Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-30 (of 55 Records) |
Query Trace: Ussery F [original query] |
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Building Evidence, Building Community: The Physical Activity Policy Research and Evaluation Network (PAPREN)
Lemon SC , Goins KV , Ussery EN , Rose KM , Chriqui JF . J Healthy Eat Act Living 12/28/2021 1 (4) 165-168 Regular physical activity is an essential action people can take to improve their health (U.S. Department of Health and Human Services, 2018). Despite well-established benefits, only 1 in 4 U.S. adults meet the combined aerobic and muscle-strengthening physical activity guidelines (Centers for Disease Control and Prevention). The built environment, defined as the physical makeup of where people live, learn, work, and play, can support or inhibit physical activity. The Community Preventive Services Task Force (CPSTF) recommends built environment strategies that combine new or improved pedestrian, bicycle, or transit transportation systems (i.e., activity-friendly routes) with land use components (i.e., connecting everyday destinations) (Community Preventive Services Task Force, 2016). Active People, Healthy NationSM is a national initiative led by the Centers for Disease Control and Prevention (CDC) to help 27 million Americans become more physically active by 2027 (Fulton et al., 2018). To reach this goal, states and communities can implement strategies for increasing physical activity (Schmid et al., 2021) across sectors and settings. Each strategy can be designed to ensure equitable access to opportunities for physical activity. However, implementation of physical activity–supportive policies across the United States remains low. The National Complete Streets Coalition reports that only 1,600 jurisdictions (mainly cities) have adopted Complete Streets policies (Smart Growth America); this is a fraction of all U.S. jurisdictions, and the quality of policies varies. There remains a need for applied research to translate knowledge into practice for implementing evidence-based policies to increase physical activity. Best practices that inform the implementation of these strategies are also needed to support communities and states. |
Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey
Mine M , Stafford KA , Laws RL , Marima R , Lekone P , Ramaabya D , Makhaola K , Patel HK , Mapondera P , Wray-Gordon F , Agbakwuru C , Okui L , Matroos S , Onyadile E , Ngidi J , Abimiku A , Bagapi K , Nkomo B , Bodika SM , Kim KJ , Moloney M , Mitchell A , Ehoche A , Ussery FL , Hong SY , Keipeile S , Matlhaga M , Mathumo R , Selato R , Charurat ME , Voetsch AC . Lancet HIV 2024 BACKGROUND: In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. METHODS: BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. FINDINGS: The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. INTERPRETATION: BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. FUNDING: US President's Emergency Plan for AIDS Relief. |
School connectedness and risk behaviors and experiences among high school students - Youth Risk Behavior Survey, United States, 2021
Wilkins NJ , Krause KH , Verlenden JV , Szucs LE , Ussery EN , Allen CT , Stinson J , Michael SL , Ethier KA . MMWR Suppl 2023 72 (1) 13-21 School connectedness, defined as students' belief that adults and peers in their school care about their learning as well as about them as persons, has been linked to positive educational, behavioral, and health outcomes in adolescence and into adulthood. Data from the 2021 nationally representative Youth Risk Behavior Survey, conducted during the COVID-19 pandemic, were used to estimate prevalence of students' perception of school connectedness and examine associations between school connectedness and seven risk behaviors and experiences: poor mental health, marijuana use, prescription opioid misuse, sexual intercourse, unprotected sex, experiencing forced sex, and missing school because of feeling unsafe. Prevalence estimates were generated and pairwise t-tests were used to detect differences among student subpopulations by sex, grade, race and ethnicity, and sexual identity; Wald chi-square tests were used to detect differences in risk behaviors by level of connectedness within a subpopulation. Logistic regression models were used to estimate prevalence ratios comparing the prevalence of risk behaviors and experiences of students with high connectedness with students with low connectedness, stratified by demographics. During 2021, 61.5% of U.S. high school students reported feeling connected to others at school. In addition, school connectedness was associated with lower prevalence of every risk behavior and experience examined in this study, although certain associations differed by race and ethnicity and sexual identity (e.g., school connectedness was associated with better mental health outcomes for youths with heterosexual, bisexual, and questioning or other sexual identities, but not for youths who identified as lesbian or gay). These findings can guide public health interventions that promote youth well-being by creating school environments where all youths have a sense of belonging and feel they are cared for and supported. |
HIV preexposure prophylaxis with emtricitabine and tenofovir disoproxil fumarate among cisgender women
Marrazzo J , Tao L , Becker M , Leech AA , Taylor AW , Ussery F , Kiragu M , Reza-Paul S , Myers J , Bekker LG , Yang J , Carter C , de Boer M , Das M , Baeten JM , Celum C . Jama 2024 IMPORTANCE: Emtricitabine and tenofovir disoproxil fumarate (F/TDF) for HIV preexposure prophylaxis (PrEP) is highly effective in cisgender men who have sex with men (MSM) when adherence is high (>4 doses/week). Real-world effectiveness and adherence with F/TDF for PrEP in cisgender women is less well characterized. OBJECTIVE: To characterize the effectiveness of F/TDF for PrEP and its relationship with adherence in cisgender women. DESIGN, SETTING, AND PARTICIPANTS: Data were pooled from 11 F/TDF PrEP postapproval studies conducted in 6 countries that included 6296 cisgender women aged 15 to 69 years conducted from 2012 to 2020. HIV incidence was evaluated according to adherence level measured objectively (tenofovir diphosphate concentration in dried blood spots or tenofovir concentration in plasma; n = 288) and subjectively (electronic pill cap monitoring, pill counts, self-report, and study-reported adherence scale; n = 2954) using group-based