A network approach to investigating the inter-relationship between health-related quality of life dimensions and depression in 1735 Chinese patients with heterogeneous cancers

Background

We aimed to explore the inter-connection between depression and HRQOL dimensions in cancer patients using a network approach, which might provide new insights for precise interventions to improve cancer patients' overall HRQOL.

Methods

Between June 1, 2016, and August 31, 2017, a total of 1735 eligible patients with heterogeneous types of cancer were recruited. The Zung Self-Rating Depression Scale (SDS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were used to measure patients' depression status and HRQOL, respectively. A regularized partial correlation network was established. Central and bridge symptoms/functions were identified using expected influence and bridge expected influence. A directed acyclic graph (DAG) was used to explore the possible causal relationship between depression and HRQOL dimensions.

Results

In this study, depression and 15 dimensions of the EORTC-QLQ-C30 scale were highly inter-correlated and could be represented as a network. We found that nearly two-thirds of cancer patients experienced various degrees of depression, and depression was consistently the central symptom in the network, in addition to nausea/vomiting, pain, and physical function. DAG and bridge symptoms indicated that depression might influence overall HRQOL in cancer patients mainly through emotional function, pain, physical function, and sleeplessness, particularly in cancer patients with moderate-to-severe depression. The disparity in network structures between mild and moderate-to-severe depression suggested that the relationship between depression and HRQOL dimensions might be bidirectional.

Conclusion

The prevalence of depression remained high in Chinese patients with cancer, and depression may influence various symptoms and functions within the HRQOL network. Screening and early treatment of depression were warranted to improve the overall HRQOL of cancer patients, in addition to adequate treatment of pain and nausea/vomiting and improvement in physical function.

Study on the correlation between suicidal ideation and ABI3BP gene、DPYSL2 gene methylation in pediatric bipolar disorder with depressive episode

Patients with bipolar disorder have a higher risk of suicide than the general population. This study aimed to explore the correlation between suicide and gene methylation, as screened by genome-wide scanning, in children and adolescents with bipolar disorder. A total of 45 children and adolescents with bipolar disorder were divided into a suicidal ideation group (n = 41), a non-suicidal ideation group (n = 4), a low-risk group (n = 12), and a middle-to-high-risk group (n = 33). A pre-experiment was conducted on the suicidal ideation (n = 6) and non-suicidal ideation groups (n = 4). Blood samples were scanned using an Illumina HD 850K microarray, and methylation levels were analysed. Differential methylation sites among the sample groups were screened from the original data, and genes related to suicide were identified. Methylation of the ABI3BP and DPYSL2 genes was detected by pyrophosphate sequencing and statistically analysed. There was a significant difference in age between the low- and middle-risk groups. The results of GO analysis for the suicidal ideation and non-suicidal ideation groups showed that the differential methylation sites were mainly involved in the interferon-γ-mediated signalling pathway, with the main signalling pathways being the inflammatory bowel disease (IBD) pathway and type 1 diabetes mellitus (T1DM) pathway. There were significant differences in the methylation of ABI3BP, HLA-DQB1, HLA-DRB1, AUTS2, SP3, NINJ2, DPYSL2, and other genes between the suicidal and non-suicidal ideation groups. There was also a statistically significant difference in the gene methylation levels between the two groups. However, there was no significant difference in the degree of methylation of the ABI3BP and DPYSL2 genes between the low- and middle-to-high-risk groups. These results suggest that suicidal ideation is correlated with the methylation levels of differentially methylated genes in children with bipolar disorder. However, the severity of suicide risk in paediatric patients with bipolar disorder may not be correlated with the degree of methylation of the ABI3BP and DPYSL2 genes. Therefore, further validation was required.

