Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021
Kallay R , Mbuyi G , Eggers C , Coulibaly S , Kangoye DT , Kubuya J , Soke GN , Mossoko M , Kazambu D , Magazani A , Fonjungo P , Luce R , Aruna A . BMC Public Health 2024 24 (1) 1150 BACKGROUND: The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018-2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. METHODS: The study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. RESULTS: Thirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times. CONCLUSION: Support is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system. |
The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center (preprint)
Mortimer TD , Pathela P , Crawley A , Rakeman JL , Lin Y , Harris SR , Blank S , Schillinger JA , Grad YH . medRxiv 2020 2020.04.30.20086413 Background Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown.Methods We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context.Results The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p<0.001) and race/ethnicity (p<0.001).Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p<0.001) and white heterosexuals compared to black heterosexuals (p<0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups.Conclusions All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [R01 AI132606 and 1 F32 AI145157-01] and the Wellcome Trust [098051].Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesWhole genome sequencing data were deposited in the European Nucleotide Archive (ERA) under study accession PRJEB10016. All additional data and scripts are available at https://github.com/gradlab/GC_NYC. https://www.ebi.ac.uk/ena/data/view/PRJEB10016 https://github.com/gradlab/GC_NYC |
The Cost of Operating Sexual Health Clinics During the Ending the (HIV) Epidemic Initiative in New York City.
Williams AM , Jamison K , Eppink ST , Pathela P , Blank S , Peters D , Gift TL , Berruti AA . Sex Transm Dis 2022 49 (11) 771-777 BACKGROUND: As part of New York State's Ending the Epidemic (EtE) initiative, Sexual Health Clinics (SHCs) in New York City (NYC) invested in clinic enhancements and expanded their HIV-related services to increase access to HIV prevention interventions and treatment. The objective of this study was to estimate and describe the change in SHC operating costs related to clinic enhancements and expanded patient services implemented as part of the EtE initiative. METHODS: A comprehensive micro-costing approach was used to collect retrospective cost information from SHCs, broken down by category and programmatic activity. Cost information was collected from eight clinics across NYC during two 6-month time periods before (2015) and during (2018 - 2019) EtE. RESULTS: Eight SHCs reported comprehensive cost data. Costs increased by $800,000 on average per clinic during the 6-month EtE period. The cost per visit at a SHC increased by $120 on average to $381 (ranging from $302-$464) during the EtE period. Personnel costs accounted for 69.9% of EtE costs and HIV-related medications accounted for 8.9% of costs. Employment of social workers and patient navigators increased costs by approximately $150,000 on average per clinic. Post-exposure prophylaxis was the costliest medication with average expenditures of $103,800 per clinic. CONCLUSIONS: This study demonstrates the key drivers of cost increases when offering enhanced HIV services in SHCs. Documenting the changes in resources necessary to implement these services and their costs can inform other health departments on the viability of offering enhanced HIV services within their own clinics. |
Notes from the Field: Recurrence of a Multistate Outbreak of Salmonella Typhimurium Infections Linked to Contact with Hedgehogs - United States and Canada, 2020.
Waltenburg MA , Nichols M , Waechter H , Higa J , Cronquist L , Lowe AM , Adams JK , McFadden K , McConnell JA , Blank R , Basler C . MMWR Morb Mortal Wkly Rep 2021 70 (32) 1100-1102 In July 2020, PulseNet, the national molecular subtyping network for enteric disease surveillance, detected a cluster of 17 Salmonella Typhimurium infections. The isolates were closely related genetically to each other (four allele differences) by whole genome sequencing (WGS) analysis and related to isolates from two previous outbreaks of S. Typhimurium infections linked to pet hedgehogs (1,2). An investigation was initiated to characterize illnesses and identify the outbreak source. | | A case was defined as the isolation of S. Typhimurium closely related by WGS to the outbreak strain in a specimen from a patient with illness onset during April–November 2020. State and local officials interviewed patients about hedgehog exposures and purchase information. Animal and environmental sampling of hedgehog enclosures was conducted at some patient residences. Hedgehog purchase locations were contacted in an attempt to identify a possible common source or supplier of hedgehogs. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.* |
Considerations for quality assurance of multiplex malaria antigen detection assays with large sample sets
Alvarado R , van den Hoogen LL , Iriemenam NC , Akinmulero OO , Thomas AN , Tamunonengiyeofori I , Erasogie E , Chimaoge AC , Dawurung AB , Esiekpe MK , Okoli MU , Mba N , Ogunniyi A , Abimiku A , Maire M , Bassey OO , Okoye M , Swaminathan M , Greby SM , Ndodo N , Ihekweazu C , Abubakar A , Steinhardt L , Rogier E . Sci Rep 2021 11 (1) 13248 Multiplex assays for malaria antigen detection can gather data from large sample sets, but considerations for the consistency and quality assurance (QA) of mass testing lack evaluation. We present a QA framework for a study occurring November 2019 to March 2020 involving 504 assay plates detecting four Plasmodium antigens: pan-Plasmodium aldolase and lactate dehydrogenase (LDH), histidine-rich protein 2 (HRP2), P. vivax LDH (PvLDH). Controls on each plate included buffer blank, antigen negative blood, and 4-point positive dilution curve. The blank and negative blood provided consistently low signal for all targets except for pAldolase, which showed variability. Positive curve signals decreased throughout the 5-month study duration but retained a coefficient of variation (CV) of < 5%, with the exception of HRP2 in month 5 (CV of 11%). Regression fittings for inter-plate control signals provided mean and standard deviations (SDs), and of 504 assay plates, 6 (1.2%) violated the acceptable deviation limits and were repeated. For the 40,272 human blood samples assayed in this study, of 161,088 potential data points (each sample × 4 antigens), 160,641 (99.7%) successfully passed quality checks. The QA framework presented here can be utilized to ensure quality of laboratory antigen detection for large sample sets. |
The distribution and spread of susceptible and resistant Neisseria gonorrhoeae across demographic groups in a major metropolitan center.
