Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
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Low self-perceived need for PrEP and behavioral indications of MSM who recently refused daily PrEP: A mixed methods study in three U.S. Cities
Kota KK , Gelaude D , Carnes N , Schoua-Glusberg A , Frew PM , Randall L , Gale B , Betley V , Mansergh G . AIDS Behav 2024 Pre-exposure prophylaxis (PrEP) reduces sexual risk for HIV transmission by 99% when used appropriately, but remains underutilized among gay, bisexual, and other men who have sex with men (MSM). In this mixed-method study, we describe reasons for PrEP refusal associated with low self-perceived need for PrEP among MSM who recently declined daily oral PrEP when offered by a provider. Data are from a quantitative behavioral survey of MSM (N = 93) living in Atlanta, Chicago, and Raleigh-Durham, who also either responded to an in-depth interview (n = 51) or participated in one of 12 focus groups (n = 42). Themes of low self-perceived need for PrEP were: low self-perceived risk for HIV acquisition (33% of respondents); confidence in remaining HIV-negative (35%); using condoms (81%); limiting number of partners and choosing partners carefully (48%); asking partners about their HIV status before having sex (45%); engaging in safer sexual positions or oral sex (28%); being in a monogamous relationship or exclusivity with one partner (26%); and regular HIV testing (18%). Low self-perceived risk for HIV acquisition and high confidence in other prevention strategies were important factors related to low self-perceived need in MSM refusing daily oral PrEP when offered. Providers should continue to discuss the benefits of PrEP as a safe and highly effective option for HIV prevention. |
Incidence of hyperlipidemia among adults initiating antiretroviral therapy in the HIV Outpatient Study (HOPS), USA, 2007-2021
Li J , Agbobli-Nuwoaty S , Palella FJ , Novak RM , Tedaldi E , Mayer C , Mahnken JD , Hou Q , Carlson K , Thompson-Paul AM , Durham MD , Buchacz K . AIDS Res Treat 2023 2023 4423132 Current U.S. guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as initial treatment for people with HIV (PWH). We assessed long-term effects of INSTI use on lipid profiles in routine HIV care. We analyzed medical record data from the HIV Outpatient Study's participants in care from 2007 to 2021. Hyperlipidemia was defined based on clinical diagnoses, treatments, and laboratory results. We calculated hyperlipidemia incidence rates and rate ratios (RRs) during initial ART and assessed predictors of incident hyperlipidemia by using Poisson regression. Among 349 eligible ART-naïve PWH, 168 were prescribed INSTI-based ART (36 raltegravir (RAL), 51 dolutegravir (DTG), and 81 INSTI-others (elvitegravir and bictegravir)) and 181 non-INSTI-based ART, including 68 protease inhibitor (PI)-based ART. During a median follow-up of 1.4 years, hyperlipidemia rates were 12.8, 22.3, 22.7, 17.4, and 12.6 per 100 person years for RAL-, DTG-, INSTI-others-, non-INSTI-PI-, and non-INSTI-non-PI-based ART, respectively. In multivariable analysis, compared with the RAL group, hyperlipidemia rates were higher in INSTI-others (RR = 2.25; 95% confidence interval (CI): 1.29-3.93) and non-INSTI-PI groups (RR = 1.89; CI: 1.12-3.19) but not statistically higher for the DTG (RR = 1.73; CI: 0.95-3.17) and non-INSTI-non-PI groups (RR = 1.55; CI: 0.92-2.62). Other factors independently associated with hyperlipidemia included older age, non-Hispanic White race/ethnicity, and ART without tenofovir disoproxil fumarate. PWH using RAL-based regimens had lower rates of incident hyperlipidemia than PWH receiving non-INSTI-PI-based ART but had similar rates as those receiving DTG-based ART, supporting federal recommendations for using DTG-based regimens as the initial therapy for ART-naïve PWH. |
Greener residential environment is associated with increased bacterial diversity in outdoor ambient air
Styles JN , Egorov AI , Griffin SM , Klein J , Scott JW , Sams EA , Hudgens E , Mugford C , Stewart JR , Lu K , Jaspers I , Keely SP , Brinkman NE , Arnold JW , Wade TJ . Sci Total Environ 2023 880 163266 In urban areas, exposure to greenspace has been found to be beneficial to human health. The biodiversity hypothesis proposed that exposure to diverse ambient microbes in greener areas may be one pathway leading to health benefits such as improved immune system functioning, reduced systemic inflammation, and ultimately reduced morbidity and mortality. Previous studies observed differences in ambient outdoor bacterial diversity between areas of high and low vegetated land cover but didn't focus on residential environments which are important to human health. This research examined the relationship between vegetated land and tree cover near residence and outdoor ambient air bacterial diversity and composition. We used a filter and pump system to collect ambient bacteria samples outside residences in the Raleigh-Durham-Chapel Hill metropolitan area and identified bacteria by 16S rRNA amplicon sequencing. Geospatial quantification of total vegetated land or tree cover was conducted within 500 m of each residence. Shannon's diversity index and weighted UniFrac distances were calculated to measure α (within-sample) and β (between-sample) diversity, respectively. Linear regression for α-diversity and permutational analysis of variance (PERMANOVA) for β-diversity were used to model relationships between vegetated land and tree cover and bacterial diversity. Data analysis included 73 ambient air samples collected near 69 residences. Analysis of β-diversity demonstrated differences in ambient air microbiome composition between areas of high and low vegetated land (p = 0.03) and tree cover (p = 0.07). These relationships remained consistent among quintiles of vegetated land (p = 0.03) and tree cover (p = 0.008) and continuous measures of vegetated land (p = 0.03) and tree cover (p = 0.03). Increased vegetated land and tree cover were also associated with increased ambient microbiome α-diversity (p = 0.06 and p = 0.03, respectively). To our knowledge, this is the first study to demonstrate associations between vegetated land and tree cover and the ambient air microbiome's diversity and composition in the residential ecosystem. |
Exploring the Applicability of Using Natural Language Processing to Support Nationwide Venous Thromboembolism Surveillance: Model Evaluation Study
