Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 46 Records) |
Query Trace: Fellows I[original query] |
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Triangulating truth and reaching consensus on population size, prevalence, and more: Modeling study
Fellows IE , Corcoran C , McIntyre AF . JMIR Public Health Surveill 2024 10 e48738 BACKGROUND: Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE: This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS: In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS: The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS: The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges. |
Advancing data science among the federal public health workforce: The data science upskilling program, Centers for Disease Control and Prevention
Bertulfo MCP , Kirkcaldy RD , Franzke LH , Papagari Sangareddy SR , Reza F . J Public Health Manag Pract 2024 30 (2) E41-e46 CONTEXT: Data can guide decision-making to improve the health of communities, but potential for use can only be realized if public health professionals have data science skills. However, not enough public health professionals possess the quantitative data skills to meet growing data science needs, including at the Centers for Disease Control and Prevention (CDC). PROGRAM: The Data Science Upskilling (DSU) program increases data science literacy among staff and fellows working and training at CDC. The DSU program was established in 2019 as a team-based, project-driven, on-the-job applied upskilling program. Learners, within interdisciplinary teams, use curated learning resources to advance their CDC projects. The program has rapidly expanded from upskilling 13 teams of 31 learners during 2019-2020 to upskilling 36 teams of 143 learners during 2022-2023. EVALUATION: All 2022-2023 cohort respondents to the end-of-project survey reported the program increased their data science knowledge. In addition, 90% agreed DSU improved their data science skills, 93% agreed it improved their confidence making data science decisions, and 96% agreed it improved their ability to perform data science work that benefits CDC. DISCUSSION: DSU is an innovative, inclusive, and successful approach to improving data science literacy at CDC. DSU may serve as an upskilling model for other organizations. |
Evaluation of Centers for Disease Control and Prevention's Evaluation Fellowship Program
Freire KE , Kuperminc G , Vo L , Kidder DP , Zorland J . Public Health Rep 2023 333549231184194 OBJECTIVE: The Centers for Disease Control and Prevention's (CDC's) Evaluation Fellowship Program is a 2-year fellowship that includes training, placement with a CDC program, and professional development funds. We evaluated whether the program contributed to CDC's evaluation capacity, prepared fellows for evaluation work, and contributed to their career advancement during its first 10 years. METHODS: We used a mixed-methods approach, including conducting an online survey and telephone interviews. External evaluators sent surveys to all 152 alumni and all 123 mentors who participated in the program from 2011 through 2020 (first 8 cohorts) and interviewed 9 mentors and 15 alumni. RESULTS: A total of 110 alumni (72.4%) and 44 mentors (35.8%) completed surveys. Of 44 mentors, most agreed their fellow(s) contributed to their program's overall evaluation capacity (90.9%) and its ability to do more evaluation (88.6%). Most (84.2%-88.1%) alumni agreed that the Evaluation Fellowship Program prepared them to apply the 6 skill sets that aligned with CDC's Framework for Program Evaluation in Public Health. Support from the Fellowship office was significantly and positively correlated with performing evaluation tasks (β = 0.25; P = .004) and alumni obtaining their first job (β = 0.36; P < .001). Host program mentoring was significantly correlated with performing evaluation tasks (β = 0.27; P = .02) and alumni obtaining their first job (β = 0.34; P = .007). CONCLUSION: CDC's Evaluation Fellowship Program has made progress toward building CDC's evaluation capacity and preparing a public health workforce to use evaluation skills in various settings. A service-learning model that provides training and applied experiences could prepare a workforce to build evaluation capacity. |
The HIV care continuum for sexually active transgender women in three metropolitan municipalities in South Africa: findings from a biobehavioural survey 2018-19
Cloete A , Mabaso M , Savva H , van der Merwe LL , Naidoo D , Petersen Z , Kose Z , Mthembu J , Moyo S , Skinner D , Jooste S , Fellows IE , Shiraishi RW , Mwandingi SL , Simbayi LC . Lancet HIV 2023 10 (6) e375-e384 BACKGROUND: Despite high HIV prevalence in transgender women in sub-Saharan Africa, to our knowledge no study presents data across the HIV care continuum for this population in the region. The aim of this study was to estimate HIV prevalence and present data to develop the HIV care continuum indicators for transgender women in three South African metropolitan municipalities. METHODS: Biobehavioural survey data were collected among sexually active transgender women in the metropolitan municipalities of Johannesburg, Buffalo City, and Cape Town, South Africa. Transgender women (aged ≥18 years, self-reporting consensual sex with a man in the 6 months before the survey) were recruited using respondent-driven sampling (RDS). An interviewer-administered questionnaire was used to determine awareness of HIV status; blood specimens were collected on dried blood spots to test for HIV antibodies, antiretroviral treatment (ART) exposure, and viral load suppression. Population-based estimates of HIV 95-95-95 cascade indicators were derived by use of individualised RDS weights with RDS Analyst software. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with each cascade indicator. All eligible participants were included in the final analysis. FINDINGS: Between July 26, 2018, and March 15, 2019, we enrolled 887 sexually active transgender women: 323 in Johannesburg, 305 in Buffalo City, and 259 in Cape Town. HIV prevalence was highest in Johannesburg where 229 (74·1%) of 309 tests were positive (weighted prevalence estimate 63·3%, 95% CI 55·5-70·5), followed by Buffalo City where 121 (43·7%) of 277 were positive (46·1%, 38·7-53·6), and then Cape Town where 122 (48·4%) of 252 were positive (45·6%, 36·7-54·7). In Johannesburg, an estimated 54·2% (95% CI 45·8-62·4) of transgender women with HIV knew their positive status, in Cape Town this was 24·2% (15·4-35·8), and in Buffalo City this was 39·5% (27·1-53·4). Among those who knew their status, 82·1% (73·3-88·5) in Johannesburg, 78·2% (57·9-90·3) in Cape Town, and 64·7% (45·2-80·2) in Buffalo City were on ART. Of those on ART, 34·4% (27·2-42·4) in Johannesburg, 41·2% (30·7-52·6) in Cape Town, and 55·0% (40·7-68·4) in Buffalo City were virally suppressed. INTERPRETATION: Innovative strategies are needed to inform efforts to diagnose and to treat transgender women living with HIV promptly to achieve viral load suppression. Differentiated HIV services tailored to transgender women of race groups other than Black South African, and those with low education attainment and low outreach exposure, innovative testing, and adherence strategies should be developed to improve the HIV cascade for South African transgender women. FUNDING: The US President's Emergency Plan For AIDS Relief and US Centers for Disease Control and Prevention. |