Mortimer TD , Pathela P , Crawley A , Rakeman JL , Lin Y , Harris SR , Blank S , Schillinger JA , Grad YH . Clin Infect Dis 2020 73 (9) e3146-e3155 BACKGROUND: Genomic epidemiology studies of gonorrhea in the United States have primarily focused on national surveillance for antibiotic resistance, and patterns of local transmission between demographic groups of resistant and susceptible strains are unknown. METHODS: We analyzed a convenience sample of genome sequences, antibiotic susceptibility, and patient data from 897 gonococcal isolates cultured at the NYC Public Health Laboratory from NYC Department of Health and Mental Hygiene (DOHMH) Sexual Health Clinic (SHC) patients, primarily in 2012-13. We reconstructed the gonococcal phylogeny, defined transmission clusters using a 10 non-recombinant single nucleotide polymorphism threshold, tested for clustering of demographic groups, and placed NYC isolates in a global phylogenetic context. RESULTS: The NYC gonococcal phylogeny reflected global diversity with isolates from 22/23 of the prevalent global lineages (96%). Isolates clustered on the phylogeny by patient sexual behavior (p&0.001) and race/ethnicity (p&0.001). Minimum inhibitory concentrations were higher across antibiotics in isolates from men who have sex with men compared to heterosexuals (p&0.001) and white heterosexuals compared to black heterosexuals (p&0.01). In our dataset, all large transmission clusters (≥10 samples) of N. gonorrhoeae were susceptible to ciprofloxacin, ceftriaxone, and azithromycin and comprised isolates from patients across demographic groups. CONCLUSIONS: All large transmission clusters were susceptible to gonorrhea therapies, suggesting that resistance to empiric therapy was not a main driver of spread, even as risk for resistance varied across demographic groups. Further study of local transmission networks is needed to identify drivers of transmission. |
The HIV pre-exposure prophylaxis (PrEP) cascade at NYC sexual health clinics: navigation is the key to uptake
Pathela P , Jamison K , Blank S , Daskalakis D , Hedberg T , Borges C . J Acquir Immune Defic Syndr 2020 83 (4) 357-364 BACKGROUND: Clinics providing sexual health care pose unique opportunities to implement HIV pre-exposure prophylaxis (PrEP) programs. The PrEP program at New York City's Sexual Health Clinics provides intensive on-site navigation for linkage to PrEP care. We assessed uptake of this intervention. METHODS: We categorized men-who-have-sex-with-men (MSM) without HIV hierarchically as having had: 1) HIV post-exposure (PEP) use (past-year); or 2) selected sexually transmitted infections (STI) (past-year); or 3) HIV-diagnosed sex/needle-sharing partners (past 6 months); or 4) expressed interest in PrEP (day of clinic visit). We constructed PrEP cascades and used multivariable regression to examine acceptance of PrEP navigation, referral to a PrEP provider, linkage (<60 days), and PrEP prescription. RESULTS: 1,301 of 2,106 PrEP (62%) patients accepted navigation. Of those, 55% (718/1,301) were black or Hispanic MSM. STI and PEP patients had lowest navigation acceptance levels (35-46%). Of navigated patients, 56% (628/1,114) accepted referrals, 46% (288/628) linked to PrEP providers, and 82% (235/288) were prescribed PrEP; overall, 11% of those offered navigation (235/2,106) received prescriptions. Navigated MSM with PEP history (adjusted prevalence ratio (aPR) 1.34, 95% CI 1.16-1.56), prior STI (aPR 1.28, 95% CI 1.12-1.45), or HIV-diagnosed partners (aPR 1.18, 95% CI 1.01-1.37) were more likely than those with PrEP interest to accept referrals. Probability of linkage varied by insurance status; prescription did not vary by patient factors. CONCLUSIONS: Although MSM in key priority groups (e.g., prior STI) showed low navigation uptake, those who accepted navigation were likely to be referred for PrEP, suggesting a need for expanded up-front engagement. |
Universal human papillomavirus typing by whole genome sequencing following target enrichment: evaluation of assay reproducibility and limit of detection.