Wendelboe A , Saber I , Dvorak J , Adamski A , Feland N , Reyes N , Abe K , Ortel T , Raskob G . JMIR Bioinform Biotech 2022 3 (1) BACKGROUND: Venous thromboembolism (VTE) is a preventable, common vascular disease that has been estimated to affect up to 900,000 people per year. It has been associated with risk factors such as recent surgery, cancer, and hospitalization. VTE surveillance for patient management and safety can be improved via natural language processing (NLP). NLP tools have the ability to access electronic medical records, identify patients that meet the VTE case definition, and subsequently enter the relevant information into a database for hospital review. OBJECTIVE: We aimed to evaluate the performance of a VTE identification model of IDEAL-X (Information and Data Extraction Using Adaptive Learning; Emory University)-an NLP tool-in automatically classifying cases of VTE by "reading" unstructured text from diagnostic imaging records collected from 2012 to 2014. METHODS: After accessing imaging records from pilot surveillance systems for VTE from Duke University and the University of Oklahoma Health Sciences Center (OUHSC), we used a VTE identification model of IDEAL-X to classify cases of VTE that had previously been manually classified. Experts reviewed the technicians' comments in each record to determine if a VTE event occurred. The performance measures calculated (with 95% CIs) were accuracy, sensitivity, specificity, and positive and negative predictive values. Chi-square tests of homogeneity were conducted to evaluate differences in performance measures by site, using a significance level of .05. RESULTS: The VTE model of IDEAL-X "read" 1591 records from Duke University and 1487 records from the OUHSC, for a total of 3078 records. The combined performance measures were 93.7% accuracy (95% CI 93.7%-93.8%), 96.3% sensitivity (95% CI 96.2%-96.4%), 92% specificity (95% CI 91.9%-92%), an 89.1% positive predictive value (95% CI 89%-89.2%), and a 97.3% negative predictive value (95% CI 97.3%-97.4%). The sensitivity was higher at Duke University (97.9%, 95% CI 97.8%-98%) than at the OUHSC (93.3%, 95% CI 93.1%-93.4%; P<.001), but the specificity was higher at the OUHSC (95.9%, 95% CI 95.8%-96%) than at Duke University (86.5%, 95% CI 86.4%-86.7%; P<.001). CONCLUSIONS: The VTE model of IDEAL-X accurately classified cases of VTE from the pilot surveillance systems of two separate health systems in Durham, North Carolina, and Oklahoma City, Oklahoma. NLP is a promising tool for the design and implementation of an automated, cost-effective national surveillance system for VTE. Conducting public health surveillance at a national scale is important for measuring disease burden and the impact of prevention measures. We recommend additional studies to identify how integrating IDEAL-X in a medical record system could further automate the surveillance process. |
Refusal of daily oral PrEP: Implementation considerations and reported likelihood of using various HIV prophylaxis products in a diverse sample of MSM
Mansergh G , Kota KK , Carnes N , Gelaude D . J Acquir Immune Defic Syndr 2023 92 (3) 212-216 BACKGROUND: An important subgroup of gay, bisexual, and other men who have sex with men (MSM) with behavioral indications refuse daily oral pre-exposure prophylaxis (PrEP) when recommended by a provider. Emerging HIV prophylaxis products (eg, injectable, event-driven) offer more options to MSM who refuse daily PrEP. In this article, we assess reasons for refusal and likelihood to use various products among MSM who refused PrEP. METHODS: MSM who reported anal sex without condoms or PrEP and refused daily oral PrEP in the past 6 months were recruited through clinics, community venues, and online in Atlanta, Chicago, and Raleigh-Durham. Men were asked their main reason for recently refusing daily PrEP and likelihood of using various PrEP options in the future. Bivariate and multivariable regression models were used to estimate associations. RESULTS: MSM (n = 93; 70% Black, 48% age 18-29 years) reported their main reason for refusing daily PrEP were potential side effects (35%), a daily pill regimen (22%), and not having enough information (18%). Reported likelihood of using PrEP products was 58% for penile gel, 54% for event-driven oral, 52% for injectable, and 50% for daily PrEP. MSM who reported daily regimen as the main reason for refusing PrEP had greater odds of likelihood to use an injectable [adjusted odds ratio (AOR) = 5.21, 95% confidence interval (CI): 1.32 to 20.52]. Younger men (18-29 vs 30+ years) had greater odds of likelihood to use condoms (AOR = 3.40, 95% CI: 1.15 to 10.04) and daily PrEP (AOR = 2.76, 95% CI: 1.06 to 7.16); there were no product preference differences by race. CONCLUSION: Most men who refused daily PrEP indicated likelihood of using some form of PrEP in the future. |
Weight gain and metabolic effects in persons with HIV who switch to ART regimens containing integrase inhibitors or tenofovir alafenamide
Palella FJ , Hou Q , Li J , Mahnken J , Carlson KJ , Durham M , Ward D , Fuhrer J , Tedaldi E , Novak R , Buchacz K . J Acquir Immune Defic Syndr 2022 92 (1) 67-75 BACKGROUND: The timing and magnitude of antiretroviral therapy-associated weight change attributions are unclear. SETTING: HIV Outpatient Study participants. METHODS: We analyzed 2007-2018 records of virally suppressed (VS) persons without integrase inhibitor (INSTI) experience who switched to either INSTI- or another non-INSTI-based ART, and remained VS. We analyzed BMI changes using linear mixed models (LMM), INSTI-and tenofovir alafenamide (TAF) contributions to BMI change by LMM-estimated slopes, and BMI inflection points. RESULTS: Among 736 participants (5,316 person-years), 441 (60%) switched to INSTI-based ART; the remainder to non-INSTI-based ART. Mean follow-up was 7.15 years for INSTI recipients, 7.35 years for non-INSTI. Pre-switch, INSTI and non-INSTI groups had similar median BMI (26.3 versus 25.9 kg/m2, p=0.41). INSTI regimens included raltegravir (178), elvitegravir (112) and dolutegravir (143). Monthly BMI increases post-switch were greater with INSTI than non-INSTI (0.0525 versus 0.006, p<0.001). A BMI inflection point occurred eight months after switch among INSTI users; slopes were similar regardless of TAF use immediately post-switch. Among INSTI+TAF users, during eight months post-switch, 87% of BMI slope change was associated with INSTI use, 13% with TAF use; after eight months, estimated contributions were 27% and 73%, respectively. For non-INSTI+TAF, 84% of BMI gain was TAF-associated consistently post switch. Persons switching from TDF to TAF had greater BMI increases than others (p<0.001). CONCLUSION: Among VS persons who switched ART, INSTI and TAF use were independently associated with BMI increases. During eight months post-switch, BMI changes were greatest and most associated with INSTI use; afterward, gradual BMI gain was largely TAF-associated. |
Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina
Saber I , Adamski A , Kuchibhatla M , Abe K , Beckman M , Reyes N , Schulteis R , Pendurthi Singh B , Sitlinger A , Thames EH , Ortel TL . Res Pract Thromb Haemost 2022 6 (5) e12769 BACKGROUND: Venous thromboembolism (VTE) affects approximately 1-2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. OBJECTIVE: To determine risk factors, incidence, treatments, and outcomes of VTE through a 2-year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). PATIENTS/METHODS: We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. RESULTS: A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital-associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were younger than White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). CONCLUSIONS: Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospital-associated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals. |