Improving biomarker-based HIV incidence estimation in the treatment era
Fellows IE , Hladik W , Eaton JW , Voetsch AC , Parekh BS , Shiraishi RW . Epidemiology 2023 34 (3) 353-364 BACKGROUND: Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty about what input parameters to use for false recency rate (FRR) and mean duration of recent infection (MDRI) after applying a recent infection testing algorithm (RITA). METHODS: This article shows how testing and diagnosis reduce both FRR and mean duration of recent infection compared to a treatment-naive population. A new method is proposed for calculating appropriate context-specific estimates of FRR and mean duration of recent infection. The result of this is a new formula for incidence that depends only on reference FRR and mean duration of recent infection parameters derived in an undiagnosed, treatment-naive, nonelite controller, non-AIDS-progressed population. RESULTS: Applying the methodology to eleven cross-sectional surveys in Africa results in good agreement with previous incidence estimates, except in 2 countries with very high reported testing rates. CONCLUSIONS: Incidence estimation equations can be adapted to account for the dynamics of treatment and recent infection testing algorithms. This provides a rigorous mathematical foundation for the application of HIV recency assays in cross-sectional surveys. |
A nationally representative survey of COVID-19 in Pakistan, 2021-2022
Aheron S , Victory KR , Imtiaz A , Fellows I , Gilani SI , Gilani B , Reed C , Hakim AJ . Emerg Infect Dis 2022 28 (13) S69-s75 We conducted 4,863 mobile phone and 1,715 face-to-face interviews of adults >18 years residing in Pakistan during June 2021-January 2022 that focused on opinions and practices related to COVID-19. Of those surveyed, 26.3% thought COVID-19 was inevitable, and 16.8% had tested for COVID-19. Survey participants who considered COVID-19 an inevitability shared such traits as urban residency, concerns about COVID-19, and belief that the virus is a serious medical threat. Survey respondents who had undergone COVID-19 testing shared similarities regarding employment status, education, mental health screening, and the consideration of COVID-19 as an inevitable disease. From this survey, we modeled suspected and confirmed COVID-19 cases and found nearly 3 times as many suspected and confirmed COVID-19 cases than had been reported. Our research also suggested undertesting for COVID-19 even in the presence of COVID-19 symptoms. Further research might help uncover the reasons behind undertesting and underreporting of COVID-19 in Pakistan. |
Estimation of HIV-1 incidence using a testing history-based method; analysis from the population-based HIV impact assessment survey data in 12 African countries
Gurley SA , Stupp PW , Fellows IE , Parekh BS , Young PW , Shiraishi RW , Sullivan PS , Voetsch AC . J Acquir Immune Defic Syndr 2023 92 (3) 189-196 BACKGROUND: Estimating HIV incidence is essential to monitoring progress in sub-Saharan African nations toward global epidemic control. One method for incidence estimation is to test nationally representative samples using laboratory-based incidence assays. An alternative method based on reported HIV testing history and the proportion of undiagnosed infections has recently been described. METHODS: We applied an HIV incidence estimation method which uses history of testing to nationally representative cross-sectional survey data from 12 sub-Saharan African nations with varying country-specific HIV prevalence. We compared these estimates with those derived from laboratory-based incidence assays. Participants were tested for HIV using the national rapid test algorithm and asked about prior HIV testing, date and result of their most recent test, and date of antiretroviral therapy initiation. RESULTS: The testing history-based method consistently produced results that are comparable and strongly correlated with estimates produced using a laboratory-based HIV incidence assay (ρ = 0.85). The testing history-based method produced incidence estimates that were more precise compared with the biomarker-based method. The testing history-based method identified sex-, age-, and geographic location-specific differences in incidence that were not detected using the biomarker-based method. CONCLUSIONS: The testing history-based method estimates are more precise and can produce age-specific and sex-specific incidence estimates that are informative for programmatic decisions. The method also allows for comparisons of the HIV transmission rate and other components of HIV incidence among and within countries. The testing history-based method is a useful tool for estimating and validating HIV incidence from cross-sectional survey data. |
COVID-19 response roles among CDC International Public Health Emergency Management Fellowship Graduates
Krishnan S , Espinosa C , Podgornik MN , Haile S , Aponte JJ , Brown CK , Vagi SJ . Emerg Infect Dis 2022 28 (13) S145-s150 Since 2013, the US Centers for Disease Control and Prevention has offered the Public Health Emergency Management Fellowship to health professionals from around the world. The goal of this program is to build an international workforce to establish public health emergency management programs and operations centers in participating countries. In March 2021, all 141 graduates of the fellowship program were invited to complete a web survey designed to examine their job roles and functions, assess their contributions to their country's COVID-19 response, and identify needs for technical assistance to strengthen national preparedness and response systems. Of 141 fellows, 89 successfully completed the survey. Findings showed that fellowship graduates served key roles in COVID-19 response in many countries, used skills they gained from the fellowship, and desired continuing engagement between the Centers for Disease Control and Prevention and fellowship alumni to strengthen the community of practice for international public health emergency management. |
Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda.