Implications for TB control among migrants in large cities in China: A prospective population-based genomic epidemiology study in Shenzhen

Internal migrants are a challenge for TB control in large Chinese cities and understanding this epidemiology is crucial for designing effective control and prevention strategies. We conducted a prospective genomic epidemiological study of culture-positive TB patients diagnosed between June 1, 2018 and May 31, 2021 in the Longhua District of Shenzhen. Treatment status was obtained from local and national TB registries and all isolates were sequenced. Genomic clusters were defined as strains differing by ≤12 SNPs. Risk factors for clustering were identified with multivariable analysis and then Bayesian models and TransPhylo were used to infer the timing of transmission within clusters. Of the 2277 culture-positive patients, 70.1% (1596/2277) were migrants: 72.1% (1043/1446) of the migrants patients developed TB within two years of arriving in Longhua; 38.8% within 6 months of arriving; and 12.3% (104/843) had TB symptoms when they arrived. Only 15.4% of Longhua strains were in genomic clusters. More than one third (33.6%) of patients were not treated in Shenzhen but were involved in nearly one third of the recent transmission events. Clustering was associated with migrants not treated in Shenzhen, males, and teachers/trainers. TB in Longhua is prinicipally due to reactivation of infections in migrants, but a proportion may have had clinical or incipient TB upon arrival in the district. Patients diagnosed but not treated in Longhua were involved in recent local TB transmission. Controlling TB in Shenzhen will require strategies to comprehensively diagnose and treat active TB in the internal migrant population.

Treatment outcomes of multidrug-resistant tuberculosis patients receiving ambulatory treatment in Shenzhen, China: a retrospective cohort study

Background

WHO recommended multidrug-resistant tuberculosis (MDR-TB) should be treated mainly under ambulatory model, but outcome of ambulatory treatment of MDR-TB in China was little known.

Methods

The clinical data of 261 MDR-TB patients treated as outpatients in Shenzhen, China during 2010-2015 were collected and analyzed retrospectively.

Results

Of 261 MDR-TB patients receiving ambulatory treatment, 71.1% (186/261) achieved treatment success (cured or completed treatment), 0.4% (1/261) died during treatment, 11.5% (30/261) had treatment failure or relapse, 8.0% (21/261) were lost to follow-up, and 8.8% (23/261) were transferred out. The culture conversion rate at 6 months was 85.0%. Although 91.6% (239/261) of patients experienced at least one adverse event (AE), only 2% of AEs caused permanent discontinuation of one or more drugs. Multivariate analysis showed that previous TB treatment, regimens containing capreomycin and resistance to FQs were associated with poor outcomes, while experiencing three or more AEs was associated with good outcomes.

Conclusion

Good treatment success rates and early culture conversions were achieved with entirely ambulatory treatment of MDR-TB patients in Shenzhen, supporting WHO recommendations. Advantageous aspects of the local TB control program, including accessible and affordable second-line drugs, patient support, active monitoring and proper management of AEs and well-implemented DOT likely contributed to treatment success rates.

Zero-profile implant versus conventional cage-plate construct in anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis

BACKGROUND

The clinical outcomes of single-level anterior cervical discectomy and fusion (ACDF) with the Zero-profile (Zero-p) were evaluated in comparison with the anterior cervical cage-plate construct (CPC).

METHODS

We performed a systematic search covering PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Medline, China National Knowledge Infrastructure (NCKI), Wan Fang Database, and Wei Pu Database. Articles focused on single-level ACDF or data of the single - level that can be extracted were included, and articles that did not directly compare Zero-p and CPC were excluded. Twenty-seven studies were included with a total of 1866 patients, 931 in the Zero-p group and 935 in the CPC group. All outcomes were analyzed using Review Manager 5.4.

RESULTS

The meta-analysis outcomes indicated that operative time (WMD = - 12.47, 95% CI (- 16.89, - 8.05), P < 0.00001), intraoperative blood loss (WMD = - 13.30, 95% CI (- 18.83, - 7.78), P < 0.00001), risk of adjacent segment degeneration (ASD) (OR 0.31, 95% CI (0.20, 0.48), P < 0.0001), risk of dysphagia of short-term (OR 0.40, 95% CI (0.30, 0.54), P < 0.0001), medium-term (OR 0.31, 95% CI (0.20, 0.49), P < 0.0001), and long-term (OR 0.29, 95% CI (0.17, 0.51), P < 0.0001) of Zero-p group were significantly lower. The JOA score of Zero-p group at the final follow-up was significantly higher (WMD = - 0.17, 95% CI (- 0.32, - 0.03), P = 0.02). There were no significant differences in length of stay (LOS), Neck Disability Index (NDI), Visual Analogue Score (VAS), fusion rate, segmental Cobb angle, cervical Cobb angle, prevertebral soft tissue thickness (PSTT), SF-36, subsidence, implant failure, and hoarseness between the two groups. This study was registered with PROSPERO, CRD42022347146.

