Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-30 (of 66 Records) |
Query Trace: Deluca N [original query] |
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Process and outcome evaluation of the Centers for Disease Control and Prevention's Think. Test. Treat TB health communications campaign, United States, March-September 2022
Caruso E , Parmer J , Allen L , Maiuri A , Mangan J , Bouwkamp B , DeLuca N . Public Health Rep 2024 333549241268644 OBJECTIVES: The Think. Test. Treat TB health communications campaign aims to increase the awareness of latent tuberculosis infection (LTBI) primarily among people born in the Philippines and Vietnam and other non-US-born groups (consumers) and the health care providers (providers) who serve them. We conducted a process evaluation to assess reach and audience engagement and an outcome evaluation to assess awareness, knowledge, perceptions, and behavioral intentions among audiences of the campaign. METHODS: To evaluate the process, the Centers for Disease Control and Prevention measured exposure to (eg, with impressions [total advertisements]) and engagement with (eg, online clicks) the campaign during its rollout (March-September 2022). After the rollout, to evaluate outcomes, we administered online surveys to consumers and providers who were exposed and not exposed to the campaign. RESULTS: The Think. Test. Treat TB campaign resulted in >33 million impressions, >2000 materials downloaded from the internet, and >33 000 materials shipped. Of 173 consumers who completed the evaluation survey, 123 (71.1%) were exposed to the campaign, with 108 (87.8%) reporting intention to ask their provider about tuberculosis (TB) during their next visit. Of 44 providers who completed the evaluation survey, 24 (54.5%) did not feel that they were the intended audience of the campaign, yet all felt the campaign materials were relevant to their patients, and 42 (95.5%) felt the materials were relevant to providers who serve patients at risk for TB. CONCLUSION: The Think. Test. Treat TB campaign was successful in raising awareness of LTBI among the intended audiences. Continuing engagement with key audiences about LTBI to encourage testing and treatment is integral to eliminate TB in the United States. |
Linking exposure to per- and polyfluoroalkyl substances (PFAS) in house dust and biomonitoring data in eight impacted communities
Minucci JM , DeLuca NM , Durant JT , Goodwin B , Kowalski P , Scruton K , Thomas K , Cohen Hubal EA . Environ Int 2024 188 108756 Per- and polyfluoroalkyl substances (PFAS) are widely used in industry and have been linked to various adverse health effects. Communities adjacent to sites where PFAS are manufactured, stored, or used may be at elevated risk. In these impacted communities, significant exposure often occurs through contaminated drinking water, yet less is known about the role of other pathways such as residential exposure through house dust. We analyzed a paired serum and house dust dataset from the Agency for Toxic Substances and Disease Registry's PFAS Exposure Assessments, which sampled eight United States communities with a history of drinking water contamination due to aqueous film forming foam (AFFF) use at nearby military bases. We found that serum PFAS levels of residents were significantly positively associated with the dust PFAS levels in their homes, for three of seven PFAS analyzed, when accounting for site and participant age. We also found that increased dust PFAS levels were associated with a shift in the relative abundance of PFAS in serum towards those chemicals not strongly linked to AFFF contamination, which may suggest household sources. Additionally, we analyzed participant responses to exposure questionnaires to identify factors associated with dust PFAS levels. Dust PFAS levels for some analytes were significantly elevated in households where participants were older and had lived at the home longer, cleaned less frequently, used stain resistant products, and had carpeted living rooms. Our results suggest that residential exposure to PFAS via dust or other indoor pathways may contribute to overall exposure and body burden, even in communities impacted by AFFF contamination of drinking water, and the magnitude of this exposure may also be influenced by demographic, behavioral, and housing factors. |
Experience of public health departments in implementation of COVID-19 case investigation and contact tracing programs
Staatz C , Loosier PS , Hsu R , Fiscus M , Gupta R , Sabin ER , Vohra D , Matulewicz H , Taylor MM , Caruso EC , DeLuca N , Moonan PK , Oeltmann JE , Thorpe P . Public Health Rep 2024 333549241239556 OBJECTIVE: Case investigation and contact tracing (CI/CT) are fundamental public health efforts widely used during the COVID-19 pandemic to mitigate transmission. This study investigated how state, local, and tribal public health departments used CI/CT during the COVID-19 pandemic, including CI/CT methodology, staffing models, training and support, and efforts to identify or prioritize populations disproportionately affected by COVID-19. METHODS: During March and April 2022, we conducted key informant interviews with up to 3 public health officials from 43 state, local, and tribal public health departments. From audio-recorded and transcribed interviews, we used the framework method to analyze key themes. RESULTS: Major adjustments to CI/CT protocols during the pandemic included (1) prioritizing populations for outreach; (2) implementing automated outreach for nonprioritized groups, particularly during COVID-19 surges; (3) discontinuing contact tracing and focusing exclusively on case investigation; and (4) adding innovations to provide additional support. Key informants also discussed the utility of having backup staffing to support overwhelmed public health departments and spoke to the difficulty in "right-sizing" the public health workforce, with COVID-19 surges leaving public health departments understaffed as case rates rose and overstaffed as case rates fell. CONCLUSIONS: When addressing future epidemics or outbreaks, public health officials should consider strategies that improve the effectiveness of CI/CT efforts over time, such as prioritizing populations based on disproportionate risk, implementing automated outreach, developing models that provide flexible additional staffing resources as cases rise and fall among local public health departments, incorporating demographic data in laboratory reporting, providing community connections and support, and having a system of self-notification of contacts. |
