead-based Luminex assay (eBiosciences/Affymetrix, San Diego, California, USA). We used tertile bins and Chi square tests to identify differences in proportions of cytokines between samples from patients with active and treated syphilis. We constructed a network of cytokine profiles from those findings. We used R software (R version 3.4.1, R, Vienna, Austria) to fit models. Results: We identified 20 pairs of cytokines (out of 1953 possible pairs) that differed between active and treated syphilis. From those, we identified three cytokine networks of interest: an Eotaxin-Rantes-Leptin network, a Mig-IL1ra-Trail-CD40L network, and an IL12p40-IL12p70 network. Conclusions: Differences in cytokine profiles are present among men and male-to-female transgender women with active and treated syphilis. Cytokine assays may be a potentially useful tool for identifying active syphilis among patients with serologic syphilis reactivity.
Journal of Clinical Microbiology, 2016
Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syp... more Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syphilis screening into already existing HIV screening programs, which may be particularly beneficial in settings such as antenatal care. Using the INSTI Multiplex downward-flow immunoassay, we tested 200 stored serum samples from high-risk patients enrolled in a longitudinal study on HIV infection and syphilis in Peruvian men who have sex with men and transgender women. This rapid assay detected HIV andTreponema pallidumserum antibodies with sensitivities of 100% (95% confidence interval [CI], 95.9% to 100%) and 87.4% (95% CI, 81.4% to 92.0%), respectively, and specificities of 95.5% (95% CI, 89.9% to 98.5%) and 97.0% (95% CI, 84.2% to 99.9%), respectively (n= 200). The sensitivity for syphilis antibody detection was higher in patients with a rapid plasma reagin titer of ≥1:8 (97.3%) than in those with a titer of ≤1:4 (90%) or a nonreactive titer (66.7%).
Sexually Transmitted Infections, 2015
stillbirth, fetal loss, neonatal death, low birth weight, preterm birth and syphilis infection in... more stillbirth, fetal loss, neonatal death, low birth weight, preterm birth and syphilis infection in the infant. In Haiti, 90% of pregnant women report at least one antenatal visit. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test in a high-risk setting in Port-au-Prince, Haiti using whole blood fingerprick specimens. Methods GHESKIO (Haitian Study Group for Kaposi's sarcoma and Opportunistic Infections) clinic attendees 18 years of age or older were invited to participate. Venipuncture blood specimens were used for reference testing: for HIV, Murex HIV-1.2.0 (Dia-Sorin S.p. A.) or Determine HIV-1/2 (Alere Inc). Positive results were confirmed with the HIV(1+2) Rapid Test Strip (KHB Shanghai Kehua Bioengineering Co. Ltd). For Treponema pallidum (Tp) antibody comparison, Treponema Pallidum Hemagglutination Assay (TPHA) (Human Gesellschaft fur Biochemica und Diagnostica mbH) was used. For 21 TPHA indeterminate results, specimens were retested using a Tp enzyme-linked immunosorbent assay test (ELISA) (Architect Syphilis Tp, Abbott Laboratories). Sensitivity and specificity were calculated and the exact binomial method was used to determine 95% confidence intervals (CI). Results Of 298 study participants, 61 (20.5%) were male. Of 237 females, 49 (20.7%) were pregnant. For the HIV component, sensitivity and specificity were 99.2% (95% CI: 95.8%, 100%) and 97.0% (95% CI: 93.2%, 99.0%), respectively. All 21 TPHA indeterminate results were Tp ELISA reactive. For the Tp component, sensitivity and specificity were 96.5% (95% CI: 91.2%, 99.0%) and 90.8% (95% CI: 85.7%, 94.6%), respectively. In pregnant women, the HIV component sensitivity and specificity were 93.3% (95% CI: 68.0%, 99.8%) and 94.1% (95% CI: 80.3%, 99.3%), respectively; and for the Tp component were 100% (95% CI: 81.5%, 100%) and 96.8% (83.3%, 99.9%), respectively. Conclusion The HIV antibody component of the Duo test shows excellent performance. The Treponema pallidum antibody component showed high sensitivity, and slightly lower specificity. Amongst pregnant women the test performed very well. Disclosure of interest statement The study was supported in part by Standard Diagnostics.