Longitudinal changes in, and factors associated with, the frequency of condomless sex among people in care for HIV infection, HIV outpatient study USA, 2007-2019
Durham MD , Armon C , Novak RM , Mahnken JD , Carlson K , Li J , Buchacz K . AIDS Behav 2022 26 (10) 3199-3209 During 2007-2019, the percentage of HIV Outpatient Study participants reporting anal or vaginal condomless sex in the past 6 months ranged from a low of 17% among heterosexual males to 59% for men who have sex with men (MSM). MSM reported having had condomless sex more frequently than heterosexual males and females and were the only group in which an increase in condomless sex was observed during the study period (from 39 to 59%). Although persons with undetectable HIV viral load have effectively no risk of transmitting HIV sexually (U = U), there is still the potential risk of transmission or acquisition of other sexually transmitted infections (STIs) when engaging in condomless sex. Continuing education about risks of HIV and STI transmission as well as ongoing screening for and treatment of STIs, retention in HIV treatment, and support for sexual health are critical components of care for people living with HIV. |
Changes and Geographic Variation in Rates of Preterm Birth and Stillbirth during the COVID-19 Pandemic According to Health Insurance Claims in the United States, April-June 2019-2020.
Chen J , Ferre C , Ouyang L , Mohamoud Y , Barfield W , Cox S . Am J Obstet Gynecol MFM 2022 4 (1) 100508 OBJECTIVE: Studies from Europe1 reported a reduction in the preterm birth rates early in the COVID-19 pandemic, but data from other world regions offered conflicting evidence.2 In the United States, evidence on preterm birth and stillbirth rates during the pandemic is also mixed.3,4 Existing studies were often limited to specific US hospitals or states or had missing information on stillbirths. We examined the temporal changes in US preterm birth and stillbirth rates by comparing the prepandemic rates with those during a period of reduced population movement (lockdown) and we investigated the geographic variation in the changes by census regions. | | STUDY DESIGN: We used IQVIA's PharMetrics Plus database (IQVIA, Durham, NC) a large convenience sample of claims data that included about one-fifth of US births covered by commercial health insurance, to compare rates between the lockdown period (AprilJune 2020) and a comparison prepandemic period (AprilJune 2019). We identified singleton delivery hospitalizations at 20 weeks gestation using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology codes. We extracted information about the weeks of gestation and birth outcomes (live birth or stillbirth) for each delivery. Preterm birth rates (birth at <37 weeks gestation), late preterm birth rates (birth at 34 to 36 weeks gestation), and early preterm birth rates (birth at <34 weeks gestation) were examined. Stillbirth rates were also examined. We used a logistic regression to compare the birth outcome rates between the 2 time periods, adjusting for census region and maternal age. Although race and ethnicity data were available through data linkages for 12% of the sample, the missing or unknown category in the linked data was still more than 30%, limiting our ability to adjust for or stratify by this variable. We reported the adjusted rate measured in percentage point (%), adjusted rate difference (ARD), and adjusted rate ratio using predictive margins from each regression model. To examine geographic variation, we used interaction terms between the indicator variables for the time period and census region. | | RESULTS: Among 165,433 privately-insured women with singleton deliveries at 20 weeks gestation during the study periods, 0.2% were stillbirths, and 99.8% were live births; and of the live births, approximately 7% were preterm in both the time periods (Table 1). The adjusted rate of preterm birth during the 2020 lockdown was lower than the adjusted rate during the same months in 2019 (7.0% vs 7.4%; ARD=0.4%; 95% CI, 0.6 to 0.1). There was no change in the adjusted rate of stillbirth (ARD=0.02%; 95% CI, 0.07 to 0.02). The reduction in preterm birth was driven by the decrease in late preterm birth (ARD=0.3%; 95% CI, 0.6 to 0.1) (Table 2). The largest reduction in preterm birth was in the Northeast (ARD=1.1; 95% CI, 1.8 to 0.5) (Table 2). |
Costs associated with incorporation of network approaches into STD program activities
Williams AM , Eppink ST , Guy JN , Sea AC , Berruti AA . Sex Transm Dis 2022 Online Ahead of Print (5) 325-329 Network approaches can be used to study sociosexual partnerships and identify individuals at high risk of infection. Little is known about the cost structure of these services and their association with STD diagnoses. METHOD: We collected costs associated with using a peer network strategy to recruit MSM and transwomen of color in 4 counties in North Carolina: Guilford, Forsyth, Durham, and Wake from February through October 2019. We used a comprehensive costing approach to gather detailed retrospective information on the intervention cost, broken down by category and programmatic activity. RESULTS: The sociosexual networks collected consisted of 31 initial seeds (index cases) and 49 peers of those seeds. In peers, 5 cases of HIV and 10 cases of syphilis were identified. The cost per case (HIV or syphilis) identified was $7,325. Personnel costs accounted for 80% of total expenditures, followed by laboratory expenses (12%). Personnel cost was distributed between DIS patient navigators (51%), non-clinical (37%), and management (12%) staff. General administration was the costliest programmatic activity (37%), followed by case management and field services (37%), and study activities (11%). The estimated average cost per patient tested was $2,242. CONCLUSIONS: Finding positive peer cases in non-clinical settings is costly but may be crucial for limiting the spread of sexually transmitted diseases. The cost of staff was the major driver. This study demonstrates that using a network strategy can be a cost-effective way to identify, test, and refer patients at high-risk of syphilis and HIV infections to care. |
Disparities in Treatment with Direct-Acting Hepatitis C Virus Antivirals Persist Among Adults Coinfected with HIV and Hepatitis C Virus in US Clinics, 2010-2018