Improving HIV pre-exposure prophylaxis uptake with artificial intelligence and automation: A systematic review
Kamitani E , Mizuno Y , Khalil GM , Viguerie A , DeLuca JB , Mishra N . Aids 2024 OBJECTIVES: To identify studies promoting the use of artificial intelligence (AI) or automation with HIV pre-exposure prophylaxis (PrEP) care and explore ways for AI to be used in PrEP interventions. DESIGN: Systematic review. METHODS: We searched in the US Centers for Disease Control and Prevention Research Synthesis database through November 2023 PROSPERO (CRD42023458870). We included studies published in English that reported using AI or automation in PrEP interventions. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using either the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials or an adapted Newcastle-Ottawa Quality Assessment Scale for non-randomized studies. RESULTS: Our search identified 12 intervention studies (i.e., interventions that used AI/automation to improve PrEP care). Currently available intervention studies showed AI/automation interventions were acceptable and feasible in PrEP care while improving PrEP-related outcomes (i.e., knowledge, uptake, adherence, discussion with care providers). These interventions have used AI/automation to reduce workload (e.g., directly observed therapy) and helped non-HIV specialists prescribe PrEP with AI-generated clinical decision-support. Automated tools can also be developed with limited budget and staff experience. CONCLUSIONS: AI and automation have high potential to improve PrEP care. Despite limitations of included studies (e.g., the small sample sizes and lack of rigorous study design), our review suggests that by using aspects of AI and automation appropriately and wisely, these technologies may accelerate PrEP use and reduce HIV infection. |
Design and modification of COVID-19 case investigation and contact tracing interview scripts used by health departments throughout the COVID-19 pandemic
Orfield C , Loosier PS , Wagner S , Sabin ER , Fiscus M , Matulewicz H , Vohra D , Staatz C , Taylor MM , Caruso EC , DeLuca N , Moonan PK , Oeltmann JE , Thorpe P . J Public Health Manag Pract 2024 30 (3) 336-345 OBJECTIVES: We sought to (1) document how health departments (HDs) developed COVID-19 case investigation and contact tracing (CI/CT) interview scripts and the topics covered, and (2) understand how and why HDs modified those scripts. DESIGN: Qualitative analysis of CI/CT interview scripts and in-depth key informant interviews with public health officials in 14 HDs. Collected scripts represent 3 distinct points (initial, the majority of which were time stamped May 2020; interim, spanning from September 2020 to August 2021; and current, as of April 2022). SETTING: Fourteen state, local, and tribal health jurisdictions and Centers for Disease Control and Prevention (CDC). PARTICIPANTS: Thirty-six public health officials involved in leading CI/CT from 14 state, local, and tribal health jurisdictions (6 states, 3 cities, 4 counties, and 1 tribal area). MAIN OUTCOME MEASURE: Interview script elements included in CI/CT interview scripts over time. RESULTS: Many COVID-19 CI/CT scripts were developed by modifying questions from scripts used for other communicable diseases. Early in the pandemic, scripts included guidance on isolation/quarantine and discussed symptoms of COVID-19. As the pandemic evolved, the length of scripts increased substantially, with significant additions on contact elicitation, vaccinations, isolation/quarantine recommendations, and testing. Drivers of script changes included changes in our understanding of how the virus spreads, risk factors and symptoms, new treatments, new variants, vaccine development, and adjustments to CDC's official isolation and quarantine guidance. CONCLUSIONS: Our findings offer suggestions about components to include in future CI/CT efforts, including educating members of the public about the disease and its symptoms, offering mitigation guidance, and providing sufficient support and resources to help people act on that guidance. Assessing the correlation between script length and number of completed interviews or other quality and performance measures could be an area for future study. |
Tuberculosis testing and latent tuberculosis infection treatment practices among health care providers - United States, 2020-2022
Caruso E , Mangan JM , Maiuri A , Bouwkamp B , DeLuca N . MMWR Morb Mortal Wkly Rep 2023 72 (44) 1183-1189 CDC recommends testing persons at increased risk for tuberculosis (TB) infection as part of routine health care, using TB blood tests, when possible, and, if a diagnosis of latent TB infection (LTBI) is made, prescribing a rifamycin-based, 3- or 4-month treatment regimen (short-course) to prevent the development of TB disease. In 2022, approximately three quarters (73%) of reported TB cases in the United States occurred among non-U.S.-born persons. To assess TB-related practices among health care providers (HCPs) in the United States, CDC analyzed data from the 2020-2022 Porter Novelli DocStyles surveys. Approximately one half (53.3%) of HCPs reported routinely testing non-U.S.-born patients for TB, and of those who did, 35.7% exclusively ordered recommended blood tests, 44.2% exclusively ordered skin tests, and 20.2% ordered TB skin tests and blood tests. One third (33.0%) of HCPs reported prescribing recommended short-course LTBI treatment regimens, and 4.0% reported doing none of the treatment practices available for patients with LTBI (i.e., prescribing short-course regimens, longer course regimens, or referring patients to a health department). Further efforts are needed to identify and overcome barriers for providers to test for and treat persons at risk for TB. |
Home-based testing and COVID-19 isolation recommendations, United States
Moonan PK , Smith JP , Borah BF , Vohra D , Matulewicz HH , DeLuca N , Caruso E , Loosier PS , Thorpe P , Taylor MM , Oeltmann JE . Emerg Infect Dis 2023 29 (9) 1921-1924 Using a nationally representative panel survey, we examined isolation behaviors among persons in the United States who had positive SARS-CoV-2 test results during January 2021-March 2022. Compared with persons who received provider-administered results, persons with home-based results had 29% (95% CI 5%-47%) lower odds of following isolation recommendations. |
Effectiveness of 2 and 3 mRNA COVID-19 Vaccines Doses against Omicron and Delta-Related Outpatient Illness among Adults, October 2021 - February 2022 (preprint)
