Publication date: May 2017 Source:Biological Conservation, Volume 209 Author(s): J. Castro-Prieto, S. Martinuzzi, V.C. Radeloff, D.P. Helmers, M. Quiñones, W.A. Gould Increasing residential development around protected areas is a major threat for protected areas worldwide, and human population growth is often the most important cause. However, population is decreasing in many regions as a result of socio-economic changes, and it is unclear how residential development around protected areas is affected in these situations. We investigated whether decreasing human population alleviates pressures from residential development around protected areas, using Puerto Rico—an island with declining population—as a case study. We calculated population and housing changes from the 2000 to 2010 census around 124 protected areas, using buffers of different sizes. We found that the number of houses around protected areas continued to increase while population declined both around protected areas and island-wide. A total of 32,300 new houses were constructed within only 1km from protected areas, while population declined by 28,868 within the same area. At the same time, 90% of protected areas showed increases in housing in the surrounding lands, 47% showed population declines, and 40% showed population increases, revealing strong spatial variations. Our results highlight that residential development remains an important component of lands surrounding protected areas in Puerto Rico, but the spatial variations in population and housing changes indicate that management actions in response to housing effects may need to be individually targeted. More broadly, our findings reinforce the awareness that residential development effects on protected areas are most likely widespread and common in many socioeconomic and demographic settings.
Publication date: Available online 28 March 2017 Source:Quaternary International Author(s): Qianzhu Zhang, Zhen Tao, Zanwen Ma, Wenkui Tang, Quanzhou Gao, Peng Xu, Jian Ding, Zufa Liu, Youwen Lin, Dan Su, Wei Zheng The continent–ocean transfer of dissolved silica (DSi, formed as SiO2) via rivers constitutes an important part of the global silica cycle. The uptake of terrestrial vegetation and riverine phytoplankton are the key process controlling DSi migration within the drainage basin. Anthropogenic activities (including land use change and damming) have been altering DSi export by changing biological uptakes in the basin. A significant artificial lake effect of damming was exhibited on the spatial variations of chlorophyll-a (Chl.a) and DSi, which caused 15.39% of riverine DSi to be detained in the reservoir region of Changhuajiang River basin, Hainan Island, China. The biological uptake of terrestrial vegetation was behindhand responsible for seasonal fluctuations of DSi. The DSi uptake yields ranged from 19.44 t/km2/yr to 86.76 t/km2/yr during the different terrestrial vegetation types in the basin, in turn, tropical rainforest > crops > artificial economic forests > grassland. The try calculating of the DSi yield released by the silicates weathering was carried out taking biological processes in the basin into account. Taking into the plants uptake within the basin consideration, the corrected DSi yield from the silicates weathering was 18.6 t/km2/yr. Accordingly, the silicates weathering rate was up to 41.55 t/km2/yr, which was 1.36 times higher than that (30.39 t/km2/yr) without consideration of the biological uptake, and close to the fastest weathering rate of the granite basin (Puerto Rico) in the earth surface. Of the DSi released by the silicates weathering, 28.56% was absorbed by terrestrial vegetation, and 31.43% was consumed by riverine phytoplankton, and the rest was drainaged into the South China Sea.
Publication date: Available online 27 March 2017 Source:Regional Studies in Marine Science Author(s): Carla A. Salgado-Ramírez, Imar Mansilla-Rivera, Carlos J. Rodríguez-Sierra Metal pollution in aquatic systems are a health concern worldwide. This study compared the distribution As, Cd, Cu, Pb, Se, and Zn, in liver, gonad, gill and muscle of S. cavallaand L. synagris from Jobos Bay to levels in S. regalisand L. synagrisfrom La Parguera (reference site). Levels of Hg were only determined in fish muscle. Arsenic, Se, and Hg (only for S. cavalla) were significantly higher in tissues of fish species from Jobos Bay when compared to fish from La Parguera. Liver displayed higher metal concentrations, while muscle tended to accumulate less metals. In all tissues, Zn exhibited the highest concentrations, while Cd and Pb were limited to liver and gill of L. synagris from both sampling areas. Most metal content in different tissues of S. cavalla and L. synagris from the Jobos Bay area fell in the range of metal concentrations that were associated to low aquatic metal pollution, although As and Hg concentrations in fish muscle represent a human health concern based on health criteria values.
