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Borkowski P, Borkowska N. The Impact of Social Determinants of Health on Outcomes Among Individuals With HIV and Heart Failure: A Literature Review. Cureus 2024; 16:e55913. [PMID: 38601377 PMCID: PMC11003873 DOI: 10.7759/cureus.55913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
This narrative review examines the complex interplay between social determinants of health (SDoH) and the outcomes for individuals living with human immunodeficiency virus (HIV) and heart failure (HF), two conditions that pose significant socioeconomic burdens globally. With millions affected by these conditions, the review delves into how socioeconomic status, education, geography, and immigration status influence health outcomes. It further explores the exacerbating roles of stigma and mental health issues, underscoring the need for comprehensive interventions and the importance of enhancing health literacy and community support. Key findings suggest that lower socioeconomic status, limited education, rural residency, and immigrant status are associated with poorer health outcomes in individuals with HIV and HF. These factors contribute to increased morbidity and mortality and decreased quality of life, highlighting the necessity of addressing SDoH to improve patient care and outcomes. There is a critical need for integrated care models that consider the medical, social, and psychological factors affecting those with HIV and HF. Strategies proposed include improving access to care, addressing socioeconomic disparities, enhancing educational efforts, and fostering community engagement. Moreover, the importance of mental healthcare integration into the management of HIV and HF is strongly advocated to improve patient outcomes. By taking a comprehensive look at the various social challenges, embracing integrated care models, and making sure everyone has fair access to healthcare services, we can make real progress in enhancing the lives of those affected by HIV and HF. This approach cannot only lower death rates but also significantly improve the quality of life for these individuals.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, USA
| | - Natalia Borkowska
- Pediatrics, SPZOZ (Samodzielny Publiczny Zakład Opieki Zdrowotnej) Krotoszyn, Krotoszyn, POL
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2
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Ochieng BO, Khagayi S, Otieno M, Were JA, Nyothach EA, Hawi S, Kwaro D. The long-term impact of HIV/AIDS on socio-economic status: a comparative analysis of households headed by HIV-positive and HIV-negative individuals in Western Kenya. AIDS Care 2023:1-9. [PMID: 37217167 DOI: 10.1080/09540121.2023.2214863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impact of HIV/AIDS on households' socio-economic status between 2010 and 2018. We compared changes in socio-economic status between households headed by HIV-negative and -positive individuals. A logistic regression was used to assess factors that influence socio-economic status. The level of education and household size were not significant predictors of households' socio-economic status. Households headed by HIV-positive individuals could maintain their baseline socio-economic status (unadjusted RRR = 1.17, 95% CI: 1.01, 1.36) but improvement chances were reduced despite a non-significant association (unadjusted RRR = 0.98, 95% CI: 0.80, 1.20). While HIV/AIDS is known to disrupt economic growth, in this setting, being a male household head, old and widowed reduces chances of improved socio-economic status. The elderly people, widows and widowers are disadvantaged. Consequently, there is a need for special programmes, which seek to empower the identified vulnerable groups economically. .
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Affiliation(s)
| | - Sammy Khagayi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Moses Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Joyce Akinyi Were
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sarah Hawi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Daniel Kwaro
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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3
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Edmonds A, Breskin A, Cole SR, Westreich D, Ramirez C, Cocohoba J, Wingood G, Cohen MH, Golub ET, Kassaye SG, Metsch LR, Sharma A, Konkle-Parker D, Wilson TE, Adimora AA. Poverty, Deprivation, and Mortality Risk Among Women With HIV in the United States. Epidemiology 2021; 32:877-885. [PMID: 34347686 PMCID: PMC8478815 DOI: 10.1097/ede.0000000000001409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies suggest neighborhood poverty and deprivation are associated with adverse health outcomes including death, but evidence is limited among persons with HIV, particularly women. We estimated changes in mortality risk from improvement in three measures of area-level socioeconomic context among participants of the Women's Interagency HIV Study. METHODS Starting in October 2013, we linked geocoded residential census block groups to the 2015 Area Deprivation Index (ADI) and two 2012-2016 American Community Survey poverty variables, categorized into national tertiles. We used parametric g-computation to estimate, through March 2018, impacts on mortality of improving each income or poverty measure by one and two tertiles maximum versus no improvement. RESULTS Of 1596 women with HIV (median age 49), 91 (5.7%) were lost to follow-up and 83 (5.2%) died. Most women (62%) lived in a block group in the tertile with the highest proportions of individuals with income:poverty <1; 13% lived in areas in the tertile with the lowest proportions. Mortality risk differences comparing a one-tertile improvement (for those in the two highest poverty tertiles) in income:poverty <1 versus no improvement increased over time; the risk difference was -2.2% (95% confidence interval [CI] = -3.7, -0.64) at 4 years. Estimates from family income below poverty level (-1.0%; 95% CI = -2.7, 0.62) and ADI (-1.5%; 95% CI = -2.8, -0.21) exposures were similar. CONCLUSIONS Consistent results from three distinct measures of area-level socioeconomic environment support the hypothesis that interventions to ameliorate neighborhood poverty or deprivation reduce mortality risk for US women with HIV. See video abstract at, http://links.lww.com/EDE/B863.