trajectory modeling. EXPOSURES: F/TDF prescribed orally once a day. HIV incidence was analyzed in subgroups based on adherence trajectory. MAIN OUTCOMES AND MEASURES: HIV incidence. RESULTS: Of the 6296 participants, 46% were from Kenya, 28% were from South Africa, 21% were from India, 2.9% were from Uganda, 1.6% were from Botswana, and 0.8% were from the US. The mean (SD) age at PrEP initiation across all studies was 25 (7) years, with 61% of participants being younger than 25 years. The overall HIV incidence was 0.72 per 100 person-years (95% CI, 0.51-1.01; 32 incident HIV diagnoses among 6296 participants). Four distinct groups of adherence trajectories were identified: consistently daily (7 doses/week), consistently high (4-6 doses/week), high but declining (from a mean of 4-6 doses/week and then declining), and consistently low (less than 2 doses/week). None of the 498 women with consistently daily adherence acquired HIV. Only 1 of the 658 women with consistently high adherence acquired HIV (incidence rate, 0.13/100 person-years [95% CI, 0.02-0.92]). The incidence rate was 0.49 per 100 person-years (95% CI, 0.22-1.08) in the high but declining adherence group (n = 1166) and 1.27 per 100 person-years (95% CI, 0.53-3.04) in the consistently low adherence group (n = 632). CONCLUSIONS AND RELEVANCE: In a pooled analysis of 11 postapproval studies of F/TDF for PrEP among cisgender women, overall HIV incidence was 0.72 per 100 person-years; individuals with consistently daily or consistently high adherence (4-6 doses/week) to PrEP experienced very low HIV incidence. |
Comparison of HIV prevalence, incidence, and viral load suppression in Zambia population-based HIV impact assessments from 2016 and 2021
Mulenga LB , Hines JZ , Stafford KA , Dzekedzeke K , Sivile S , Lindsay B , Chola M , Ussery F , Patel HK , Abimiku A , Birhanu S , Minchella P , Stevens T Jr , Hanunka B , Chisenga T , Shibemba A , Fwoloshi S , Siame M , Mutukwa J , Chirwa L , Siwingwa M , Mulundu G , Agbakwuru C , Mapondera P , Detorio M , Agolory SG , Monze M , Bronson M , Charurat ME . AIDS 2024 BACKGROUND: The Zambian government has implemented a public health response to control the HIV epidemic in the country. Zambia conducted a population-based HIV impact assessment (ZAMPHIA) survey in 2021 to assess the status of the HIV epidemic to guide its public health programs. METHODS: ZAMPHIA 2021 was a cross-sectional two-stage cluster sample household survey among persons aged ≥15 years conducted in Zambia across all 10 provinces. Consenting participants were administered a standardized questionnaire and whole blood was tested for HIV according to national guidelines. HIV-1 viral load (VL), recent HIV infection, and antiretroviral medications were tested for in HIV-seropositive samples. Viral load suppression (VLS) was defined as <1000 copies/ml. ZAMPHIA 2021 results were compared to ZAMPHIA 2016 for persons aged 15-59 years (i.e., the overlapping age ranges). All estimates were weighted to account for nonresponse and survey design. RESULTS: During ZAMPHIA 2021, of 25 483 eligible persons aged ≥15 years, 18 804 (73.8%) were interviewed and tested for HIV. HIV prevalence was 11.0% and VLS prevalence was 86.2% overall, but was <80% among people living with HIV aged 15-24 years and in certain provinces. Among persons aged 15-59 years, from 2016 to 2021, HIV incidence declined from 0.6% to 0.3% (P-value: 0.07) and VLS prevalence increased from 59.2% to 85.7% (P-value: <0.01). DISCUSSION: Zambia has made substantial progress toward controlling the HIV epidemic from 2016 to 2021. Continued implementation of a test-and-treat strategy, with attention to groups with lower VLS in the ZAMPHIA 2021, could support reductions in HIV incidence and improve overall VLS in Zambia. |
Risk factors for recent HIV infections among adults in 14 countries in Africa identified by population-based HIV impact assessment surveys, 2015-2019
Currie DW , West CA , Patel HK , Favaloro J , Asiimwe F , Ndagije F , Silver R , Mugurungi O , Shang J , Ndongmo CB , Williams DB , Dzinotyiweyi E , Waruru A , Pasipamire M , Nuwagaba-Biribonwoha H , Dlamini S , McLeod N , Kayirangwa E , Rwibasira G , Minchella PA , Auld AF , Nyirenda R , Getaneh Y , Hailemariam AH , Tondoh-Koui I , Kohemun N , Mgomella GS , Njau PF , Kirungi WL , Dalhatu I , Stafford KA , Bodika SM , Ussery F , McCracken S , Stupp P , Brown K , Duong YT , Parekh BS , Voetsch AC . Emerg Infect Dis 2023 29 (11) 2325-2334 Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15-49 years of age who had sex during the previous year and used a recent infection testing algorithm to distinguish recent from long-term infections. We collected risk factor information via participant interviews and assessed correlates of recent infection using multinomial logistic regression, incorporating each survey's complex sampling design. Compared with HIV-negative persons, persons with higher odds of recent HIV infection were women, were divorced/separated/widowed, had multiple recent sex partners, had a recent HIV-positive sex partner or one with unknown status, and lived in communities with higher HIV viremia prevalence. Prevention programs focusing on persons at higher risk for HIV and their sexual partners will contribute to reducing HIV incidence. |
Awareness and knowledge of the physical activity guidelines for Americans, 2nd Edition
Chen TJ , Whitfield GP , Watson KB , Fulton JE , Ussery EN , Hyde ET , Rose K . J Phys Act Health 2023 20 (8) 1-10 BACKGROUND: Assessing awareness and knowledge of the Physical Activity Guidelines for Americans, 2nd edition (Guidelines), released in 2018, is important for monitoring factors that contribute to increasing physical activity. METHODS: We estimated prevalence of awareness and knowledge of the adult aerobic guideline (≥150 min/wk of moderate-intensity equivalent aerobic physical activity preferably spread out over a week) among adults (n = 3471) and of the youth aerobic guideline (≥60 min/d of mostly moderate- to vigorous-intensity aerobic physical activity) among a subset of parents (n = 744) from a nationwide sample of US adults in the 2019 FallStyles survey. We estimated odds ratios using logistic regression, adjusting for demographic and other characteristics. RESULTS: Approximately 1 in 10 US adults and parents reported being aware of the Guidelines. Only 3% of adults knew the correct adult aerobic guideline. The most common responses were "don't know/not sure" (44%) and "30 minutes a day, 5 or more days a week" (28%). Among parents, 15% knew the youth aerobic guideline. Awareness and knowledge tended to be lower with lower education and income. CONCLUSIONS: Limited awareness and knowledge of the Guidelines suggest communication about the Guidelines could be strengthened, especially among adults with low income or education. |
Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study)
Grund JM , Onchiri F , Mboya E , Ussery F , Musingila P , Ohaga S , Odoyo-June E , Bock N , Ayieko B , Agot K . PLoS One 2023 18 (2) e0276593 INTRODUCTION: Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region. MATERIALS AND METHODS: We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome. RESULTS: At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67. DISCUSSION: Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02497989. |
Awareness and knowledge of the 2018 physical activity guidelines among US adults
Chen TiffanyJ , Whitfield GeoffreyP , Ussery EmilyN , Watson KathleenB , Hyde EricT , Fulton JanetE , Rose Ken . Med Sci Sports Exerc 2022 54 56-57 The Physical Activity Guidelines for Americans, second edition was released in 2018 and recommends adults do 150 minutes/week of moderate-intensity equivalent aerobic physical activity preferably spread out over a week (adult aerobic guideline). Assessing awareness and knowledge of the guideline is important for monitoring public understanding of physical activity and health. PURPOSE: To describe prevalence and correlates of reported awareness and knowledge of the aerobic guideline among US adults. METHODS: National data from the 2019 FallStyles survey were analyzed. Adults (n=3471) who reported seeing, hearing, or reading anything about governmental physical activity guidelines in the last year were considered aware of the guidelines. Adults who selected 150 minutes spread out over a week when asked about the minimum amount of moderate-intensity physical activity the government recommends for substantial health benefits were considered knowledgeable of the adult aerobic guideline. Weighted prevalence and adjusted odds ratios from logistic regression models were estimated. RESULTS: Overall, 9.2% of adults reported being aware of the guidelines and 2.9% knew the aerobic guideline, though 27.5% selected 30 minutes/day, 5 days/week, which is one way to meet the guideline. After adjusting for covariates, the odds of awareness were higher with older age, higher education level, and among married adults (bivariate differences by income no longer significant). Adults who were aware of the guidelines had higher odds of knowing the guideline (bivariate differences by education, income, and meeting the guideline no longer significant). |
Epidemiological and viral characteristics of undiagnosed HIV infections in Botswana.
Bhebhe L , Moyo S , Gaseitsiwe S , Pretorius-Holme M , Yankinda EK , Manyake K , Kgathi C , Mmalane M , Lebelonyane R , Gaolathe T , Bachanas P , Ussery F , Letebele M , Makhema J , Wirth KE , Lockman S , Essex M , Novitsky V , Ragonnet-Cronin M . BMC Infect Dis 2022 22 (1) 710 BACKGROUND: HIV-1 is endemic in Botswana. The country's primary challenge is identifying people living with HIV who are unaware of their status. We evaluated factors associated with undiagnosed HIV infection using HIV-1 phylogenetic, behavioural, and demographic data. METHODS: As part of the Botswana Combination Prevention Project, 20% of households in 30 villages were tested for HIV and followed from 2013 to 2018. A total of 12,610 participants were enrolled, 3596 tested HIV-positive at enrolment, and 147 participants acquired HIV during the trial. Extensive socio-demographic and behavioural data were collected from participants and next-generation sequences were generated for HIV-positive cases. We compared three groups of participants: (1) those previously known to be HIV-positive at enrolment (n = 2995); (2) those newly diagnosed at enrolment (n = 601) and (3) those who tested HIV-negative at enrolment but tested HIV-positive during follow-up (n = 147). We searched for differences in demographic and behavioural factors between known and newly diagnosed group using logistic regression. We also compared the topology of each group in HIV-1 phylogenies and used a genetic diversity-based algorithm to classify infections as recent (< 1 year) or chronic (≥ 1 year). RESULTS: Being male (aOR = 2.23) and younger than 35 years old (aOR = 8.08) was associated with undiagnosed HIV infection (p < 0.001), as was inconsistent condom use (aOR = 1.76). Women were more likely to have undiagnosed infections if they were married, educated, and tested frequently. For men, being divorced increased their risk. The genetic diversity-based algorithm classified most incident infections as recent (75.0%), but almost none of known infections (2.0%). The estimated proportion of recent infections among new diagnoses was 37.0% (p < 0.001). CONCLUSION: Our results indicate that those with undiagnosed infections are likely to be young men and women who do not use condoms consistently. Among women, several factors were predictive: being married, educated, and testing frequently increased risk. Men at risk were more difficult to delineate. A sizeable proportion of undiagnosed infections were recent based on a genetic diversity-based classifier. In the era of "test and treat all", pre-exposure prophylaxis may be prioritized towards individuals who self-identify or who can be identified using these predictors in order to halt onward transmission in time. |
Systematic review of active travel to school surveillance in the United States and Canada
