Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Mayer O[original query] |
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Influenza vaccine effectiveness against hospitalizations and emergency department or urgent care encounters for children, adolescents, and adults during the 2023-2024 season, United States
Tenforde MW , Reeves EL , Weber ZA , Tartof SY , Klein NP , Dascomb K , DeSilva MB , Yang DH , Grannis SJ , Irving SA , Ong TC , Link-Gelles R , Salas SB , Sy LS , Lewin B , Contreras R , Zerbo O , Fireman B , Hansen J , Timbol J , Sheffield T , Bride D , Arndorfer J , VanOtterloo J , McEvoy CE , Akinsete OO , Essien IJ , Dixon BE , Rogerson C , Fadel WF , Duszynski T , Naleway AL , Barron MA , Rao S , Mayer D , Chavez C , Ball SW , Payne AB , Ray C , Dickerson M , Neelam V , Adams K , Flannery B , DeCuir J , Garg S . Clin Infect Dis 2024 BACKGROUND: The 2023-2024 influenza season had predominant influenza A(H1N1)pdm09 virus activity, but A(H3N2) and B viruses co-circulated. Seasonal influenza vaccine strains were well-matched to these viruses. METHODS: Using health care encounters data from health systems in 8 states, we evaluated influenza vaccine effectiveness (VE) against influenza-associated medical encounters from October 2023-April 2024. Using a test-negative design, we compared the odds of vaccination between patients with an acute respiratory illness (ARI) who tested positive (cases) versus negative (controls) for influenza by molecular assay, adjusting for confounders. VE was stratified by age group, influenza type (overall, influenza A, influenza B), and care setting (hospitalization, emergency department or urgent care [ED/UC] encounter). RESULTS: Overall, 74,000 encounters in children and adolescents aged 6 months - 17 years (3,479 hospitalizations, 70,521 ED/UC encounters) and 267,606 in adults aged ≥18 years (66,828 hospitalizations, 200,778 ED/UC encounters) were included. Across care settings, among children and adolescents 15% (2,758/17,833) of cases versus 32% (18,240/56,167) of controls had received vaccination. Among adults, 25% (11,632/46,614) of cases versus 44% (97,811/220,992) of controls across care settings had received vaccination. VE was 58% (95% confidence interval [95% CI]: 44-69%) against hospitalization and 58% (95% CI: 56-60%) against ED/UC encounters for children and adolescents, and 39% (95% CI: 35-43) against hospitalization and 47% (95% CI: 46-49%) against ED/UC encounters for adults. Across age groups, VE was higher against influenza B than influenza A. CONCLUSIONS: Influenza vaccines provided protection against influenza-associated illness across health care settings and age groups during the 2023-2024 influenza season. |
Why is roll-out of long-acting PrEP agents so slow?
Patel RR , Mayer KH . Curr Opin HIV AIDS 2025 20 (1) 48-53 PURPOSE OF REVIEW: Injectable cabotegravir for HIV preexposure prophylaxis (PrEP) is effective, yet global implementation has been slow. We review factors which have contributed to the delayed roll-out of this medication. RECENT FINDINGS: Fifty-three countries have approved cabotegravir for HIV prevention yet roll-out has been slow. Cabotegravir made up 2.5% of all U.S. PrEP prescriptions in 2023 and is very slowly increasing after FDA approval in 2021. Medication has not been available outside of implementation science studies in Africa and Asia. There is a lengthy process for generic medication production despite agreements signed in 2021; the first available generic dose is not anticipated until 2027. In the United States, where some of the cabotegravir medication costs can be covered under individual insurance plans, high costs and medication acquisition pathways for health centers have been complex, contributing to national implementation delays. The intensity of the staffing required for medication acquisition, insurance paperwork filing, process documentation, billing, injection administration, appointment scheduling, missed appointment monitoring and client follow up has burdened healthcare organizations. SUMMARY: Injectable cabotegravir PrEP has not reaped its potential to be an alternative in those for whom adherence to a daily PrEP pill is challenging. Lessons learned regarding cabotegravir medication acquisition pathways and clinical delivery strategies can inform the rollout of future HIV prevention long-acting agents. |
HIV-1 incidence, adherence, and drug resistance in individuals taking daily emtricitabine/tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: Pooled analysis from 72 global studies
Landovitz RJ , Tao L , Yang J , de Boer M , Carter C , Das M , Baeten JM , Liu A , Hoover KW , Celum C , Grinsztejn B , Morris S , Wheeler DP , Mayer KH , Golub SA , Bekker LG , Diabaté S , Hoornenborg E , Myers J , Leech AA , McCormack S , Chan PA , Sweat M , Matthews LT , Grant R . Clin Infect Dis 2024 79 (5) 1197-1207 ![]() ![]() BACKGROUND: Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (F/TDF) has high efficacy against HIV-1 acquisition. Seventy-two prospective studies of daily oral F/TDF PrEP were conducted to evaluate HIV-1 incidence, drug resistance, adherence, and bone and renal safety in diverse settings. METHODS: HIV-1 incidence was calculated from incident HIV-1 diagnoses after PrEP initiation and within 60 days of discontinuation. Tenofovir concentrations in dried blood spots (DBS), drug resistance, and bone/renal safety indicators were evaluated in a subset of studies. RESULTS: Among 17 274 participants, there were 101 cases with new HIV-1 diagnosis (.77 per 100 person-years; 95% confidence interval [CI]: .63-.94). In 78 cases with resistance data, 18 (23%) had M184I or V, 1 (1.3%) had K65R, and 3 (3.8%) had both mutations. In 54 cases with tenofovir concentration data from DBS, 45 (83.3%), 2 (3.7%), 6 (11.1%), and 1 (1.9%) had average adherence of <2, 2-3, 4-6, and ≥7 doses/wk, respectively, and the corresponding incidence was 3.9 (95% CI: 2.9-5.3), .24 (.060-.95), .27 (.12-.60), and .054 (.008-.38) per 100 person-years. Adherence was low in younger participants, Hispanic/Latinx and Black participants, cisgender women, and transgender women. Bone and renal adverse event incidence rates were 0.69 and 11.8 per 100 person-years, respectively, consistent with previous reports. CONCLUSIONS: Leveraging the largest pooled analysis of global PrEP studies to date, we demonstrate that F/TDF is safe and highly effective, even with less than daily dosing, in diverse clinical settings, geographies, populations, and routes of HIV-1 exposure. |
