Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Etheredge A[original query] |
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Viral load suppression among patients receiving antiretroviral therapy in outpatient clinics in Democratic Republic of Congo
Ewetola R , Shah GH , Etheredge G , Maluantesa L , Waterfield K , Olivas M , Engetele E , Bijou MB . HIV AIDS Rev 2023 22 (3) 198-203 Introduction: Education and disease management have resulted in global decline of new HIV infections, from 2.8 million a year in 2000 to about 1.5 million in 2020 (46% reduction) as well as number of deaths, from 1.4 million in 2000 to 690,000 a year in 2020 (51% reduction). The purpose of this study was to examine factors associated with viral load (VL) suppression (< 1,000 copies/ml), including age, sex, and geographic and clinical characteristics of patients on antiretroviral therapy (ART) in outpatient clinics in Kinshasa and Haut-Katanga Provinces, Democratic Republic of Congo (DRC). Material and methods: Using a retrospective cohort study design, we analyzed data of 5,338 people living with HIV (PLHIV) on ART from 116 HIV/AIDS clinics located in the Haut-Katanga and Kinshasa Provinces in DRC. c2 and multivariable logistic regression analyses were applied. Results: Age and urban health zones were significantly associated with VL suppression. Eighty-six percent of adult patients (15 years or older) had achieved a VL suppression, compared to 73.5% of patients younger than 15 years. Average time on ART was less than three years, and majority of participants were 15 years of age or older, females, and mostly living in urban areas. Conclusions: Our findings indicated that younger patients on ART and patients living in semi-rural areas (vs. urban) had a significantly lower probability of risk of VL suppression, underscoring the need for enhanced efforts targeting these populations. © 2023 Termedia Publishing House Ltd.. All rights reserved. |
Retention and predictors of attrition among HIV-infected children on antiretroviral therapy in Cte d'Ivoire between 2012 and 2016
Touré F , Etheredge GD , Brennan C , Parris K , Diallo MO , Ouffoue AF , Ekra A , Prao H , Assamoua NV , Gnongoue C , Kone F , Koffi C , Kamagaté F , Rivadeneira E , Carpenter D . Pediatr Infect Dis J 2023 42 (4) 299-304 BACKGROUND: An estimated 21,000 children aged 0-14 years were living with HIV in Côte d'Ivoire in 2020, of whom only 49% have been diagnosed and are receiving antiretroviral therapy (ART). Retention in HIV care and treatment is key to optimize clinical outcomes. We evaluated pediatric retention in select care and treatment centers (CTCs) in Côte d'Ivoire. METHODS: We retrospectively reviewed medical records using 2-stage cluster sampling for children under 15 years initiated on ART between 2012 and 2016. Kaplan-Meier time-to-event analysis was done to estimate cumulative attrition rates per total person-years of observation. Cox proportional hazard regression was performed to identify factors associated with attrition. RESULTS: A total of 1198 patient records from 33 CTCs were reviewed. Retention at 12, 24, 36, 48 and 60 months after ART initiation was 91%, 84%, 74%, 72% and 70%, respectively. A total of 309 attrition events occurred over 3169 person-years of follow-up [266 children were lost to follow-up (LTFU), 29 transferred to another facility and 14 died]. LTFU determinants included attending a "public-private" CTC [adjusted hazard ratio (aHR) 6.05; 95% confidence interval (CI): 4.23-8.65], receiving care at a CTC without an on-site laboratory (aHR: 4.01; 95% CI: 1.70-9.46) or attending a CTC without an electronic medical record (EMR) system (aHR: 2.22; 95% CI: 1.59-3.12). CONCLUSIONS: In Cote d'Ivoire, patients attending a CTC that is public-private, does not have on-site laboratory or EMR system were likely to be LTFU. Decentralization of laboratory services and scaling use of EMR systems could help to improve pediatric retention. |
Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo.