Li T , Unger ER , Rajeevan MS . BMC Genomics 2019 20 (1) 231 BACKGROUND: We recently described a method for unbiased detection of all known human papillomaviruses (HPV) types with the potential for the determination of their variant and integration from the resulting whole genome sequence data. Considering the complex workflow for target-enriched next generation sequencing (NGS), we focused on the reproducibility and limit of detection (LOD) of this new universal HPV typing assay in this study. RESULTS: We evaluated the reproducibility and LOD for HPV genotyping based on our recently published method that used RNA-baits targeting whole genomes of 191 HPV types, Agilent SureSelect protocol for target enrichment and Illumina HiSeq 2500 for sequencing (eWGS, enriched whole genome sequencing). Two libraries, prepared from pooled plasmids representing 9 vaccine HPV types at varying input (1-625 copies/reaction), were sequenced twice giving four replicates for evaluating reproducibility and LOD. eWGS showed high correlation in the number of reads mapped to HPV reference genomes between the two flow-cell lanes within (R(2) = 1) and between experiments (R(2) = 0.99). The number of mapped reads was positively correlated to copy number (beta = 13.9, p < 0.0001). The limit of blank (LOB) could be calculated based on mapped reads to HPV types not included in each sample. HPV genotyping was reproducible for all 9 types at 625 copies using multiple cut-off criteria but LOD was 25 copies based on number of reads above LOB even when multiple types were present. eWGS showed no bias for HPV genotyping under single or multiple infection (p = 0.16-0.99). CONCLUSIONS: The universal eWGS method for HPV genotyping has sensitivity, competitive with widely used consensus PCR methods with reduced type competition, and with the potential for determination of variant and integration status. The protocol used in this study, using defined samples varying in complexity and copy number, analyzed in replicate and duplicate assays, is applicable to most WGS methods. |
Neisseria gonorrhoeae - rising infection rates, dwindling treatment options
Blank S , Daskalakis DC . N Engl J Med 2018 379 (19) 1795-1797 Gonorrhea infection is the second most commonly reported notifiable condition in the United States, and case rates have been increasing since 2009. In 2017, a total of 555,608 cases of gonorrhea were reported nationally, the largest number since 1991 and an 18.6% increase over 2016 (see graph).1 |
Collaborative method performance study of the measurement of nicotine, its metabolites, and total nicotine equivalents in human urine
Wang L , Bernert JT , Benowitz NL , Feng J , Jacob P , McGahee E , Caudill SP , Scherer G , Scherer M , Pluym N , Doig MV , Newland K , Murphy SE , Caron NJ , Sander LC , Shimizu M , Yamazaki H , Kim S , Langman LJ , Pritchett JS , Sniegoski LT , Li Y , Blount B , Pirkle JL . Cancer Epidemiol Biomarkers Prev 2018 27 (9) 1083-1090 BACKGROUND: Biomarkers of tobacco exposure have a central role in studies of tobacco use and nicotine intake. The most significant exposure markers are nicotine itself and its metabolites in urine. Therefore, it is important to evaluate the performance of laboratories conducting these biomarker measurements. METHODS: This report presents the results from a method performance study involving 11 laboratories from 6 countries which are currently active in this area. Each laboratory assayed blind replicates of 7 human urine pools at various concentrations on 3 separate days. The samples included 5 pools blended from smoker and nonsmoker urine sources, and 2 additional blank urine samples fortified with pure nicotine, cotinine and hydroxycotinine standards. All laboratories used their own methods, and all were based on some form of liquid chromatography / tandem mass spectrometry. RESULTS: Overall, good agreement was found among the laboratories in this study. Intralaboratory precision was good, and in the fortified pools the mean bias observed was < + 3.5% for nicotine, approximately 1.2% for hydroxycotinine, and less than 1% for cotinine (1 outlier excluded in each case). Both indirect and direct methods for analyzing the glucuronides gave comparable results. CONCLUSIONS: This evaluation indicates that the experienced laboratories participating in this study can produce reliable and comparable human urinary nicotine metabolic profiles in samples from people with significant recent exposure to nicotine. IMPACT: This work supports the reliability and agreement of an international group of established laboratories measuring nicotine and its metabolites in urine in support of nicotine exposure studies. |
Optimizing the impact of alcohol and drug screening and early intervention in a high-risk population receiving services in New York City sexual health clinics: A process and outcome evaluation of Project Renew
Harris BR , Yu J , Wolff M , Rogers M , Blank S . Prev Med 2018 112 160-167 Unhealthy substance use is associated with increased rates of STDs, including HIV. Within three high-risk New York City (NYC) sexual health clinics between 2008 and 2012 (n=146,657), 17% of patients screened positive for a current SUD but only 5.3% ever received prior treatment. The goal of Project Renew was to expand the reach of substance use early intervention services within and across sexual health clinics citywide and decrease substance use, poor mental health, and risky sexual behavior. To accomplish this goal, Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based substance use early intervention model, was implemented in all eight NYC sexual health clinics February 2012-January 2015. Clinic patients were screened for substance misuse using the AUDIT/DAST-10, and those who screened positive were eligible for on-site brief intervention. Overall, 130,597 substance misuse screenings were conducted (66,989, or 51%, positive), and 17,474 on-site brief interventions and 1238 referrals were provided (not unique to individual patients). A 10% sample of 14,709 unique patients who screened positive were interviewed using a federal data collection tool at baseline and six months later to assess changes in substance use, sexual risk behaviors, mental health, and health status (n=1328). At six-month follow-up, patients reported reduced substance use, less sexual activity, improved overall health, and fewer days of depression and anxiety compared to measures at baseline (p<0.05). Based on positive results, Project Renew SBIRT services have been sustained, ensuring essential care which may help prevent acquisition of HIV/STDs among a large population of high-risk New Yorkers. |