Kim SS , Chung JR , Talbot HK , Grijalva CG , Wernli KJ , Martin ET , Monto AS , Belongia EA , McLean HQ , Gaglani M , Mamawala M , Nowalk MP , Geffel KM , Tartof SY , Florea A , Lee JS , Tenforde MW , Patel MM , Flannery B , Bentz ML , Burgin A , Burroughs M , Davis ML , Howard D , Lacek K , Madden JC , Nobles S , Padilla J , Sheth M , Arroliga A , Beeram M , Dunnigan K , Ettlinger J , Graves A , Hoffman E , Jatla M , McKillop A , Murthy K , Mutnal M , Priest E , Raiyani C , Rao A , Requenez L , Settele N , Smith M , Stone K , Thomas J , Volz M , Walker K , Zayed M , Annan E , Daley P , Kniss K , Merced-Morales A , Ayala E , Amundsen B , Aragones M , Calderon R , Hong V , Jimenez G , Kim J , Ku J , Lewin B , McDaniel A , Reyes A , Shaw S , Takhar H , Torres A , Burganowski R , Kiniry E , Moser KA , Nguyen M , Park S , Wellwood S , Wickersham B , Alvarado-Batres J , Benz S , Berger H , Bissonnette A , Blake J , Boese K , Botten E , Boyer J , Braun M , Breu B , Burbey G , Cravillion C , Delgadillo C , Donnerbauer A , Dziedzic T , Eddy J , Edgren H , Ermeling A , Ewert K , Fehrenbach C , Fernandez R , Frome W , Guzinski S , Heeren L , Herda D , Hertel M , Heuer G , Higdon E , Ivacic L , Jepsen L , Kaiser S , Karl J , Keffer B , King J , Koepel TK , Kohl S , Kohn S , Kohnhorst D , Kronholm E , Le T , Lemieux A , Marcis C , Maronde M , McCready I , McGreevey K , Meece J , Mehta N , Miesbauer D , Moon V , Moran J , Nikolai C , Olson B , Olstadt J , Ott L , Pan N , Pike C , Polacek D , Presson M , Price N , Rayburn C , Reardon C , Rotar M , Rottscheit C , Salzwedel J , Saucedo J , Scheffen K , Schug C , Seyfert K , Shrestha R , Slenczka A , Stefanski E , Strupp M , Tichenor M , Watkins L , Zachow A , Zimmerman B , Bauer S , Beney K , Cheng CK , Faraj N , Getz A , Grissom M , Groesbeck M , Harrison S , Henson K , Jermanus K , Johnson E , Kaniclides A , Kimberly A , Lamerato LE , Lauring A , Lehmann-Wandell R , McSpadden EJ , Nabors L , Truscon R , Balasubramani GK , Bear T , Bobeck J , Bowser E , Clarke K , Clarke LG , Dauer K , Deluca C , Dierks B , Haynes L , Hickey R , Johnson M , Jonsson A , Luosang N , McKown L , Peterson A , Phaturos D , Rectenwald A , Sax TM , Stiegler M , Susick M , Suyama J , Taylor L , Walters S , Weissman A , Williams JV , Blair M , Carter J , Chappell J , Copen E , Denney M , Graes K , Halasa N , Lindsell C , Liu Z , Longmire S , McHenry R , Short L , Tan HN , Vargas D , Wrenn J , Wyatt D , Zhu Y . medRxiv 2022 10 Background: We estimated SARS-CoV-2 Delta and Omicron-specific effectiveness of 2 and 3 mRNA COVID-19 vaccine doses in adults against symptomatic illness in US outpatient settings. Method(s): Between October 1, 2021, and February 12, 2022, research staff consented and enrolled eligible participants who had fever, cough, or loss of taste or smell and sought outpatient medical care or clinical SARS-CoV-2 testing within 10 days of illness onset. Using the test-negative design, we compared the odds of receiving 2 or 3 mRNA COVID-19 vaccine doses among SARS-CoV-2 cases versus controls using logistic regression. Regression models were adjusted for study site, age, onset week, and prior SARS-CoV-2 infection. Vaccine effectiveness (VE) was calculated as (1 - adjusted odds ratio) x 100%. Result(s): Among 3847 participants included for analysis, 574 (32%) of 1775 tested positive for SARS-CoV-2 during the Delta predominant period and 1006 (56%) of 1794 participants tested positive during the Omicron predominant period. When Delta predominated, VE against symptomatic illness in outpatient settings was 63% (95% CI: 51% to 72%) among mRNA 2-dose recipients and 96% (95% CI: 93% to 98%) for 3-dose recipients. When Omicron predominated, VE was 21% (95% CI: -6% to 41%) among 2-dose recipients and 62% (95% CI: 48% to 72%) among 3-dose recipients. Conclusion(s): In this adult population, 3 mRNA COVID-19 vaccine doses provided substantial protection against symptomatic illness in outpatient settings when the Omicron variant became the predominant cause of COVID-19 in the U.S. These findings support the recommendation for a 3rd mRNA COVID-19 vaccine dose. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license. |
Cost-effectiveness of routine annual influenza vaccination by age and risk status
Kim DeLuca E , Gebremariam A , Rose A , Biggerstaff M , Meltzer MI , Prosser LA . Vaccine 2023 41 (29) 4239-4248 BACKGROUND: The epidemiology of circulating seasonal influenza strains changed following the 2009 pandemic influenza A(H1N1). A universal influenza vaccination recommendation has been implemented and new vaccine types have become available post-2009. The objective of this study was to evaluate the cost-effectiveness of routine annual influenza vaccination in the context of this new evidence. METHODS: A state transition simulation model was constructed to estimate the health and economic outcomes of influenza vaccination compared to no vaccination for hypothetical US cohorts stratified by age and risk status. Model input parameters were derived from multiple sources, including post-2009 vaccine effectiveness data from the US Flu Vaccine Effectiveness Network. The analysis used societal and healthcare sector perspectives and a one-year time horizon, except permanent outcomes were also included. The primary outcome was the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life years (QALYs) gained. RESULTS: Compared to no vaccination, vaccination yielded ICERs lower than $95,000/QALY for all age and risk groups, except for non-high-risk adults 18-49 years ($194,000/QALY). Vaccination was cost-saving for adults ≥50 years at higher risk for influenza-related complications. Results were most sensitive to changes in the probability of influenza illness. Performing the analysis from the healthcare sector perspective, excluding vaccination time costs, delivering vaccinations in lower-cost settings, and including productivity losses improved the cost-effectiveness of vaccination. Sensitivity analysis revealed that vaccination remains below $100,000/QALY for older persons ≥65 years at vaccine effectiveness estimates as low as 4 %. CONCLUSIONS: Cost-effectiveness of influenza vaccination varied by age and risk status and was less than $95,000/QALY for all subgroups, except for non-high-risk working-age adults. Results were sensitive to the probability of influenza illness and vaccination was more favorable under certain scenarios. Vaccination for higher risk subgroups resulted in ICERs below $100,000/QALY even at low levels of vaccine effectiveness or circulating virus. |