Publication date: Available online 22 March 2017 Source:Biochemical and Biophysical Research Communications Author(s): Benjamin D. Kuiper, Kristin Slater, Nicholas Spellmon, Joshua Holcomb, Prasanna Medapureddy, Kendall M. Muzzarelli, Zhe Yang, Reuben Ovadia, Franck Amblard, Iulia A. Kovari, Raymond F. Schinazi, Ladislau C. Kovari Zika virus (ZIKV) is a flavivirus spread by daytime-active Aedes spp. mosquitoes such as A. aegypti and A. albopictus. Previously thought to be a mild infection, the latest ZIKV outbreak in the Americas is causally associated with more severe symptoms as well as severe birth defects, such as microcephaly. Currently no vaccine or antiviral exists. However, recent progress has demonstrated the viral NS2B/NS3 protease may be a suitable target for the development of small-molecule antiviral agents. To better understand the ZIKV protease, we expressed, purified, and characterized unlinked and linked NS2B/NS3 protease corresponding to an isolate from the recent outbreak in Puerto Rico. Unlinked ZIKV protease is more active and binds substrate with greater affinity than linked ZIKV protease. Therefore, we propose that unlinked ZIKV protease be used when evaluating or designing ZIKV protease inhibitors. Additionally, potent inhibitors of related viral proteases, like West Nile Virus and Dengue virus, may serve as advanced starting points to identify and develop ZIKV protease inhibitors.
Publication date: Available online 22 March 2017 Source:Bioorganic & Medicinal Chemistry Letters Author(s): Oleg I. Artyushin, Elena V. Sharova, Natalya M. Vinogradova, Galina K. Genkina, Aleksandra A. Moiseeva, Zinaida.S. Klemenkova, Iana R. Orshanskaya, Anna A. Shtro, Renata A. Kadyrova, Vladimir V. Zarubaev, Olga I. Yarovaya, Nariman F. Salakhutdinov, Valery K. Brel A series of seventeen tetrazole derivatives of 1,7,7-trimethyl-[2.2.1]bicycloheptane were synthesized using click chemistry methodology and characterized by spectral data. Studies of cytotoxitity and in vitro antiviral activity against influenza virus A/Puerto Rico/8/34 (H1N1) in MDCK cells of the compounds obtained were performed. The structure-activity relationship analysis suggests that to possess virus-inhibiting activity, the compounds of this group should bear oxygen atom with short linker (C2-C4), either as a hydroxyl group (18, 19, 29), keto-group (21) or as a part of heterocycle (24). These compounds demonstrated low cytotoxicity along with high anti-viral activity. Graphical abstract
Publication date: 1 June 2017 Source:Ocean & Coastal Management, Volume 141 Author(s): Tarsila Seara, Richard B. Pollnac, John J. Poggie, Carlos Garcia-Quijano, Iris Monnereau, Victor Ruiz
Publication date: Available online 6 March 2017 Source:Mathematical Biosciences Author(s): Tridip Sardar, Bapi Saha In the last few years, fractional order derivatives have been used in epidemiology to capture the memory phenomena. However, these models do not have proper biological justification in most of the cases and lack a derivation from a stochastic process. In this present manuscript, using theory of a stochastic process, we derived a general time dependent single strain vector borne disease model. It is shown that under certain choice of time dependent transmission kernel this model can be converted into the classical integer order system. When the time-dependent transmission follows a power law form, we showed that the model converted into a vector borne disease model with fractional order transmission. We explicitly derived the disease-free and endemic equilibrium of this new fractional order vector borne disease model. Using mathematical properties of nonlinear Volterra type integral equation it is shown that the unique disease-free state is globally asymptotically stable under certain condition. We define a threshold quantity which is epidemiologically known as the basic reproduction number (R 0). It is shown that if R 0 > 1, then the derived fractional order model has a unique endemic equilibrium. We analytically derived the condition for the local stability of the endemic equilibrium. To test the model capability to capture real epidemic, we calibrated our newly proposed model to weekly dengue incidence data of San Juan, Puerto Rico for the time period 30 th April 1994 to 23 rd April 1995. We estimated several parameters, including the order of the fractional derivative of the proposed model using aforesaid data. It is shown that our proposed fractional order model can nicely capture real epidemic.