PrEP initiation and adherence among Black cisgender women in Mississippi: The role of HIV and PrEP stigma and social support
Knight D , Monger M , Phillips K , Antar A , Baral S , Stockman JK , Nunn A , Chan P , Mayer K , Mena L , Kershaw T , Willie TC . Womens Health (Lond) 2024 20 17455057241296905 BACKGROUND: Stigma and lack of social support are barriers to HIV prevention, especially among cisgender Black women in the United States. While HIV pre-exposure prophylaxis (PrEP) can decrease HIV transmission, PrEP initiation and adherence remains low among Black women, especially in the U.S. South. OBJECTIVES: The purpose of this study was to characterize experiences with stigma and social support among PrEP-naïve and PrEP-experienced Black cisgender women in Mississippi. DESIGN: Qualitative study in which semi-structured interviews and focus groups were conducted. METHODS: We purposively recruited PrEP-naïve cisgender Black women who met PrEP indications to participate in focus groups and all PrEP-experienced cisgender Black women at a sexual health clinic in Jackson, Mississippi to participate in one-on-one semi-structured interviews. Inductive thematic analysis was used to analyze focus group and interview transcripts. RESULTS: A total of 37 PrEP-naïve Black cisgender women participated across 6 focus groups and 8 PrEP-experienced cisgender Black women completed semi-structured interviews. Four themes were identified: (1) the intersection of gendered racism, discrimination, and HIV stigma, (2) enacted and anticipated PrEP stigma, (3) stigma mitigation strategies and PrEP adherence, and (4) social support's role in PrEP initiation and adherence. PrEP-naïve and -experienced Black women discussed the negative consequence that sexual stigmatization and gendered racism has on HIV testing. PrEP-naïve Black women discussed how HIV stigma decreases PrEP initiation. Conversely, PrEP-experienced Black women were able to identify strategies they utilized to mitigate stigma. PrEP-experienced Black women discussed how differing levels of social support impact their PrEP use. CONCLUSION: Improving social support and stigma mitigation strategies could help improve PrEP initiation and adherence among cisgender Black women at-risk of acquiring HIV in the U.S. South. Educating communities on PrEP, and training providers on stigma-mitigating strategies when serving Black women in the U.S. South who are seeking HIV prevention is paramount. | PrEP initiation and adherence among Black cisgender women in Mississippi: The role of HIV and PrEP stigma and social supportWhy was the study done?Stigma and lack of social support have been demonstrated as barriers to HIV prevention, especially among cisgender Black women in the United States (U.S.). While HIV pre-exposure prophylaxis (PrEP), a HIV prevention medication, has the ability to decrease HIV transmission, rates of starting PrEP remain low among Black women, especially in the U.S. South. Improving PrEP programs for US Black women calls for understanding how stigma and social support impact PrEP use among Black women.What did the researchers do?We recruited cisgender Black women who was eligible for PrEP but have never taken PrEP (PrEP-naïve) to participate in focus groups and cisgender Black women who have taken PrEP (PrEP-experienced) to participate in one-on-one in-depth interviews from healthcare clinics in Jackson, Mississippi. Inductive thematic analysis was used to analyze focus group and interview transcripts.What did the researchers find?A total of 37 Black cisgender women across six groups participated in focus groups and eight cisgender Black women were interviewed. PrEP-naïve women reported: · HIV stigma in the community, which can lead to anticipated PrEP stigma · Experiencing sex-based sexual stigmatization at provider’s offices when seeking HIV testing PrEP-experienced Black women reported: Experiencing stigma when disclosing their PrEP use, such as their family and friends thinking that the woman and/or her partner is living with HIV. PrEP-experienced Black women who were in serodifferent partnership and had others in their network who knew about PrEP received support to take PrEP.What do the findings mean?Improving social support and stigma mitigation strategies could help improve PrEP initiation and adherence among cisgender Black women at-risk of acquiring HIV in the U.S. South. This includes educating communities on HIV and PrEP, and training providers on stigma-mitigating strategies when serving Black women in the U.S. South. | eng |
Promising results of HIV prevention trials highlight the benefits of collaboration in global health: The perspective of the Forum HIV Recency Assay Working Group
Schaefer R , Donaldson L , Leus M , Osakwe CE , Chimukangara B , Dalal S , Duerr A , Gao F , Glidden DV , Grinsztejn B , Justman J , Kumwenda G , Laeyendecker O , Lee HY , Maldarelli F , Mayer KH , Murray J , Parekh BS , Rice B , Robertson MN , Saito S , Vannappagari V , Warren M , Zeballos D , Zinserling J , Miller V . PLOS Glob Public Health 2024 4 (10) e0003878 ![]() |
Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalisations and emergency department encounters among adults aged 60 years and older in the USA, October, 2023, to March, 2024: a test-negative design analysis
Payne AB , Watts JA , Mitchell PK , Dascomb K , Irving SA , Klein NP , Grannis SJ , Ong TC , Ball SW , DeSilva MB , Natarajan K , Sheffield T , Bride D , Arndorfer J , Naleway AL , Koppolu P , Fireman B , Zerbo O , Timbol J , Goddard K , Dixon BE , Fadel WF , Rogerson C , Allen KS , Rao S , Mayer D , Barron M , Reese SE , Rowley EAK , Najdowski M , Ciesla AA , Mak J , Reeves EL , Akinsete OO , McEvoy CE , Essien IJ , Tenforde MW , Fleming-Dutra KE , Link-Gelles R . Lancet 2024 404 (10462) 1547-1559 BACKGROUND: Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years. METHODS: We conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region. FINDINGS: Among 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71-85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52-92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48-85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70-83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type. INTERPRETATION: Respiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023-24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved. FUNDING: The Centers for Disease Control and Prevention. |