Evaluation of the impact of guideline communication from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services among US healthcare providers: COVID-19 prevention counselling guidance
Taylor MM , Deb A , Frazier B , Lueken JR , Das M , Molke J , Fitzgerald E , Ullian T , Nair R , Couch M , Turbyfill C , Horter L , Joshi C , DeLuca N . Nurs Open 2023 10 (11) 7437-7445 AIM: To evaluate healthcare provider awareness and uptake of the Centers for Medicare & Medicaid Services (CMS) billing for coronavirus disease 2019 (COVID-19) prevention counselling and the delivery of prevention counselling to patients awaiting severe acute respiratory syndrome coronavirus 2 test results. DESIGN: Cross sectional survey of US-based healthcare providers in February 2021. METHODS: Analysis of associations with healthcare provider-reported awareness of CMS prevention counselling guidance and billing with provider type, specialty, and work setting. RESULTS: A total of 1919 healthcare providers responded to the survey. Overall, 38% (726/1919) of providers reported awareness of available CMS reimbursement for COVID-19 patient counselling and 29% (465/1614) of CMS billing-eligible providers reported billing for this counselling. Among physicians, those aware of CMS guidance were significantly more likely to bill (58%) versus those unaware (10%). Among RNSights respondents eligible for CMS billing (n = 114), 31% of those aware of the guidance reported billing as compared to 0% of those not aware. |
Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services
Kamitani E , Mizuno Y , DeLuca JB , Collins CB . AIDS 2023 37 (10) 1593-1602 OBJECTIVES: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. DESIGN: Systematic review and narrative synthesis. METHODS: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS: This review identified 16 studies published between 2018-2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP , and mail-in testing. CONCLUSIONS: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g., pharmacist prescribers), as well as the settings of PrEP care (i.e., telePrEP) and laboratory screening (i.e., mail-in testing) may increase PrEP access and care delivery. |
Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study
Pneumonia Etiology Research for Child Health Study Group , O'Brien Katherine L , Levine Orin S , Knoll Maria Deloria , Feikin Daniel R , DeLuca Andrea N , Driscoll Amanda J , Fancourt Nicholas , Fu Wei , Haddix Meredith , Hammitt Laura L , Higdon Melissa M , Kagucia E Wangeci , Karron Ruth A , Li Mengying , Park Daniel E , Prosperi Christine , Shi Qiyuan , Wu Zhenke , Zeger Scott L , Watson Nora L , Crawley Jane , Murdoch David R , Brooks W Abdullah , Endtz Hubert P , Zaman Khalequ , Goswami Doli , Hossain Lokman , Jahan Yasmin , Chisti Mohammod Jobayer , Howie Stephen R C , Ebruke Bernard E , Antonio Martin , McLellan Jessica L , Machuka Eunice M , Shamsul Arifin , Zaman Syed M A , Mackenzie Grant , Scott J Anthony G , Awori Juliet O , Morpeth Susan C , Kamau Alice , Kazungu Sidi , Ominde Micah Silaba , Kotloff Karen L , Tapia Milagritos D , Sow Samba O , Sylla Mamadou , Tamboura Boubou , Onwuchekwa Uma , Kourouma Nana , Toure Aliou , Sissoko Seydou , Madhi Shabir A , Moore David P , Adrian Peter V , Baillie Vicky L , Kuwanda Locadiah , Mudau Azwifarwi , Groome Michelle J , Mahomed Nasreen , Simões Eric A F , Baggett Henry C , Thamthitiwat Somsak , Maloney Susan A , Bunthi Charatdao , Rhodes Julia , Sawatwong Pongpun , Akarasewi Pasakorn , Thea Donald M , Mwananyanda Lawrence , Chipeta James , Seidenberg Phil , Mwansa James , Somwe Somwe Wa , Kwenda Geoffrey , Anderson Trevor P , Mitchell Joanne L . Lancet 2019 394 (10200) 757-779 BACKGROUND: Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings. METHODS: We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1-59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data. FINDINGS: Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6-97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3-65·6) of causes, whereas bacteria accounted for 27·3% (23·3-31·6) and Mycobacterium tuberculosis for 5·9% (3·9-8·3). Viruses were less common (54·5%, 95% CrI 47·4-61·5 vs 68·0%, 62·7-72·7) and bacteria more common (33·7%, 27·2-40·8 vs 22·8%, 18·3-27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4-34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus-enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site's aetiological fraction. INTERPRETATION: In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes. FUNDING: Bill & Melinda Gates Foundation. |
Isolation and quarantine for COVID-19 in the United States, 2020-2022
Oeltmann JE , Vohra D , Matulewicz HH , DeLuca N , Smith JP , Couzens C , Lash RR , Harvey B , Boyette M , Edwards A , Talboy PM , Dubose O , Regan P , Loosier P , Caruso E , Katz DJ , Taylor MM , Moonan PK . Clin Infect Dis 2023 77 (2) 212-219 BACKGROUND: Public health programs varied in ability to reach people with COVID-19 and their contacts to encourage separation from others. For both adult cases of COVID-19 and contacts, we estimated the impact of contact tracing activities on separation behaviors from January, 2020 until March, 2022. METHODS: We used a probability-based panel survey of a nationally representative sample to gather data for estimates and comparisons. RESULTS: An estimated 64,255,351 adults reported a positive SARS-CoV-2 test result; 79.6% isolated for >5 days, 60.2% isolated for >10 days, and 79.2% self-notified contacts. 24,057,139 (37.7%) completed a case investigation and 46.2% reported contacts to health officials. More adults who completed a case investigation isolated than adults who did not (>5 days, 82.6%; >10 days, 69.8% versus >5 days, 78.2% and >10 days 54.8%; p-values for both measures <0.05).84,946,636 adults were a contact to a COVID-19 case; 73.1% learned of their exposure directly from a case; 49.4% quarantined for >5 days, 18.7% quarantined for >14 days, and 13.5% completed a contact tracing call. More who completed a contact tracing call quarantined than those who did not (>5 days, 61.2%; >14 days, 25.2% versus >5 days, 48.5%; >14 days, 18.0%; p-values for both measures <0.05). CONCLUSIONS: Engagement in contact tracing positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging, and limited the ability to promote quarantining, and testing. |
Experiences with COVID-19 case investigation and contact tracing: A qualitative analysis