Simoncini GM , Hou Q , Carlson K , Buchacz K , Tedaldi E , Palella F Jr , Durham M , Li J . AIDS Patient Care STDS 2021 35 (10) 392-400 Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection carries substantial risk for all-cause mortality and liver-related morbidity and mortality, yet many persons coinfected with HIV/HCV remain untreated for HCV. We explored demographic, clinical, and sociodemographic factors among participants in routine HIV care associated with prescription of direct-acting antivirals (DAAs). The HIV Outpatient Study (HOPS) is an ongoing longitudinal cohort study of persons with HIV in care at participating clinics since 1993. There are currently eight study sites in six US cities. We analyzed medical records data of HOPS participants diagnosed with HCV since June 2010. Sustained virological response (SVR) was documented with first undetectable HCV viral load (VL). We assessed factors associated with being prescribed DAAs by multi-variable logistic regression and described the cumulative rate of SVR. Among 306 eligible participants, 131 (43%) were prescribed DAA therapy. Factors associated with greater odds of being prescribed DAA were older age, private health insurance, higher CD4 cell count, being a person who injects drugs, and receiving care at publicly funded sites (p < 0.05). Of 127 (97%) participants with at least 1 follow-up HCV VL, 110 (87%) achieved SVR at 12 weeks. Of the total 131 participants, 123 (94%) eventually achieved SVR. Less than half of HIV/HCV coinfected patients in HOPS have been prescribed DAAs. Interventions are needed to address deficits in DAA prescription, including among patients with public or no health insurance, younger age, and lower CD4 cell count. |
The HIV Outpatient Study - 25 years of HIV patient care and epidemiologic research
Buchacz K , Armon C , Palella FJJr , Novak RM , Fuhrer J , Tedaldi E , Ward D , Mayer C , Battalora L , Carlson K , Purinton S , Durham M , Li J . Open Forum Infect Dis 2020 7 (5) ofaa123 Background: The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum. Methods: We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993-2017) and mortality (1994-2017) for 10 566 HOPS participants. Results: The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm(3) to 640 cells/mm(3) from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P < .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92.2% in 2017. Conclusions: Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative. |
Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA
Durham MD , Armon C , Mahnken JD , Novak RM , Palella F , Tedaldi E , Buchacz K . Prev Med 2020 134 106011 BACKGROUND: Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. METHODS: Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses of case-matched participants. RESULTS: Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4years [IQR: 38.7-50.3], median (IQR) CD4 count was 439 cells/mm(3) (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm(3) (aRR 1.32; 95%CI 1.05-1.65), have a viral load >/=50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71). CONCLUSION: Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions. |
Chlamydia and gonorrhea incidence and testing among patients in the HIV Outpatient Study, 2007-2017
Li J , Armon C , Palella FJ , Novak RM , Ward D , Purinton S , Durham M , Buchacz K . Clin Infect Dis 2019 71 (8) 1824-1835 BACKGROUND: Although chlamydia (CT) and gonorrhea (GC) infections are increasing in the United States, there are limited data on their incidence, testing rates and associated risk factors among persons with HIV (PWH), including by anatomic site among men who have sex with men (MSM). METHODS: We analyzed 2007-2017 medical record data from HIV Outpatient Study participants in care at nine HIV clinics. We calculated CT (and GC) incidence and testing rates and assessed associations with sociodemographic and clinical factors using log-linear regression. RESULTS: Among 4,727 PWH, 397 had 881 CT infections and 331 had 861 GC infections, with incidence of 2.95 and 2.88 per 100 person-years, respectively. From 2007-2017, incidence and testing rates increased by approximately 3.0- and 1.9-fold for CT and GC, respectively. Multivariable factors associated with incident CT (GC) included younger age, MSM, and prior diagnoses of sexually transmitted diseases (STDs). Among 1,159 MSM, 583 (50.3%) had 844 CT and 843 GC tests during 2016-2017, and 26.6% of tests were 3-site (urethra, rectum, and pharynx), yielding the highest rates of CT (GC) detection. Multivariable factors associated with CT (GC) testing included younger age, non-Hispanic/Latino black race, and having prior STDs. CONCLUSIONS: Recent CT and GC incidence and testing increased among PWH; however, only half of MSM were tested for CT or GC during 2016-2017 and < 1/3 of tests were 3-site. To promote sexual health and STD prevention among PWH, including MSM, research regarding the added value of CT and GC testing across three anatomic sites is needed. |
Design and implementation of a comprehensive surveillance system for venous thromboembolism in a defined region using electronic and manual approaches
Ortel TL , Arnold K , Beckman M , Brown A , Reyes N , Saber I , Schulteis R , Singh BP , Sitlinger A , Thames EH . Appl Clin Inform 2019 10 (3) 552-562 BACKGROUND: Systematic surveillance for venous thromboembolism (VTE) in the United States has been recommended by several organizations. Despite adoption of electronic medical records (EMRs) by most health care providers and facilities, however, systematic surveillance for VTE is not available. OBJECTIVES: This article develops a comprehensive, population-based surveillance strategy for VTE in a defined geographical region. METHODS: The primary surveillance strategy combined computerized searches of the EMR with a manual review of imaging data at the Duke University Health System in Durham County, North Carolina, United States. Different strategies of searching the EMR were explored. Consolidation of results with autopsy reports (nonsearchable in the EMR) and with results from the Durham Veterans' Administration Medical Center was performed to provide a comprehensive report of new VTE from the defined region over a 2-year timeframe. RESULTS: Monthly searches of the primary EMR missed a significant number of patients with new VTE who were identified by a separate manual search of radiology records, apparently related to delays in data entry and coding into the EMR. Comprehensive searches incorporating a location-restricted strategy were incomplete due to the assigned residence reflecting the current address and not the address at the time of event. The most comprehensive strategy omitted the geographic restriction step and identified all patients with VTE followed by manual review of individual records to remove incorrect entries (e.g., outside the surveillance time period or geographic location; no evidence for VTE). Consolidation of results from the EMR searches with results from autopsy reports and the separate facility identified additional patients not diagnosed within the Duke system. CONCLUSION: We identified several challenges with implementing a comprehensive VTE surveillance program that could limit accuracy of the results. Improved electronic strategies are needed to cross-reference patients across multiple health systems and to minimize the need for manual review and confirmation of results. |