Ewetola R , Shah GH , Maluantesa L , Etheredge G , Waterfield K , Mulenga A , Kilundu A . Int J Environ Res Public Health 2021 18 (10) Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients' clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment de-livery, the research evidence explaining factors associated with patients' clinical stages is needed. Objective(s): The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Method(s): Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Result(s): A small proportion (i.e., 4.4%) of PLHIV were at WHO's clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p <= 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98- 6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29- 1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusion(s): Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era. |
Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo
Shah GH , Ewetola R , Etheredge G , Maluantesa L , Waterfield K , Engetele E , Kilundu A . Int J Environ Res Public Health 2021 18 (10) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94-2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82-2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46-0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients. |
Urinary concentrations of monohydroxylated polycyclic aromatic hydrocarbons in adults from the U.S. Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014)
Wang Y , Wong LY , Meng L , Pittman EN , Trinidad DA , Hubbard KL , Etheredge A , Del Valle-Pinero AY , Zamoiski R , van Bemmel DM , Borek N , Patel V , Kimmel HL , Conway KP , Lawrence C , Edwards KC , Hyland A , Goniewicz ML , Hatsukami D , Hecht SS , Calafat AM . Environ Int 2018 123 201-208 BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants formed from incomplete combustion of organic matter; some PAHs are carcinogens. Smoking, diet, and other activities contribute to exposure to PAHs. Exposure data to PAHs among combustible tobacco product users (e.g. cigarette smokers) exist; however, among non-combustible tobacco products users (e.g., e-cigarette users), such data are rather limited. OBJECTIVES: We sought to evaluate exposure to PAHs among participants in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study based on the type of tobacco product (combustible vs non-combustible), and frequency and intensity of product use. METHODS: We quantified seven PAH urinary biomarkers in 11,519 PATH Study participants. From self-reported information, we categorized 8327 participants based on their use of tobacco products as never-tobacco user (never user, n=1700), exclusive current established combustible products user (combustible products user, n=5767), and exclusive current established non-combustible products user (non-combustible products user, n=860). We further classified tobacco users as exclusive cigarette user (cigarette user, n=3964), exclusive smokeless product user (SLT user, n=509), and exclusive e-cigarette user (e-cigarette user, n=280). Last, we categorized frequency of product use (everyday vs some days) and time since use (last hour, within 3days, over 3days). We calculated geometric mean (GM) concentrations, and evaluated associations between tobacco product user categories and PAH biomarkers concentrations. RESULTS: Combustible products users had significantly higher GMs of all biomarkers than non-combustible products users and never users; non-combustible products users had significantly higher GMs than never users for four of seven biomarkers. For all biomarkers examined, cigarette users had the highest GMs compared to other tobacco-product users. Interestingly, GMs of 2-hydroxyfluorene, 3-hydroxyfluorene and summation operator2,3-hydroxyphenanthrene were significantly higher in SLT users than in e-cigarette users; 3-hydroxyfluorene and 1-hydroxypyrene were also significantly higher in e-cigarette and SLT users than in never users. Everyday cigarette and SLT users had significantly higher GMs for most biomarkers than some days' users; cigarette and SLT users who used the product in the last hour had significantly higher GMs of most biomarkers than other occasional cigarette or SLT users respectively. By contrast, everyday e-cigarette users' GMs of most biomarkers did not differ significantly from those in some days' e-cigarette users; we did not observe clear trends by time of last use among e-cigarette users. CONCLUSIONS: Users of tobacco products had higher PAH urinary biomarker concentrations compared to never users, and concentrations differed by type and frequency of tobacco product use. |
Quantification of urinary mono-hydroxylated metabolites of polycyclic aromatic hydrocarbons by on-line solid phase extraction-high performance liquid chromatography-tandem mass spectrometry
Wang Y , Meng L , Pittman EN , Etheredge A , Hubbard K , Trinidad DA , Kato K , Ye X , Calafat AM . Anal Bioanal Chem 2016 409 (4) 931-937 Human exposure to polycyclic aromatic hydrocarbons (PAHs) can be assessed through monitoring of urinary mono-hydroxylated PAHs (OH-PAHs). Gas chromatography (GC) has been widely used to separate OH-PAHs before quantification by mass spectrometry in biomonitoring studies. However, because GC requires derivatization, it can be time consuming. We developed an on-line solid phase extraction coupled to isotope dilution-high performance liquid chromatography-tandem mass spectrometry (on-line-SPE-HPLC-MS/MS) method for the quantification in urine of 1-OH-naphthalene, 2-OH-naphthalene, 2-OH-fluorene, 3-OH-fluorene, 1-OH-phenanthrene, the sum of 2-OH and 3-OH-phenanthrene, 4-OH-phenanthrene, and 1-OH-pyrene. The method, which employed a 96-well plate platform and on-line SPE, showed good sensitivity (i.e., limits of detection ranged from 0.007 to 0.09 ng/mL) and used only 100 muL of urine. Accuracy, calculated from the recovery percentage at three spiking levels, varied from 94 to 113 %, depending on the analyte. The inter- and intra-day precision, calculated from 20 repeated measurements of two quality control materials, varied from 5.2 to 16.7 %. Adequate method performance was also confirmed by acceptable recovery (83-102 %) of two NIST standard reference materials (3672 and 3673). This high-throughput on-line-SPE-HPLC-MS/MS method can be applied in large-scale epidemiological studies. Graphical abstract Example LC-MS chromatogram of urinary mono-hydroxylated PAH metabolites. |
Rapid-learning system for cancer care
Abernethy AP , Etheredge LM , Ganz PA , Wallace P , German RR , Neti C , Bach PB , Murphy SB . J Clin Oncol 2010 28 (27) 4268-74 Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care." In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled "A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care" in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action. |
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