Differences in COVID-19 outpatient antiviral treatment among adults aged ≥65 years by age group - national patient-centered clinical research network, United States, April 2022-September 2023
Quinlan CM , Shah MM , DeSantis CE , Bertumen JB , Draper C , Ahmad FS , Arnold J , Mayer KH , Carton TW , Cowell LG , Smith S , Saydah S , Jones JM , Patel P , Hagen MB , Block J , Koumans EH . MMWR Morb Mortal Wkly Rep 2024 73 (39) 876-882 Adults aged ≥65 years experience the highest risk for COVID-19-related hospitalization and death, with risk increasing with increasing age; outpatient antiviral treatment reduces the risk for these severe outcomes. Despite the proven benefit of COVID-19 antiviral treatment, information on differences in use among older adults with COVID-19 by age group is limited. Nonhospitalized patients aged ≥65 years with COVID-19 during April 2022-September 2023 were identified from the National Patient-Centered Clinical Research Network. Differences in use of antiviral treatment among patients aged 65-74, 75-89, and ≥90 years were assessed. Multivariable logistic regression was used to estimate the association between age and nonreceipt of antiviral treatment. Among 393,390 persons aged ≥65 years, 45.9% received outpatient COVID-19 antivirals, including 48.4%, 43.5%, and 35.2% among those aged 65-75, 76-89, and ≥90 years, respectively. Patients aged 75-89 and ≥90 years had 1.17 (95% CI = 1.15-1.19) and 1.54 (95% CI = 1.49-1.61) times the adjusted odds of being untreated, respectively, compared with those aged 65-74 years. Among 12,543 patients with severe outcomes, 2,648 (21.1%) had received an outpatient COVID-19 antiviral medication, compared with 177,874 (46.7%) of 380,847 patients without severe outcomes. Antiviral use is underutilized among adults ≥65 years; the oldest adults are least likely to receive treatment. To prevent COVID-19-associated morbidity and mortality, increased use of COVID-19 antiviral medications among older adults is needed. |
Closing the dissemination gap: Accessible toolkits for the rapid replication of evidence-informed interventions to improve health outcomes among people with HIV
Goldhammer H , Marc LG , Massaquoi M , Cancio R , Cahill S , Downes A , Rebchook G , Bourdeau B , Head J , Psihopaidas D , Chavis NS , Cohen SM , Mayer KH , Keuroghlian AS . AIDS Behav 2024 Despite advances in HIV care and treatment in the U.S., disparities in outcomes along the HIV care continuum persist. The widespread replication of effective and sustainable interventions that prioritize the engagement of underserved populations has been identified as a promising path to ending the HIV epidemic in the U.S. Intervention dissemination products, however, rarely provide the comprehensive and accessible information needed to replicate interventions within community settings. To bridge the divide between research and community-based implementation, the Using Evidence-informed Interventions to Improve Health Outcomes among People Living with HIV (E2i) initiative-grounded in the HIV/AIDS Bureau Implementation Science Framework-created a suite of tools to promote the rapid replication of interventions focused on transgender women, Black men who have sex with men, behavioral health integration, and identifying and addressing trauma. The resulting dissemination products are detailed and digestible multimedia toolkits that follow adult learning theory principles and align with the Template for Intervention Description and Replication criteria for adapting non-pharmacological interventions. Each E2i toolkit consists of five components: implementation guides, narrative videos of site implementation, best practice demonstration videos, interactive learning modules, and recruitment posters and brochures. Over 2 years (2022-2024), the E2i toolkit webpages amassed 7703 unique users and 17,666 pageviews. These toolkits can serve as a blueprint for designing comprehensive and accessible dissemination products for replication of HIV interventions in care settings. Dissemination products that bridge the gap between intervention research and replication in community settings are a crucial missing tool for ending the HIV epidemic. |
Interventions to mitigate the impact of COVID-19 among people experiencing sheltered homelessness: Chicago, Illinois, March 1, 2020-May 11, 2023
Tietje L , Ghinai I , Cooper A , Tung EL , Borah B , Funk M , Ramachandran D , Gerber B , Man B , Singer R , Bell E , Moss A , Weidemiller A , Chaudhry M , Lendacki F , Bernard R , Gretsch S , English K , Huggett TD , Tornabene M , Cool C , Detmer WM , Schroeter MK , Mayer S , Davis E , Boegner J , Glenn EE , Phillips G 2nd , Falck S , Barranco L , Toews KA . Am J Public Health 2024 e1-e9 Objectives. To compare the incidence, case-hospitalization rates, and vaccination rates of COVID-19 between people experiencing sheltered homelessness (PESH) and the broader community in Chicago, Illinois, and describe the impact of a whole community approach to disease mitigation during the public health emergency. Methods. Incidence of COVID-19 among PESH was compared with community-wide incidence using case-based surveillance data from March 1, 2020, to May 11, 2023. Seven-day rolling means of COVID-19 incidence were assessed for the overall study period and for each of 6 distinct waves of COVID-19 transmission. Results. A total of 774 009 cases of COVID-19 were detected: 2579 among PESH and 771 430 in the broader community. Incidence and hospitalization rates per 100 000 in PESH were more than 5 times higher (99.84 vs 13.94 and 16.88 vs 2.14) than the community at large in wave 1 (March 1, 2020-October 3, 2020). This difference decreased through wave 3 (March 7, 2021-June 26, 2021), with PESH having a lower incidence rate per 100 000 than the wider community (8.02 vs 13.03). Incidence and hospitalization of PESH rose again to rates higher than the broader community in waves 4 through 6 but never returned to wave 1 levels. Throughout the study period, COVID-19 incidence among PESH was 2.88 times higher than that of the community (70.90 vs 24.65), and hospitalization was 4.56 times higher among PESH (7.51 vs 1.65). Conclusions. Our findings suggest that whole-community approaches can minimize disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission between vulnerable populations and the broader community, and reinforce the benefits of a shared approach that include multiple partners when addressing public health emergencies in special populations. (Am J Public Health. Published online ahead of print August 28, 2024:e1-e9. https://doi.org/10.2105/AJPH.2024.307801). |