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Affiliation(s)
- Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alexander Breskin
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- NoviSci Inc., Durham, NC
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel Westreich
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, The University of California San Francisco, San Francisco, CA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | | | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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4
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Sass D, Farkhad BF, Li B, Sally Chan MP, Albarracín D. Are spatial models advantageous for predicting county-level HIV epidemiology across the United States? Spat Spatiotemporal Epidemiol 2021; 38:100436. [PMID: 34353528 DOI: 10.1016/j.sste.2021.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
Predicting human immunodeficiency virus (HIV) epidemiology is vital for achieving public health milestones. Incorporating spatial dependence when data varies by region can often provide better prediction results, at the cost of computational efficiency. However, with the growing number of covariates available that capture the data variability, the benefit of a spatial model could be less crucial. We investigate this conjecture by considering both non-spatial and spatial models for county-level HIV prediction over the US. Due to many counties with zero HIV incidences, we utilize a two-part model, with one part estimating the probability of positive HIV rates and the other estimating HIV rates of counties not classified as zero. Based on our data, the compound of logistic regression and a generalized estimating equation outperforms the candidate models in making predictions. The results suggest that considering spatial correlation for our data is not necessarily advantageous when the purpose is making predictions.
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Affiliation(s)
| | | | - Bo Li
- University of Illinois at Urbana-Champaign, USA
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Benjamins MR, Saiyed N, Bunting S, Lorenz P, Hunt B, Glick N, Silva A. HIV mortality across the 30 largest U.S. cities: assessing overall trends and racial inequities. AIDS Care 2021; 34:916-925. [PMID: 34125639 DOI: 10.1080/09540121.2021.1939849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite decreases in overall HIV mortality in the U.S., large racial inequities persist. Most previous analyses of HIV mortality and mortality inequities have utilized national- or state-level data. METHODS Using vital statistics mortality data and American Community Survey population estimates, we calculated HIV mortality rates and Black:White HIV mortality rate ratios (RR) for the 30 most populous U.S. cities at two time points, 2010-2014 (T1) and 2015-2019 (T2). RESULTS Almost all cities (28) had HIV mortality rates higher than the national rate at both time points. At T2, HIV mortality rates ranged from 0.8 per 100,000 (San Jose, CA) to 15.2 per 100,000 (Baltimore, MD). Across cities, Black people were approximately 2-8 times more likely to die from HIV compared to White people at both time points. Over the decade, these racial disparities decreased at the national level (T1: RR = 11.0, T2: RR = 9.8), and in one city (Charlotte, NC). DISCUSSION We identified large geographic and racial inequities in HIV mortality in U.S. urban areas. These city-specific data may motivate change in cities and can help guide city leaders and other health advocates as they implement, test, and support policies and programming to decrease HIV mortality.
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Affiliation(s)
- Maureen R Benjamins
- Sinai Urban Health Institute, Chicago, IL, USA.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Samuel Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Peter Lorenz
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Bijou Hunt
- Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Abigail Silva
- Loyola University Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
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Zhang L, Abohashem S, Osborne MT, Naddaf N, Park R, Moore K, Patrich T, Deeks SG, Hsue PY, Tawakol AA. Brief Report: Lower Socioeconomic Status Associates With Greater Systemic and Arterial Inflammation in HIV. J Acquir Immune Defic Syndr 2021; 87:706-710. [PMID: 33492022 PMCID: PMC8026700 DOI: 10.1097/qai.0000000000002630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES In the general population, the lower socioeconomic status (SES) associates with greater systemic and arterial inflammation and a greater risk of cardiovascular disease. Because arterial inflammation is heightened in individuals living with HIV, we tested the hypothesis that SES associates with arterial inflammation in this population. SETTINGS Prospective cohort study. METHODS Men living with HIV were recruited. Arterial inflammation and leukopoietic activity (ie, bone marrow activity) were measured using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Zip code-level SES measures were derived from the US Census Bureau. Linear regression and mediation analyses were used to assess associations between SES, arterial inflammation, leukopoietic activity, C-reactive protein (CRP), and interleukin-6. RESULTS Thirty-nine virologically suppressed men living with HIV were studied (mean ± SD age 50.5 ± 11.1 years). The median CD4 count was 663 cells/mm3 (interquartile range: 399-922); 82% were receiving antiretroviral therapies. Local median income inversely associated with arterial inflammation [standardized β (95% confidence interval): -0.42 (-0.76 to -0.08)] after adjusting for age, Framingham risk score, statin use, antiretroviral use, and nadir CD4 count. The high-school graduation rate independently associated with arterial inflammation [-0.45 (-0.78 to -0.12)] and CRP [-0.49 (-0.86 to -0.012)]. Mediation analysis demonstrated the impact of SES on arterial inflammation was partially mediated by heightened circulating inflammatory levels: ↓SES (as high school graduation rate) →↑CRP →↑arterial inflammation accounting for 44% of the total effect (P < 0.05). CONCLUSION In individuals living with HIV, lower SES independently associated with higher leukopoietic activity, circulating markers of inflammation, and arterial inflammation. Furthermore, the link between SES and arterial inflammation was mediated by increased systemic inflammation.