Harris JR , Kadobera D , Kwesiga B , Kabwama SN , Bulage L , Kyobe HB , Kagirita AA , Mwebesa HG , Wanyenze RK , Nelson LJ , Boore AL , Ario AR . BMC Health Serv Res 2022 22 (1) 1532 BACKGROUND: The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda. METHODS: We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs. RESULTS: Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners. CONCLUSION: Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact. |
Development of automated HIV case reporting system using national electronic medical record in Thailand
Yingyong T , Aungkulanon S , Saithong W , Jantaramanee S , Phokhasawad K , Fellows I , Naiwatanakul T , Mobnarin J , Charoen N , Waikayee P , Northbrook SC . BMJ Health Care Inform 2022 29 (1) Background: An electronic medical record (EMR) has the potential to improve completeness and reporting of notifiable diseases. We developed and assessed the validity of an HIV case detection algorithm and deployed the final algorithm in a national automated HIV case reporting system in Thailand. Method(s): The HIV case detection algorithms leveraged a combination of standard laboratory codes, prescriptions and International Classification of Diseases, 10th Revision diagnostic codes to identify potential cases. The initial algorithm was applied to the national EMR from 2014 to June 2020 to identify HIV-infected subjects to build the national HIV case reporting system (Epidemiological Intelligence Information System (EIIS)). A subset of potential positives identified by the initial algorithm were then validated and reviewed by infectious disease specialists. This review identified that a proportion of the false positives were due to pre-exposure prophylaxis/postexposure prophylaxis (PrEP/PEP) antiretrovirals, and so the algorithm was refined into a 'Final Algorithm' to address this. Result(s): Positive predictive value of identifying HIV cases was 90% overall for the initial algorithm. Individuals misclassified as HIV-positive were HIV-negative patients with incorrect diagnostic codes, prescription records for PrEP, PEP and hepatitis B treatment. Additional revision to the algorithm included triple drug regimen to avoid further misclassification. The final HIV case detection algorithm was applied to national EMR between 2014 and 2020 with 449 088 HIV-infected subjects identified from 1496 hospitals. EIIS was designed by applying the final algorithm to automated extract HIV cases from the national EMR, analysing them and then transmitting the results to the Ministry of Public Health. Conclusion(s): EMR data can complement traditional provider-based and laboratory-based disease reports. An automated algorithm incorporating laboratory, diagnosis codes and prescriptions have the potential to improve completeness and timeliness of HIV reporting, leading to the implementation of a national HIV case reporting system. Copyright 2022 Author(s) (or their employer(s)). |
Kathryn V. Holmes: A Career of Contributions to the Coronavirus Field.
Bonavia A , Dominguez SR , Dveksler G , Gagneten S , Howard M , Jeffers S , Qian Z , Smith MK , Thackray LB , Tresnan DB , Wentworth DE , Wessner DR , Williams RK , Miura TA . Viruses 2022 14 (7) Over the past two years, scientific research has moved at an unprecedented rate in response to the COVID-19 pandemic. The rapid development of effective vaccines and therapeutics would not have been possible without extensive background knowledge on coronaviruses developed over decades by researchers, including Kathryn (Kay) Holmes. Kay's research team discovered the first coronavirus receptors for mouse hepatitis virus and human coronavirus 229E and contributed a wealth of information on coronaviral spike glycoproteins and receptor interactions that are critical determinants of host and tissue specificity. She collaborated with several research laboratories to contribute knowledge in additional areas, including coronaviral pathogenesis, epidemiology, and evolution. Throughout her career, Kay was an extremely dedicated and thoughtful mentor to numerous graduate students and post-doctoral fellows. This article provides a review of her contributions to the coronavirus field and her exemplary mentoring. |
Uganda public health fellowship program's contributions to the National HIV and TB Programs, 2015-2020
Ario AR , Bulage L , Wibabara Y , Muwereza P , Eurien D , Kabwama SN , Kwesiga B , Kadobera D , Turyahabwe S , Musinguzi JB , Wanyenze RK , Nasirumbi PM , Lukoye D , Harris JR , Mills LA , Nelson LJ . Glob Health Sci Pract 2022 10 (2) Despite remarkable progress in controlling HIV and TB, Uganda is one of the 30 high-burden TB/HIV countries. Approximately 53,000 Ugandans had a new HIV diagnosis in 2019, and approximately 88,000 Ugandans had a TB diagnosis in 2020. Fellows in the Uganda Public Health Fellowship Program (UPHFP) work directly with the Ministry of Health AIDS and TB Control Programs, the U.S. Centers for Disease Control and Prevention, UPHFP supervisors, and implementing partners to investigate and evaluate HIV-related and TB-related issues. These activities have contributed to the Uganda HIV and TB programs. UPHFP fellows complete projects in 7 competency domains, including outbreak investigations, surveillance evaluations, and data quality improvement. Priority HIV/AIDS/TB information gaps/topics are identified in consultation with key stakeholders, and fellows complete projects to guide program improvements and policy decisions. During 2015-2020, UPHFP fellows implemented 127 HIV and TB projects covering key program areas in AIDS and TB control programs, including care and treatment (16 projects), TB/HIV (18), prevention of mother-to-child HIV transmission (24), key and priority populations (9), pre-exposure and post-exposure prophylaxis (7), adolescent girls and young women (6), service delivery (13), and diagnosis of TB including drug-resistant TB and TB in high-risk groups (32). These projects have helped improve retention, quality of care, and treatment outcomes for people living with HIV, HIV and TB coinfected patients, and TB patients. They have also contributed to the decrease in pediatric TB and infant HIV positivity rates and improved service delivery for key populations. UPHFP results were disseminated to relevant stakeholders such as government departments, implementing partners, districts, and the general community and guided decision making. UPHFP has significantly improved HIV and TB control in Uganda. Other countries with similar programs could benefit from this approach and utilize program fellows to support HIV and TB control. |
Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface.