Assessing patient opinions about electronic messaging for gonorrhea and chlamydia result notification and partner services, Durham, North Carolina
Cope AB , Sena AC , Eagle C , Pol A , Rahman M , Peterman TA . Sex Transm Dis 2019 46 (9) 625-628 Text or e-mail messages can provide timely notification of sexually transmitted disease (STD) results to patients. We assessed STD clinic patient opinions about text/e-mail notification via a service called Chexout. Among 113 patients who opted in, the majority found results notification via texts/e-mails to be satisfactory (99.0%) and easy (92.9%). |
Integrated hepatitis C testing and linkage to care at a local health department STD clinic: Determining essential resources and evaluating outcomes
Rhea S , Sena AC , Hilton A , Hurt CB , Wohl D , Fleischauer A . Sex Transm Dis 2017 45 (4) 229-232 Guidance about integration of comprehensive hepatitis C virus (HCV)-related services in sexually transmitted disease (STD) clinics is limited. We evaluated a federally-funded HCV testing and linkage-to-care program at an STD clinic in Durham County, North Carolina. During December 10, 2012-March 31, 2015, the program tested 733 patients for HCV who reported >/=1 HCV risk factor; 81 (11%) were HCV-infected (i.e., HCV antibody-positive and HCV ribonucleic acid-positive). Fifty-one infected patients (63%) were linked to care. We concluded that essential program resources include reflex HCV ribonucleic acid testing; a dedicated bridge counselor to provide test results, health education, and linkage-to-care assistance; and referral relationships for local HCV management and treatment. |
Disparities in HIV viral load suppression by race/ethnicity among men who have sex with men in the HIV Outpatient Study
Buchacz K , Armon C , Tedaldi E , Palella FJ , Novak RM , Ward D , Hart R , Durham M , Brooks J . AIDS Res Hum Retroviruses 2018 34 (4) 357-364 INTRODUCTION: Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. METHODS: We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black) or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA < 50 copies/mL) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed ART for >/= 6 months and assessed VS for a subset of participants with behavioral interview data. RESULTS: Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), P < 0.001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4+ cell count, blacks had lower prevalence of VS than whites (adjusted prevalence ratio [PR] 0.87, 95% confidence interval [95% CI] 0.81-0.93) and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past six months. DISCUSSION: In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes. |
Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015
Geter A , Sutton MY , Armon C , Durham MD , Palella FJ Jr , Tedaldi E , Hart R , Buchacz K . PLoS One 2018 13 (1) e0189973 In the United States, women accounted for 19% of new HIV diagnoses in 2015 and were less likely to reach virologic suppression when compared to men. We assessed trends and disparities in virologic suppression among HIV-positive women to inform HIV treatment strategies. Data were from a prospective cohort of the HIV Outpatient Study and collected at nine United States HIV clinics. We included women aged >/=18 years, with >/=1 visit, who were prescribed antiretroviral therapy, and had >/=1 viral load test performed between 2010 and 2015. We defined virologic suppression as viral load <50 copies/mL and calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for virologic suppression by race/ethnicity and year of measure. Generalized estimating equations were used for multivariable analyses to assess factors associated with virologic suppression. Among 809 women (median age = 44 years), 482 (60%) were black, 177 (22%) white, 150 (19%) Hispanic/Latina. Virologic suppression was less prevalent among black women (73%) compared with Hispanic/Latina women (83%) and white women (91%). In multivariable analyses, not achieving virologic suppression was more likely among black women (aPR = 2.13; CI = 1.50-3.02) or Hispanic/Latina women (aPR = 1.66; CI = 1.08-2.56) compared with white women, and among women who attended public clinics (aPR = 1.42; CI = 1.07-1.87) compared with those who attended a private clinic. Between 2010 and 2015, virologic suppression among HIV-positive women increased from 68% to 83%, but racial/ethnic disparities persisted. Black and Hispanic/Latina women had significantly lower rates of virologic suppression than white women. Interventions targeting virologic suppression improvement among HIV-positive women of color, especially those who attend public clinics, are warranted. |
Methylprednisolone acetate induces, and Delta7-dafachronic acid suppresses, Strongyloides stercoralis hyperinfection in NSG mice
Patton JB , Bonne-Annee S , Deckman J , Hess JA , Torigian A , Nolan TJ , Wang Z , Kliewer SA , Durham AC , Lee JJ , Eberhard ML , Mangelsdorf DJ , Lok JB , Abraham D . Proc Natl Acad Sci U S A 2017 115 (1) 204-209 Strongyloides stercoralis hyperinfection causes high mortality rates in humans, and, while hyperinfection can be induced by immunosuppressive glucocorticoids, the pathogenesis remains unknown. Since immunocompetent mice are resistant to infection with S. stercoralis, we hypothesized that NSG mice, which have a reduced innate immune response and lack adaptive immunity, would be susceptible to the infection and develop hyperinfection. Interestingly, despite the presence of large numbers of adult and first-stage larvae in S. stercoralis-infected NSG mice, no hyperinfection was observed even when the mice were treated with a monoclonal antibody to eliminate residual granulocyte activity. NSG mice were then infected with third-stage larvae and treated for 6 wk with methylprednisolone acetate (MPA), a synthetic glucocorticoid. MPA treatment of infected mice resulted in 50% mortality and caused a significant >10-fold increase in the number of parasitic female worms compared with infected untreated mice. In addition, autoinfective third-stage larvae, which initiate hyperinfection, were found in high numbers in MPA-treated, but not untreated, mice. Remarkably, treatment with Delta7-dafachronic acid, an agonist of the parasite nuclear receptor Ss-DAF-12, significantly reduced the worm burden in MPA-treated mice undergoing hyperinfection with S. stercoralis Overall, this study provides a useful mouse model for S. stercoralis autoinfection and suggests a therapeutic strategy for treating lethal hyperinfection. |
Association between biomarkers of ovarian reserve and infertility among older women of reproductive age