CONCLUSION

Zero-p group reduced operative time, intraoperative blood loss, JOA score at follow-up and reduced the incidence of dysphagia and postoperative ASD, but the two devices had the same efficacy in restoring the cervical curvature, preventing the cage subsidence, and in postoperative VAS, NDI, LOS, PSTT, SF-36, fusion rate, implant failure, and hoarseness in single-level ACDF. The use of Zero-p in single-level ACDF was recommended.

Association of in vitro fertilization with maternal and perinatal outcomes among pregnant women with active tuberculosis: A retrospective hospital-based cohort study

Background

Study on effect of fertilization methods on maternal and perinatal outcomes with respect to TB during pregnancy was scarce. This study aimed to analyze maternal and perinatal outcomes in active TB cases after in vitro fertilization (IVF) treatment vs. normal pregnancy.

Methods

Clinical data of 80 pregnant women with active TB hospitalized at Shanghai Public Health Clinical Center between June 1st, 2014 and November 30th, 2020 were extracted and retrospectively analyzed. History of receiving IVF was recorded at admission and its association with maternal and perinatal outcomes were assessed using multivariable logistic regression models with adjustment for potential confounders.

Results

Of the 80 pregnant women with active TB, 28 (35.0%) received IVF treatment and 52 (65.0%) did not receive IVF treatment. After adjusting for potential confounders, receiving IVF was associated with worse maternal and perinatal outcomes, including maternal criticality (21.4 vs. 2.0%, adjusted OR = 28.3, P = 0.015), miliary TB (89.3 vs. 13.5%, adjusted OR = 75.4, P < 0.001), TB meningitis (32.1 vs. 7.7%, adjusted OR = 6.2, P = 0.010), and perinatal mortality (64.3 vs. 28.8%, adjusted OR = 9.8, P = 0.001).

Conclusion

The additional risk of TB to women receiving IVF treatment is a public health challenge specific to countries with a high tuberculosis burden. Increased awareness of latent tuberculosis infection in women receiving IVF treatment is needed.

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

Tuberculosis (TB) is more prevalent in rural than urban areas in China, and delineating TB transmission patterns in rural populations could improve TB control. We conducted a prospective population-based study of culture-positive pulmonary TB patients diagnosed between July 1, 2009 and December 31, 2020 in two rural counties in China. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms, based on whole-genome sequencing. Risk factors for clustering were identified by logistic regression. Transmission links were sought through epidemiological investigation of genomic-clustered patients. Of 1517 and 751 culture-positive pulmonary TB patients in Wusheng and Wuchang counties, respectively, 1289 and 699 strains were sequenced. Overall, 624 (31.4%, 624/1988) patients were grouped into 225 genomic clusters. Epidemiological links were confirmed in 41.8% (196/469) of clustered isolates, including family (32.7%, 64/196) and social contacts (67.3%, 132/196). Social contacts were generally with relatives, within the community or in shared aggregated settings outside the community, but the proportion of clustered contacts in each category differed between the two sites. The time interval between diagnosis of student cases and contacts was significantly shorter than family and social contacts, probably due to enhanced student contact screening. Transmission of multidrug-resistant (MDR) strains was likely responsible for 81.4% (83/102) of MDR-TB cases, with minimal acquisition of additional resistance mutations. A large proportion of TB transmission in rural China occurred among social contacts, suggesting that active screening and aggressive contact tracing could benefit TB control, but contact screening should be tailored to local patterns of social interactions.

Predictors and Trends of MDR/RR-TB in Shenzhen China: A Retrospective 2012-2020 Period Analysis

Purpose

We analyzed the trends and predictors of multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis (TB) in culture-positive cases in Shenzhen during 2012–2020, after the implementation of improved strategies (scale-up molecular drug susceptibility testing [mDST], expansion of DST eligibility, and generous reimbursement of MDR-TB outpatient care costs).