Publication date: Available online 4 February 2017 Source:Journal of Allergy and Clinical Immunology Author(s): Erick Forno, Joanne Sordillo, John Brehm, Wei Chen, Takis Benos, Qi Yan, Lydiana Avila, Manuel Soto-Quirós, Michelle M. Cloutier, Angel Colón-Semidey, Maria Alvarez, Edna Acosta-Pérez, Scott T. Weiss, Augusto A. Litonjua, Glorisa Canino, Juan C. Celedón Background Childhood asthma is likely the result of gene-by-environment (G × E) interactions. Dust mite is a known risk factor for asthma morbidity. Yet, there have been no genome-wide G × E studies of dust mite allergen on asthma-related phenotypes. Objective We sought to identify genetic variants whose effects on lung function in children with asthma are modified by the level of dust mite allergen exposure. Methods A genome-wide interaction analysis of dust mite allergen level and lung function was performed in a cohort of Puerto Rican children with asthma (Puerto Rico Genetics of Asthma and Lifestyle [PRGOAL]). Replication was attempted in 2 independent cohorts, the Childhood Asthma Management Program (CAMP) and the Genetics of Asthma in Costa Rica Study. Results Single nucleotide polymorphism (SNP) rs117902240 showed a significant interaction effect on FEV1 with dust mite allergen level in PRGOAL (interaction P = 3.1 × 10−8), and replicated in the same direction in CAMP white children and CAMP Hispanic children (combined interaction P = .0065 for replication cohorts and 7.4 × 10−9 for all cohorts). Rs117902240 was positively associated with FEV1 in children exposed to low dust mite allergen levels, but negatively associated with FEV1 in children exposed to high levels. This SNP is on chromosome 8q24, adjacent to a binding site for CCAAT/enhancer-binding protein beta, a transcription factor that forms part of the IL-17 signaling pathway. None of the SNPs identified for FEV1/forced vital capacity replicated in the independent cohorts. Conclusions Dust mite allergen exposure modifies the estimated effect of rs117902240 on FEV1 in children with asthma. Analysis of existing data suggests that this SNP may have transcription factor regulatory functions. Graphical abstract
Publication date: Available online 1 March 2017 Source:Revista Mexicana de Biodiversidad Author(s): Juan Antonio Sánchez-Jiménez, Alfrancis Teresa Arredondo-Chávez, Margarita Yareli López-Arroyo, José Adán Caballero-Vázquez, Omar Domínguez-Domínguez El blenio cornudo (Hypsoblennius exstochilus) pertenece a la familia Blenniidae, fácilmente identificable por el gran tamaño y forma de los cirros oculares, el patrón de coloración de la cabeza y la solapa carnosa que presenta y se extiende desde la comisura de la boca. La especie fue descrita originalmente en las Bahamas y posteriormente fue registrada en Cuba, Islas Vírgenes, Jamaica y Puerto Rico. Sin embargo, no existían registros en la parte continental del Caribe y golfo de México. Mediante fotografía de un ejemplar, se registra por primera vez esta especie en aguas del Caribe continental (México). The longhorn blenny (Hypsoblennius exstochilus) belongs to the family Bleniidae. It is easy to identify by the size and form of the ocular cirri, the color pattern of the head and the fleshy flap that extends from the corner of the mouth. It was originally described in the Bahamas, and later it was recorded in Cuba, Virgin Islands, Jamaica, and Puerto Rico. No previous records from the continental Caribbean and Gulf of Mexico exist. By photographic record of 1 specimen, we provide the first report of Hypsoblennius exstochilus in the Continental Caribbean (Mexico).