Wolfe MK , McDonald NC , Ussery EN , George SM , Watson KB . J Healthy Eat Act Living 2023 1 (3) 127-141 Active travel to school is one way youths can incorporate physical activity into their daily schedule. It is unclear the extent to which active travel to school is systematically monitored at local, state, or national levels. To determine the scope of active travel to school surveillance in the US and Canada and catalog the types of measures captured, we conducted a systematic review of peer-reviewed literature documenting active travel to school surveillance published from 2004 to February 2018. A study was included if it addressed children's school travel mode across two or more time periods in the US or Canada. Criteria were applied to determine whether a data source was considered an active travel to school surveillance system. We identified 15 unique data sources; 4 of these met our surveillance system criteria. One system is conducted in the US, is nationally representative, and occurs every 5-8 years. Three are conducted in Canada, are limited geographically to regions and provinces, and are administered with greater frequency (e.g., 2-year cycles). School travel mode was the primary measure assessed, most commonly through parent report. None of the systems collected data on school policies or program supports related to active travel to school. We concluded that incorporating questions related to active travel to school behaviors into existing surveillance systems, as well as maintaining them over time, would enable more consistent monitoring. Concurrently capturing behavioral information along with related environmental, policy, and program supports may inform efforts to promote active travel to school. |
Male circumcision uptake during the Botswana Combination Prevention Project
Marukutira T , Ussery F , Kadima E , Mills LA , Moore J , Block L , Bachanas P , Davis S , Schissler T , Mosha R , Komotere O , Diswai T , Ntsuape C , Lebelonyane R , Bock N . PLoS One 2022 17 (6) e0269178 INTRODUCTION: Voluntary medical male circumcision (VMMC) uptake has been slow in some countries, including Botswana. To inform demand creation efforts, we examined sociodemographic characteristics and referral procedures associated with VMMC uptake in the Botswana Combination Prevention Project (BCPP) and examined the effectiveness of referral of men to MC services from HIV testing venues. DESIGN: BCPP was a community-randomized trial evaluating the impact of a combination HIV prevention package which included VMMC on community HIV incidence. We conducted a sub-analysis of VMMC uptake in intervention communities. METHODS: During the initial VMMC campaign in 15 intervention communities, baseline male circumcision (MC) status was assessed among men eligible for HIV testing. Uncircumcised male community residents aged 16-49 years with negative/unknown HIV status were mobilized and linked to study VMMC services. Outcomes included MC baseline status and uptake through study services. Univariate and multivariate logistic regressions were performed to identify factors associated with MC uptake. RESULTS: Of 12,864 men eligible for testing, 50% (n = 6,448) were already circumcised. Among the uncircumcised men (n = 6,416), 10% (n = 635) underwent MC. Of the 5,071 men identified as eligible for MC through HIV testing services, 78% declined referral and less than 1% of those were circumcised. Of those accepting referral (n = 1,107), 16% were circumcised. Younger (16-24 years) (aOR: 1.51; 95%CI:1.22,1.85), unemployed men (aOR:1.34; 95%CI: 1.06,1.69), and those undergoing HIV testing at mobile venues (aOR: 1.88; 95%CI: 1.53,2.31) were more likely to get circumcised. Fear of pain was the most prevalent (27%) reason given for not being circumcised. CONCLUSION: Younger, unemployed men seeking HIV testing at mobile sites in Botswana were more likely to get VMMC. Addressing unique barriers for employed and older men may be necessary. Given the simplicity of VMMC as an intervention, the HIV testing programs offer a platform for identifying uncircumcised men and offering information and encouragement to access services. |
HIV incidence in Botswana rural communities with high antiretroviral treatment coverage: Results from the Botswana Combination Prevention Project, 2013-2017
Ussery F , Bachanas P , Alwano MG , Lebelonyane R , Block L , Wirth K , Ussery G , Sento B , Gaolathe T , Kadima E , Abrams W , Segolodi T , Hader S , Lockman S , Moore J . J Acquir Immune Defic Syndr 2022 91 (1) 9-16 BACKGROUND: and Setting: The Botswana Combination Prevention Project (BCPP) demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. We report rates and characteristics of incident HIV infections. METHODS: BCPP was a community-randomized controlled trial conducted in 30 rural/peri-urban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate (IR; number of new HIV infections per 100 person-years (py) at risk) among repeat testers and risk factors with a Cox proportional hazards regression model. RESULTS: During 27,517py, 195 (women,79%) of 18,597 became HIV-infected (0.71/100py). Women had a higher IR (1.01/100py; 95% CI, 0.99 to 1.02) than men (0.34/100py; 95% CI, 0.33 to 0.35). The highest IRs were among women aged 16-24 years (1.87/100py) and men aged 25-34 years (0.56/100py). The lowest IRs were among those aged 35-64 years (women,0.41/100py; men,0.20/100py). Hazard of incident infection was highest among women aged 16-24 (HR=7.05). Sex and age were significantly associated with incidence (both P<0.0001). CONCLUSIONS: Despite an overall reduction in HIV incidence and approaching the UNAIDS 95-95-95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services [pre-exposure prophylaxis (PrEP), DREAMS] to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV. |
Differences in park plans and policies across U.S. municipalities
Peterson EL , Carlson SA , Ussery EN , Dunn I , Brown DR , Galuska DA . J Park Recreat Admi 2021 39 (4) Park planning documents may be valuable tools in order to promote policies and direct resources toward parks. However, the prevalence of such planning documents and policies specific to parks across municipal characteristics is not well known. This study compares the presence of parks and recreation plans and policies that address park safety and maintenance by municipality characteristics. Na-tionally representative data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living were analyzed (n=2005, response rate: 45%). About 7 out of 10 U.S. municipalities with a population of at least 1,000 reported having a parks and recreation plan. Prevalence of specific park or outdoor recreation policies was 78% for lighting, 85% for patrols by police and security, and 87% for maintenance of green space and equipment. The prevalence of a parks and recreation plan and of specific park or outdoor recreation policies were significantly lower in the smaller communities examined in this study. Most communities with at least 1,000 residents have park planning documents and policies, and opportunities may exist for practitioners to leverage the planning process to better engage residents. Future studies could in-vestigate the role and importance of using planning documents, policies, or bud-get provisions to address park access and quality in less populous municipalities. © 2020 Sagamore-Venture Publishing. |