McIntyre AF , Fellows IE , Gutreuter S , Hladik W . JMIR Public Health Surveill 2022 8 (4) e32645 BACKGROUND: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis. OBJECTIVE: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE. METHODS: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine. RESULTS: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided. CONCLUSIONS: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa. |
Seroprevalence of SARS-CoV-2 after the second wave in South Africa in HIV-infected and uninfected persons: a cross-sectional household survey.
Wolter N , Tempia S , von Gottberg A , Bhiman JN , Walaza S , Kleynhans J , Moyes J , Buys A , McMorrow ML , Aitken S , Magni S , Yun J , Fellows T , Maakamedi T , Weiner R , Cawood C , Martinson N , Lebina L , Jassat W , Brauer M , Cohen C . Clin Infect Dis 2022 75 (1) e57-e68 BACKGROUND: Seroprevalence studies are important for quantifying the burden of SARS-CoV-2 infections in resource-constrained countries. METHODS: We conducted a cross-sectional household survey spanning the second pandemic wave (November 2020 - April 2021) in three communities. Blood was collected for SARS-CoV-2 antibody (two ELISA assays targeting spike and nucleocapsid) and HIV testing. An individual was considered seropositive if testing positive on ≥1 assay. Factors associated with infection, and the age-standardised infection to case detection rate (ICR), infection hospitalisation rate (IHR) and infection fatality rate (IFR) were calculated. RESULTS: Overall 7959 participants were enrolled, with a median age of 34 years and HIV prevalence of 22.7%. SARS-CoV-2 seroprevalence was 45.2% (95% confidence interval 43.7% - 46.7%), and increased from 26.9% among individuals enrolled in December 2020 to 47.1% among individuals in April 2021. On multivariable analysis, seropositivity was associated with age, sex, race, being overweight/obese, having respiratory symptoms, and low socioeconomic status. Persons living with HIV (PLWHIV) with high viral load were less likely to be seropositive compared to HIV-uninfected individuals. The site-specific ICR, IHR and IFR ranged across sites from 4.4% to 8.2%, 1.2% to 2.5% and 0.3% to 0.6%, respectively. CONCLUSIONS: South Africa has experienced a large burden of SARS-CoV-2 infections, with <10% of infections diagnosed. Lower seroprevalence among non-virally suppressed PLWHIV, likely as a result of inadequate antibody production, highlights the need to prioritise this group for intervention. |
Naomi: a new modelling tool for estimating HIV epidemic indicators at the district level in sub-Saharan Africa.
Eaton JW , Dwyer-Lindgren L , Gutreuter S , O'Driscoll M , Stevens O , Bajaj S , Ashton R , Hill A , Russell E , Esra R , Dolan N , Anifowoshe YO , Woodbridge M , Fellows I , Glaubius R , Haeuser E , Okonek T , Stover J , Thomas ML , Wakefield J , Wolock TM , Berry J , Sabala T , Heard N , Delgado S , Jahn A , Kalua T , Chimpandule T , Auld A , Kim E , Payne D , Johnson LF , FitzJohn RG , Wanyeki I , Mahy MI , Shiraishi RW . J Int AIDS Soc 2021 24 Suppl 5 e25788 INTRODUCTION: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. METHODS: Small-area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016-2018. RESULTS: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty-eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. CONCLUSIONS: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data. |
Perchloroethylene and dry cleaning: It's time to move the industry to safer alternatives
Ceballos DM , Fellows KM , Evans AE , Janulewicz PA , Lee EG , Whittaker SG . Front Public Health 2021 9 638082 Perchloroethylene (PERC) is the most common solvent used for dry cleaning in the United States. PERC is a reproductive toxicant, neurotoxicant, potential human carcinogen, and a persistent environmental pollutant. The Environmental Protection Agency is evaluating PERC under the Frank R. Lautenberg Chemical Safety for the 21st Century Act, which amended the Toxic Substances Control Act (amended TSCA), and has mandated that PERC dry cleaning machines be removed from residential buildings. Some local and state programs are also requiring or facilitating transitions to alternative cleaning technologies. However, the potential for these alternatives to harm human health and the environment is not well-understood. This review describes the issues surrounding the use of PERC and alternative solvents for dry cleaning while highlighting the lessons learned from a local government program that transitioned PERC dry cleaners to the safest current alternative: professional wet cleaning. Implications for future public health research and policy are discussed: (1) we must move away from PERC, (2) any transition must account for the economic instability and cultural aspects of the people who work in the industry, (3) legacy contamination must be addressed even after safer alternatives are adopted, and (4) evaluations of PERC alternatives are needed to determine their implications for the long-term health and sustainability of the people who work in the industry. |
Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention - 15 African countries, 2015-2019
Lucas T , Hines JZ , Samuelson J , Hargreave T , Davis SM , Fellows I , Prainito A , Watts DH , Kiggundu V , Thomas AG , Ntsuape OC , Dare K , Odoyo-June E , Soo L , Toti-Mokoteli L , Manda R , Kapito M , Msungama W , Odek J , Come J , Canda M , Gaspar N , Mekondjo A , Zemburuka B , Bonnecwe C , Vranken P , Mmbando S , Simbeye D , Rwegerera F , Wamai N , Kyobutungi S , Zulu JE , Chituwo O , Xaba S , Mandisarisa J , Toledo C . BMC Urol 2021 21 (1) 23 BACKGROUND: Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. METHODS: Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. RESULTS: In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6-2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14-27). CONCLUSIONS: Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2-3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR's recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years. |
Developing excellence in biostatistics leadership, training and science in Africa: How the Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB) trainingunites expertise to deliver excellence
