Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Duffus WA[original query] |
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Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020 (preprint)
Holden TM , Richardson RAK , Arevalo P , Duffus WA , Runge M , Whitney E , Wise L , Ezike NO , Patrick S , Cobey S , Gerardin J . medRxiv 2021 BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS: We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS: By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS: Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission. |
SARS-CoV-2 Infection Among Pregnant People at Labor and Delivery and Changes in Infection Rates in the General Population: Lessons Learned From Illinois.
Goyal S , Gerardin J , Cobey S , Son C , McCarthy O , Dror A , Lightner S , Ezike NO , Duffus WA , Bennett AC . Public Health Rep 2022 137 (4) 333549221091826 OBJECTIVES: The Illinois Department of Public Health (IDPH) assessed whether increases in the SARS-CoV-2 test positivity rate among pregnant people at labor and delivery (L&D) could signal increases in SARS-CoV-2 prevalence in the general Illinois population earlier than current state metrics. MATERIALS AND METHODS: Twenty-six birthing hospitals universally testing for SARS-CoV-2 at L&D voluntarily submitted data from June 21, 2020 through January 23, 2021, to IDPH. Hospitals reported the daily number of people who delivered, SARS-CoV-2 tests, and test results as well as symptom status. We compared the test positivity rate at L&D with the test positivity rate of the general population and the number of hospital admissions for COVID-19-like illness by quantifying correlations in trends and identifying a lead time. RESULTS: Of 26 633 reported pregnant people who delivered, 96.8% (n = 25 772) were tested for SARS-CoV-2. The overall test positivity rate was 2.4% (n = 615); 77.7% (n = 478) were asymptomatic. In Chicago, the only region with a sufficient sample size for analysis, the test positivity rate at L&D (peak of 5% on December 7, 2020) was lower and more stable than the test positivity rate of the general population (peak of 14% on November 13, 2020) and lagged hospital admissions for COVID-19-like illness (peak of 118 on November 15, 2020) and the test positivity rate of the general population by about 10 days (Pearson correlation = 0.73 and 0.75, respectively). PRACTICE IMPLICATIONS: Trends in the test positivity rate at L&D did not provide an earlier signal of increases in Illinois's SARS-CoV-2 prevalence than current state metrics did. Nonetheless, the role of universal testing protocols in identifying asymptomatic infection is important for clinical decision making and patient education about infection prevention and control. |
Acquired HIV drug resistance and virologic monitoring in a HIV hyper-endemic setting in KwaZulu-Natal Province, South Africa.
Chimukangara B , Lessells RJ , Singh L , Grigalionyte I , Yende-Zuma N , Adams R , Dawood H , Dlamini L , Buthelezi S , Chetty S , Diallo K , Duffus WA , Mogashoa M , Hagen MB , Giandhari J , de Oliveira T , Moodley P , Padayatchi N , Naidoo K . AIDS Res Ther 2021 18 (1) 74 BACKGROUND: Introduction of tenofovir (TDF) plus lamivudine (3TC) and dolutegravir (DTG) in first- and second-line HIV treatment regimens in South Africa warrants characterization of acquired HIV-1 drug resistance (ADR) mutations that could impact DTG-based antiretroviral therapy (ART). In this study, we sought to determine prevalence of ADR mutations and their potential impact on susceptibility to drugs used in combination with DTG among HIV-positive adults (≥ 18 years) accessing routine care at a selected ART facility in KwaZulu-Natal, South Africa. METHODS: We enrolled adult participants in a cross-sectional study between May and September 2019. Eligible participants had a most recent documented viral load (VL) ≥ 1000 copies/mL after at least 6 months on ART. We