Pediatric and adolescent HIV viral load coverage and suppression rates in the context of the COVID-19 pandemic in 12 PEPFAR-supported sub-Saharan African countries in 2019 and 2020
Carpenter D , Hast M , Buono N , Hrapcak S , Sato K , Mrina R , Cox MH , Agaba PA , Vrazo AC , Wolf H , Rivadeneira ED , Shang JD , Mayer MM , Prao AH , Longuma HO , Kabwe C , Lwana PN , Tilahun T , Ts'oeu M , Mutisya I , Omoto LN , Cowan JG , Deus Mijt , Fagbamigbe OJ , Ene U , Ikpeazu A , Ndlovu MB , Matiko E , Schaad N , Bisimba J , Lema E , Musokotwane K , Maphosa T , Buthelezi B , Olarinoye A , Lawal I , Mukungunugwa S , Mwambona JT , Wondimu T , Kathure IA , Igboelina OD , Nzima VN , Bissai RG , Lenka M , Shasha W , Olivier NK , Matsinhe M , Wate A , Godfrey L , Alexander H , Alemnji G , Lecher S . PLOS Glob Public Health 2024 4 (8) e0003513 The early period of the COVID-19 pandemic limited access to HIV services for children and adolescents living with HIV (C/ALHIV). To determine progress in providing care and treatment services, we describe viral load coverage (VLC) and suppression (VLS) (<1000 copies/ mL) rates during the COVID-19 pandemic in 12 United States President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries. Data for children (0-9 years) and adolescents (10-19 years) on VLC and VLS were analyzed for 12 sub-Saharan African (SSA) countries between 2019 (pre-COVID-19) and 2020 (during COVID-19). We report the number of viral load (VL) tests, and percent change in VLC and VLS for patients on ART. For 12 countries, 181,192 children had a VL test during the pre-COVID-19 period compared with 177,683 December 2020 during COVID-19. VLC decreased from 68.8% to 68.3% overall. However, 9 countries experienced an increase ranging from a 0.7%-point increase for Tanzania and Zimbabwe to a 15.3%-point increase for Nigeria. VLS increased for all countries from 71.2% to 77.7%. For adolescents the number with a VL test increased from 377,342 to 402,792. VLC decreased from 77.4% to 77.1%. However, 7 countries experienced an increase ranging from 1.8% for Mozambique to 13.8% for Cameroon. VLS increased for all countries from 76.8% to 83.8%. This analysis shows variation in HIV VLC across 12 SSA countries. VLS consistently improved across all countries demonstrating resilience of countries during 2020. Countries should continue to improve clinical outcomes from C/ALHIV despite service disruptions that may occur during pandemic response. |
HIV immunocapture reveals particles expressed in semen under integrase strand transfer inhibitor-based therapy are largely myeloid cell-derived and disparate
Johnson JA , Li JF , Politch JA , Lipscomb JT , Tino AS , DeFelice J , Gelman M , Anderson DJ , Mayer KH . J Infect Dis 2024 230 (1) 78-85 ![]() As use of human immunodeficiency virus (HIV) integrase strand transfer inhibitors (INSTI) increases and formulations are being developed for maintenance therapies and chemoprophylaxis, assessing virus suppression under INSTI-based regimens in prevention-relevant biologic compartments, such as the male genital tract, is timely. We used cell-source marker virion immunocapture to examine amplification of particle RNA then assessed the phylogenetic relatedness of seminal and blood viral sequences from men with HIV who were prescribed INSTI-based regimens. Seminal plasma immunocaptures yielded amplifiable virion RNA from 13 of 24 (54%) men, and the sequences were primarily associated with markers indicative of macrophage and resident dendritic cell sources. Genetic distances were greatest (>2%) between seminal virions and circulating proviruses, pointing to ongoing low-level expression from tissue-resident cells. While the low levels in semen predict an improbable likelihood of transmission, viruses with large genetic distances are expressed under potent INSTI therapy and have implications for determining epidemiologic linkages if adherence is suboptimal. |
Case series of patients with Marburg Virus Disease, Equatorial Guinea, 2023
Fontana L , Ondo Avomo CO , Ngomo Mikue LE , Fuga Eyemam DÑ , Nguere MA , Mometolo IE , Bibang Nzang RN , Nguema Maye DM , Giuliani R , Jacquerioz F , Lang HJ , Kojan R , Chaillon A , Ngai S , le Polain de Waroux O , Silenzi A , Di Marco M , Negrón ME , Klena JD , Choi MJ , Mayer O , Scholte FEM , Welch SR , Zielinski-Gutierrez E , Diaz J . N Engl J Med 2024 391 (3) 283-285 |
Preventive service usage and new chronic disease diagnoses: Using PCORnet data to identify emerging trends, United States, 2018-2022
Jackson SL , Lekiachvili A , Block JP , Richards TB , Nagavedu K , Draper CC , Koyama AK , Womack LS , Carton TW , Mayer KH , Rasmussen SA , Trick WE , Chrischilles EA , Weiner MG , Podila PSB , Boehmer TK , Wiltz JL . Prev Chronic Dis 2024 21 E49 BACKGROUND: Data modernization efforts to strengthen surveillance capacity could help assess trends in use of preventive services and diagnoses of new chronic disease during the COVID-19 pandemic, which broadly disrupted health care access. METHODS: This cross-sectional study examined electronic health record data from US adults aged 21 to 79 years in a large national research network (PCORnet), to describe use of 8 preventive health services (N = 30,783,825 patients) and new diagnoses of 9 chronic diseases (N = 31,588,222 patients) during 2018 through 2022. Joinpoint regression assessed significant trends, and health debt was calculated comparing 2020 through 2022 volume to prepandemic (2018 and 