DeLuca N , Caruso E , Gupta R , Kemmerer C , Coughlin R , Chan O , Vohra D , Oeltmann JE , Taylor MM , Moonan PK , Thorpe PG , Loosier PS , Haile G . SSM Qual Res Health 2023 3 100244 Case investigation and contact tracing (CI/CT) is a critical part of the public health response to COVID-19. Individuals' experiences with CI/CT for COVID-19 varied based on geographic location, changes in knowledge and guidelines, access to testing and vaccination, as well as demographic characteristics including age, race, ethnicity, income, and political ideology. In this paper, we explore the experiences and behaviors of adults with positive SARS-CoV-2 test results, or who were exposed to a person with COVID-19, to understand their knowledge, motivations, and facilitators and barriers to their actions. We conducted focus groups and one-on-one interviews with 94 cases and 90 contacts from across the United States. We found that participants were concerned about infecting or exposing others, which motivated them to isolate or quarantine, notify contacts, and get tested. Although most cases and contacts were not contacted by CI/CT professionals, those who were reported a positive experience and received helpful information. Many cases and contacts reported seeking information from family, friends, health care providers, as well as television news and Internet sources. Although participants reported similar perspectives and experiences across demographic characteristics, some highlighted inequities in receiving COVID-19 information and resources. |
Global responses to the COVID-19 pandemic
Cassell CH , Raghunathan PL , Henao O , Pappas-DeLuca KA , Rémy WL , Dokubo EK , Merrill RD , Marston BJ . Emerg Infect Dis 2022 28 (13) S4-s7 Confronted with a novel coronavirus, countries worldwide were forced to rapidly adjust their public health systems, platforms, and tools to respond to COVID-19. The US Centers for Disease Control and Prevention (CDC) and its global partners adapted health systems and programs originally developed for other purposes, such as controlling the HIV/AIDS pandemic through the US President’s Emergency Plan for AIDS Relief (PEPFAR), Global Health Security Agenda implementation, influenza surveillance, and vaccine-preventable disease elimination and eradication. This special supplement of Emerging Infectious Diseases highlights responses to the early phases of the COVID-19 pandemic from >80 countries, spanning 6 continents and representing >130 organizations. This article summarizes global adaptations of core public health functions during COVID-19: surveillance, information, and laboratory systems; workforce, institutional, and public health capacity; and clinical and health services delivery. |
What factors are associated with willingness to use HIV pre-exposure prophylaxis (PrEP) among U.S. Men who have sex with men not on PrEP A systematic review and meta-analysis
Kamitani E , Wichser ME , Mizuno Y , DeLuca JB , Higa DH . J Assoc Nurses AIDS Care 2022 34 (2) 135-145 Pre-exposure prophylaxis (PrEP), an antiretroviral medication to prevent HIV, is becoming more widely available in the United States since the Federal Drug Administration approved it in 2012. However, PrEP use among men who have sex with men (MSM) is still limited and many MSM who are willing to take PrEP are not on PrEP. We performed a systematic review to identify factors associated with willingness to use PrEP among MSM who are not on PrEP. The majority of the 23 relevant studies had low risk of bias and used a cross-sectional design. Willingness was associated with being Hispanic/Latino (odds ratio [OR] = 1.68, 95% confidence interval [CI] [1.01-2.78]), Black (OR = 1.41, 95% CI [1.02-1.95]), younger (OR = 1.08, 95% CI [1.02-1.15]), having no college degree (OR = 1.37, 95% CI [1.12-1.59]), or low income (OR = 1.21, 95% CI [1.12-1.32]). A higher proportion of MSM who had recent condomless anal sex (OR = 1.85, 95% CI [1.49-2.29]) were diagnosed with sexually transmitted infection (OR = 1.60, 95% CI [1.27-2.01]), or MSM who had multiple sex partners (OR = 1.58, 95% CI [1.07-2.32]) were more willing to use PrEP compared with their respective counterparts. Findings suggest that MSM with racial/ethnic minority status, low-socioeconomic status, younger age, and engagement in HIV risk behaviors are willing to take PrEP but may lack access. Study limitations include the inability to conduct meta-analyses on certain predictor variables due to a small number of studies. This review identified MSM subpopulations who may benefit from interventions increasing PrEP access. |
Risk of HIV acquisition among high-risk heterosexuals with nonviral sexually transmitted infections: A systematic review and meta-analysis
Barker EK , Malekinejad M , Merai R , Lyles CM , Sipe TA , DeLuca JB , Ridpath AD , Gift TL , Tailor A , Kahn JG . Sex Transm Dis 2022 49 (6) 383-397 BACKGROUND: Nonviral sexually transmitted infections (STIs) increase risk of sexually-acquired HIV infection. Updated risk estimates carefully scrutinizing temporality bias of studies are needed. METHODS: We conducted a systematic review (PROSPERO # CRD42018084299) of peer-reviewed studies evaluating variation in risk of HIV infection among high-risk heterosexuals diagnosed with any of: Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, Treponema pallidum, and/or Trichomonas vaginalis. We searched PubMed, Web of Science, and Embase databases through December 2017 and included studies where STIs and HIV were assessed using laboratory tests or medical exams and where STI was diagnosed before HIV. After dual screening, data extraction, and risk of bias assessment, we meta-analytically pooled risk ratios (RR). RESULTS: We found 32 eligible studies reporting k = 97 effect size estimates of HIV acquisition risk due to infection with one of the above STIs. Most data were based on females engaged in sex work or other high-risk occupations in developing countries. Many studies did not measure or adjust for known confounders including drug injection and condom use and most were at medium or high risk of bias due to potential for undetected HIV infection to have occurred prior to STI infection. HIV acquisition risk increased among females infected with any pathogen; the effect was greatest for females infected with Mycoplasma genitalium (RR = 3.10; 95% CI 1.63, 5.92; k = 2) and gonorrhea (RR = 2.81; 95% CI 2.25, 3.50; k = 16) but also statistically significant for females infected with syphilis (RR = 1.67; 95% CI 1.23, 2.27; k = 17), trichomonas (RR = 1.54; 95% CI 1.31, 1.82; k = 17) and chlamydia (RR = 1.49; 95% CI 1.08, 2.04; k = 14). For males, data were space except for syphilis (RR = 1.77; 95% CI 1.22, 2.58; k = 5). CONCLUSION: Nonviral STI increases risk of heterosexual HIV acquisition, although uncertainty remains due to risk of bias in primary studies. |