Surveillance of physical activity and sedentary behavior among youth and adults in the United States: History and opportunities
Omura JD , Whitfield GP , Chen TJ , Hyde ET , Ussery EN , Watson KB , Carlson SA . J Phys Act Health 2021 18 S6-s24 BACKGROUND: Surveillance is a core function of public health, and approaches to national surveillance of physical activity and sedentary behavior have evolved over the past 2 decades. The purpose of this paper is to provide an overview of surveillance of physical activity and sedentary behavior in the United States over the past 2 decades, along with related challenges and emerging opportunities. METHODS: The authors reviewed key national surveillance systems for the assessment of physical activity and sedentary behavior among youth and adults in the United States between 2000 and 2019. RESULTS: Over the past 20 years, 8 surveillance systems have assessed physical activity, and 5 of those have assessed sedentary behavior. Three of the 8 originated in nonpublic health agencies. Most systems have assessed physical activity and sedentary behavior via surveys. However, survey questions varied over time within and also across systems, resulting in a wide array of available data. CONCLUSION: The evolving nature of physical activity surveillance in the United States has resulted in both broad challenges (eg, balancing content with survey space; providing data at the national, state, and local level; adapting traditional physical activity measures and survey designs; and addressing variation across surveillance systems) and related opportunities. |
Change in prevalence of meeting the aerobic physical activity guideline among US adults, by states and territories-Behavioral Risk Factor Surveillance System, 2011 and 2019
Ussery EN , Omura JD , McCain K , Watson KB . J Phys Act Health 2021 18 S84-s85 Overall, the percentage of US adults who met the aerobic physical activity guideline1,I was 51.3% in 2011 and 51.3% in 2019 (P = .876).II In 2011, the prevalence of meeting the aerobic guideline was <45% in 7 jurisdictions, 45% to <50% in 16 jurisdictions, 50% to <55% in 16 jurisdictions, and ≥55% in 14 jurisdictions. In 2019, the prevalence of meeting the aerobic guideline was <45% in 4 jurisdictions, 45% to <50% in 17 jurisdictions, 50% to <55% in 16 jurisdictions, and ≥55% in 15 jurisdictions. Between 2011 and 2019, the prevalence significantly decreased in 12 jurisdictions (CA, CO, HI, KY, ME, MA, MO, OH, OK, OR, VA, PR), significantly increased in 11 jurisdictions (AL, KS, LA, MD, MN, MT, NC, TN, VT, WA, WV), and did not significantly change in 29 jurisdictions.III The absolute change in prevalence ranged from an 11.0 percentage point decrease in Kentucky to an 8.6 percentage point increase in Tennessee. |
Trends in self-reported sitting time by physical activity levels among US adults, NHANES 2007/2008-2017/2018
Ussery EN , Whitfield GP , Fulton JE , Galuska DA , Matthews CE , Katzmarzyk PT , Carlson SA . J Phys Act Health 2021 18 S74-s83 BACKGROUND: High levels of sedentary behavior and physical inactivity increase the risk of premature mortality and several chronic diseases. Monitoring national trends and correlates of sedentary behavior and physical inactivity can help identify patterns of risk in the population over time. METHODS: The authors used self-reported data from the National Health and Nutrition Examination Surveys (2007/2008-2017/2018) to estimate trends in US adults' mean daily sitting time, overall, and stratified by levels of leisure-time and multidomain physical activity, and in the joint prevalence of high sitting time (>8 h/d) and physical inactivity. Trends were tested using orthogonal polynomial contrasts. RESULTS: Overall, mean daily sitting time increased by 19 minutes from 2007/2008 (332 min/d) to 2017/2018 (351 min/d) (Plinear < .05; Pquadratic < .05). The highest point estimate occurred in 2013/2014 (426 min/d), with a decreasing trend observed after this point (Plinear < .05). Similar trends were observed across physical activity levels and domains, with one exception: an overall linear increase was not observed among sufficiently active adults. The mean daily sitting time was lowest among highly active adults compared with less active adults when using the multidomain physical activity measure. CONCLUSIONS: Sitting time among adults increased over the study period but decreased in recent years. |
Trends in aerobic physical activity participation across multiple domains among US adults, National Health and Nutrition Examination Survey 2007/2008 to 2017/2018
Whitfield GP , Ussery EN , Saint-Maurice PF , Carlson SA . J Phys Act Health 2021 18 S64-s73 BACKGROUND: Understanding how participation is changing across domains of physical activity is important for monitoring progress and informing promotion efforts. The authors examined changes in physical activity participation in the National Health and Nutrition Examination Survey 2007/2008 to 2017/2018. METHODS: The prevalence of inactivity, insufficient activity, and meeting the aerobic physical activity guideline in multidomain physical activity and each domain (leisure time, occupational/household, and transportation) was estimated for each cycle and stratified by selected characteristics. The authors tested trends over time and overall changes (2017/2018 vs 2007/2008). RESULTS: For multidomain physical activity, the prevalence of inactivity decreased linearly; meeting the aerobic guideline increased nonmonotonically, and the 2017/2018 prevalence (68.1%) was higher than 2007/2008 (64.1%). Similar findings were observed for adults aged ≥65 years, non-Hispanic Blacks, Hispanics, high school graduates, and adults with obesity. Domain-specific results varied, but decreasing trends in inactivity and increasing trends in meeting the guideline were consistently observed across subgroups for occupational/household activity. Meeting the guideline through transportation activity was rare. CONCLUSIONS: Increases in meeting the guideline and decreases in inactivity in multidomain activity and selected domains are encouraging results, especially among subgroups historically reporting low activity participation. Activity promotion efforts are important to maintain progress, and the transportation domain may be an underutilized source of physical activity. |
To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach
Lebelonyane R , Bachanas P , Block L , Ussery F , Alwano MG , Marukutira T , El Halabi S , Roland M , Abrams W , Ussery G , Miller JA , Lockman S , Gaolathe T , Holme MP , Hader S , Mills LA , Wirth K , Bock N , Moore J . PLoS One 2021 16 (8) e0255227 BACKGROUND: Increasing HIV treatment coverage is crucial to reducing population-level HIV incidence. METHODS: The Botswana Combination Prevention Project (BCPP) was a community randomized trial examining the impact of multiple prevention interventions on population-level HIV incidence and was conducted from October 2013 through June 2017. Home and mobile campaigns offered HIV testing to all individuals ≥ age 16. All identified HIV-positive persons who were not on antiretroviral therapy (ART) were referred to treatment and tracked to determine linkage to care, ART status, retention in treatment, and viral suppression. RESULTS: Of an estimated total of 14,270 people living with HIV (PLHIV) residing in the 15 intervention communities, BCPP identified 13,328 HIV-positive persons (93%). At study start, 10,703 (80%) of estimated PLHIV knew their status; 2,625 (20%) learned their status during BCPP, a 25% increase with the greatest increases occurring among men (37%) and youth (77%). At study start, 9,258 (65%) of estimated PLHIV were on ART. An additional 3,001 persons started ART through the study. By study end, 12,259 had initiated and were retained on ART, increasing coverage to 93%. A greater increase in ART coverage was achieved among men (40%) compared to women (29%). Of the 11,954 persons who had viral load (VL) test results, 11,687 (98%) were virally suppressed (HIV-1 RNA ≤400 copies/mL). Overall, 82% had documented VL suppression by study end. CONCLUSIONS: Knowledge of HIV-positive status and ART coverage increased towards 95-95 targets with universal testing, linkage interventions, and ART. The increases in HIV testing and ART use among men and youth were essential to reaching these targets. CLINICAL TRIAL NUMBER: NCT01965470. |
Cross-sectional study of changes in physical activity behavior during the COVID-19 pandemic among US adults.
Watson KB , Whitfield GP , Huntzicker G , Omura JD , Ussery E , Chen TJ , Fanfair RN . Int J Behav Nutr Phys Act 2021 18 (1) 91 BACKGROUND: Physical activity (PA) provides numerous health benefits relevant to the COVID-19 pandemic. However, concerns exist that PA levels may have decreased during the pandemic thus exacerbating health disparities. This study aims to determine changes in and locations for PA and reasons for decreased PA during the pandemic. METHODS: Reported percentage of changes in and locations for PA and reasons for decreased PA were examined in 3829 US adults who completed the 2020 SummerStyles survey. RESULTS: Overall, 30% reported less PA, and 50% reported no change or no activity during the pandemic; percentages varied across subgroups. Adults who were non-Hispanic Black (Black) or Hispanic (vs. non-Hispanic White, (White)) reported less PA. Fewer Black adults (vs. White) reported doing most PA in their neighborhood. Concern about exposure to the virus (39%) was the most common reason adults were less active. CONCLUSIONS: In June 2020, nearly one-third of US adults reported decreased PA; 20% reported increased PA. Decreased activity was higher among Black and Hispanic compared to White adults; these two groups have experienced disproportionate COVID-19 impacts. Continued efforts are needed to ensure everyone has access to supports that allow them to participate in PA while still following guidance to prevent COVID-19 transmission. |
Finding, treating and retaining persons with HIV in a high HIV prevalence and high treatment coverage country: Results from the Botswana Combination Prevention Project.
Bachanas P , Alwano MG , Lebelonyane R , Block L , Behel S , Raizes E , Ussery G , Wang H , Ussery F , Pretorius Holme M , Sexton C , Pals S , Lasry A , Del Castillo L , Hader S , Lockman S , Bock N , Moore J . PLoS One 2021 16 (4) e0250211 INTRODUCTION: The scale-up of Universal Test and Treat has resulted in reductions in HIV morbidity, mortality and incidence. However, healthcare system and personal challenges have impacted the levels of treatment coverage achieved. We implemented interventions to improve linkage to care, retention, viral load (VL) coverage and service delivery, and describe the HIV care cascade over the course of the Botswana Combination Prevention Project (BCPP) study. METHODS: BCPP was designed to evaluate the impact of prevention interventions on HIV incidence in 30 communities in Botswana. We followed a longitudinal cohort of newly identified and known HIV-positive persons not on antiretroviral therapy (ART) identified through community-based testing activities through BCPP and referred with appointments to local HIV clinics in 15 intervention communities. Those who did not keep the first or follow-up appointments were tracked and traced through phone and home contacts. Improvements to service delivery models in the intervention clinics were also implemented. RESULTS: A total of 3,657 newly identified or HIV-positive persons not on ART were identified and referred to their local HIV clinic; 90% (3,282/3,657) linked to care and of those, 93% (3,066/3,282) initiated treatment. Near the end of the study, 221 persons remained >90 days late for appointments or missing. Tracing efforts identified 54/3,066 (2%) persons who initiated treatment but died, and 106/3,066 (3%) persons were located and returned to treatment. At study end, 61/3,066 (2%) persons remained missing and were never reached. Overall, 2,951 (98%) persons living with HIV (PLHIV) who initiated treatment were still alive, retained in care and still receiving ART out of the 3,001 persons alive at the end of the study. Of those on ART, 2,854 (97%) had current VL results and 2,784 (98%) of those were virally suppressed at study end. CONCLUSIONS: This study achieved high rates of linkage, treatment initiation, retention and VL coverage and suppression in a cohort of newly identified and known PLHIV not on ART. Tracking and tracing interventions effectively identified those persons who needed more resource intensive follow-up. The interventions implemented to improve service delivery and data quality may have also contributed to high linkage and retention rates. Clinical trial number: NCT01965470. |
County-Level COVID-19 Vaccination Coverage and Social Vulnerability - United States, December 14, 2020-March 1, 2021.