Codability of industry and occupation information from cancer registry records: Differences by patient demographics, casefinding source, payor, and cancer type
Silver SR , Tsai RJ , Morris CR , Boiano JM , Ju J , Scocozza MS , Calvert GM . Am J Ind Med 2018 61 (6) 524-532 INTRODUCTION: Industry and occupation (I&O) information collected by cancer registries is useful for assessing associations among jobs and malignancies. However, systematic differences in I&O availability can bias findings. METHODS: Codability by patient demographics, payor, identifying (casefinding) source, and cancer site was assessed using I&O text from first primaries diagnosed 2011-2012 and reported to California Cancer Registry. I&O were coded to a U.S. Census code or classified as blank/inadequate/unknown, retired, or not working for pay. RESULTS: Industry was codable for 37% of cases; 50% had "unknown" and 9% "retired" instead of usual industry. Cases initially reported by hospitals, covered by preferred providers, or with known occupational etiology had highest codable industry; cases from private pathology laboratories, with Medicaid, or diagnosed in outpatient settings had least. Occupation results were similar. CONCLUSIONS: Recording usual I&O for retirees and improving linkages for reporting entities without patient access would improve I&O codability and research validity. |
The epidemiology of syphilis in New York City; historic trends and the current outbreak among men who have sex with men, 2016
Schillinger JA , Slutsker JS , Pathela P , Klingler E , Hennessy RR , Toro B , Blank S . Sex Transm Dis 2018 45 S48-S54 BACKGROUND: Male primary and secondary (P&S) and early latent (EL) syphilis cases have increased markedly in New York City (NYC) after a historic nadir in 1998. The majority of cases are among men-who-have-sex-with-men (MSM). We describe the epidemiology of syphilis among NYC males to provide a model of how one jurisdiction collects, analyzes, interprets, uses, and disseminates local data to guide programmatic activities directed at syphilis control. METHODS: We analyzed trends in reported infectious syphilis cases using routinely collected surveillance and case investigation data. HIV co-infection status was ascertained by routine deterministic match between sexually transmitted infection and HIV surveillance registries, and self-report. We mapped diagnosing facilities to display the relative contribution of different public/private facilities. Characteristics of male syphilis cases diagnosed in public sexual health (SH) clinics were compared to those diagnosed elsewhere. RESULTS: During 2012-2016, male P&S syphilis case rates increased 81%, from 24.8 to 44.8/100,000 (1832 cases); the highest rates were among black non-Hispanic men. Overall, 87.6% (902/1030) of interviewed men in 2016 disclosed >1 male partner. HIV co-infection rates are high among MSM with P&S syphilis (43.4%; 394/907 in 2016), but appear to be decreasing (from 54.1% in 2012). Maps highlighted SH clinics' contribution to diagnosing P&S syphilis cases among men of color. HIV co-infection rates were lower among men with P&S syphilis diagnosed in SH clinics than among those diagnosed elsewhere (34%, SH clinics versus 49%, other settings, p<0.0001). CONCLUSIONS: Syphilis infections continue to increase among MSM in NYC. Novel interventions responsive to the drivers of the current outbreak are needed. |
Interlaboratory validation of an improved method for detection of Cyclospora cayetanensis in produce using a real-time PCR assay.
Murphy HR , Cinar HN , Gopinath G , Noe KE , Chatman LD , Miranda NE , Wetherington JH , Neal-McKinney J , Pires GS , Sachs E , Stanya KJ , Johnson CL , Nascimento FS , Santin M , Molokin A , Samadpour M , Janagama H , Kahler A , Miller C , da Silva AJ . Food Microbiol 2018 69 170-178 A collaborative validation study was performed to evaluate the performance of a new U.S. Food and Drug Administration method developed for detection of the protozoan parasite, Cyclospora cayetanensis, on cilantro and raspberries. The method includes a sample preparation step in which oocysts are recovered from produce using an enhanced produce washing solution containing 0.1% Alconox and a commercially available method to disrupt the C. cayetanensis oocysts and extract DNA. A real-time PCR assay targeting the C. cayetanensis 18S rDNA gene with an internal amplification control to monitor PCR inhibition provides species-specific identification. Five laboratories blindly analyzed a total of 319 samples consisting of 25 g of cilantro or 50 g of raspberries which were either uninoculated or artificially contaminated with C. cayetanensis oocysts. Detection rates for cilantro inoculated with 200, 10, and 5 oocysts, were 100%, 80%, and 31%, respectively. For raspberries, the detection rates for samples inoculated with 200, 10, and 5 oocysts were 100%, 90% and 50%, respectively. All uninoculated samples, DNA blank extracts, and no-template PCR controls were negative. Reproducibility between laboratories and analysts was high and the method was shown to be an effective analytical tool for detection of C. cayetanensis in produce. |
Ultraperformance liquid chromatography tandem mass spectrometry method to determine formaldehyde hemoglobin adducts in humans as biomarker for formaldehyde exposure
Yang M , Ospina M , Tse C , Toth S , Caudill SP , Vesper HW . Chem Res Toxicol 2017 30 (8) 1592-1598 Formaldehyde (FA) is an environmental chemical classified as a human carcinogen. It is highly reactive and can bind covalently with hemoglobin (Hb) to produce Hb adducts. Measurement of these Hb adducts provides valuable information about exposure to this chemical. We developed a robust, ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for quantifying FA-Hb adducts in red blood cells. The method measures the FA-VHLTPEEK peptide after trypic digestion. The peptide is a FA adduct at the N-terminus of the beta chain of human Hb. Method mean (+/-SD) accuracy, determined by recovery in quality control and blank material was 103.2% +/- 8.11. The mean among-day and within-day coefficients of variation determined at three concentration levels (%CV) were 9.2% (range: 7.2-10.2%) and 4.9% (range 3.1-7.3%), respectively. The limit of detection was 3.4 nmol/g Hb. This method was applied to the analysis of 135 human blood samples, and FA-VHLTPEEK was detected in all study samples. FA-VHLTPEEK concentrations were not significantly different between smokers and nonsmokers. This work is the first validated UPLC-MS/MS method in which a FA peptide derived from a FA-Hb adduct could be used to monitor exposure to FA in population studies. |