Materials and Methods

We retrospectively extracted and analyzed data from the TB Information System on drug-resistant pulmonary tuberculosis diagnosed in Shenzhen during the 2012–2020 period. We analyzed trends in RR- and MDR-TB rates in new cases during 2012–2018 and 2018–2020 periods, and among previously-treated cases during 2012–2017 and 2017–2020 periods, using Cochran-Armitage tests. We generated multivariate logistic regression models to analyze demographic predictors of MDR/RR-TB rates.

Results

We found 21,367 positive mycobacterial cultures in Shenzhen during the 2012–2020 period, and 19,951 (93.4%) were identified as Mycobacterium tuberculosis and had DST results (92.0% of those were mDST-based). Of these patients with DST results, 1630 (8.2%) were RR-TB, and 1142 (5.7%) were MDR-TB. Of the RR-TB, 70% were MDR-TB. The MDR/RR-TB rate in new TB cases increased significantly during the 2012–2018 period (P_trend < 0.05), but it decreased in the 2018–2020 period (P_trend > 0.05, with a significant trend for MDR-TB). Among previously treated cases, the temporal MDR/RR-TB rate trends did not differ significantly (P_trend > 0.05). Our multivariate analysis showed that age younger than 30 years, housework service/unemployment, local residency, and previous TB treatment were all predictors of MDR/RR-TB. The percentage of patients with MDR-TB on treatment increased from 49.4% in 2012 to 70.5% in 2020. The treatment success rate of patients with MDR-TB during the 2012–2018 period was 71%.

Conclusion

During the study period in Shenzhen, the cases of MDR/RR-TB were detected, and the treatment enrollment increased and the MDR-TB rates decreased gradually after 2017. Decreasing trends may reflect the efficacy of improved strategies; however, their long-term impact on the MDR-TB burden remains to be investigated. The predictors of MDR-TB identified in our study should be considered when developing targeted MDR-TB control strategies.

Prevalence and risk factors of anal human papillomavirus infection among HIV-negative men who have sex with men in Urumqi city of Xinjiang Uyghur Autonomous Region, China

BACKGROUND

Infection with human papillomavirus (HPV) is the most common sexually transmitted infection among men who have sex with men (MSM). Study on prevalence and risk factors of anal HPV infection among HIV-negative MSM in Northwestern China was rare.

METHODS

We performed a cross-sectional study of HPV prevalence using anal swab specimens among HIV-negative MSM in Urumqi city of Xinjiang Uyghur Autonomous Region, China between April 1st and October 30th in 2016. Prevalence of any anal HPV infection, high-risk and low-risk HPV infection was estimated. Risk factors associated with any anal HPV infection was analyzed using univariate and multivariate logistic regression models.

RESULTS

Among 538 potential participants, 500(92.9%) were recruited in this study. The genotyping results of anal HPV infection were available for all. Of them, 259 (51.8%), 190 (38.0%) and 141(28.2%) were positive for at least one of the targeted 37 HPV genotypes, high-risk HPV genotypes, and any low-risk HPV genotypes. The most prevalent anal HPV genotype was HPV 6(11.8%), followed by HPV 16(11.2%), HPV 11(10.8%), HPV 51(7.0%) and HPV 18(5.4%).Among those infected with at least one of the targeted 37 anal HPV genotypes, 75(29.0%), 155(59.8%) and 191(73.7%) were infected with 2-valent, quadrivalent and 9-valent HPV vaccine-covered genotypes. Receptive anal intercourse in the past year was the only predictor of any anal HPV infection in multivariate logistic regression model.

CONCLUSION

Prevalence of any anal HPV infection and high-risk HPV infection among HIV-negative MSM in Urumqi city of Xinjiang is high. The majority of genotypes detected in our study were covered by quadrivalent and 9-valent HPV vaccines. Regular anal exams and early HPV vaccination among MSM may be considered in future HPV prevention programs in Xinjiang, China.

Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: A systematic review and meta-analysis

Collateral circulation affects the prognosis of patients with acute ischemic stroke (AIS) treated by thrombolysis. The present study performed a systematic assessment of the impact of the collateral circulation status on the outcomes of patients receiving thrombolysis treatment. Relevant full-text articles from the Cochrane Library, Ovid, Medline, Embase and PubMed databases published from January 1, 2000 to November 1, 2016 were retrieved. The quality of the studies was assessed and data were extracted by 2 independent investigators. The random-effects model was used to estimate the impact of good vs. poor collateral circulation, as well as baseline characteristics, on the outcome within the series presented as risk ratios. Subgroup analyses explored the potential factors that may interfere with the effects of the collateral circulation status on the outcome. A total of 29 studies comprising 4,053 patients were included in the present meta-analysis. A good collateral circulation status was revealed to have a beneficial effect on favorable functional outcome (modified Rankin scale, 0–3 at 3–6 months; P<0.001) and a higher rate of recanalization (P<0.001) compared with poor collateral circulation. Good collateral circulation was also associated with a lower rate of symptomatic intracranial hemorrhage (P<0.01), a lower rate of mortality (P<0.01) and a smaller infarct size (P<0.01). In conclusion, good collateral circulation was demonstrated to have a favorable prognostic value regarding the outcome for patients with AIS receiving thrombolysis treatment. Assessment of collateral circulation and penumbra area during pre-treatment imaging within an appropriate time-window prior to thrombolytic therapy will therefore improve the identification of AIS patients who may benefit from thrombolysis treatment.

High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China

Background

Tuberculosis and HIV co-epidemics are problems in many parts of the world. Xinjiang is a high tuberculosis and HIV prevalence area in China. We aimed to investigate the prevalence and cure rate of tuberculosis among HIV positive patients in Xinjiang.

Methods

In a retrospective study between 2006 and 2011, clinical and laboratory data on 333 patients with HIV and tuberculosis were compared to 2668 patients with HIV only. There were 31 HIV positive patients with no data on tuberculosis.

Results

The prevalence of tuberculosis co-infection among the HIV positive patients was 11% (95% CI 10–12%), significantly higher than the national figure in China of 2%. In most cases HIV was diagnosed late, with advanced immunodeficiency. The use of isoniazid preventive therapy was only 57.9% in patients without tuberculosis who fulfilled the criteria for receiving this prevention. The cure rate one year after diagnosis was 69.2%, which was lower than the officially reported 91.4% in all tuberculosis cases in Xinjiang in 2011. The hazard of not surviving over the five years was significantly higher in patients with HIV + tuberculosis compared to HIV only after adjusting for sex and Intravenous drug use with HR = 1.84 (95% CI 1.43-2.35; p < 0.0001).

Conclusions

The prevalence of tuberculosis among HIV positive patients in Xinjiang was higher than in China taken as a whole, and HIV was diagnosed late, with underuse of isoniazid preventive therapy. The low cure rate and reduced survival can be due to late diagnosis of HIV and no testing for antibiotic resistance, together with insufficient control of adherence to the treatment regimens for tuberculosis and HIV.

Incidence and Predictors of Angiographic Vasospasm, Symptomatic Vasospasm and Cerebral Infarction in Chinese Patients with Aneurysmal Subarachnoid Hemorrhage

INTRODUCTION

Cerebral vasospasm (CVS) is the most common neurological complication after aneurysmal subarachnoid hemorrhage (aSAH) and associated with poor functional outcome and mortality. Reports on incidence and predictors of CVS in Chinese patients with aSAH were scarce. We aimed to estimate the incidence and predictors of angiographic vasospasm (AV), symptomatic vasospasm (SV), and cerebral infarction in Chinese patients with aSAH.

METHODS

We retrospectively reviewed the medical records of 542 consecutive aSAH patients admitted to neurosurgery department of the First Affiliated Hospital of Xinjiang Medical University in Urumqi city of China between January 1, 2011 and December 31, 2015. AV, SV and cerebral infarction were defined based on clinical data and neuroimaging findings. Univariate and multivariate analyses were performed to identify predictors of AV, SV or cerebral infarction.