Hughes MM , Wang A , Grossman MK , Pun E , Whiteman A , Deng L , Hallisey E , Sharpe JD , Ussery EN , Stokley S , Musial T , Weller DL , Murthy BP , Reynolds L , Gibbs-Scharf L , Harris L , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (12) 431-436 The U.S. COVID-19 vaccination program began in December 2020, and ensuring equitable COVID-19 vaccine access remains a national priority.* COVID-19 has disproportionately affected racial/ethnic minority groups and those who are economically and socially disadvantaged (1,2). Thus, achieving not just vaccine equality (i.e., similar allocation of vaccine supply proportional to its population across jurisdictions) but equity (i.e., preferential access and administra-tion to those who have been most affected by COVID-19 disease) is an important goal. The CDC social vulnerability index (SVI) uses 15 indicators grouped into four themes that comprise an overall SVI measure, resulting in 20 metrics, each of which has national and state-specific county rankings. The 20 metric-specific rankings were each divided into lowest to highest tertiles to categorize counties as low, moderate, or high social vulnerability counties. These tertiles were combined with vaccine administration data for 49,264,338 U.S. residents in 49 states and the District of Columbia (DC) who received at least one COVID-19 vaccine dose during December 14, 2020-March 1, 2021. Nationally, for the overall SVI measure, vaccination coverage was higher (15.8%) in low social vulnerability counties than in high social vulnerability counties (13.9%), with the largest coverage disparity in the socioeconomic status theme (2.5 percentage points higher coverage in low than in high vulnerability counties). Wide state variations in equity across SVI metrics were found. Whereas in the majority of states, vaccination coverage was higher in low vulnerability counties, some states had equitable coverage at the county level. CDC, state, and local jurisdictions should continue to monitor vaccination coverage by SVI metrics to focus public health interventions to achieve equitable coverage with COVID-19 vaccine. |
Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program - United States, December 14, 2020-January 14, 2021.
Painter EM , Ussery EN , Patel A , Hughes MM , Zell ER , Moulia DL , Scharf LG , Lynch M , Ritchey MD , Toblin RL , Murthy BP , Harris LQ , Wasley A , Rose DA , Cohn A , Messonnier NE . MMWR Morb Mortal Wkly Rep 2021 70 (5) 174-177 In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel(†) and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities(§) initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3). |
Perceived importance of physical activity and walkable neighborhoods among US adults, 2017
Carlson SA , Ussery EN , Watson KB , Cornett KA , Fulton JE . Prev Chronic Dis 2020 17 E168 The importance of physical activity and community-level promotion strategies are well established, but little is known about adult perception of the importance of physical activity. In a nationwide sample of US adults, we examined self-reported importance of regular physical activity and the importance of living in walkable neighborhoods. About 55% of adults strongly agreed that regular physical activity is important, 40% strongly agreed that living in a walkable neighborhood is important, and 31% strongly agreed that both are important. Separately for each measure, estimates were lower among adults with lower education levels and who did not meet the aerobic physical activity guideline. Opportunities exist to improve the perception of the importance of physical activity and the importance of walkable neighborhoods. |
Combining data from assessments of leisure, occupational, household, and transportation physical activity among US adults, NHANES 2011-2016
Whitfield GP , Ussery EN , Carlson SA . Prev Chronic Dis 2020 17 E117 Physical activity occurs in 4 domains (leisure, occupational, household, and transportation), but US surveillance often focuses on leisure-time only. We compared estimates of self-reported leisure-time physical activity and estimates of all-domain activity among adults in the National Health and Nutrition Examination Survey for 2011-2016. During the study period, 38.6% met the aerobic physical activity guideline in leisure-time, 58.5% in leisure-time and occupational/household activity, and 63.7% in all domains. Differences within most subgroups when using all domains were similar to differences when using leisure-time activity only, except that we observed no urban/rural differences in the multidomain assessment. Assessment of multiple domains of activity instead of leisure-time-only activity affects prevalence estimates to a greater extent than it affects subgroup differences. |
Update: Characteristics of Health Care Personnel with COVID-19 - United States, February 12-July 16, 2020.