Chirwa TF , Matsena Zingoni Z , Munyewende P , Manda SO , Mwambi H , Kandala NB , Kinyanjui S , Young T , Musenge E , Simbeye J , Musonda P , Mahande MJ , Weke P , Onyango NO , Kazembe L , Tumwesigye NM , Zuma K , Yende-Zuma N , Omanyondo Ohambe MC , Kweku EN , Maposa I , Ayele B , Achia T , Machekano R , Thabane L , Levin J , Eijkemans MJC , Carpenter J , Chasela C , Klipstein-Grobusch K , Todd J . AAS Open Res 2020 3 51 The increase in health research in sub-Saharan Africa (SSA) has led to a high demand for biostatisticians to develop study designs, contribute and apply statistical methods in data analyses. Initiatives exist to address the dearth in statistical capacity and lack of local biostatisticians in SSA health projects. The Sub-Saharan African Consortium for Advanced Biostatistics (SSACAB) led by African institutions was initiated to improve biostatistical capacity according to the needs identified by African institutions, through collaborative masters and doctoral training in biostatistics. SACCAB has created a critical mass of biostatisticians and a network of institutions over the last five years and has strengthened biostatistics resources and capacity for health research studies in SSA. SSACAB comprises 11 universities and four research institutions which are supported by four European universities. In 2015, only four universities had established Masters programmes in biostatistics and SSACAB supported the remaining seven to develop Masters programmes. In 2019 the University of the Witwatersrand became the first African institution to gain Royal Statistical Society accreditation for a Biostatistics Masters programme. A total of 150 fellows have been awarded scholarships to date of which 123 are Masters fellowships (41 female) of whom 58 have already graduated. Graduates have been employed in African academic (19) and research (15) institutions and 10 have enrolled for PhD studies. A total of 27 (10 female) PhD fellowships have been awarded; 4 of them are due to graduate by 2020. To date, SSACAB Masters and PhD students have published 17 and 31 peer-reviewed articles, respectively. SSACAB has also facilitated well-attended conferences, face-to-face and online short courses. Pooling of limited biostatistics resources in SSA combined with co-funding from external partners has shown to be an effective strategy for the development and teaching of advanced biostatistics methods, supervision and mentoring of PhD candidates. |
A new method for estimating HIV incidence from a single cross-sectional survey
Fellows IE , Shiraishi RW , Cherutich P , Achia T , Young PW , Kim AA . PLoS One 2020 15 (8) e0237221 Estimating incidence from cross-sectional data sources is both important to the understanding of the HIV epidemic and challenging from a methodological standpoint. We develop a new incidence estimator that measures the size of the undiagnosed population and the amount of time spent undiagnosed in order to infer incidence and transmission rates. The estimator is calculated using commonly collected information on testing history and HIV status and, thus, can be deployed in many HIV surveys without additional cost. If ART biomarker status and/or viral load information is available, the estimator can be adjusted for biases in self-reported testing history. The performance of the estimator is explored in two large surveys in Kenya, where we find our point estimates to be consistent with assay-derived estimates, with much smaller standard errors. |
Supporting public health employee engagement and retention: One U.S. national center's analysis and approach
Smith CK , Spears-Jones C , Acker C , Dean HD . Workplace Health Saf 2020 68 (8) 366-373 Background: Employee engagement, exemplified by positive perceptions of supervisors, workplace, and job, improves productivity and employee retention. We identified the extent of and barriers to employee engagement at Centers for Disease Control and Prevention's (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Methods: In 2015, NCHHSTP's leadership collected baseline data through a centerwide Employee Engagement Pulse Survey (EEPS) from NCHHSTP's full-time Civil Service employees, U.S. Public Health Service Commissioned Corps officers, and Title 42 service fellows. EEPS included six demographic questions; nine Likert-type scale questions measuring 26 perceptions related to immediate supervisors, the work environment, and job satisfaction; and four open-ended questions soliciting recommendations for improvement. Findings: Among 727 of 1,171 staff (response rate = 62%), positive perceptions of supervisors ranged from a high of 94% (supervisor conducts performance reviews) to a low of 63% (supervisor assists employees with career development). Perceptions of work experience ranged from 98% (respondents were willing to put in extra effort to get a job done) to 68% (respondents' talents were used well in the workplace). Perceptions of job satisfaction ranged from 87% (support from their coworkers) to 69% (satisfaction with opportunities to learn or grow professionally). Conclusion/Application to Practice: Overall, NCHHSTP staff have positive perceptions of their work, their leaders, and the agency. Other public- and private-sector employers might be able to improve their employees' engagement and retention by listening to their opinions and needs and frequently recognizing their individual achievements. NCHHSTP's workforce development initiatives can be used as a model for assessing a baseline of their employees' engagement. |
An exploratory review of the literature evaluating nonclinical fellowship programs
Paek M , Radkey C , Honeycutt S , Glynn MK . Eval Program Plann 2020 80 101812 Fellowship programs offer career development opportunities, provide experiential training, and can be used to recruit personnel to address specific challenges facing the public health workforce. Given the potential influence fellowships have on the future public health workforce, it is important to understand and articulate the results of such programs and to identify areas of improvement to meet current workforce needs. The purpose of this literature review was to identify common practices used to evaluate nonclinical fellowship programs. After a search of the internet and selected databases, we screened titles and abstracts using predetermined selection criteria. We then conducted a detailed review of selected papers to extract information about program characteristics (program description, sector, and program length) and evaluation characteristics (primary evaluation type, framework for evaluation, data collection methods, and respondent populations) from 33 papers. We found a limited number of published papers on the evaluation of nonclinical fellowship programs, and most focused on outcomes associated with fellows or alumni. The most useful papers for our purposes clearly described the evaluation framework that guided the evaluation. |