genotyped HIV-1 reverse transcriptase and protease genes by Sanger sequencing and assessed ADR. We characterized the effect of ADR mutations on the predicted susceptibility to drugs used in combination with DTG. RESULTS: From 143 participants enrolled, we obtained sequence data for 115 (80%), and 92.2% (95% CI 85.7-96.4) had ADR. The proportion with ADR was similar for participants on first-line ART (65/70, 92.9%, 95% CI 84.1-97.6) and those on second-line ART (40/44, 90.9%, 95% CI 78.3-97.5), and was present for the single participant on third-line ART. Approximately 89% (62/70) of those on first-line ART had dual class NRTI and NNRTI resistance and only six (13.6%) of those on second-line ART had major PI mutations. Most participants (82%) with first-line viraemia maintained susceptibility to Zidovudine (AZT), and the majority of them had lost susceptibility to TDF (71%) and 3TC (84%). Approximately two in every five TDF-treated individuals had thymidine analogue mutations (TAMs). CONCLUSIONS: Susceptibility to AZT among most participants with first-line viraemia suggests that a new second-line regimen of AZT + 3TC + DTG could be effective. However, atypical occurrence of TAMs in TDF-treated individuals suggests a less effective AZT + 3TC + DTG regimen in a subpopulation of patients. As most patients with first-line viraemia had at least low-level resistance to TDF and 3TC, identifying viraemia before switch to TDF + 3TC + DTG is important to avoid DTG functional monotherapy. These findings highlight a need for close monitoring of outcomes on new standardized treatment regimens. |
Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, March to December 2020.
Holden TM , Richardson RAK , Arevalo P , Duffus WA , Runge M , Whitney E , Wise L , Ezike NO , Patrick S , Cobey S , Gerardin J . BMC Public Health 2021 21 (1) 1105 BACKGROUND: Availability of SARS-CoV-2 testing in the United States (U.S.) has fluctuated through the course of the COVID-19 pandemic, including in the U.S. state of Illinois. Despite substantial ramp-up in test volume, access to SARS-CoV-2 testing remains limited, heterogeneous, and insufficient to control spread. METHODS: We compared SARS-CoV-2 testing rates across geographic regions, over time, and by demographic characteristics (i.e., age and racial/ethnic groups) in Illinois during March through December 2020. We compared age-matched case fatality ratios and infection fatality ratios through time to estimate the fraction of SARS-CoV-2 infections that have been detected through diagnostic testing. RESULTS: By the end of 2020, initial geographic differences in testing rates had closed substantially. Case fatality ratios were higher in non-Hispanic Black and Hispanic/Latino populations in Illinois relative to non-Hispanic White populations, suggesting that tests were insufficient to accurately capture the true burden of COVID-19 disease in the minority populations during the initial epidemic wave. While testing disparities decreased during 2020, Hispanic/Latino populations consistently remained the least tested at 1.87 tests per 1000 population per day compared with 2.58 and 2.87 for non-Hispanic Black and non-Hispanic White populations, respectively, at the end of 2020. Despite a large expansion in testing since the beginning of the first wave of the epidemic, we estimated that over half (50-80%) of all SARS-CoV-2 infections were not detected by diagnostic testing and continued to evade surveillance. CONCLUSIONS: Systematic methods for identifying relatively under-tested geographic regions and demographic groups may enable policymakers to regularly monitor and evaluate the shifting landscape of diagnostic testing, allowing officials to prioritize allocation of testing resources to reduce disparities in COVID-19 burden and eventually reduce SARS-CoV-2 transmission. |
Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event - Illinois, February 2021.