Risk of HIV acquisition among men who have sex with men infected with bacterial sexually transmitted infections: A systematic review and meta-analysis
Malekinejad M , Barker EK , Merai R , Lyles CM , Bernstein KT , Sipe TA , DeLuca JB , Ridpath AD , Gift TL , Tailor A , Kahn JG . Sex Transm Dis 2021 48 (10) e138-e148 BACKGROUND: Men who have sex with men (MSM) who have bacterial sexually transmitted infections (STIs) are at increased risk for HIV infection. We enhanced and updated past summary risk estimates. METHODS: We systematically reviewed (PROSPERO No. CRD42018084299) peer-reviewed studies assessing the risk of HIV infection among MSM attributable to Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and/or Trichomonas vaginalis (TV). We searched 3 databases through December 2017. We excluded studies with self-reported data or simultaneous STI and HIV assessment. We conducted dual screening and data extraction, meta-analytically pooled risk ratios (RRs), and assessed potential risk of bias. RESULTS: We included 26 studies yielding 39 RR (k) for HIV acquisition due to one of TP, NG, or CT. We did not identify eligible data for MG or TV, or for HIV transmission. HIV acquisition risk increased among MSM infected with TP (k = 21; RR, 2.68, 95% confidence interval [CI], 2.00-3.58), NG (k = 11; RR, 2.38; 95% CI, 1.56-3.61), and CT (k = 7; RR, 1.99; 95% CI, 1.59-2.48). Subanalysis RRs for all 3 pathogens were ≥1.66 and remained statistically significant across geography and methodological characteristics. Pooled RR increased for data with the lowest risk of bias for NG (k = 3; RR, 5.49; 95% CI, 1.11-27.05) and TP (k = 4; RR, 4.32; 95% CI, 2.20-8.51). We observed mostly moderate to high heterogeneity and moderate to high risk of bias. CONCLUSIONS: Men who have sex with men infected with TP, NG, or CT have twice or greater risk of HIV acquisition, although uncertainties exist because of data heterogeneity and risk of bias. |
Health care providers' views on clinic infrastructure and practice models that may facilitate HIV preexposure prophylaxis (PrEP) prescribing: A qualitative meta-synthesis
Mizuno Y , Gelaude DJ , Crepaz N , Kamitani E , DeLuca JB , Leighton CA , Wichser ME , Smith DK . Health Promot Pract 2021 23 (6) 999-1014 HIV (human immunodeficiency virus) preexposure prophylaxis (PrEP) is an effective biomedical HIV prevention tool. Increasing PrEP use among populations disproportionately affected by HIV is one of the key efforts in the United States' Ending the HIV Epidemic (EHE) initiative and the HIV National Strategic Plan for the United States. Given that PrEP is available only through prescription, it is important to explore structural, organizational, or environmental factors that could facilitate or impede health care provider's PrEP prescribing behavior. The purpose of this systematic review (PROSPERO [CRD: 42019138889]) is to identify qualitative studies that addressed this topic and conduct meta-synthesis using the thematic synthesis method to identify major themes on the characteristics of clinic infrastructure or clinic models that providers consider as facilitators of PrEP prescribing in the United States. Eighteen citations representing 15 studies were included in this review. Five overarching themes were identified: (1) routinized HIV risk assessment; (2) interdisciplinary/coordinated PrEP teams or services; (3) clinic capacity to provide essential PrEP-related services; (4) low out-of-pocket patient costs; and (5) access to the priority populations. Some of these themes are consistent with the recommendations of CDC's PrEP clinical guidelines and the EHE initiative. More recent studies that include perspectives of diverse providers, timely analysis of these studies, and implementation research to assess strategies to address the current practice gaps are needed to further promote PrEP prescribing among providers in the United States. |
Effectiveness of HIV Stigma Interventions for Men who have Sex with Men (MSM) With and Without HIV in the United States: A Systematic Review and Meta-Analyses
Gunn JKL , Rooks-Peck C , Wichser ME , Denard C , McCree DH , Jeffries WL4th , DeLuca JB , Ross LW , Herron A , Barham T , Flores SA , Higa DH . AIDS Behav 2021 26 51-89 Stigma may contribute to HIV disparities for men who have sex with men (MSM). This systematic review quantified the effects of HIV stigma interventions for MSM on stigma and sex risk. We conducted a systematic search to identify US-based studies published between 2000 and June 2019 focused on HIV and MSM, and either measured stigma pre-post or included a stigma intervention component. Twenty-nine articles, representing 26 unique studies met inclusion criteria. Random effect models showed no intervention effect for reducing stigma and a non-significant increase in HIV testing. Significant decreases in condomless sex with males, condomless sex with females, and substance-influenced sex were found. Few intervention studies measured stigma pre-post. Findings suggest that including a stigma reduction component in interventions can improve HIV testing and reduce sex risk for MSM. Developing interventions to address stigma may be important in decreasing HIV infection among MSM and ending the HIV epidemic. |
Latent tuberculosis infection: Misperceptions among non-U.S.-born-populations from countries where tuberculosis is common
Parmer J , Macario E , Tatum K , Brackett A , Allen L , Picard R , DeLuca N , Dowling M . Glob Public Health 2021 17 (8) 1-15 ABSTRACTThe Centers for Disease Control and Prevention works to eliminate tuberculosis (TB) disease by finding and treating cases of TB disease and expanding latent tuberculosis infection (LTBI) testing and treatment to prevent TB disease. Approximately 70% of reported TB cases in the United States occur among non-U.S.-born persons. We conducted 15 focus groups with U.S. residents born in the six most common countries of birth among non-U.S.-born TB patients: Mexico, the Philippines, India, Vietnam, China and Guatemala. Participants reacted to 39 messages on LTBI and TB disease risk factors, the Bacille Calmette-Guérin (BCG) vaccine, and LTBI testing and treatment. There was low awareness of LTBI, the TB blood test, and how the TB blood test is not affected by prior BCG vaccination. Several participants thought TB disease is contracted by sharing kitchenware. Some felt negatively targeted when presented with information about countries where TB disease is more common than the U.S. Findings highlight the need for communication aimed at increasing LTBI testing and treatment to include messages framed in ways that will be resonant and actionable to populations at risk. Focus groups revealed LTBI misconceptions which highlight areas for targeted education to decrease TB stigma and increase LTBI testing and treatment. |