Lessons from the first 6 years of an intervention-based field epidemiology training programme in Papua New Guinea, 2013-2018
Ropa B , Flint J , O'Reilly M , Pavlin BI , Dagina R , Peni B , Bauri M , Pukienei A , Merritt T , Terrell-Perica S , Yamba A , Prybylski D , Collins J , Durrheim DN , Henderson A , Bieb S . BMJ Glob Health 2019 4 (6) e001969 Papua New Guinea (PNG) faces a critical shortage of human resources to address pressing public health challenges arising from an increasing burden of communicable and non-communicable diseases. PNG is an independent State in the Pacific and home to 8.2 million people. Resource and infrastructure constraints due to the country's challenging geography have made it difficult and expensive to deliver health services and implement health programmes. The National Department of Health and its partners developed a field epidemiology training programme of Papua New Guinea (FETPNG) to strengthen the country's public health workforce. The training programme covers field epidemiology competencies and includes the design, implementation and evaluation of evidence-based interventions by Fellows. From 2013 to 2018, FETPNG graduated 81 field epidemiologists. Most FETPNG graduates (84%) were from provincial or district health departments or organisations. Many of their intervention projects resulted in successful public health outcomes with tangible local impacts. Health challenges addressed included reducing the burden of multi-drug resistant-tuberculosis (TB), increasing immunisation coverage, screening and treating HIV/TB patients, and improving reproductive health outcomes. FETPNG Fellows and graduates have also evaluated disease surveillance systems and investigated disease outbreaks. Early and unwavering national ownership of FETPNG created a sustainable programme fitting the needs of this low-resource country. A focus on designing and implementing effective public health interventions not only provides useful skills to Fellows but also contributes to real-time, tangible and meaningful improvements in the health of the population. The graduates of FETPNG now provide a critical mass of public health practitioners across the country. Their skills in responding to outbreaks and public health emergencies, in collecting, analysing and interpreting data, and in designing, implementing and evaluating public health interventions continues to advance public health in PNG. |
Strategic development of the public health workforce: A unified logic model for a multifaceted program at the Centers for Disease Control and Prevention
Glynn MK , Paek M , Radkey C , Arvelo W , Greene E , Hardwick I , Neri A . J Public Health Manag Pract 2019 27 (1) 62-69 CONTEXT: Public health has a responsibility to ensure the ability of its workforce to deliver essential services, including mastering the core public health competencies. PROGRAM: The Division of Scientific Education and Professional Development (DSEPD) of the Centers for Disease Control and Prevention has a mission to improve health outcomes through a competent, sustainable, and empowered public health workforce. The DSEPD programs offer fellowships and other training opportunities, develop and disseminate quality public health training, and advance public health workforce development science. EVALUATION: The DSEPD developed a unified division logic model to describe the combined activities and intended outcomes of all DSEPD programs and their intended contribution to a robust public health workforce and to support ongoing program planning and evaluation. The logic model has 4 streams of work that include (1) producing and disseminating quality learning products; (2) implementing and managing fellowship programs that support learning; (3) providing public health service through fellows; and (4) advancing workforce development science through collaboration with other public health leaders.The underlying program theory is that a robust workforce has sufficient workforce, organizational, and systems capacity to deliver public health essential services and, therefore, to protect the public's health. Three scientific theories support the program theory: the quality of learning; the accepted practice of competency-based programs and the service-learning model; and use of evidence-guided decision making in workforce development programs. DISCUSSION: A unified division logic model allows DSEPD to describe its combined approaches to workforce development as a coherent portfolio with well-defined goals and measureable outcomes. The logic model effectively communicates the relationship among division programs, their shared outcomes, and their combined contributions to developing and maintaining a robust public health workforce. A unified logic model can serve as effective frame of reference for division evaluation and as evidence in public health workforce development science. |
Support for breastfeeding physicians
Nelson JM , Onyema-Melton N , Hanley LE , Meek JY , Wood JK . J Pediatr 2019 211 225 With interest, we read the commentary by Pesch et al on the need for pediatricians to support their fellow breastfeeding colleagues.1 The American Academy of Pediatrics currently is funded by the Centers for Disease Control and Prevention to address improvements in breastfeeding-related physician education and training. As part of this project, the American Academy of Pediatrics, with input from representatives of the American College of Obstetrics and Gynecology, the American Academy of Family Physicians, and multiple other stakeholder organizations on the Project Advisory Committee developed the “Physician Education and Training on Breastfeeding Action Plan.”2 A key component of that plan is support for the breastfeeding physician. The plan included support for the revision of the Academy of Breastfeeding Medicine’s statement on breastfeeding-related educational objectives and skills needed for physicians, which includes a statement of support for breastfeeding medical students, residents, faculty, and staff.3 In addition, the American Academy of Family Physicians is leading efforts towards drafting a model policy describing how institutions can support their medical trainees (students, residents, and fellows). Finally, the Project Advisory Committee is in the process of developing a plan to create a culture of support for breastfeeding within the medical community that will emphasize support for breastfeeding physicians as a component of wellness. We agree with the authors’ conclusion that there is a need to support the breastfeeding physician. As the proportion of women physicians increases,4 with a majority being of reproductive age, creating environments that support breastfeeding physicians may help them meet their personal breastfeeding goals,5 improve their health and that of their own children,6, 7 and enhance their skills at providing breastfeeding care to their patients.5, 8 Breastfeeding physicians, as with all women who choose to breastfeed, need supportive environments to make breastfeeding a success. |