Sami S , Turbyfill CR , Daniel-Wayman S , Shonkwiler S , Fisher KA , Kuhring M , Patrick AM , Hinton S , Minor AS , Ricaldi JN , Ezike N , Kauerauf J , Duffus WA . MMWR Morb Mortal Wkly Rep 2021 70 (14) 528-532 During February 2021, an opening event was held indoors at a rural Illinois bar that accommodates approximately 100 persons. The Illinois Department of Public Health (IDPH) and local health department staff members investigated a COVID-19 outbreak associated with this opening event. Overall, 46 COVID-19 cases were linked to the event, including cases in 26 patrons and three staff members who attended the opening event and 17 secondary cases. Four persons with cases had COVID-19-like symptoms on the same day they attended the event. Secondary cases included 12 cases in eight households with children, two on a school sports team, and three in a long-term care facility (LTCF). Transmission associated with the opening event resulted in one school closure affecting 650 children (9,100 lost person-days of school) and hospitalization of one LTCF resident with COVID-19. These findings demonstrate that opening up settings such as bars, where mask wearing and physical distancing are challenging, can increase the risk for community transmission of SARS-CoV-2, the virus that causes COVID-19. As community businesses begin to reopen, a multicomponent approach should be emphasized in settings such as bars to prevent transmission* (1). This includes enforcing consistent and correct mask use, maintaining ≥6 ft of physical distance between persons, reducing indoor bar occupancy, prioritizing outdoor seating, improving building ventilation, and promoting behaviors such as staying at home when ill, as well as implementing contact tracing in combination with isolation and quarantine when COVID-19 cases are diagnosed. |
HIV infection-related care outcomes among U.S.-born and non-U.S.-born blacks with diagnosed HIV in 40 U.S. areas: The National HIV Surveillance System, 2016
Demeke HB , Johnson AS , Zhu H , Gant Z , Duffus WA , Dean HD . Int J Environ Res Public Health 2018 15 (11) HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged >/=13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in </=1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs. |
Screening for latent tuberculosis infection among HIV-infected Medicaid enrollees
Friedman EE , Khan A , Duffus WA . Public Health Rep 2018 133 (4) 33354918776639 OBJECTIVES: In the United States, universal screening for latent tuberculosis (TB) infection among people with HIV is recommended, but the percentage receiving screening is unknown. This study assessed screening for latent TB infection among people with HIV enrolled in Medicaid during 2006-2010. METHODS: We used nationwide fee-for-service Medicaid records to identify people with HIV, measure screening for latent TB infection, and examine associated demographic, social, and clinical factors. We used logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs). We created 2 multivariate models to prevent collinearity between variables for length of HIV infection. RESULTS: Of 152 831 people with HIV, 26 239 (17.2%) were screened for latent TB infection. The factor most strongly associated with screening was TB exposure or suspected TB (OR = 3.78; 95% CI, 3.27-4.37). Significant demographic characteristics associated with screening included being African American (OR = 1.28; 95% CI, 1.24-1.32) or </=20 years of age (OR = 1.35; 95% CI, 1.28-1.42). Significant clinical and social factors associated with screening included poor housing conditions, low body mass index, chemotherapy treatment, and use of certain substances (ORs ranged from 1.24 [95% CI, 1.20-1.27] to 1.47 [95% CI, 1.22-1.76]). The screening rate for latent TB infection was higher among people with newly diagnosed HIV infection than among those with established infection (OR = 1.37; 95% CI, 1.32-1.41) and among people with a longer established HIV infection than among those with shorter HIV infection (OR = 1.24; 95% CI, 1.23-1.26 for each additional year). CONCLUSION: Screening for latent TB infection among fee-for-service Medicaid beneficiaries with HIV was suboptimal, despite the presence of demographic, social, or clinical characteristics that should have increased the likelihood of screening. The lack of certain data in Medicaid may have resulted in an underestimation of screening. |