Critical gaps in laboratory leadership to meet global health security goals
Albetkova A , Isadore J , Ridderhof J , Ned-Sykes R , Maryogo-Robinson L , Blank E , Cognat S , Dolmazon V , Gasquet P , Rayfield M , Peruski L . Bull World Health Organ 2017 95 (8) 547-547a Public health laboratories play a critical role in the detection, prevention and control of diseases. However, reliable laboratory testing continues to be limited in many low- and middle-income countries.1 The 2013–2016 Ebola virus disease outbreak in West Africa provided many examples of how functioning laboratories were needed for disease control and prevention efforts.2 This outbreak highlighted the need for laboratory directors to be able to influence national laboratory policy and to implement national laboratory strategic plans.3,4 Global health initiatives such as The United States President’s Emergency Plan for AIDS Relief (2003),5 the International Health Regulations (IHR; 2005),6 the Global Health Security Agenda (GHSA; 2014)5 and the health-related United Nations sustainable development goal (SDG 3) of the 2030 Agenda for sustainable development (2015),7 all emphasize the need for laboratory systems capable of providing affordable, sustainable and quality laboratory testing. However, despite progress made, only 22% (42/193) of countries reported meeting the IHR core capacities’ requirements for surveillance and response by the June 2012 target date and 34% (65/193) by the November 2015 target date.5,6 The GHSA was launched in 2014 to accelerate progress towards global health preparedness and to support capacity-building efforts. The GHSA objectives and IHR’s core capacities overlap in several areas, including laboratory systems and workforce development.5 | The GHSA Workforce Development Action Package8 outlines the need for rigorous and sustainable training programmes for public health professionals and emphasizes the need for practical, hands-on experience to support public health systems. Ideally, such programmes would help the public health laboratory workforce in gaining the skills and expertise to navigate an often-chaotic environment.9 |
Assessment of a novel bile solubility test and MALDI-TOF for the differentiation of Streptococcus pneumoniae from other mitis group streptococci
Slotved HC , Facklam RR , Fuursted K . Sci Rep 2017 7 (1) 7167 This study assesses a novel bile solubility test and MALDI-TOF for the differentiation of Streptococcus pneumoniae from other mitis group streptococci, including differentiation of S. pneumoniae from Streptococcus pseudopneumoniae. Eighty-four species verified mitis group isolates were subjected to our bile solubility test (which measures and calculates the differences of absorbance in the test tube containing 10% sodium deoxycholate versus a blank control tube, after incubation for 10 minutes at 36 degrees C using a spectrophotometer) and MALDI-TOF MS (both the standard result output and by visual spectra evaluation). Applying a calculated optimal cut-off absorbance-value of 2.1, differentiated S. pneumoniae from all but one other mitis group streptococci (one S. mitis isolate generated an OD-value above 2.1). MALDI-TOF score value identification identified correctly 46 S. pneumoniae and 4 S. pseudopneumoniae but misidentified 16 other mitis group strains. Visual spectra evaluation correctly identified all S. pneumoniae and S. pseudopneumoniae strains but misidentified 13 other mitis group strains. The bile solubility test based on spectrophotometric reading described in this study can differentiate S. pneumoniae from other Streptococcus species. Combining the bile solubility test and the MALDI-TOF spectra results provide a correct identification of all S. pneumoniae and S. pseudopneumoniae isolates. |
Sociodemographic characteristics and health outcomes among lesbian, gay, and bisexual U.S. adults using Healthy People 2020 leading health indicators
Lunn MR , Cui W , Zack MM , Thompson WW , Blank MB , Yehia BR . LGBT Health 2017 4 (4) 283-294 PURPOSE: This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs). METHODS: Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate. RESULTS: In 2013-2015, sexual minority adults represented 2.4% of the U.S. POPULATION: Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion. CONCLUSION: Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors. |
AOAC SMPR 2016.009: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Brucella suis in field-deployable, Department of Defense aerosol collection devices
Roberto F , Arce J , Beck LC , Blank TR , Cahall R , Damer K , Ficht T , Foster J , Kiss K , Nikolich M , Olsen S , Ozanich R , Rozak D , Schaefer F , Sozhamannan S , Tiller R , Coates SG . J AOAC Int 2017 100 (1) 255-260 Intended Use: Field-deployed use for analysis of | aerosol collection filters and/or liquids | 1 Applicability | Detection of Brucella suis in collection buffers from aerosol | collection devices. Field-deployable assays are preferred. | 2 Analytical Technique | Molecular detection of nucleic acid. | 3 Definitions | Acceptable minimum detection level (AMDL).— | Predetermined minimum level of an analyte, as specified by | an expert committee which must be detected by the candidate | method at a specified probability of detection (POD). | Exclusivity.—Study involving pure nontarget strains, which | are potentially cross-reactive, that shall not be detected or | enumerated by the candidate method. | Inclusivity.—Study involving pure target strains that shall be | detected or enumerated by the candidate method. | Maximum time-to-result.—Maximum time to complete an | analysis starting from the collection buffer to assay result. | Probability of detection (POD).—Proportion of positive | analytical outcomes for a qualitative method for a given matrix | at a specified analyte level or concentration with a ≥0.95 | confidence interval. | System false-negative rate.—Proportion of test results that | are negative contained within a population of known positives. | System false-positive rate.—Proportion of test results that are | positive contained within a population of known negatives. | 4 Method Performance Requirements | See Table 1. | 5 System Suitability Tests and/or Analytical Quality control | The controls listed in Table 2 shall be embedded in assays as | appropriate. Manufacturer must provide written justification if | controls are not embedded in the assay |