Toward An Enhanced Understanding of HIV Patient Navigation as a Health Care Intervention: An Analysis of Navigation in Practice
Koenig LJ , Higa DH , Leighton CA , Roland KB , DeLuca JB , Mizuno Y . AIDS Behav 2021 25 (12) 4044-4054 Patient navigation is a promising strategy for improving health among persons with multiple barriers to HIV care, yet little is known about navigation's core components. From 24 systematically identified navigation studies, we abstracted navigators' activities, grouped activities into 20 thematic activity categories, and ordered them by frequency. Subsequently, Principal Components Analysis of activity categories was used identify independent clusters. Accompaniment characterized 71% of navigation programs; ≥ half included health education (58%), collaboration/coordination (58%), linkage-to-care (54%), transportation support (54%), service referrals (50%) and instrumental support (50%). Five unique components (comprising 13 activity categories) were identified: (1) services beyond office, (2) health education and relationship building, (3) accompaniment and instrumental support, (4) locating patients and tracking information, and (5) beyond HIV care. Navigators who located patients or tracked information were less likely to provide accompaniment or instrumental support (r = - 0.60, p = 0.002). Findings can enhance precision in developing, describing, evaluating and improving navigation programs. |
HIV patient navigation in the United States: A qualitative meta-synthesis of navigators' experiences
Roland KB , Higa DH , Leighton CA , Mizuno Y , DeLuca JB , Koenig LJ . Health Promot Pract 2020 23 (1) 74-85 Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation. |
Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children
McCollum ED , Park DE , Watson NL , Fancourt NSS , Focht C , Baggett HC , Abdullah Brooks W , Howie SRC , Kotloff KL , Levine OS , Madhi SA , Murdoch DR , Scott JAG , Thea DM , Awori JO , Chipeta J , Chuananon S , DeLuca AN , Driscoll AJ , Ebruke BE , Elhilal M , Emmanouilidou D , Githua LP , Higdon MM , Hossain L , Jahan Y , Karron RA , Kyalo J , Moore DP , Mulindwa JM , Naorat S , Prosperi C , Verwey C , West JE , Knoll MD , Brien KLO , Feikin DR , Hammitt LL . Pediatr Pulmonol 2020 55 (11) 3197-3208 BACKGROUND: Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps. METHODS: We enrolled 1-59 month old children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and reclassified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata. RESULTS: Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI) 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR 2.13, 95%CI 0.91, 4.96) or any wheeze (with or without crackle) (aOR 0.63, 95%CI 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends towards greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs 9.1%, p=0.03). CONCLUSIONS: Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care. This article is protected by copyright. All rights reserved. |
Evidence of behaviour change during an Ebola virus disease outbreak, Sierra Leone
Jalloh MF , Sengeh P , Bunnell RE , Jalloh MB , Monasch R , Li W , Mermin J , Deluca N , Brown V , Nur SA , August EM , Ransom RL , Namageyo-Funa A , Clements SA , Dyson M , Hageman K , Pratt SA , Nuriddin A , Carroll DD , Hawk N , Manning C , Hersey S , Marston BJ , Kilmarx PH , Conteh L , Ekström AM , Zeebari Z , Redd JT , Nordenstedt H , Morgan O . Bull World Health Organ 2020 98 (5) 330-340B Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9–9.1); and (ii) wait for a burial team following a relative’s death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2–6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4–4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1–0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2–9.1) than low-transmission (aOR: 2.3; 95% CI: 1.4–3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4–2.5) and aOR: 0.8 (95% CI: 0.6–1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. |
HIV prevention research on men who have sex with men: A scoping review of systematic reviews, 1988-2017
Higa DH , Crepaz N , McDonald CM , Adegbite-Johnson A , DeLuca JB , Kamitani E , Sipe TA . AIDS Educ Prev 2020 32 (1) 1-24 In the United States, men who have sex with men (MSM) are disproportionately affected by HIV. To identify research gaps and inform HIV prevention for MSM, we conducted a scoping review of systematic reviews using CDC's Prevention Research Synthesis database. Eligibility criteria comprised English-language systematic reviews focused on HIV prevention for MSM, published during 1988-2017, and included at least one U.S. primary study. We coded data type, subpopulations, topics, and key findings. To assess study quality, we used the Assessment of Multiple Systematic Reviews (AMSTAR). Among 129 relevant systematic reviews, study quality was high or moderate for 63%. Most common topics were sexual behavior and disease vulnerability. The most frequently mentioned MSM subgroups were HIV-positive, Black or African American, and young. Research gaps include Hispanic/Latino MSM, pre-exposure prophylaxis (PrEP), treatment as prevention, social determinants of health, health disparities, syndemics, and protective factors for sexual health. |
Mapping the study characteristics and topics of HIV pre-exposure prophylaxis research literature: A scoping review
Kamitani E , Mizuno Y , Wichser M , Adegbite AH , DeLuca JB , Higa DH . AIDS Educ Prev 2019 31 (6) 505-522 Since WHO released the first PrEP guidance in 2012, the PrEP research literature has rapidly increased, but PrEP uptake is still low. To identify research gaps, this scoping review describes study characteristics, identifies populations, and maps study topics in PrEP publications. We identified 561 PrEP primary studies published in English between 2006 and 2018. The most commonly used study design was cross-sectional. Almost half of studies were conducted in non-U.S. countries and focused on men who have sex with men. We mapped study topics using five categories. The most studied category was Potential PrEP user/prescriber (41.3%) followed by Considerations while on PrEP (28.2%), PrEP efficacy and safety (20.9%), Cost-effectiveness or economic evaluation (5.2%), and Methods of and experiences with PrEP clinical trials (4.2%). Although the PrEP literature has dramatically increased, some research areas (e.g., PrEP awareness in non-U.S. countries, intervention studies to promote PrEP use) and populations (e.g., Black women) are still understudied. |