Global Public Health, 2016
Journal of clinical microbiology, Jan 9, 2015
We assessed the laboratory performance of the Chembio Dual Path Platform® HIV-Syphilis rapid immu... more We assessed the laboratory performance of the Chembio Dual Path Platform® HIV-Syphilis rapid immunodiagnostic test and electronic reader for HIV and Treponema pallidum antibody detection in 450 previously characterized serum specimens. For HIV antibody detection, visual and electronic reader sensitivity was 100% and specificity was 98.7%. For Treponema pallidum antibody detection, test sensitivity was 94.7% and specificity was 100.0% for visual interpretation; the electronic reader's sensitivity was 94.7% and specificity was 99.7%.
Sexually transmitted infections, Jan 15, 2015
Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidi... more Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-of-care tests that can detect multiple infections with a single fingerprick whole blood specimen using a single device are gaining popularity. We evaluated the field performance of a rapid dual HIV and syphilis test in people at high risk of HIV and syphilis infections. Participants included men who have sex with men and transgender women recruited in Lima, Peru. Reference standard testing for detection of HIV and syphilis infections, conducted using blood samples from venipuncture, included Treponema pallidum particle agglutination and fourth-generation HIV enzyme immunoassay for which positive results had a confirmation HIV Western blot test. For the evaluation test, SD BIOLINE HIV/Syphilis Duo test (Standard Diagnostics, Korea), a fingerprick blood specimen was used. Sensitivity and specif...
Sexually Transmitted Diseases, 2016
Culture, health & sexuality, 2013
Sexually Transmitted Infections, 2011
The Journal of Infectious Diseases, 2020
To investigate the role of serum cytokine assays to distinguish between active from treated syphi... more To investigate the role of serum cytokine assays to distinguish between active from treated syphilis among serofast patients, we recruited individuals into a prospective cohort study. Participants underwent routine syphilis screening. We selected specimens from a majority cohort of serofast participants with treated and active syphilis. We analyzed specimens with a 62-cytokine multiplex bead-based enzyme-linked immunosorbent assay. Cytokines, brain-derived neurotrophic factor and tumor necrosis factor β, were most predictive. We built a decision tree that was 82.4% accurate, 100% (95% confidence interval, 82%–100%) sensitive, and 45% (18%–75%) specific. Our decision tree differentiated between serum specimens from serofast participants with treated syphilis versus active syphilis.
Nature Communications, 2021
Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achi... more Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field’s longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
In spite of its immutable susceptibility to penicillin, Treponema pallidum (T. pallidum) subsp. p... more In spite of its immutable susceptibility to penicillin, Treponema pallidum (T. pallidum) subsp. pallidum continues to cause millions of cases of syphilis each year worldwide, resulting in significant morbidity and mortality and underscoring the urgency of developing an effective vaccine to curtail the spread of the infection. Several technical challenges, including absence of an in vitro culture system until very recently, have hampered efforts to catalog the diversity of strains collected worldwide. Here, we provide near-complete genomes from 196 T. pallidum strains – including 191 T. pallidum subsp. pallidum – sequenced directly from patient samples collected from 8 countries and 6 continents. Maximum likelihood phylogeny revealed that samples from most sites were predominantly SS14 clade. However, 99% (84/85) of the samples from Madagascar formed two of the five distinct Nichols subclades. Although recombination was uncommon in the evolution of modern circulating strains, we foun...
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Papers by Carlos F. Caceres
formulate recommendations and strategic directions for sexual
health. Two specific recommendations, derived from the consultation were: (a) to develop a conceptual framework on sexual health that clearly outlines the elements of sexual health and how it overlaps and differs from reproductive health and the role of sexuality; (b) to develop, operationalize and promote sexual health indicators. Method The WHO Department of Reproductive Health and Research established consultative processes, including a review of the existing evidence, conducted interviews with key informants and held expert consultations to address the aforementioned recommendations.
Results Two documents; Towards a conceptual framework for sexual health: understanding and improving sexual health for all and Core Set of Sexual Health Indicators were developed during 2011–2013. The conceptual framework outlines the central role that key sexual health concepts of autonomy, individual choice and protection of human rights play in achieving health and development outcomes. The document proposes new ways of ‘framing’ sexual health in order to reach the widest audience, which in turn can influence and deliver positive approaches for ensuring sexual health for all.
The proposed indicators cover the following areas of sexual
health: adolescent sexual health, family planning, harmful practises, healthy sexuality, sexual dysfunctions and concerns, STI/HIV, and sexual violence. Indicators range from policy, to services (access) to outcome/impact. Most of the proposed indicators have previously been validated, however some new population-based survey indicators have been submitted for validation through special surveys among men who have sex with men and people who inject drugs, to be conducted throughout 2012/2013 in the WHO European region. Preliminary validation results are available.
Conclusion Both documents are concrete steps towards promoting sexual health as a public health concept at international and national levels.