AOAC SMPR 2016.010: Standard Method Performance Requirements (SMPRs) for DNA-based methods of detecting Burkholderia pseudomallei in field-deployable, Department of Defense aerosol collection devices
Gee J , Arce J , Beck LC , Blank TR , Blyn L , Cahall R , Clark AJ , Currie B , Damer K , Davenport M , DeShazer D , Johns M , Keim PS , Kiss K , Lesho M , Lin N , Morse SA , Naraghi-Arani P , Ozanich R , Roberto F , Rozak D , Sahl J , Schaefer F , Schutzer S , Schweizer HP , Sozhamannan S , Tuanyok A , Coates S . J AOAC Int 2017 100 (1) 261-265 Intended Use: Field-deployed use for analysis of | aerosol collection filters and/or liquids | 1 Applicability | Detection of Burkholderia pseudomallei in collection buffers | from aerosol collection devices. Field-deployable assays are | preferred. | 2 Analytical Technique | Molecular detection of nucleic acid. | 3 Definitions | Acceptable minimum detection level (AMDL).— | Predetermined minimum level of an analyte, as specified by | an expert committee which must be detected by the candidate | method at a specified probability of detection (POD). | Exclusivity.—Study involving pure nontarget strains, which | are potentially cross-reactive, that shall not be detected or | enumerated by the candidate method. | Inclusivity.—Study involving pure target strains that shall be | detected or enumerated by the candidate method. | Maximum time-to-result.—Maximum time to complete an | analysis starting from the collection buffer to assay result. | Probability of detection (POD).—Proportion of positive | analytical outcomes for a qualitative method for a given matrix | at a specified analyte level or concentration with a ≥0.95 | confidence interval. | System false-negative rate.—Proportion of test results that | are negative contained within a population of known positives. | System false-positive rate.—Proportion of test results that are | positive contained within a population of known negatives. | 4 Method Performance Requirements | See Table 1. | 5 System Suitability Tests and/or Analytical Quality Control | The controls listed in Table 2 shall be embedded in assays as | appropriate. Manufacturer must provide written justification if | controls are not embedded in the assay. |
Incidence and predictors of HIV infection among men who have sex with men attending public sexually transmitted disease clinics, New York City, 2007-2012
Pathela P , Jamison K , Braunstein SL , Schillinger JA , Varma JK , Blank S . AIDS Behav 2016 21 (5) 1444-1451 We examined five annual cohorts (2007-2011) of men who have sex with men (MSM) attending New York City STD clinics who had negative HIV-1 nucleic acid amplification tests (NAATs) on the day of clinic visit. Annual HIV incidence was calculated using HIV diagnoses within 1 year of negative NAAT, determined by matching with the citywide HIV registry. Predictors (demographic; behavioral; bacterial STD from citywide STD registry match) of all new HIV diagnoses through 2012 were calculated from Cox proportional hazards models. Among 10,487 HIV NAAT-negative MSM, 371 had an HIV diagnosis within 1 year. Annual incidence was 2.4/100 person-years, and highest among non-Hispanic black MSM (4.1/100 person-years) and MSM aged <20 years (5.7/100 person-years). Characteristics associated with all 648 new HIV diagnoses included: black race (aHR 2.2; 95 % CI 1.6-3.1), condomless receptive anal sex (aHR 2.1; 95 % CI 1.5-2.8), condomless insertive anal sex (aHR 1.3; 95 % CI 1.1-1.8), and incident STD diagnosis (aHR 1.6; 95 % CI 1.3-1.9). MSM attending STD clinics have substantial HIV incidence and report risk behaviors that are highly associated with HIV acquisition. Increased uptake of effective interventions, e.g., pre- and post-exposure prophylaxis, is needed. |
Long-term stability of volatile nitrosamines in human urine
Hodgson JA , Seyler TH , Wang L . J Anal Toxicol 2016 40 (6) 414-8 Volatile nitrosamines (VNAs) are established teratogens and carcinogens in animals and classified as probable (group 2A) and possible (group 2B) carcinogens in humans by the IARC. High levels of VNAs have been detected in tobacco products and in both mainstream and sidestream smoke. VNA exposure may lead to lipid peroxidation and oxidative stress (e.g., inflammation), chronic diseases (e.g., diabetes) and neurodegenerative diseases (e.g., Alzheimer's disease). To conduct epidemiological studies on the effects of VNA exposure, short-term and long-term stabilities of VNAs in the urine matrix are needed. In this report, the stability of six VNAs (N-nitrosodimethylamine, N-nitrosomethylethylamine, N-nitrosodiethylamine, N-nitrosopiperidine, N-nitrosopyrrolidine and N-nitrosomorpholine) in human urine is analyzed for the first time using in vitro blank urine pools fortified with a standard mixture of all six VNAs. Over a 24-day period, analytes were monitored in samples stored at approximately 20 degrees C (collection temperature), 4-10 degrees C (transit temperature) and -20 and -70 degrees C (long-term storage temperatures). All six analytes were stable for 24 days at all temperatures (n = 15). The analytes were then analyzed over a longer time period at -70 degrees C; all analytes were stable for up to 1 year (n = 62). A subset of 44 samples was prepared as a single batch and stored at -20 degrees C, the temperature at which prepared samples are stored. These prepared samples were run in duplicate weekly over 10 weeks, and all six analytes were stable over the entire period (n = 22). |
Validation of a standardized extraction method for formalin-fixed paraffin-embedded tissue samples.