Putting the 'M' back in maternal-fetal medicine: A five-year report card on a collaborative effort to address maternal morbidity and mortality in the U.S
D'Alton ME , Friedman AM , Bernstein PS , Brown HL , Callaghan WM , Clark SL , Grobman WA , Kilpatrick SJ , O'Keeffe DF , Montgomery DM , Srinivas SK , Wendel GD , Wenstrom KD , Foley MR . Am J Obstet Gynecol 2019 221 (4) 311-317 e1 The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014 with a mortality rate of 18.0 per 100,000, higher than many other developed countries. In 2012 the first "Putting the 'M' back in Maternal Fetal Medicine" session was held at the Society for Maternal Fetal Medicine's (SMFM) Annual Meeting. With the realization that rising risk for severe maternal morbidity and mortality required action, the "M in MFM" meeting identified urgent needs to: (i) enhance education and training in maternal care for maternal-fetal medicine (MFM) fellows; (ii) improve the medical care and management of pregnant women across the country; and (iii) address critical research gaps in maternal medicine. Since that first meeting a broad collaborative effort has made a number of major steps forward including the proliferation of maternal mortality review committees, advances in research, increasing educational focus on maternal critical care, and development of comprehensive clinical strategies to reduce maternal risk. Five years later, the 2017 "M in MFM" meeting served as a "report card" looking back at progress made but also looking forward to what needs to be done over the next five years given that too many mothers still experience preventable harm and adverse outcomes. |
Strengthening global health security through Africa's first absolute post-master's fellowship program in field epidemiology in Uganda
Ario AR , Wanyenze RK , Opio A , Tusiime P , Kadobera D , Kwesiga B , Bulage L , Kihembo C , Kabwama SN , Matovu JKB , Becknell S , Zhu BP . Health Secur 2018 16 S87-s97 Uganda is prone to epidemics of deadly infectious diseases and other public health emergencies. Though significant progress has been made in response to emergencies during the past 2 decades, system weaknesses still exist, including lack of a robust workforce with competencies to identify, investigate, and control disease outbreaks at the source. These deficiencies hamper global health security broadly. To address need for a highly competent workforce to combat infectious diseases, the Uganda Ministry of Health established the Public Health Fellowship Program (PHFP), the advanced-level Field Epidemiology Training Program (FETP), closely modeled after the CDC's Epidemic Intelligence Service (EIS) program. The 2-year, full-time, non-degree granting program is the first absolute post-master's FETP in Africa for mid-career public health professionals. Fellows gain competencies in 7 main domains, which are demonstrated by deliverables, while learning through service delivery 80% of the time in the ministry of health. During 2015-2017, PHFP enrolled 3 cohorts of 31 fellows. By January 2018, PHFP had graduated 2 cohorts (2015 and 2016) of 19 fellows. Fellows were placed in 17 priority areas of the ministry of health. They completed 153 projects (including 60 outbreak investigations, 12 refugee assessments, 40 surveillance projects, and 31 applied epidemiologic studies), of which 49 involved potential bioterrorism agents or epidemic-prone diseases. They made 132 conference presentations, prepared 40 manuscripts for peer-reviewed publication (17 published as of December 2017), and produced 3 case studies. Many of these projects have resulted in public health interventions that led to improvements in disease control and surveillance systems. The program has produced 19 issues of ministry of health bulletins. One year after graduation, graduates have been placed in key public health decision-making positions. Within 3 years, PHFP has strengthened global health security through improvement in public health emergency response; identification, investigation and control of outbreaks at their sources; and documentation and dissemination of findings to inform decision making by relevant stakeholders. |
Cholera outbreak in a fishing village in Uganda: a case study
Zhu BP , Pande G , Kwesiga B , Ario AR . Pan Afr Med J 2018 30 8 In June 2015, the District Health Officer of Kasese District, southwestern Uganda reported an outbreak of cholera in a fishing village. Two fellows of the Uganda Public Health Fellowship Program - Field Epidemiology Track conducted an investigation to verify the existence of an outbreak, determine the mode of transmission, and recommend control measures. This case study describes that investigation, which teaches the steps in an outbreak investigation and the details in each step, what needs to be done in each step to achieve the objectives of the investigation, and what might be the common pitfalls during an outbreak investigation. This case study can be used to teach the fundamental principles of an outbreak investigation and use of Epi Info for outbreak analysis. The audience are field epidemiologists at various levels in different settings. |
The links between agriculture, Anopheles mosquitoes, and malaria risk in children younger than 5 years in the Democratic Republic of the Congo: a population-based, cross-sectional, spatial study