Analysis of systematic reviews of medication adherence interventions for persons with HIV, 1996-2017
Rooks-Peck CR , Wichser ME , Adegbite AH , DeLuca JB , Barham T , Ross LW , Higa DH , Sipe TA . AIDS Patient Care STDS 2019 33 (12) 528-537 This overview of reviews summarizes the evidence from systematic reviews (SR) on the effectiveness of antiretroviral therapy (ART) adherence interventions for people with HIV (PWH) and descriptively compares adherence interventions among key populations. Relevant articles published during 1996-2017 were identified by comprehensive searches of CDC's HIV/acquired immunodeficiency syndrome (AIDS) Prevention Research Synthesis Database and manual searches. Included SRs examined primary interventions intended to improve ART adherence, focused on PWH, and assessed medication adherence or biologic outcomes (e.g., viral load). We synthesized the qualitative data and used the Assessment of Multiple Systematic Reviews (AMSTAR) for quality assessment. Forty-one SRs met inclusion criteria. Average quality was high. SRs that evaluated text-messaging interventions (n = 9) consistently reported statistically significant improvements in adherence and biologic outcomes. Other ART adherence strategies (e.g., behavioral, directly administered antiretroviral therapy [DAART]) reported improvements, but did not report significant effects for both outcomes, or intervention effects that did not persist postintervention. In the review focused on people who inject drugs (n = 1), DAART alone or in combination with medication-assisted therapy improved both outcomes. In SRs focused on children or adolescents aged <18 years (n = 5), regimen-related and hospital-based DAART improved biologic outcomes. ART adherence interventions (e.g., text-messaging) improved adherence and biologic outcomes; however, results differed for other intervention strategies, populations, and outcomes. Because few SRs reported evidence for populations at high risk (e.g., men who have sex with men), the results are not generalizable to all PWH. Future implementation studies are needed to examine medication adherence interventions in specific populations and address the identified gaps. |
Client perspectives and experiences with HIV patient navigation in the United States: A qualitative meta-synthesis
Roland KB , Higa DH , Leighton CA , Mizuno Y , DeLuca JB , Koenig LJ . Health Promot Pract 2019 21 (1) 1524839919875727 Patient navigation is increasingly utilized to link and (re)engage persons with HIV to care. Understanding client experiences with HIV patient navigation can facilitate intervention design and translation of evidence to practice. We conducted a qualitative meta-synthesis of client experiences with HIV patient navigation. Data were analyzed using thematic synthesis. We identified seven relevant studies; all collected data via in-depth interviews with persons with HIV who participated in HIV patient navigation. Four interrelated themes emerged from analysis that pertain to (1) the complexity of the health and social service environment and the holistic approaches taken by the navigator, (2) the profound significance of the client-navigator relationship, (3) client reluctance to end the navigation program, and (4) client self-efficacy and feelings of hope and psychological change as a result of their navigation experience. The unifying theme across all studies was the value and impact of the client-navigator relationship on client experience and quality of life. Programs should consider hiring navigators who possess strong relational skills and are peers of the clients, and clearly delineating the role of the navigator. Research should examine the impact of the client-navigator relationship on client outcomes and further investigate how participating in patient navigation affects client self-efficacy, client resiliency, and the role of posttraumatic growth to achieve improved HIV outcomes. This review underscores the significance of the relationship within intensive, multilevel interventions for individuals and communities marginalized and isolated from health and social service systems. |
Factors affecting pre-exposure prophylaxis implementation for women in the United States: A systematic review
Bradley E , Forsberg K , Betts JE , DeLuca JB , Kamitami E , Porter SE , Sipe TA , Hoover KW . J Womens Health (Larchmt) 2019 28 (9) 1272-1285 Oral HIV pre-exposure prophylaxis (PrEP) is a highly effective pill that HIV-negative individuals can take once daily to prevent HIV infection. Although PrEP is a private, user-controlled method that empowers women to protect themselves without relying on a partner's behavior, women's PrEP use has been extremely low. We systematically reviewed the literature to identify and summarize factors that may be affecting PrEP implementation for women in the United States. We conducted a search of the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database (MEDLINE, EMBASE, and CINAHL) and PubMed to identify peer-reviewed studies published between January 2000 and April 2018 that reported U.S. women's or health care providers' PrEP knowledge or awareness, willingness to use or prescribe, attitudes, barriers and facilitators to use or prescription, or PrEP adherence and discontinuation influences. Thirty-nine studies (26 women, 13 providers) met the eligibility criteria. In these studies, 0%-33% of women had heard of PrEP. Between 51% and 97% of women were willing to try PrEP, and 60%-92% of providers were willing to prescribe PrEP to women. Implementation barriers included access, cost, stigma, and medical distrust. Three studies addressed adherence or discontinuation. PrEP knowledge is low among women and providers. However, women and providers generally have positive views when aware of PrEP, including a willingness to use or prescribe PrEP to women. Most of the implementation barriers highlighted in studies were social or structural factors (e.g., access). Additional studies are needed to address research gaps, including studies of PrEP adherence and discontinuation. |
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