Lagheden C , Eklund C , Kleppe SN , Unger ER , Dillner J , Sundstrom K . J Clin Virol 2016 80 36-39 BACKGROUND: Formalin-fixed paraffin-embedded (FFPE) samples can be DNA-extracted and used for human papillomavirus (HPV) genotyping. The xylene-based gold standard for extracting FFPE samples is laborious, suboptimal and involves health hazards for the personnel involved. OBJECTIVES: To compare extraction with the standard xylene method to a xylene-free method used in an HPV LabNet Global Reference Laboratory at the Centers for Disease Control (CDC); based on a commercial method with an extra heating step. STUDY DESIGN: Fifty FFPE samples were randomly selected from a national audit of all cervical cancer cases diagnosed in Sweden during 10 years. For each case-block, a blank-block was sectioned, as a control for contamination. For xylene extraction, the standard WHO Laboratory Manual protocol was used. For the CDC method, the manufacturers' protocol was followed except for an extra heating step, 120 degrees C for 20min. Samples were extracted and tested in parallel with beta-globin real-time PCR, HPV16 real-time PCR and HPV typing using modified general primers (MGP)-PCR and Luminex assays. RESULTS: For a valid result the blank-block had to be betaglobin-negative in all tests and the case-block positive for beta-globin. Overall, detection was improved with the heating method and the amount of HPV-positive samples increased from 70% to 86% (p=0.039). For all samples where HPV type concordance could be evaluated, there was 100% type concordance. CONCLUSIONS: A xylene-free and robust extraction method for HPV-DNA typing in FFPE material is currently in great demand. Our proposed standardized protocol appears to be generally useful. |
Viral loads among HIV-infected persons diagnosed with primary and secondary syphilis in 4 US cities: New York City, Philadelphia, PA, Washington, DC, and Phoenix, AZ
Taylor MM , Newman DR , Schillinger JA , Lewis FMT , Furness B , Braunstein S , Mickey T , Skinner J , Eberhart M , Opoku J , Blank S , Peterman TA . J Acquir Immune Defic Syndr 2015 70 (2) 179-185 BACKGROUND: Incident syphilis among HIV-infected persons indicates the ongoing behavioral risk for HIV transmission. Detectable viral loads (VLs) among coinfected cases may amplify this risk. METHODS: Primary and secondary cases reported during 2009-2010 from 4 US sites were crossmatched with local HIV surveillance registries to identify syphilis case-persons infected with HIV before or shortly after the syphilis diagnosis. We examined HIV VL and CD4 results collected within 6 months before or after syphilis diagnosis for the coinfected cases identified. Independent correlates of detectable VLs (≥200 copies/mL) were determined. RESULTS: We identified 1675 cases of incident primary or secondary syphilis among persons with HIV. Median age was 37 years; 99.5% were men, 41.1% were African American, 24.5% were Hispanics, and 79.9% of the HIV diagnoses were made at least 1 year before syphilis diagnosis. Among those coinfected, there were no VL results reported for 188 (11.2%); of the 1487 (88.8%) with reported VL results, 809 (54.4%) had a detectable VL (median, 25,101 copies/mL; range, 206-3,590,000 copies/mL). Detectable VLs independently correlated with syphilis diagnosed at younger age, at an sexually transmitted disease clinic, and closer in time to HIV diagnosis. CONCLUSIONS: More than half of syphilis case-persons identified with HIV had a detectable VL collected within 6 months of the syphilis diagnosis. This suggests virologic and active behavioral risk for transmitting HIV. |
Replacement of filters for respirable quartz measurement in coal mine dust by infrared spectroscopy
Farcas D , Lee T , Chisholm WP , Soo JC , Harper M . J Occup Environ Hyg 2015 13 (2) D16-22 The objective of the present study is to compare and characterize nylon, polypropylene (PP), and polyvinyl chloride (PVC) membrane filters that might be used to replace the vinyl/acrylic co-polymer (DM-450) filter currently used in the Mine Safety and Health Administration (MSHA) P-7 method (Quartz Analytical Method) and the National Institute for Occupational Safety and Health (NIOSH) Manual of Analytical Methods 7603 method (QUARTZ in coal mine dust, by IR re-deposition). This effort is necessary because the DM-450 filters are no longer commercially available. For example, the MSHA Pittsburgh laboratory alone analyses annually approximately 15,000 samples according to the MSHA P-7 method that requires DM-450 filters. There is an impending shortage of DM-450 filters. Membrane filters suitable for on-filter analysis should have high infrared (IR) transmittance in the spectral region 600-1000 cm-1. Nylon (47 mm, 0.45 microm pore size), PP (47 mm, 0.45 microm pore size) and PVC (47 mm, 5 microm pore size) filters meet this specification. Limits of detection and limits of quantification were determined from Fourier transform infrared spectroscopy (FTIR) measurements of blank filters. The average measured quartz mass and coefficient of variation were determined from test filters spiked with respirable alpha-quartz following MSHA P-7 and NIOSH 7603 methods. Quartz was also quantified in samples of respirable coal dust on each test filter type using the MSHA and NIOSH analysis methods. The results indicate that PP and PVC filters may replace the DM-450 filters for quartz measurement in coal dust by FTIR. PVC filters of 5 microm pore size was seemed to be suitable replacement although their ability to retain small particulates should be checked by filter experiment. |
Impact of a brief intervention for substance use on acquisition of sexually transmitted diseases including HIV: findings from an urban sexually transmitted disease clinic population
Rogers M , Johnson K , Yu J , Cuoco L , Blank S . Sex Transm Dis 2015 42 (10) 569-74 BACKGROUND: Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. METHODS: A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. RESULTS: Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63-0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. CONCLUSIONS: Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes. |
The CDC clearance process: supporting quality science