2019) levels. RESULTS: From 2018 to 2022, use of some preventive services increased (hemoglobin A(1c) and lung computed tomography, both P < .05), others remained consistent (lipid testing, wellness visits, mammograms, Papanicolaou tests or human papillomavirus tests, stool-based screening), and colonoscopies or sigmoidoscopies declined (P < .01). Annual new chronic disease diagnoses were mostly stable (6% hypertension; 4% to 5% cholesterol; 4% diabetes; 1% colonic adenoma; 0.1% colorectal cancer; among women, 0.5% breast cancer), although some declined (lung cancer, cervical intraepithelial neoplasia or carcinoma in situ, cervical cancer, all P < .05). The pandemic resulted in health debt, because use of most preventive services and new diagnoses of chronic disease were less than expected during 2020; these partially rebounded in subsequent years. Colorectal screening and colonic adenoma detection by age group aligned with screening recommendation age changes during this period. CONCLUSION: Among over 30 million patients receiving care during 2018 through 2022, use of preventive services and new diagnoses of chronic disease declined in 2020 and then rebounded, with some remaining health debt. These data highlight opportunities to augment traditional surveillance with EHR-based data. |
Evaluation of hospital-onset bacteraemia and fungaemia in the USA as a potential healthcare quality measure: a cross-sectional study
Leekha S , Robinson GL , Jacob JT , Fridkin S , Shane A , Sick-Samuels A , Milstone AM , Nair R , Perencevich E , Puig-Asensio M , Kobayashi T , Mayer J , Lewis J , Bleasdale S , Wenzler E , Mena Lora AJ , Baghdadi J , Schrank GM , Wilber E , Aldredge AA , Sharp J , Dyer KE , Kendrick L , Ambalam V , Borgetti S , Carmack A , Gushiken A , Patel A , Reddy S , Brown CH , Dantes RB , Harris AD . BMJ Qual Saf 2024 BACKGROUND: Hospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability. METHODS: We conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1-3 were collectively considered 'potentially preventable' and 4-6 'potentially not preventable'. RESULTS: Among 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance. DISCUSSION: Factors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric. |
Climate change, malaria and neglected tropical diseases: a scoping review
Klepac P , Hsieh JL , Ducker CL , Assoum M , Booth M , Byrne I , Dodson S , Martin DL , Turner CMR , van Daalen KR , Abela B , Akamboe J , Alves F , Brooker SJ , Ciceri-Reynolds K , Cole J , Desjardins A , Drakeley C , Ediriweera DS , Ferguson NM , Gabrielli AF , Gahir J , Jain S , John MR , Juma E , Kanayson P , Deribe K , King JD , Kipingu AM , Kiware S , Kolaczinski J , Kulei WJ , Laizer TL , Lal V , Lowe R , Maige JS , Mayer S , McIver L , Mosser JF , Nicholls RS , Nunes-Alves C , Panjwani J , Parameswaran N , Polson K , Radoykova HS , Ramani A , Reimer LJ , Reynolds ZM , Ribeiro I , Robb A , Sanikullah KH , Smith DRM , Shirima GG , Shott JP , Tidman R , Tribe L , Turner J , Vaz Nery S , Velayudhan R , Warusavithana S , Wheeler HS , Yajima A , Abdilleh AR , Hounkpatin B , Wangmo D , Whitty CJM , Campbell-Lendrum D , Hollingsworth TD , Solomon AW , Fall IS . Trans R Soc Trop Med Hyg 2024 To explore the effects of climate change on malaria and 20 neglected tropical diseases (NTDs), and potential effect amelioration through mitigation and adaptation, we searched for papers published from January 2010 to October 2023. We descriptively synthesised extracted data. We analysed numbers of papers meeting our inclusion criteria by country and national disease burden, healthcare access and quality index (HAQI), as well as by climate vulnerability score. From 42 693 retrieved records, 1543 full-text papers were assessed. Of 511 papers meeting the inclusion criteria, 185 studied malaria, 181 dengue and chikungunya and 53 leishmaniasis; other NTDs were relatively understudied. Mitigation was considered in 174 papers (34%) and adaption strategies in 24 (5%). Amplitude and direction of effects of climate change on malaria and NTDs are likely to vary by disease and location, be non-linear and evolve over time. Available analyses do not allow confident prediction of the overall global impact of climate change on these diseases. For dengue and chikungunya and the group of non-vector-borne NTDs, the literature privileged consideration of current low-burden countries with a high HAQI. No leishmaniasis papers considered outcomes in East Africa. Comprehensive, collaborative and standardised modelling efforts are needed to better understand how climate change will directly and indirectly affect malaria and NTDs. |
Biomarkers of organophosphate and polybrominated diphenyl ether (PBDE) flame retardants of American workers and associations with inhalation and dermal exposures
Estill CF , Mayer AC , Chen IC , Slone J , LaGuardia MJ , Jayatilaka N , Ospina M , Sjodin A , Calafat AM . Environ Sci Technol 2024 This study evaluated workers' exposures to flame retardants, including polybrominated diphenyl ethers (PBDEs), organophosphate esters (OPEs), and other brominated flame retardants (BFRs), in various industries. The study aimed to characterize OPE metabolite urinary concentrations and PBDE serum concentrations among workers from different industries, compare these concentrations between industries and the general population, and evaluate the likely route of exposure (dermal or inhalation). The results showed that workers from chemical manufacturing had significantly higher (p <0.05) urinary concentrations of OPE metabolites compared to other industries. Spray polyurethane foam workers had significantly higher (p <0.05) urinary concentrations of bis(1-chloro-2-propyl) phosphate (BCPP) compared to other industries. Electronic scrap workers had higher serum concentrations of certain PBDE congeners compared to the general population. Correlations were observed between hand wipe samples and air samples containing specific flame-retardant parent chemicals and urinary metabolite concentrations for some industries, suggesting both dermal absorption and inhalation as primary routes of exposure for OPEs. Overall, this study provides insights into occupational exposure to flame retardants in different industries and highlights the need for further research on emerging flame retardants and exposure reduction interventions. |