Janko MM , Irish SR , Reich BJ , Peterson M , Doctor SM , Mwandagalirwa MK , Likwela JL , Tshefu AK , Meshnick SR , Emch ME . Lancet Planet Health 2018 2 (2) e74-e82 Background: The relationship between agriculture, Anopheles mosquitoes, and malaria in Africa is not fully understood, but it is important for malaria control as countries consider expanding agricultural projects to address population growth and food demand. Therefore, we aimed to assess the effect of agriculture on Anopheles biting behaviour and malaria risk in children in rural areas of the Democratic Republic of the Congo (DR Congo). Methods: We did a population-based, cross-sectional, spatial study of rural children (<5 years) in the DR Congo. We used information about the presence of malaria parasites in each child, as determined by PCR analysis of dried-blood spots from the 2013-14 DR Congo Demographic and Health Survey (DHS). We also used data from the DHS, a longitudinal entomological study, and available land cover and climate data to evaluate the relationships between agriculture, Anopheles biting behaviour, and malaria prevalence. Satellite imagery was used to measure the percentage of agricultural land cover around DHS villages and Anopheles sites. Anopheles biting behaviour was assessed by Human Landing Catch. We used probit regression to assess the relationship between agriculture and the probability of malaria infection, as well as the relationship between agriculture and the probability that a mosquito was caught biting indoors. Findings: Between Aug 13, 2013, and Feb 13, 2014, a total of 9790 dried-blood spots were obtained from the DHS, of which 4612 participants were included in this study. Falciparum malaria infection prevalence in rural children was 38.7% (95% uncertainty interval [UI] 37.3-40.0). Increasing exposure to agriculture was associated with increasing malaria risk with a high posterior probability (estimate 0.07, 95% UI -0.04 to 0.17; posterior probability [estimate >0]=0.89), with the probability of malaria infection increased between 0.2% (95% UI -0.1 to 3.4) and 2.6% (-1.5 to 6.6) given a 15% increase in agricultural cover, depending on other risk factors. The models predicted that large increases in agricultural cover (from 0% to 75%) increase the probability of infection by as much as 13.1% (95% UI -7.3 to 28.9). Increased risk might be due to Anopheles gambiae sensu lato, whose probability of biting indoors increased between 11.3% (95% UI -15.3 to 25.6) and 19.7% (-12.1 to 35.9) with a 15% increase in agriculture. Interpretation: Malaria control programmes must consider the possibility of increased risk due to expanding agriculture. Governments considering initiating large-scale agricultural projects should therefore also consider accompanying additional malaria control measures. Funding: National Institutes of Health, National Science Foundation, Bill & Melinda Gates Foundation, President's Malaria Initiative, and Royster Society of Fellows at the University of North Carolina at Chapel Hill. |
Evaluating interest in an influenza A(H5N1) vaccine among laboratory workers who work with highly-pathogenic avian influenza viruses in the United States
Russell KE , Bresee JS , Katz JM , Olsen SJ . Vaccine 2017 36 (2) 306-312 BACKGROUND: Highly pathogenic avian influenza A (HPAI) viruses found in poultry and wild birds occasionally infect humans and can cause serious disease. In 2014, the Advisory Committee on Immunization Practices (ACIP) reviewed data from one licensed ASO3-adjuvanted influenza A(H5N1) vaccine for consideration of use during inter-pandemic periods among persons with occupational exposure. To guide vaccine policy decisions, we conducted a survey of laboratory workers to assess demand for HPAI vaccination. METHODS: We designed an anonymous web survey (EpiInfo 7.0) to collect information on demographics, type of work and time spent with HPAI viruses, and interest in HPAI vaccination. Eligible participants were identified from 42 entities registered with United States Department of Agriculture's Agricultural Select Agent program in 2016 and emailed electronic surveys. Personnel with Biosafety Level 3 enhanced (BSL-3E) laboratory access were surveyed. Descriptive analysis was performed. RESULTS: Overall, 131 responses were received from 33 principal investigators, 26 research scientists, 24 technicians, 15 postdoctoral fellows, 6 students, and 27 others. The estimated response rate was 15% among the laboratory personnel of responding principal investigators. One hundred respondents reported working in a BSL-3E area where HPAI experiments occurred with a mean time of 5.1-11.7h per week. Overall, 49% were interested in receiving an A(H5N1) vaccine. By role, interest was highest among students (80%) and among those who spent >50% of their time in a BSL-3E area (64%). Most (61%) of those who said they might be or were not interested in vaccine believed it would not provide additional protection to current safety practices. CONCLUSIONS: Half of responding laboratory workers was interested in receiving an influenza A(H5N1) vaccine. HPAI vaccination of laboratory workers at risk of occupational exposure could be used along with existing safety practices to protect this population. |
Screening and treatment for iron deficiency anemia in women: Results of a survey of obstetrician-gynecologists
Marcewicz LH , Anderson BL , Byams VR , Grant AM , Schulkin J . Matern Child Health J 2017 21 (8) 1627-1633 Objective To better understand the knowledge, attitudes and practices of obstetrician-gynecologists with respect to screening and treatment for iron deficiency anemia (IDA). Methods A total of 1,200 Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were invited to participate in a survey on blood disorders. Respondents completed a questionnaire regarding their patient population, screening and treatment practices for IDA, and general knowledge about IDA and its risk factors. Results Overall response rate was 42.4%. Thirty-eight percent of respondents screen non-pregnant patients regularly, based on risk factors; 30.5% screen only when symptoms of anemia are present. For pregnant patients, 50.0% of respondents screen patients at their initial visit, while 46.2% screen every trimester. Sixty-one percent of respondents supplement pregnant patients when there is laboratory evidence of anemia; 31.6% supplement all pregnant patients. Forty-two percent of respondents screen post-partum patients based on their risk factors for IDA. However, when asked to identify risk factors for post-partum anemia, slightly more than half of respondents correctly identified young age and income level as risk factors for post-partum anemia; only 18.9% correctly identified pre-pregnancy obesity as a risk factor. Conclusion There are opportunities for increased education on IDA for obstetrician-gynecologists, specifically with respect to risk factors. There also appears to be substantial practice variance regarding screening and supplementation for IDA, which may correspond to variability in professional guidelines. Increased education on IDA, especially the importance of sociodemographic factors, and further research and effort to standardize guidelines is needed. |
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