Publication date: Available online 15 February 2017 Source:International Soil and Water Conservation Research Author(s): Miguel Oliveras-Berrocales, David Sotomayor-Ramírez, Jorge A. Delgado, Luis R. Pérez-Alegría Nutrient loss from agricultural fields is one of the main factors influencing surface- and ground-water quality. Typical fertilizer nitrogen (N) consumption rates in vegetable production systems and horticultural crops in Puerto Rico fluctuate between 112 and 253kgN/ha. The nitrogen use efficiency of vegetable crops is low, increasing the potential for nitrogen losses and high residual soil nitrate content. Quantification of residual soil N and N losses to the environment can be a difficult task. Simulation models such as the USDA-ARS N Index can be used to identify the relative magnitude of varying N-loss pathways and to identify best management practices. Field studies were conducted to quantify residual soil N and crop N removal, and to validate the Nitrogen Index in onion, tropical pumpkin and tomato production systems in the Lajas Valley in southwestern Puerto Rico. Relationships between observed and simulated values were determined to examine the capability of the model for evaluating N losses. There was good correlation between observed and predicted values for residual soil N (r =0.88) and crop N removal (r =0.99) (p<0.05). In the production systems evaluated, the N volatilization losses ranged from 1 to 4kgN/ha, the denitrification losses ranged from 18 to 46kgN/ha, the leaching losses ranged from 155 to 779kgN/ha, and the residual soil nitrate ranged from 64 to 401kgN/ha. The N use efficiency ranged from 15% to 39%. The results obtained showed that the Nitrogen Index tool can be a useful tool for evaluating N transformations in vegetable production systems of Puerto Rico's semi-arid zone.
Publication date: Available online 13 February 2017 Source:Deep Sea Research Part II: Topical Studies in Oceanography Author(s): Katrin Linse, Enrico Schwabe While biodiversity patterns of Atlantic deep-sea bivalves and gastropods have served as model taxa for setting global latitudinal and bathymetric hypotheses, less is known on abyssal, amphi-Atlantic molluscan assemblage compositions. The Vema-TRANSIT expedition sampled 17 stations in the Vema Fracture Zone (VFZ) and the Puerto Rico Trench (PRT) by epibenthic sledge. These samples comprised a total of 1333 specimens and 64 morphospecies of the classes Caudofoveata (7 species), Solenogastres (7 spp.), Bivalvia (22 spp.), Gastropoda (24 spp.), and Scaphopoda (4 spp.) while Cephalopoda, Monoplacophora and Polyplacophora were absent. The majority of species was rare with 21 uniques (32.8% of all species) and 10 duplicates (15.6% of all species) and of these 15 (48% of rare/ 23.4% of all species) morphospecies were singletons and 8 (25.8% of rare/ 12.5% of all species) morphospecies were doubletons. Overall bivalves (686 specimens) were most abundant, followed by scaphopods (314 spec.), while solenogastres (180 spec.), caudofoveates (86 spec.) and gastropods (67 spec.) were less abundant. The abyssal macro-molluscan species composition did not vary significantly between the eastern and western Atlantic sides of the VFZ while abundances standardized to 1000m2 trawled area were higher on the eastern side. The abyssal PRT stations resembled the VFZ ones in species composition and abundances, in the latter the eastern VFZ. The hadal PRT differed in species composition from the abyssal VFZ and PRT and abundances were similarly low like the western VFZ. The Mid-Atlantic Ridge appeared not to be a barrier for the dispersal of the mostly lecitotrophic or plankotrophic larval stages of the reported molluscan species in this study.
Publication date: Available online 10 February 2017 Source:Preventive Medicine Reports Author(s): Ian Duncan, Ric Curtis, Juan Carlos Reyes, Roberto Abadie, Bilal Khan, Kirk Dombrowski Due to the high cost of treatment, preventative measures to limit Hepatitis C (HCV) transmission among people who inject drugs (PWID) are encouraged by many public health officials. A key one of these is serosorting, where PWID select risk partners based on concordant HCV status. Research on the general U.S. population by Smith et al. (2013) found that knowledge of one's own HCV status facilitated serosorting behaviors among PWID, such that respondents with knowledge of their own status were more likely to ask potential partners about their status prior to sharing risk. Our objective was to see if this held true in rural Puerto Rico. We replicate this study using a sample of PWID in rural Puerto Rico to draw comparisons. We used respondent driven sampling to survey 315 participants, and have a final analytic sample of 154. The survey was heavily modeled after the National HIV Behavioral Survey, which was the dataset used by the previous researchers. We found that among PWID in rural Puerto Rico, unlike in the general population, knowledge of one's own HCV status had no significant effect on the selection of one's most recent injection partner, based on his/her HCV status. We conclude that PWID in rural Puerto Rico differ from the general U.S. population when it comes to serosorting behaviors, and that these differences should be taken into account in future outreaches and intervention strategies.