Emerging from the shadows: Trends in HIV ambulatory care, viral load testing, and viral suppression in a U.S. HIV cohort, 2019-2022: Impact of COVID-19 pandemic
Tedaldi EM , Hou Q , Armon C , Mahnken J , Palella F , Simoncini G , Fuhrer J , Mayer C , Ewing AC , Chagaris K , Carlson K , Li J , Buchacz K . J Investig Med 2024 10815589241252592 OBJECTIVES: Analyze the acute impact and the longer-term recovery of COVID-19 pandemic effects on clinical encounter types, HIV viral load (VL) testing and suppression (HIV VL<200 copies/mL). DESIGN: Longitudinal cohort study of participants seen during 2019-2022 at eight HIV Outpatient Study (HOPS) sites. METHODS: Generalized linear mixed models (GLMM) estimated monthly rates of all encounters, office and telemedicine visits, and HIV VL tests using 2010-2022 data. We examined factors associated with non-suppressed VL (VL ≥ 200 copies/mL) and not having ambulatory care visits during the pandemic using GLMM for logistic regression with 2017-2022 and 2019-2022 data, respectively. RESULTS: Of 2351 active participants, 76.0% were male, 57.6% aged ≥ 50 years, 40.7% non-Hispanic White, 38.2% non-Hispanic Black, 17.3% Hispanic/Latino, and 51.0% publicly insured. The monthly rates of in-person and telemedicine visits varied during 2020 through mid-year 2022. Multivariable logistic regression showed persons with no encounters were more likely to be male or have VL ≥ 200 copies/mL. For participants with ≥1 VL test, the prevalence rate of HIV VL ≥ 200 copies/mL during 2020 was close to the rates from 2014 to 2019. The change in probability of viral suppression was not associated with participant's age, sex, race/ethnicity or insurance type. CONCLUSION: In thent encounters declined over 2 years during the pandemic with variations in telemedicine and in-person events, with relative maintenance of viral suppression. Ongoing recovery from the impact of COVID-19 on ambulatory care will require continued efforts to improve retention and patient access to medical services. |
Mammogram and pap smear uptake among women in the HIV Outpatient Study USA, 2010-2021
Firnhaber C , Simoncini G , Mayer C , Armon C , Ewing AC , Tedaldi E , Battalora L , Carlson K , Chagaris K , Buchacz K , Li J . AIDS Patient Care STDS 2024 38 (4) 151-154 |
Evaluating workplace protection factors (WPFs) of different firefighter PPE interface control measures for select volatile organic compounds (VOCs)
Kander MC , Mayer AC , Wilkinson AF , Bertke S , Kesler RM , Smith DL , Horn GP , Fent KW . J Occup Environ Hyg 2024 1-12 Structural firefighters are exposed to a complex set of contaminants and combustion byproducts, including volatile organic compounds (VOCs). Additionally, recent studies have found structural firefighters' skin may be exposed to multiple chemical compounds via permeation or penetration of chemical byproducts through or around personal protective equipment (PPE). This mannequin-based study evaluated the effectiveness of four different PPE conditions with varying contamination control measures (incorporating PPE interface design features and particulate blocking materials) to protect against ingress of several VOCs in a smoke exposure chamber. We also investigated the effectiveness of long-sleeve base layer clothing to provide additional protection against skin contamination. Outside gear air concentrations were measured from within the smoke exposure chamber at the breathing zone, abdomen, and thigh heights. Personal air concentrations were collected from mannequins under PPE at the same general heights and under the base layer at abdomen and thigh heights. Sampled contaminants included benzene, toluene, styrene, and naphthalene. Results suggest that VOCs can readily penetrate the ensembles. Workplace protection factors (WPFs) were near one for benzene and toluene and increased with increasing molecular weight of the contaminants. WPFs were generally lower under hoods and jackets compared to under pants. For all PPE conditions, the pants appeared to provide the greatest overall protection against ingress of VOCs, but this may be due in part to the lower air concentrations toward the floor (and cuffs of pants) relative to the thigh-height outside gear concentrations used in calculating the WPFs. Providing added interface control measures and adding particulate-blocking materials appeared to provide a protective benefit against less-volatile chemicals, like naphthalene and styrene. |
Correction: A peer-to-peer collaborative learning approach for the implementation of evidence-informed interventions to improve HIV-related health outcomes
Keuroghlian AS , Marc L , Goldhammer H , Massaquoi M , Downes A , Stango J , Bryant H , Cahill S , Yen J , Perez AC , Head JM , Mayer KH , Myers J , Rebchook GM , Bourdeau B , Psihopaidas D , Chavis NS , Cohen SM . AIDS Behav 2024 |
HIV immunocapture reveals particles expressed in semen under INSTI-based therapy are largely myeloid cell-derived and disparate from circulating provirus
Johnson JA , Li JF , Politch JA , Lipscomb JT , Santos Tino A , DeFelice J , Gelman M , Anderson DJ , Mayer KH . J Infect Dis 2024 ![]() ![]() As use of HIV integrase strand transfer inhibitors (INSTI) increases and formulations are being developed for maintenance therapies and chemoprophylaxis, assessing virus suppression under INSTI-based regimens in prevention-relevant biologic compartments, such as the male genital tract, is timely. We used cell-source marker virion immunocapture to examine amplification of particle RNA then assessed the phylogenetic relatedness of seminal and blood viral sequences from men with HIV who were prescribed INSTI-based regimens. Seminal plasma immunocaptures yielded amplifiable virion RNA from 13/24 (54%) men, and the sequences were primarily associated with markers indicative of macrophage and resident dendritic cell sources. Genetic distances were greatest (>2%) between seminal virions and circulating proviruses, pointing to ongoing low-level expression from tissue-resident cells. While the low levels in semen predict an improbable likelihood of transmission, viruses with large genetic distances are expressed under potent INSTI therapy and have implications for determining epidemiologic linkages if adherence is suboptimal. |