Steiner AZ , Pritchard D , Stanczyk FZ , Kesner JS , Meadows JW , Herring AH , Baird DD . JAMA 2017 318 (14) 1367-1376 Importance: Despite lack of evidence of their utility, biomarkers of ovarian reserve are being promoted as potential markers of reproductive potential. Objective: To determine the associations between biomarkers of ovarian reserve and reproductive potential among women of late reproductive age. Design, Setting, and Participants: Prospective time-to-pregnancy cohort study (2008 to date of last follow-up in March 2016) of women (N = 981) aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, recruited from the community in the Raleigh-Durham, North Carolina, area. Exposures: Early-follicular-phase serum level of antimullerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and urinary level of FSH. Main Outcomes and Measures: The primary outcomes were the cumulative probability of conception by 6 and 12 cycles of attempt and relative fecundability (probability of conception in a given menstrual cycle). Conception was defined as a positive pregnancy test result. Results: A total of 750 women (mean age, 33.3 [SD, 3.2] years; 77% white; 36% overweight or obese) provided a blood and urine sample and were included in the analysis. After adjusting for age, body mass index, race, current smoking status, and recent hormonal contraceptive use, women with low AMH values (<0.7 ng/mL [n = 84]) did not have a significantly different predicted probability of conceiving by 6 cycles of attempt (65%; 95% CI, 50%-75%) compared with women (n = 579) with normal values (62%; 95% CI, 57%-66%) or by 12 cycles of attempt (84% [95% CI, 70%-91%] vs 75% [95% CI, 70%-79%], respectively). Women with high serum FSH values (>10 mIU/mL [n = 83]) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (63%; 95% CI, 50%-73%) compared with women (n = 654) with normal values (62%; 95% CI, 57%-66%) or after 12 cycles of attempt (82% [95% CI, 70%-89%] vs 75% [95% CI, 70%-78%], respectively). Women with high urinary FSH values (>11.5 mIU/mg creatinine [n = 69]) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (61%; 95% CI, 46%-74%) compared with women (n = 660) with normal values (62%; 95% CI, 58%-66%) or after 12 cycles of attempt (70% [95% CI, 54%-80%] vs 76% [95% CI, 72%-80%], respectively). Inhibin B levels (n = 737) were not associated with the probability of conceiving in a given cycle (hazard ratio per 1-pg/mL increase, 0.999; 95% CI, 0.997-1.001). Conclusions and Relevance: Among women aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, biomarkers indicating diminished ovarian reserve compared with normal ovarian reserve were not associated with reduced fertility. These findings do not support the use of urinary or blood follicle-stimulating hormone tests or antimullerian hormone levels to assess natural fertility for women with these characteristics. |
Antiretroviral nonadherence and condomless sex in the HIV Outpatient Study, USA, 2007-2014
Durham MD , Hart R , Buchacz K , Hammer J , Young B , Yang D , Wood K , Yangco B , Brooks JT . Int J STD AIDS 2017 29 (2) 956462417720547 Effective antiretroviral therapy (ART) reduces plasma HIV RNA viral load (VL) to undetectable levels and its effectiveness depends on consistent adherence. Consistent adherence and use of safe sex practices may substantially decrease the risk of HIV transmission. We sought to explore the potential association between self-reported nonadherence to ART and engaging in unsafe sexual practices capable of transmitting HIV. Using clinical and audio computer-assisted self-interview data from the prospective HIV Outpatient Study from 2007 to 2014, we assessed the frequency of self-reported ART nonadherence during the three days prior to the survey among HIV-infected persons in care and factors associated with self-reported ART nonadherence. Of 1729 patients included in this analysis (median age = 48 years, 74.3% men who have sex with men), 17% were nonadherent, 15% had a detectable VL, and 42% reported condomless anal or vaginal sex in the past six months. In multivariable analysis, self-reported nonadherence was independently associated with younger age (adjusted odds ratio [aOR] 0.8 per additional ten years, [95% CI] 0.7-1.0), non-Hispanic black race/ethnicity (aOR 1.9; 95% CI 1.4-2.6 versus white), public health insurance (aOR 1.6, 95% CI 1.2-2.3 compared with private), survey date in 2011-2014 versus 2007-2010 (aOR 0.7, 95% CI 0.5-0.9), CD4 cell count ≥ 500 versus < 200 cells/mm3 (aOR 0.3, 95% CI 0.2-0.5), greater number of ART regimen doses (aOR 1.6, 95% CI 1.3-2.2), and binge drinking (aOR 1.4, 95% CI, 1.1-1.9). In this analysis, self-reported nonadherence was not associated with engaging in condomless sex. |
Sexually transmitted disease testing of human immunodeficiency virus-infected men who have sex with men: Room for improvement
Dean BB , Scott M , Hart R , Battalora L , Novak RM , Durham MD , Brooks JT , Buchacz K . Sex Transm Dis 2017 44 (11) 678-684 BACKGROUND: In the United States, sexually transmitted infection (STI) testing is recommended at least annually for sexually active men who have sex with men (MSM). We evaluated human immunodeficiency virus (HIV) providers' STI testing practices and frequency of positive test results. METHODS: We analyzed data from HIV Outpatient Study (HOPS) participants who, from 2007 to 2014, completed a confidential survey about risk behaviors. Using medical records data, we assessed the frequency of gonorrhea, chlamydia, and syphilis testing and positive results during the year after the survey for MSM who reported sex without a condom in the prior 6 months. We compared testing frequency and positivity for men having 1, 2 to 3, and 4 or more sexual partners. Correlates of STI testing were assessed using general linear model to derive relative risks (RR) with associated 95% confidence intervals (CI). RESULTS: Among 719 MSM, testing frequency was 74.5%, 74.3%, and 82.9% for gonorrhea, chlamydia, and syphilis, respectively, and was higher in those men who reported more sexual partners (P < 0.001 for all). In multivariable analysis, testing for gonorrhea was significantly more likely among non-Hispanic black versus white men (RR, 1.17; 95% CI, 1.03-1.33), among men seen in private versus public clinics (RR, 1.16; 95% CI, 1.05-1.28), and among men with 2 to 3 and 4 or more sexual partners versus 1 partner (RR, 1.12; 95% CI, 1.02-1.23, and RR, 1.18; 95% CI, 1.08-1.30, respectively). Correlates of chlamydia and syphilis testing were similar. Test positivity was higher among men with more sexual partners: for gonorrhea 0.0%, 3.0%, and 6.7% for men with 1, 2 to 3, and 4 or more partners, respectively (P < 0.001, syphilis 3.7%, 3.8% and 12.5%, P < 0.001). CONCLUSIONS: Among HIV-infected MSM patients in HIV care who reported sex without a condom, subsequent testing was not documented in clinic records during the following year for up to a quarter of patients. Exploring why STI testing did not occur may improve patient care. |