Publication date: 2017 Source:Rare and Interesting Cases in Pulmonary Medicine Author(s): Ali Ataya, Eloise Harman Hermansky-Pudlak syndrome is a genetic disorder that is prevalent among individuals from Puerto Rico. Abnormal intracellular vesicles transportation results in the different manifestations of the disease, with pulmonary fibrosis contributing significantly to the mortality of these patients. Management is directed at treating the platelet diathesis and preventing the progression of the pulmonary fibrosis.
Publication date: Available online 9 February 2017 Source:Cancer Genetics Author(s): Annette Y. Sunga, Charité Ricker, Carin R. Espenschied, Danielle Castillo, Marilena Melas, Josef Herzog, Sarah Bannon, Marcia Cruz-Correa, Patrick Lynch, Ilana Solomon, Stephen B. Gruber, Jeffrey N. Weitzel Lynch syndrome (LS), the most common hereditary colorectal cancer syndrome, is caused by mismatch repair (MMR) gene mutations. However, data about MMR mutations in Hispanics are limited. This study aims to describe the spectrum of MMR mutations in Hispanics with LS and explore ancestral origins. This case series involved an IRB-approved retrospective chart review of self-identified Hispanic patients (n=397) seen for genetic cancer risk assessment at four collaborating academic institutions in California, Texas, and Puerto Rico who were evaluated by MMR genotyping and/or tumor analysis. A literature review was conducted for all mutation identified. Of those who underwent clinical genetic testing (n=176), 71 had MMR gene mutations. Nine mutations were observed more than once. One third (3/9) of recurrent mutations and two additional mutations (seen only once) were previously reported in Spain, confirming the influence of Spanish ancestry on MMR mutations in Hispanic populations. The recurrent mutations identified (n=9) included both previously reported mutations as well as unique mutations not in the literature. This is the largest report of Hispanic MMR mutations in North America; however, a larger sample and haplotype analyses are needed to better understand recurrent MMR mutations in Hispanic populations.
Publication date: Available online 9 February 2017 Source:Preventive Medicine Author(s): Yan Li, Julia Berenson, Andrew E. Moran, José A. Pagán Excessive sodium intake is linked to an increased risk for hypertension and cardiovascular disease. Although health care providers and other health professionals frequently provide counseling on healthful levels of sodium consumption, many people who consume sodium in excess of recommend levels still do not watch or reduce their sodium intake. In this study, we used a population segmentation approach to identify profiles of adults who are not watching or reducing their sodium intake despite been advised to do so. We analyzed sodium intake data in 125,764 respondents sampled in 15 states, the District of Columbia and Puerto Rico through the Behavioral Risk Factor Surveillance System to identify and segment adults into subgroups according to differences in sodium intake behaviors. We found that about 16% of adults did not watch or reduce their sodium intake despite been told to do so by a health professional. This proportion varied substantially across the 25 different population subgroups identified. For example, about 44% of adults 18 to 44years of age who live in West Virginia were not reducing their sodium intake whereas only about 7.2% of black adults 65years of age and older with diabetes were not reducing their sodium intake. Population segmentation identifies subpopulations most likely to benefit from targeted and intensive public health and clinical interventions. In the case of sodium consumption, population segmentation can guide public health practitioners and policymakers to design programs and interventions that change sodium intake in people who are resistant to behavior change.