Cono J , Jaffe H . Am J Public Health 2015 105 (6) e1 In their recent editorial, Blank and Jemmott raise concerns about the value and efficiency of the Centers for Disease Control and Prevention (CDC) clearance review policy for scientific manuscripts, in particular as the policy applies to manuscripts led by non-CDC authors. CDC appreciates the concerns raised by the authors. CDC values the partnerships and collaborations that it has with the many non-CDC scientists with whom we work and reaffirms its commitment to its responsibility of providing timely, high-quality scientific information. |
The high risk of an HIV diagnosis following a diagnosis of syphilis: a population-level analysis of New York City men
Pathela P , Braunstein SL , Blank S , Shepard C , Schillinger JA . Clin Infect Dis 2015 61 (2) 281-7 BACKGROUND: Epidemiologic studies have shown that syphilis is associated with risk for HIV infection. We used population-level syphilis and HIV data to quantify HIV incidence among men following primary or secondary (P&S) syphilis diagnoses, and identify the highest-risk subgroups for intensified prevention, such as pre-exposure prophylaxis with antiretroviral medications. METHODS: Male cases reported to the New York City HIV/AIDS and Sexually Transmitted Disease (STD) surveillance registries were matched using a deterministic algorithm. We measured HIV incidence following P&S syphilis diagnosed between 2000-June 2010, and identified risk factors for HIV infection using Cox proportional hazards models. RESULTS: Of 2,805 men with syphilis contributing 11,714 person-years of follow-up, 423 (15.1%) acquired HIV; annual incidence was 3.61% (95% confidence interval (CI): 3.27%, 3.97%). HIV incidence was high among: men who have sex with men (MSM) (5.56%, 95% CI: 5.02%-6.13%); males with secondary compared with primary syphilis (4.10% vs. 2.64%, p<.0001); and males diagnosed with another bacterial STD after syphilis (7.89%, 95% CI: 6.62%-9.24%). CONCLUSIONS: HIV incidence among men diagnosed with syphilis is high; one in 20 MSM were diagnosed with HIV within a year. Our data have implications for syphilis and HIV screening, and may be useful for further targeting HIV-negative populations for pre-exposure prophylaxis. |
Evaluation of diffuse reflection infrared sectrometry for end-of-shift measurement of alpha-quartz in coal dust samples
Miller AL , Murphy NC , Bayman SJ , Briggs ZP , Kilpatrick AD , Quinn CA , Wadas MR , Cauda EG , Griffiths PR . J Occup Environ Hyg 2015 12 (7) 421-30 The inhalation of toxic substances is a major threat to the health of miners, and dust containing respirable crystalline silica (alpha-quartz) is of particular concern, due to the recent rise in cases of coal workers' pneumoconiosis and silicosis in some U.S. mining regions. Currently, there is no field-portable instrument that can measure airborne alpha-quartz and give miners timely feedback on their exposure. The U.S. National Institute for Occupational Safety and Health (NIOSH) is therefore conducting studies to investigate technologies capable of end-of-shift or real-time measurement of airborne quartz. The present study focuses on the potential application of Fourier transform infrared (FT-IR) spectrometry conducted in the diffuse reflection (DR) mode as a technique for measuring alpha-quartz in respirable mine dust. A DR accessory was used to analyze lab-generated respirable samples of Min-U-Sil 5 (which contains more than 90% alpha-quartz) and coal dust, at mass loadings in the ranges of 100-600 microg and 600-5300 microg respectively. The dust samples were deposited onto three different types of filters, borosilicate fiberglass, nylon and polyvinyl chloride (PVC). The reflectance, R, was calculated by the ratio of a blank filter and a filter with deposited mine dust. Results suggest that for coal and pure quartz dusts deposited on 37-mm PVC filters, measurements of log R correlate linearly with known amounts of quartz on filters, with R2 values of approximately 0.99 and 0.94, respectively, for samples loaded up to ~4000 microg. Additional tests were conducted to measure quartz in coal dusts deposited onto the borosilicate fiberglass and nylon filter media used in the NIOSH-developed Personal Dust Monitor (PDM). The nylon filter was shown to be amenable to DR analysis, but quantification of quartz is more accurate when the filter is "free", as opposed to being mounted in the PDM filter holder. The borosilicate fiberglass filters were shown to produce excessive interference, making quartz quantification impossible. It was concluded that, while the DR/FT-IR method is potentially useful for on-filter measurement of quartz in dust samples, the use of PVC filters produced the most accurate results. |
HIV testing among adults with mental illness in the United States
Yehia BR , Cui W , Thompson WW , Zack MM , McKnight-Eily L , DiNenno E , Rose CE , Blank MB . AIDS Patient Care STDS 2014 28 (12) 628-34 Nationally representative data from the 2007 National Health Interview Survey (NHIS) were used to compare HIV testing prevalence among US adults with mental illness (schizophrenia spectrum disorder, bipolar disorder, depression, and/or anxiety) to those without, providing an update of prior work using 1999 and 2002 NHIS data. Logistic regression modeling was used to estimate the probability of ever being tested for HIV by mental illness status, adjusting for age, sex, race/ethnicity, marital status, substance abuse, excessive alcohol or tobacco use, and HIV risk factors. Based on data from 21,785 respondents, 15% of adults had a psychiatric disorder and 37% ever had an HIV test. Persons with schizophrenia (64%), bipolar disorder (63%), and depression and/or anxiety (47%) were more likely to report ever being tested for HIV than those without mental illness (35%). In multivariable models, individuals reporting schizophrenia (adjusted prevalence ratio=1.68, 95% confidence interval=1.33-2.13), bipolar disease (1.58, 1.39-1.81), and depression and/or anxiety (1.31, 1.25-1.38) were more likely to be tested for HIV than persons without these diagnoses. Similar to previous analyses, persons with mental illness were more likely to have been tested than those without mental illness. However, the elevated prevalence of HIV in populations with mental illness suggests that high levels of testing along with other prevention efforts are needed. |
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