Cost-effectiveness analysis of four simulated colorectal cancer screening interventions, North Carolina
Hassmiller Lich K , Cornejo DA , Mayorga ME , Pignone M , Tangka FK , Richardson LC , Kuo TM , Meyer AM , Hall IJ , Smith JL , Durham TA , Chall SA , Crutchfield TM , Wheeler SB . Prev Chronic Dis 2017 14 E18 INTRODUCTION: Colorectal cancer (CRC) screening rates are suboptimal, particularly among the uninsured and the under-insured and among rural and African American populations. Little guidance is available for state-level decision makers to use to prioritize investment in evidence-based interventions to improve their population's health. The objective of this study was to demonstrate use of a simulation model that incorporates synthetic census data and claims-based statistical models to project screening behavior in North Carolina. METHODS: We used individual-based modeling to simulate and compare intervention costs and results under 4 evidence-based and stakeholder-informed intervention scenarios for a 10-year intervention window, from January 1, 2014, through December 31, 2023. We compared the proportion of people living in North Carolina who were aged 50 to 75 years at some point during the window (that is, age-eligible for screening) who were up to date with CRC screening recommendations across intervention scenarios, both overall and among groups with documented disparities in receipt of screening. RESULTS: We estimated that the costs of the 4 intervention scenarios considered would range from $1.6 million to $3.75 million. Our model showed that mailed reminders for Medicaid enrollees, mass media campaigns targeting African Americans, and colonoscopy vouchers for the uninsured reduced disparities in receipt of screening by 2023, but produced only small increases in overall screening rates (0.2-0.5 percentage-point increases in the percentage of age-eligible adults who were up to date with CRC screening recommendations). Increased screenings ranged from 41,709 additional life-years up to date with screening for the voucher intervention to 145,821 for the mass media intervention. Reminders mailed to Medicaid enrollees and the mass media campaign for African Americans were the most cost-effective interventions, with costs per additional life-year up to date with screening of $25 or less. The intervention expanding the number of endoscopy facilities cost more than the other 3 interventions and was less effective in increasing CRC screening. CONCLUSION: Cost-effective CRC screening interventions targeting observed disparities are available, but substantial investment (more than $3.75 million) and additional approaches beyond those considered here are required to realize greater increases population-wide. |
Developing a motion comic for HIV/STD prevention for young people ages 15-24, part 1: Listening to your target audience
Willis LA , Kachur R , Castellanos TJ , Spikes P , Gaul ZJ , Gamayo AC , Durham M , Jones S , Nichols K , Han Barthelemy S , LaPlace L , Staatz C , Hogben M , Robinson S , Brooks JT , Sutton MY . Health Commun 2016 33 (2) 1-10 Young people (15-24 years) in the United States are disproportionately affected by infection with human immunodeficiency virus (HIV) and sexually transmitted diseases (STD). Shortfalls in HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI) likely contribute to this discrepancy. In this report we describe our experience developing a novel means of health communication combining entertainment-education theory and recent technological advances to create a HIV/STD-focused "motion comic." We also report the audience satisfaction and acceptance of the intervention. We used the Health Belief Model (HBM), entertainment-education (EE) principles, and the Sabido Method (SM) and conducted three rounds of focus groups to develop a 38-minute HIV/STD focused motion comic for young people between the ages 15 and 24 years. Participants indicated that motion comics were an acceptable method of delivering HIV/STD prevention messages. They also expressed satisfaction with motion comics plot, story settings, the tone of humor, and drama. Our results suggest that motion comics are a viable new method of delivering health communication messages about HIV/STD and other public health issues, and warrant further development and broader evaluation. |
Developing a motion comic for HIV/STD prevention for young people ages 15-24, part 2: Evaluation of a pilot intervention
Willis LA , Kachur R , Castellanos TJ , Nichols K , Mendoza MC , Gaul ZJ , Spikes P , Gamayo AC , Durham MD , LaPlace L , Straw J , Staatz C , Buge H , Hogben M , Robinson S , Brooks J , Sutton MY . Health Commun 2016 33 (3) 1-9 In the United States, young people (ages 15-24 years) are disproportionately affected by human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), due at least in part to inadequate or incorrect HIV/STD-related knowledge, attitudes, beliefs, and behavioral intentions (KABI). Comic book narratives are a proven method of HIV/STD prevention communication to strengthen KABI for HIV/STD prevention. Motion comics, a new type of comic media, are an engaging and low-cost means of narrative storytelling. The objective of this study was to quantitatively evaluate the effectiveness of a pilot six-episode HIV/STD-focused motion comic series to improve HIV/STD-related KABI among young people. We assessed change in HIV/STD knowledge, HIV stigma, condom attitudes, HIV/STD testing attitudes, and behavioral intentions among 138 participants in 15 focus groups immediately before and after viewing the motion comic series. We used paired t-tests and indicators of overall improvement to assess differences between surveys. We found a significant decrease in HIV stigma (p < .001) and increases in both HIV knowledge (p = .002) and behavioral intentions to engage in safe sex (p < .001). In summary, this motion comic intervention improved HIV/STD-related KABI of young adult viewers by reducing HIV stigma and increasing behavioral intentions to engage in safer sex. Our results demonstrate the promise of this novel intervention and support its use to deliver health messages to young people. |
CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >750 cells/mm3 and mortality risk