Publication date: Available online 7 February 2017 Source:Journal of the Academy of Nutrition and Dietetics Author(s): Cristina Palacios, Sona Rivas-Tumanyan, Eduardo J. Santiago-Rodríguez, Olga Sinigaglia, Elaine M. Ríos, Maribel Campos, Beatriz Diaz, Walter Willett Background There are limited validated food frequency questionnaires (FFQs) for infants and toddlers, most of which were evaluated in Europe or Oceania, and the ones available for use in the United States have important limitations. Objective Our aim was to assess the validity of an FFQ developed for infants and toddlers. Design A semi-quantitative FFQ was developed that included 52 food items, their sources, and portion sizes. The FFQ inquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ, followed by a 24-hour recall on two occasions with 1 week between data collection. Participants/setting A total of 296 caregivers of infants and toddlers aged 0 to 24 months enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children, Puerto Rico. Main outcome measures Intake of nutrients and food groups were averaged for the two FFQs and the two 24-hour food recalls, and adjusted for energy intake. Statistical analyses performed Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24-hour recalls. Results A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs and 24-hour recalls and between the means of FFQs and 24-hour food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-hour recalls ranged from 0.26 (folate) to 0.77 (energy), with a mean correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-hour recalls ranged from 0.28 (sweets) to 0.80 (breast milk), with a mean correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (n=186), results were similar. Conclusions This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods, and food groups in this sample of infants and toddlers.
Publication date: Available online 6 February 2017 Source:EBioMedicine Author(s): Yujiao Yang, Chao Shan, Jing Zou, Antonio E. Muruato, Diniz Nunes Bruno, Barbosa de Almeida Medeiros Daniele, Pedro F.C. Vasconcelos, Shannan L. Rossi, Scott C. Weaver, Xuping Xie, Pei-Yong Shi A purified inactivated vaccine (PIV) using the Zika virus (ZIKV) Puerto Rico strain PRVABC59 showed efficacy in monkeys, and is currently in a phase I clinical trial. High-yield manufacture of this PIV is essential for its development and vaccine access. Here we report an infectious cDNA clone-launched platform to maximize its yield. A single NS1 protein substitution (K265E) was identified to increase ZIKV replication on Vero cells (a cell line approved for vaccine production) for both Cambodian FSS13025 and Puerto Rico PRVABC59 strains. The NS1 mutation did not affect viral RNA synthesis, but significantly increased virion assembly through an increased interaction between NS1 and NS2A (a known regulator of flavivirus assembly). The NS1 mutant virus retained wild-type virulence in the A129 mouse model, but decreased its competence to infect Aedes aegypti mosquitoes. To further increase virus yield, we constructed an infectious cDNA clone of the clinical trial PIV strain PRVABC59 containing three viral replication-enhancing mutations (NS1 K265E, prM H83R, and NS3 S356F). The mutant cDNA clone produced >10-fold more ZIKV than the wild-type parent on Vero cells. This cDNA clone-launched manufacture platform has the advantages of higher virus yield, shortened manufacture time, and minimized chance of contamination.
Publication date: May 2017 Source:International Journal of Drug Policy, Volume 43 Author(s): Melissa Welch-Lazoritz, Patrick Habecker, Kirk Dombrowski, Angelica Rivera Villegas, Carmen Ana Davila, Yadira Rolón Colón, Sandra Miranda De León Background Injection drug use and its associated blood-borne infections has become a rapidly increasing problem in rural areas of the US recently. Syringe exchange programs have been shown to be effective for reducing transmission of blood borne infections, however access to these prevention efforts may be limited in rural areas. Methods This paper utilizes two separate community samples of people who inject drugs (PWID) in Puerto Rico to achieve the following research objectives: (1) compare rural and urban access to syringe exchange programs, free sterile syringes and other HIV/HCV prevention activities, and (2) examine whether utilization of prevention activities is associated with lower injection risk behaviors. Two samples were recruited with RDS (n=315 rural sample; n=512 urban sample) and included adults aged 18 years and older who have injected drugs within the past month. Results 78.5% of the urban sample utilized a syringe exchange program in the past year, compared to 58.4% of the rural sample (p<.001). 71.4% of the urban sample received free sterile needles, compared to 58.4% of the rural sample (p<.001). 66% of the urban sample received free works compared to 59% of the rural sample (p=.034). 29% of urban PWID had a conversation with an outreach worker about HIV prevention compared to 18% of the rural sample (p<0.001). Receiving free needles significantly increases the frequency of using a sterile needle to inject (p<.001). Conclusion Urban PWID were significantly more likely to have utilized syringe exchange programs, received free sterile needles, received free works, and to have talked about HIV prevention with an outreach worker during the past year than PWID residing in rural areas. Individuals who accessed these prevention activities were significantly less likely to exhibit risky injection behavior. Policy implications call for increasing access to prevention services in rural areas to reduce disease transmission.