Hughes MM , Groenewold MR , Lessem SE , Xu K , Ussery EN , Wiegand RE , Qin X , Do T , Thomas D , Tsai S , Davidson A , Latash J , Eckel S , Collins J , Ojo M , McHugh L , Li W , Chen J , Chan J , Wortham JM , Reagan-Steiner S , Lee JT , Reddy SC , Kuhar DT , Burrer SL , Stuckey MJ . MMWR Morb Mortal Wkly Rep 2020 69 (38) 1364-1368 As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials (1). The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020 (2). Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12-July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16-44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form(†) (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve. |
Empowered by tracking: Using data to solve public health problems
Curtiss C , Ussery-Hall A . J Environ Health 2020 83 (3) 28-30 The authors discuss the use of the Environmental Public Health Tracking Program of the U.S. Centers for Disease Control and Prevention to solve public health problems. Topics mentioned include the aim of the program to help address the public health data gaps that practitioners encounter, an example of data explorer side-by-side data maps, and how professionals are using the program. |
Rapid antiretroviral therapy initiation in the Botswana Combination Prevention Project: a quasi-experimental before and after study
Lebelonyane R , Bachanas P , Block L , Ussery F , Abrams W , Roland M , Theu J , Kapanda M , Matambo S , Lockman S , Gaolathe T , Makhema J , Moore J , Jarvis JN . Lancet HIV 2020 7 (8) e545-e553 BACKGROUND: Ensuring that individuals who are living with HIV rapidly initiate antiretroviral therapy (ART) is an essential step in meeting the 90-90-90 targets. We evaluated the feasibility and outcomes of rapid ART initiation in the Botswana Combination Prevention Project (BCPP). We aimed to establish whether simplified ART initiation with the offer of same-day treatment could increase uptake and reduce time from clinic linkage to treatment initiation, while maintaining rates of retention in care and viral suppression. METHODS: We did a quasi-experimental before and after study with use of data from the BCPP. The BCPP was a community-randomised HIV-prevention trial done in 30 communities across Botswana from Oct 1, 2013, to June 30, 2018. Participants in the 15 intervention clusters, who were HIV-positive and not already taking ART were offered universal HIV-treatment and same-day ART with a dolutegravir-based regimen at first clinic visit. This rapid ART intervention was implemented mid-way through the trial on June 1, 2016, enabling us to determine the effect of rapid ART guidelines on time to ART initiation and rates of retention in care and viral suppression at 1 year in the BCPP intervention group. FINDINGS: We assessed 1717 adults linked to study clinics before rapid ART introduction and 800 after rapid ART introduction. During the rapid ART period, 457 (57·1%, 95% CI 53·7-60·6) individuals initiated ART within 1 day of linkage, 589 (73·7%, 70·6-76·7) of 799 within 1 week, 678 (84·9%, 82·4-87·3) of 799 within 1 month, and 744 (93·5%, 91·6-95·1) of 796 within 1 year. Before the introduction of rapid ART, 163 (9·5%, 95% CI 8·2-11·0) individuals initiated ART within 1 day of linkage, 276 (16·1%, 14·4-17·9) within 1 week, 839 (48·9%, 46·5-51·3) within 1 month, and 1532 (89·2%, 87·7-90·6) within 1 year. 1 year after ART initiation, 1472 (90·5%, 87·4-92·8) of 1627 individuals who linked in the standard ART period were in care and had a viral load of less than 400 copies per mL, compared with 578 (91·6%, 88·1-94·1) of 631 in the rapid ART period (risk ratio 1·01, 95% CI 0·92-1·11). INTERPRETATION: Our findings provide support for the WHO recommendations for rapid ART initiation, and add to the accumulating evidence showing the feasibility, acceptability, and safety of rapid ART initiation in low-income and middle-income country settings. FUNDING: US President's Emergency Plan for AIDS Relief. |
Advanced HIV disease in the Botswana Combination Prevention Project: prevalence, risk factors, and outcomes
Lebelonyane R , Mills LA , Mogorosi C , Ussery F , Marukutira T , Theu J , Kapanda M , Matambo S , Block L , Raizes E , Makhema J , Lockman S , Bachanas P , Moore J , Jarvis JN . AIDS 2020 34 (15) 2223-2230 OBJECTIVE(S): To determine the proportion of individuals linking to HIV-care with advanced HIV-disease (CD4 ≤200 cells/μL) in the Botswana Combination Prevention Project, describe the characteristics of these individuals, and examine treatment outcomes. DESIGN: A sub-analysis of a cluster-randomized HIV-prevention trial. HIV status was assessed in 16-64-year-olds through home and mobile testing. All HIV-positive persons not on antiretroviral-therapy (ART) were referred to local Ministry of Health and Wellness clinics for treatment. METHODS: Analysis was restricted to the 15 intervention clusters. The proportion of individuals with advanced HIV disease was determined; associations between advanced HIV disease and sex and age explored; and rates of viral suppression determined at 1-year. Mortality and retention in care were compared between CD4 strata (CD4 ≤200 cells/μL vs. > 200 cells/μL). RESULTS: Overall, 17.2% (430/2,499; 95% confidence interval [CI] 15.7-18.8%) of study participants had advanced HIV disease (CD4 ≤200 cells/μL) at time of clinic linkage. Men were significantly more likely to present with CD4 ≤200 cells/μL than women (23.7% versus 13.4%, adjusted odds ratio [aOR] 1.9, 95% CI 1.5-2.3). The risk of advanced HIV disease increased with increasing age (aOR 2.2, 95% CI 1.4-3.2 > 35 years versus < 25 years). Patients with CD4 ≤200 cells/μL had significantly higher rates of attrition from care during follow-up (hazards ratio 1.47, 95% CI 1.1-2.1). CONCLUSIONS: Advanced HIV disease due to late presentation to or disengagement from ART care remains common in the Treat All era in Botswana, calling for innovative testing, linkage, and treatment strategies to engage and retain harder-to-reach populations in care. |
Physical activity before and during pregnancy, Colorado Pregnancy Risk Assessment Monitoring System, 2012-2015
Ussery EN , Hyde ET , Bombard JM , Juhl AL , Kim SY , Carlson SA . Prev Chronic Dis 2020 17 E55 We used 2012-2015 data from the Colorado Pregnancy Risk Assessment Monitoring System to describe changes in self-reported physical activity (PA) before and during pregnancy and used logistic regression to examine factors associated with regular PA. The prevalence of regular PA (ie, 30 or more minutes per day on 5 or more days per week) was 19.1% before pregnancy and decreased to 10.2% during pregnancy. At both times, adjusted odds of regular PA were lower among women who were overweight or had obesity before pregnancy than among those with normal weight. Findings suggest that most women with a recent live birth in Colorado, particularly those who are overweight or have obesity, are not obtaining many health benefits of PA either before or during pregnancy. |
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