Palella FJ Jr , Armon C , Chmiel JS , Brooks JT , Hart R , Lichtenstein K , Novak RM , Yangco B , Wood K , Durham M , Buchacz K . J Antimicrob Chemother 2016 71 (9) 2654-62 OBJECTIVES: We sought to evaluate associations between CD4 at ART initiation (AI), achieving CD4 >750 cells/mm3 (CD4 >750), long-term immunological recovery and survival. METHODS: This was a prospective observational cohort study. We analysed data from ART-naive patients seen in 1996-2012 and followed ≥3 years after AI. We used Kaplan-Meier (KM) methods and log-rank tests to compare time to achieving CD4 >750 by CD4 at AI (CD4-AI); and Cox regression models and generalized estimating equations to identify factors associated with achieving CD4 >750 and mortality risk. RESULTS: Of 1327 patients, followed for a median of 7.9 years, >85% received ART for ≥75% of follow-up time; 64 died. KM estimates evaluating likelihood of CD4 >750 during 5 years of follow-up, stratified by CD4-AI <50, 50-199, 200-349, 350-499 and 500-750, were 20%, 25%, 56%, 80% and 87%, respectively (log-rank P < 0.001). In adjusted models, CD4-AI ≥200 (versus CD4-AI <200) was associated with achievement of CD4 >750 [adjusted HR (aHR) = 4.77]. Blacks were less likely than whites to achieve CD4 >750 (33% versus 49%, aHR = 0.77). Mortality rates decreased with increasing CD4-AI (P = 0.004 across CD4 strata for AIDS causes and P = 0.009 for non-AIDS death causes). Among decedents with CD4-AI ≥50, 56% of deaths were due to non-AIDS causes. CONCLUSIONS: Higher CD4-AI resulted in greater long-term CD4 gains, likelihood of achieving CD4 >750, longer survival and decreased mortality regardless of cause. Over 80% of persons with CD4-AI ≥350 achieved CD4 >750 by 4 years while 75% of persons with CD4-AI <200 did not. These data confirm the hazards of delayed AI and support early AI. |
Seasonal influenza vaccination rates in the HIV Outpatient Study - United States, 1999-2013
Durham MD , Buchacz K , Armon C , Patel P , Wood K , Brooks JT . Clin Infect Dis 2015 60 (6) 976-7 Due to the high burden of estimated annual deaths and hospitalizations associated with influenza epidemics in the United States [1, 2], annual influenza vaccination is recommended for persons aged ≥6 months, and for those who are at increased risk of influenza-related complications, including persons with human immunodeficiency virus (HIV) infections [3]. In 2011, we published data from the HIV Outpatient Study (HOPS), an open prospective HIV cohort study of HIV-infected outpatients seen in 9 well-established community-based private practices, public health clinics, and university-based clinics, describing annual rates of influenza vaccination among HIV-infected persons in care during influenza seasons from 1999 to 2008 [4]. We found that an average of 35% of HOPS participants received an influenza vaccination while under observation during the time period under investigation. This letter serves as an update to the previous analysis by including 5 years of additional data describing influenza vaccination rates among HOPS participants through 30 June 2013. | Among 6548 active patients (patients with at least 1 clinical encounter during the time period under investigation), 4788 were vaccinated at any time between 1 July 1999 and 30 June 2013. The annual vaccination rates ranged from a low of 26.4% to a high of 50.9% (average, 38.7%; linear regression trend P = .043; Figure 1) during the influenza seasons studied. The HOPS recorded the highest rate of vaccination during the 2009–2010 H1N1 influenza season, but that level was not sustained in subsequent seasons. Although we detected an overall temporal increase in influenza vaccination rates over the 14-year period, the observed rates continued to be consistently lower than published recommendations and below the goal of 70% set for Healthy People 2020 [3, 5], underscoring the need for improving adherence to guidelines for annual influenza vaccination for HIV-infected persons. |
Bayesian marked point process modeling for generating fully synthetic public use data with point-referenced geography
Quick H , Holan SH , Wikle CK , Reiter JP . Spat Stat 2015 14 439-451 Many data stewards collect confidential data that include fine geography. When sharing these data with others, data stewards strive to disseminate data that are informative for a wide range of spatial and non-spatial analyses while simultaneously protecting the confidentiality of data subjects' identities and attributes. Typically, data stewards meet this challenge by coarsening the resolution of the released geography and, as needed, perturbing the confidential attributes. When done with high intensity, these redaction strategies can result in released data with poor analytic quality. We propose an alternative dissemination approach based on fully synthetic data. We generate data using marked point process models that can maintain both the statistical properties and the spatial dependence structure of the confidential data. We illustrate the approach using data consisting of mortality records from Durham, North Carolina. |
Elevated Staphylococcus ceftriaxone MICs are an Etest artifact
Limbago BM , Pierce VM , Lonsway DR , Ferraro MJ . Clin Infect Dis 2014 60 (1) 162-3 The recent publication by Pickering et al [1] described a collection of methicillin-susceptible Staphylococcus aureus (MSSA) that displayed elevated ceftriaxone minimum inhibitory concentrations (MICs) when tested by Etest (bioMerieux, Durham, North Carolina) gradient diffusion and would have been called “Resistant” to ceftriaxone based on previous Clinical and Laboratory Standards Institute (CLSI) interpretive guidance. The authors reported that approximately 60% of MSSA tested at their institution would have been misclassified based on the current CLSI guidance, which recommends testing staphylococci only against penicillin and oxacillin or cefoxitin in order to infer susceptibility or resistance to other β-lactam agents. This article was available electronically ahead of print for several months. Although it was subsequently retracted as “an honest error in interpretation,” we believe a fuller explanation of the findings could improve understanding among Clinical Infectious Diseases readership. | We investigated the accuracy of the initial report by performing reference broth microdilution (BMD), disk diffusion, and Etest [both low (0.002–32 µg/mL) and high (0.016–256 µg/mL) range ceftriaxone Etest products] antimicrobial susceptibility testing on 8 pulsed field gel electrophoresis (PFGE)-matched pairs of MSSA from the Pickering study [1] reported to have mismatched ceftriaxone susceptibility. All 16 isolates were confirmed as oxacillin, cefoxitin, and ceftriaxone susceptible [2, 3] with BMD and disk methods. Ceftriaxone MICs obtained by both Etest products were typically higher than those obtained with BMD but were still in the susceptible range for 100% of isolates using the high concentration ceftriaxone Etest, and for 93.8% of isolates using the low concentration ceftriaxone Etest (1 isolate tested as intermediate). In addition, 30 consecutive, unique MSSA isolated from blood cultures during 2 months at a single hospital were tested against ceftriaxone byBMD, disk diffusion, and Etest using a single 0.5 McFarland inoculum. All isolates tested ceftriaxone susceptible by disk diffusion and BMD; 13 (43%) isolates tested nonsusceptible with Etest (Table 1). We also note that the Etest ceftriaxone package inserts do not list staphylococci as an organism group for which testing has been cleared [4, 5]. |
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