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Affiliation(s)
- Lili Zhang
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and
| | - Michael T Osborne
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and
| | - Nicki Naddaf
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and
| | - Rebecca Park
- University of California San Francisco (UCSF), San Francisco, CA
| | - Kelvin Moore
- University of California San Francisco (UCSF), San Francisco, CA
| | - Tomas Patrich
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and
| | - Steven G Deeks
- University of California San Francisco (UCSF), San Francisco, CA
| | - Priscilla Y Hsue
- University of California San Francisco (UCSF), San Francisco, CA
| | - Ahmed A Tawakol
- Cardiovascular Imaging Research Center Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA; and
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7
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Mouhanna F, Castel AD, Sullivan PS, Kuo I, Hoffman HJ, Siegler AJ, Jones JS, Mera Giler R, McGuinness P, Kramer MR. Small-area spatial-temporal changes in pre-exposure prophylaxis (PrEP) use in the general population and among men who have sex with men in the United States between 2012 and 2018. Ann Epidemiol 2020; 49:1-7. [PMID: 32951802 DOI: 10.1016/j.annepidem.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Oral emtricitabine/tenofovir disoproxil fumarate was approved for use as pre-exposure prophylaxis (PrEP) by the U.S. Food and Drug Administration in 2012. We used national pharmacy data to examine trends of PrEP use in U.S. counties from 2012 to 2018. METHODS Using multi-level small-area spatio-temporal modeling, we calculated the estimated annual percentage change (EAPC) in prevalence of PrEP use in the general population from 2012 to 2018. We also used a proxy measure for prevalence of PrEP use among men who have sex with men (MSM) to evaluate trends of use among MSM, the PrEP use-to-MSM ratio (PmR) or number of male PrEP users per 1000 MSM population. RESULTS The prevalence of PrEP use and PmR increased (EAPC range: (+26.9%, +71.0%) and (+28.4%, +158.7%), respectively) in all counties with varying magnitude of increase. Counties of the Midwest and the upper South and upper West had the slowest increase in prevalence of PrEP use (EAPC range: (+26.9%; +52.9%)). Counties of the northern part of the South had the lowest PmR (EAPC range: (+28.4%; +76.0%)). Counties of the most populous core-based statistical areas had a relatively faster increase in population prevalence of PrEP use but slower increase in PmR. CONCLUSIONS All counties in the U.S. have witnessed an increase in PrEP use with important geographic variabilities. Identifying areas with slow improvement in PrEP use, as well as "model counties" with the fastest pace of progress in PrEP coverage, is critical to inform local and state-level policies and program evaluation for PrEP scale up, particularly among MSM at higher risk for HIV.