Incorporation of social determinants of health in the peer-reviewed literature: A systematic review of articles authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Friedman EE , Dean HD , Duffus WA . Public Health Rep 2018 133 (4) 33354918774788 OBJECTIVES: Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP. METHODS: We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of </=3 foci of the article) or "minimal" (ie, one of >/=4 foci of the article). RESULTS: Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%). CONCLUSIONS: This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic. |
Missed opportunities to prescribe preexposure prophylaxis in South Carolina, 2013-2016
Smith DK , Chang MH , Duffus WA , Okoye S , Weissman S . Clin Infect Dis 2018 68 (1) 37-42 Introduction: Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important HIV prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits occurring prior to HIV infection. Methods: This retrospective cohort study linked South Carolina HIV case surveillance data to 3 statewide healthcare databases. Characteristics of patients, health care visits and providers, sexually transmitted diseases (STD), and other diagnoses, were assessed for medical encounters occurring before an initial HIV diagnosis. Adjusted odds ratios were used to identify correlates of missed opportunities for PrEP provision. Results: Of 885 persons newly diagnosed during the study period, 586 (66%) had 4,029 visits to a health care facility prior to their HIV diagnosis (mean of 6.9 visits) with missed opportunities for provision of PrEP. Emergency medicine trained clinicians conducted (61%) and primary care clinicians (family practice or internal medicine) conducted. 10% of visits. 42% of visits were by persons who were uninsured or self-paid, 36% had public insurance, and 18% had commercial insurance In multivariable analyses, being female, African American, or < 30 years of age were statistically significant predictors of having prior health care visits. Among persons at least one health care visit prior to their HIV diagnosis, 28.5% had a diagnosis of gonorrhea, syphilis, or chlamydia at any visit. Conclusion: Healthcare visits occurring among persons who would benefit from provision of PrEP, especially persons with diagnosed STDs, should be leveraged to increase use of PrEP and reduce the risk of HIV acquisition. |
Social determinants of health associated with HBV testing and access to care among foreign-born persons residing in the United States: 2009 - 2012
Greene KM , Duffus WA , Xing J , King H . J Health Dispar Res Pract 2017 10 (2) 1-20 OBJECTIVES: To describe how select Social Determinants of Health (SDH) are associated with the burden of hepatitis B virus (HBV) infection among foreign-born persons residing in the United States. METHODS: Multivariate logistic regression was used to examine the Racial and Ethnic Approaches to Community Health (REACH) 2010 Risk Factor Survey data to investigate the independent relationship between SDH and HBV testing and access to care. RESULTS: HBV infected persons with insurance were more likely to see a physician than those without. Respondents worried about money to pay rent or mortgage were more likely to report HBV infection than individuals who reported they never worry. Compared to English speakers, Spanish-speakers were less likely to report HBV infection, Vietnamese-speakers were more likely to see a physician for HBV infection, and Khmer-speakers were less likely to be tested. CONCLUSIONS: Health insurance coverage, worries about paying rent, and language of interview all differentially affect HBV testing and linkages to care among foreign-born persons. Multi-sectorial stakeholder collaborative efforts should integrate resources to provide culturally sensitive health promotion campaigns which may improve HBV related outcomes. |
Chronic health conditions in Medicare beneficiaries 65 years and older with HIV infection
Friedman EE , Duffus WA . AIDS 2016 30 (16) 2529-2536 OBJECTIVES: to examine sociodemographic factors and chronic health conditions of people living with HIV (PLWHIV/ HIV+) ≥65 years, and to compare their chronic disease prevalence to beneficiaries without HIV. DESIGN: National fee for service (FFS) Medicare claims data (parts A and B) from 2006-2009 were used to create a retrospective cohort of beneficiaries >65 years old. METHODS: Beneficiaries with 1 inpatient or skilled nursing facility claim, or 2 outpatient claims with HIV diagnosis codes were considered HIV+. HIV+ beneficiaries were compared to uninfected beneficiaries on demographic factors and on the prevalence of hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, and diabetes. Odds ratios (OR), 95% confidence intervals (CI), and p-values were calculated. Adjustment variables included age, sex, race/ethnicity, end stage renal disease (ESRD), and dual Medicare-Medicaid enrollment. Chronic conditions were examined individually, and as an index from zero to all five