RESULTS

343 (63.3%) patients fulfilled the inclusion and exclusion criteria. Of them, 182(53.1%) developed AV, 99 (28.9%) developed SV, and 87 (25.4%) developed cerebral infarction. A history of hypertension, poor modified Fisher grade (3-4) and poor Hunt-Hess grade (4-5) on admission were common risk factors for AV, SV and cerebral infarction. Patients from Uyghur ethnic group or other minorities were less likely to develop AV, SV or cerebral infarction, compared to those from Han ethic group after adjustment of other potential confounders. Additionally, age ≥53 years, leukocyte count ≥11× 109/L on admission and being current or former smokers were independent risk factors of cerebral infarction. Leukocyte count ≥11× 109/L on admission and aneurysm size ≥ 10 mm were independent risk factors of SV. Serum glucose level ≥7.0 mmol/L on admission was an independent risk factor of AV.

CONCLUSION

Risk factors of different definitions of CVS were diverse in Chinese patients with aSAH; however, risk factors of SV and cerebral infarction seem to be similar. We recommend early and aggressive therapy in these patients at-risk of CVS.

Prevalence and predictors of anaemia in patients with HIV infection at the initiation of combined antiretroviral therapy in Xinjiang, China

Summary

We retrospectively analysed routinely collected baseline data of 2252 patients with HIV infection registered in the National Free Antiretroviral Treatment Program in Xinjiang province, China, from 2006 to 2011 to estimate the prevalence and predictors of anaemia at the initiation of combined antiretroviral therapy. Anaemia was diagnosed using the criteria set forth by the World Health Organisation, and univariate and multivariate logistic regression analyses were performed to determine its predictors. The prevalences of mild, moderate, and severe anaemia at the initiation of combined antiretroviral therapy were 19.2%, 17.1%, and 2.6%, respectively. Overall, 38.9% of the patients were anaemic at the initiation of combined antiretroviral therapy. The multivariate logistic regression analysis indicated that Uyghur ethnicity, female gender, lower CD4 count, lower body mass index value, self-reported tuberculosis infection, and oral candidiasis were associated with a higher prevalence of anaemia, whereas higher serum alanine aminotransferase level was associated with a lower prevalence of anaemia. The results suggest that the overall prevalence of anaemia at the initiation of combined antiretroviral therapy in patients with HIV infection is high in Xinjiang, China, but severe anaemia is uncommon. Patients in China should be routinely checked for anaemia prior to combined antiretroviral therapy initiation, and healthcare providers should carefully select the appropriate first-line combined antiretroviral therapy regimens for anaemic patients.

Awareness of and willingness to use oral pre-exposure prophylaxis for HIV prevention among HIV-serodiscordant heterosexual couples: a cross-sectional survey in Xinjiang, China

Objectives

We aimed to investigate the awareness of and willingness to use oral pre-exposure prophylaxis (PrEP) for HIV prevention among HIV-negative partners in HIV-serodiscordant heterosexual couples in Xinjiang, China and determine factors that predict willingness to use oral PrEP.

Methods

Between November 2009 and December 2010, a cross-sectional survey was carried out among 351 HIV-negative partners in HIV-serodiscordant heterosexual couples from three cities in Xinjiang, China. Participants completed a self-administered questionnaire to assess their awareness of and willingness to use oral PrEP. Additionally, blood samples were collected to test for HIV infection. Univariate and multivariate logistic regression analyses were performed to identify predictors of willingness to use oral PrEP.

Results

Only 10 participants (2.8%) reported having heard of PrEP, and only two reported ever using PrEP. However, 297 (84.6%) reported that they were willing to use oral PrEP if it was proven to be both safe and effective. Results of multivariate analysis revealed the following independent predictors of willingness to use oral PrEP: monthly household income (adjusted odds ratio = 2.78, <1000 RMB vs. ≥1000 RMB, 95% confidence interval: 1.36–5.69), perceived likelihood of contracting HIV from HIV-positive partner (adjusted odds ratio = 2.63, likely vs. unlikely, 95% confidence interval: 1.12–6.19), and worrying about being discriminated against by others due to oral PrEP use (adjusted odds ratio  = 9.43, No vs. Yes, 95% confidence interval: 3.78–23.50).

Conclusions

Our results showed HIV-negative partners in HIV-serodiscordant heterosexual couples in China had low awareness of oral PrEP but high willingness to use oral PrEP for HIV prevention. Cost of oral PrEP should be taken into consideration in future PrEP prevention strategy. In addition, efforts should be made to reduce stigma attached to oral PrEP use, which may increase its acceptability among potential users.