A peer-to-peer collaborative learning approach for the implementation of evidence-informed interventions to improve HIV-related health outcomes
Keuroghlian AS , Marc L , Goldhammer H , Massaquoi M , Downes A , Stango J , Bryant H , Cahill S , Yen J , Perez AC , Head JM , Mayer KH , Myers J , Rebchook GM , Bourdeau B , Psihopaidas D , Chavis NS , Cohen SM . AIDS Behav 2024 The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide. |
Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults
Zhang Y , Romieu-Hernandez A , Boehmer TK , Azziz-Baumgartner E , Carton TW , Gundlapalli AV , Fearrington J , Nagavedu K , Dea K , Moyneur E , Cowell LG , Kaushal R , Mayer KH , Puro J , Rasmussen SA , Thacker D , Weiner MG , Saydah S , Block JP . BMC Infect Dis 2024 24 (1) 181 BACKGROUND: An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results. METHODS: We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020-May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test. RESULTS: After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11-1.23]; children: aOR, 1.18[95% CI, 1.08-1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38-1.63]; children: aOR, 1.40[95% CI, 1.15-1.70]) 31-150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17-1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11-1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30-1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions. CONCLUSIONS: Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection. |
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. |
Characterization of inhalation exposures at a wildfire incident during the Wildland Firefighter Exposure and Health Effects (WFFEHE) Study
Navarro KM , Fent K , Mayer AC , Brueck SE , Toennis C , Law B , Meadows J , Sammons D , Brown S . Ann Work Expo Health 2023 67 (8) 1011-1017 Wildland firefighters (WFFs) are exposed to many inhalation hazards working in the wildland fire environment. To assess occupational exposures and acute and subacute health effects among WFFs, the wildland firefighter exposure and health effects study collected data for a 2-year repeated measures study. This manuscript describes the exposure assessment from one Interagency Hotshot Crew (N = 19) conducted at a wildfire incident. Exposures to benzene, toluene, ethylbenzene, xylene isomers, formaldehyde, acetaldehyde, and naphthalene were measured through personal air sampling each work shift. Biological monitoring was done for creatinine-adjusted levoglucosan in urine pre- and post-shift. For 3 days sampling at the wildfire incident, benzene, toluene, ethylbenzene, xylene isomers (m and p, and o) exposure was highest on day 1 (geometric mean [GM] = 0.015, 0.042, 0.10, 0.42, and 0.15 ppm, respectively) when WFFs were not exposed to smoke but used chainsaws to remove vegetation and prepare fire suppression breaks. Exposure to formaldehyde and acetaldehyde was highest on day 2 (GM = 0.03 and 0.036 ppm, respectively) when the WFFs conducted a firing operation and were directly exposed to wildfire smoke. The greatest difference of pre- and post-shift levoglucosan concentrations were observed on day 3 (pre-shift: 9.7 and post-shift: 47 μg/mg creatinine) after WFFs conducted mop up (returned to partially burned area to extinguish any smoldering vegetation). Overall, 65% of paired samples (across all sample days) showed a post-shift increase in urinary levoglucosan and 5 firefighters were exposed to benzene at concentrations at or above the National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit. Our findings further demonstrate that exposure to inhalation hazards is one of many risks that wildland firefighters experience while suppressing wildfires. |
Unmet need for solid organ transplantation among people with HIV and end stage kidney or liver disease: A brief report from the HIV Outpatient Study, 2009-2023
Mayer C , Agbobli-Nuwoaty SE , Li J , Carlson K , Pallela FJ , Durham MD , Buchacz K . J Acquired Immune Defic Syndr 2024 Background:Persons with HIV (PWH) with end stage kidney disease (ESKD) who are eligible for kidney transplantation have post-transplantation outcomes similar to those without HIV infection. However, barriers to referral to care, evaluation, and receipt of transplants remain for PWH. We sought to identify PWH with ESKD or end stage liver disease (ESLD) who would be candidates for organ transplant and to review their clinical outcomes.Methods:We analyzed data from participants in the HIV Outpatient Study (HOPS) between 01-01-2009 and 06-30-2023, with a diagnosis of ESKD or ESLD. We identified a subset of PWH who would otherwise meet the general criteria for kidney or liver transplantation. Targeted clinical outcomes included dialysis, transplantation, and death.Results:Among 5,215 PWH in the HOPS, 258 with ESKD and 23 with ESLD would otherwise meet criteria for transplant. However, only 9 kidney and 2 liver transplants were performed.Conclusion:Low transplantation rates among eligible PWH may suggest timely referral to care and evaluation for kidney and liver transplantation often does not occur. Expanding access for PWH with ESKD to both deceased and living donor kidney allografts is needed. Kidney and liver transplant centers also need to seek ways to broaden access to eligible PWH with ESKD or ESLD. Copyright © 2024 Wolters Kluwer Health, Inc. |
Prevalence and determinants of hepatitis delta virus infection among HIV/hepatitis B-coinfected adults in care in the United States