conditions. RESULTS: Of 29,060,418 eligible beneficiaries, 24,735 (0.09%) were HIV+. HIV+ beneficiaries were more likely to be Hispanic, African American, male, and younger (p>0.0001), and were 1.5 to 2.1 times as likely to have a chronic disease (diabetes (aOR) 1.51 95% CI (1.47, 1.55): rheumatoid arthritis/osteoarthritis 2.14 95% CI (2.08, 2.19)), and 2.4 to 7 times as likely to have 1-5 co-morbid chronic conditions (1 condition (aOR) 2.38 95% CI (2.21, 2.57): 5 conditions 7.07 95% CI (6.61, 7.56)). CONCLUSIONS: Our results show that PLWHIV ≥65 years are at higher risk of comorbidities than other FFS Medicare beneficiaries. This finding has implications for both the management and cost of the health of PLWHIV ≥65. |
Training racial and ethnic minority students for careers in public health sciences
Duffus WA , Trawick C , Moonesinghe R , Tola J , Truman BI , Dean HD . Am J Prev Med 2014 47 S368-375 BACKGROUND: A workforce that resembles the society it serves is likely to be more effective in improving health equity for racial and ethnic minorities in the U.S. Racial and ethnic minorities are underrepresented in the U.S. public health professions. Project Imhotep is operated by Morehouse College with funding and technical assistance from CDC. Imhotep trains racial and ethnic minority students for entry into graduate and professional training programs for careers in the public health sciences. The curriculum focuses on biostatistics, epidemiology, and occupational safety and health with practical training in statistical data analysis, scientific writing, and oral presentation skills. PURPOSE: To describe the Imhotep program and highlight some of its outcomes. METHODS: Data were collected every year by self-administered questionnaire or follow-up telephone and e-mail interviews of students who participated in Imhotep during 1982-2010 and were followed through December 2013. RESULTS: Findings demonstrated that 100% of the 481 trained students earned bachelor's degrees; 73.2% earned graduate degrees (53% earned master's degrees, 11.1% earned medical degrees, and 7.3% earned other doctoral degrees); and 60% entered public health careers. CONCLUSIONS: The Imhotep program has improved the representation of racial and ethnic minorities among public health professionals in the U.S. A diverse workforce involving Imhotep graduates could augment the pool of pubic health professionals who make strategic and tactical decisions around program design and resource allocation that impact health in the most affected communities. |
Predictors of time to enter medical care after a new HIV diagnosis: a statewide population-based study
Tripathi A , Gardner LI , Ogbuanu I , Youmans E , Stephens T , Gibson JJ , Duffus WA . AIDS Care 2011 23 (11) 1366-73 Public health benefits of expanded HIV screening will be adequately realized only if an early diagnosis is followed by prompt linkage to care. We characterized rates and factors associated with failure to enter into medical care within three months of HIV diagnosis and assessed the predictors of time to enter care over a follow-up period of up to 60 months. The study cohort included 3697 South Carolina (SC) residents'≥13 years who were newly HIV-diagnosed in 2004-2008. Date of first laboratory report of CD4(+) T-cell count or viral load (VL) test after 30 days of confirmatory HIV diagnosis was used to define time to linkage to care. Results showed that of the total 3697 persons, 1768 (48%) entered care within three months, 1115 (30%) in four-12 months after diagnosis, and 814 (22%) failed to initiate care within 12 months of HIV diagnosis. At the end of study follow-up period of up to 60 months from the date of HIV diagnosis, 472/3697 (13%) individuals remained out of care. Multivariable Cox proportional hazards analysis showed that compared with hospitals, time to enter care was shorter in those diagnosed at state mental health/correctional facilities (adjusted hazards ratio [aHR] 1.16; 95% confidence interval [CI] 1.02-1.34) and longer in those diagnosed at county health departments (aHR 0.87; 95% CI 0.80-0.96) and at "Other/unknown" facilities (aHR 0.79; 95% CI 0.70-0.89). Time to entry into care was longer for men (aHR 0.82; 95% CI 0.75-0.89) compared with women, blacks (aHR 0.91; 95% CI 0.83-0.98) compared with whites, and males who have sex with males (MSM) (aHR 0.89; 95% CI 0.80-0.98) compared with heterosexual exposure. Delayed entry into HIV care remains a challenge in controlling HIV transmission in SC. Better integration of testing and care facilities could improve the proportion of newly HIV-diagnosed persons who enter care in a timely manner. |
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