Ferrante ND , Kallan MJ , Sukkestad S , Kodani M , Kitahata MM , Cachay ER , Bhattacharya D , Heath S , Napravnik S , Moore RD , Yendewa G , Mayer KH , Reddy KR , Hayden T , Kamili S , Martin JN , Kim HN , Lo Re V 3rd . J Viral Hepat 2023 30 (11) 879-888 Hepatitis delta virus (HDV) infection increases the risk of liver complications compared to hepatitis B virus (HBV) alone, particularly among persons with human immunodeficiency virus (HIV). However, no studies have evaluated the prevalence or determinants of HDV infection among people with HIV/HBV in the US. We performed a cross-sectional study among adults with HIV/HBV coinfection receiving care at eight sites within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) between 1996 and 2019. Among patients with available serum/plasma specimens, we selected the first specimen on or after their initial HBV qualifying test. All samples were tested for HDV IgG antibody and HDV RNA. Multivariable log-binomial generalized linear models were used to estimate prevalence ratios (PRs) with 95% CIs of HDV IgG antibody-positivity associated with determinants of interest (age, injection drug use [IDU], high-risk sexual behaviour). Among 597 adults with HIV/HBV coinfection in CNICS and available serum/plasma samples (median age, 43 years; 89.9% male; 52.8% Black; 42.4% White), 24/597 (4.0%; 95% CI, 2.4%-5.6%) were HDV IgG antibody-positive, and 10/596 (1.7%; 95% CI, 0.6%-2.7%) had detectable HDV RNA. In multivariable analysis, IDU was associated with exposure to HDV infection (adjusted PR = 2.50; 95% CI, 1.09-5.74). In conclusion, among a sample of adults with HIV/HBV coinfection in care in the US, 4.0% were HDV IgG antibody-positive, among whom 41.7% had detectable HDV RNA. History of IDU was associated with exposure to HDV infection. These findings emphasize the importance of HDV testing among persons with HIV/HBV coinfection, especially those with a history of IDU. |
Evaluating exposure to VOCs and naphthalene for firefighters wearing different ppe configurations through measures in air, exhaled breath, and urine
Mayer AC , Fent KW , Wilkinson AF , Chen IC , Siegel MR , Toennis C , Sammons D , Meadows J , Kesler RM , Kerber S , Smith DL , Masoud F , Bhandari D , Wang Y , Blount BC , Calafat AM , Horn GP . Int J Environ Res Public Health 2023 20 (12) Firefighters are at an increased risk of cancer due to their occupational exposure to combustion byproducts, especially when those compounds penetrate the firefighter personal protective equipment (PPE) ensemble. This has led to questions about the impact of base layers (i.e., shorts vs. pants) under PPE ensembles. This study asked 23 firefighters to perform firefighting activities while wearing one of three different PPE ensembles with varying degrees of protection. Additionally, half of the firefighters unzipped their jackets after the scenario while the other half kept their jackets zipped for five additional minutes. Several volatile organic compound (VOC) and naphthalene air concentrations outside and inside of hoods, turnout jackets, and turnout pants were evaluated; biological (urinary and exhaled breath) samples were also collected. VOCs and naphthalene penetrated the three sampling areas (hoods, jackets, pants). Significant (p-value < 0.05) increases from pre- to post-fire for some metabolites of VOCs (e.g., benzene, toluene) and naphthalene were found. Firefighters wearing shorts and short sleeves absorbed higher amounts of certain compounds (p-value < 0.05), and the PPE designed with enhanced interface control features appeared to provide more protection from some compounds. These results suggest that firefighters can dermally absorb VOCs and naphthalene that penetrate the PPE ensemble. |
Tobacco product use among adults - United States, 2021
Cornelius ME , Loretan CG , Jamal A , Davis Lynn BC , Mayer M , Alcantara IC , Neff L . MMWR Morb Mortal Wkly Rep 2023 72 (18) 475-483 Commercial cigarette smoking among U.S. adults has declined during the preceding 5 decades (1,2); however, tobacco product use remains the leading cause of preventable disease and death in the United States, and some populations continue to be disproportionately affected by tobacco use (1,2). To assess recent national estimates of commercial tobacco use among U.S. persons aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed 2021 National Health Interview Survey (NHIS) data. In 2021, an estimated 46 million U.S. adults (18.7%) reported currently using any tobacco product, including cigarettes (11.5%), e-cigarettes (4.5%), cigars (3.5%), smokeless tobacco (2.1%), and pipes (including hookah)* (0.9%).(†) Among those who used tobacco products, 77.5% reported using combustible products (cigarettes, cigars, or pipes), and 18.1% reported using two or more tobacco products.(§) The prevalence of current use of any tobacco product use was higher among the following groups: men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons(¶); residents of rural (nonmetropolitan) areas; financially disadvantaged (income-to-poverty ratio = 0-1.99); lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; adults whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress. Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (e.g., hard-hitting media campaigns, smoke-free policies, and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death, and disparities among U.S. adults (3,4). |
Youth-Serving Professionals' Perspectives on HIV Prevention Tools and Strategies Appropriate for Adolescent Gay and Bisexual Males and Transgender Youth
Cahill SR , Geffen SR , Fontenot HB , Wang TM , Viox MH , Fordyce E , Stern MJ , Harper CR , Johns MM , Avripas SA , Michaels S , Mayer KH , Dunville R . J Pediatr Health Care 2020 34 (2) e1-e11 INTRODUCTION: HIV disproportionally burdens adolescent men who have sex with men (AMSM) and transgender youth. This study explores barriers and facilitators that professionals face in delivering HIV preventive services and education. METHODS: Adolescent health providers (nurse practitioners, physicians, and other), school nurses, youth workers, and school educators were recruited nationally for this qualitative study. RESULTS: Thirty-four professionals participated. Common categories identified across professional group were (1) effective strategies for building trust with youth, (2) perceived barriers/facilitators to sexual health communication, (3) perceived barriers/facilitators to effective HIV prevention, and (4) preferred content for HIV prevention tools. DISCUSSION: Key elements for developing multidisciplinary resources to support AMSM and transgender youth should include (1) web-based or easily accessible sexual health educational materials, (2) resources for referrals, (3) trainings to support competence in caring for sexual and gender minority youth, and (4) guidance for navigating policies or eliciting policy change. |
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