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Affiliation(s)
- Farah Mouhanna
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Heather J Hoffman
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Aaron J Siegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb S Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
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Cope AB, Edmonds A, Ludema C, Cole SR, Eron JJ, Anastos K, Cocohoba J, Cohen M, Ofotokun I, Golub ET, Kassaye S, Konkle-Parker D, Metsch LR, Wilson TE, Adimora AA. Neighborhood Poverty and Control of HIV, Hypertension, and Diabetes in the Women's Interagency HIV Study. AIDS Behav 2020; 24:2033-2044. [PMID: 31907676 PMCID: PMC7319872 DOI: 10.1007/s10461-019-02757-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neighborhoods with high poverty rates have limited resources to support residents' health. Using census data, we calculated the proportion of each Women's Interagency HIV Study participant's census tract (neighborhood) living below the poverty line. We assessed associations between neighborhood poverty and (1) unsuppressed viral load [VL] in HIV-seropositive women, (2) uncontrolled blood pressure among HIV-seropositive and HIV-seronegative hypertensive women, and (3) uncontrolled diabetes among HIV-seropositive and HIV-seronegative diabetic women using modified Poisson regression models. Neighborhood poverty was associated with unsuppressed VL in HIV-seropositive women (> 40% versus ≤ 20% poverty adjusted prevalence ratio (PR), 1.42; 95% confidence interval (CI) 1.04-1.92). In HIV-seronegative diabetic women, moderate neighborhood poverty was associated with uncontrolled diabetes (20-40% versus ≤ 20% poverty adjusted PR, 1.75; 95% CI 1.02-2.98). Neighborhood poverty was associated with neither uncontrolled diabetes among HIV-seropositive diabetic women, nor uncontrolled hypertension in hypertensive women, regardless of HIV status. Women living in areas with concentrated poverty may need additional resources to control health conditions effectively.
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Affiliation(s)
- Anna B. Cope
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina Ludema
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Epidemiology and Biostatistics, School of Public Health, Indiana University at Bloomington, Bloomington, IN
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joseph J. Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Mardge Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Seble Kassaye
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Lisa R. Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Adaora A. Adimora
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Depressive Symptom Trajectories Among People Living with HIV in a Collaborative Care Program. AIDS Behav 2020; 24:1765-1775. [PMID: 31728696 DOI: 10.1007/s10461-019-02727-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Depressive symptoms may differ in severity and change over time in people living with HIV (PLWH). Describing depression trajectories and associated clinical characteristics of PLWH in an interventional study may help in developing a more personalized medicine approach. Using latent class growth analysis four, 15-month self-reported depression trajectories were identified in 416 PLWH participating in a collaborative care program. The four subgroups were characterized by improving (58.4% [of participants]), worsening (9.4%), highly responsive (19.5%) and persistently severe (12.7%) depressive symptoms. A high proportion of individuals were in trajectories marked by improvement. Further, the highly responsive group had on average, over 50% reduction of self-reported depressive symptoms. Self-reported trauma, posttraumatic stress disorder, lower neighborhood-level education and fewer HIV and psychiatry clinic visits were associated with worsening or persistently severe depressive symptom trajectories. Members of the persistently severe group were less likely to be virally suppressed after 12-months. Identifying subgroups of PLWH based on changes in self-reported depressive symptoms may further inform intervention approaches that can advance care.
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10
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Watson L, Gant Z, Hu X, Johnson AS. Exploring Social Determinants of Health as Predictors of Mortality During 2012-2016, Among Black Women with Diagnosed HIV Infection Attributed to Heterosexual Contact, United States. J Racial Ethn Health Disparities 2019; 6:892-899. [PMID: 30980295 DOI: 10.1007/s40615-019-00589-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/01/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2016, black women with HIV infection attributed to heterosexual contact accounted for 47% of all women living with diagnosed HIV, and 41% of deaths that occurred among women with diagnosed HIV in the USA that year. Social determinants of health have been found to be associated with mortality risk among people with HIV. We analyzed the role social determinants of health may have on risk of mortality among black women with HIV attributed to heterosexual contact. METHODS Data from the Center for Disease Control and Prevention's National HIV Surveillance System were merged at the county level with three social determinants of health (SDH) variables from the U.S. Census Bureau's American Community Survey for black women aged ≥ 18 years with HIV infection attributed to heterosexual contact that had been diagnosed by 2011. SDH variables were categorized into four empirically derived quartiles, with the highest quartile in each category serving as the reference variable. For black women whose deaths occurred during 2012-2016, mortality rate ratios (MRR) were calculated using age-stratified multivariate logistic regressions to evaluate associations between SDH variables and all-cause mortality risk. RESULTS Risk of mortality was lower for black women aged 18-34 years and 35-54 years who lived in counties with the lowest quartile of poverty (adjusted mortality rate ratio aMRR = 0.56, 95% confidence interval CI [0.39-0.83], and aMRR = 0.67, 95% CI [0.58-0.78], respectively) compared to those who lived in counties with the highest quartile of poverty (reference group). Compared to black women who lived in counties with the highest quartile of health insurance coverage (reference group), the mortality risk was lower for black women aged 18-34 years and black women aged 35-54 who lived in counties with the lowest 2 quartiles of health insurance coverage. Unemployment status was not associated with mortality risk. CONCLUSIONS This ecological analysis found poverty and lack of health insurance to be predictors of mortality, suggesting a need for increased prevention, care, and policy efforts targeting black women with HIV who live in environments characterized by increased poverty and lack of health insurance.
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Affiliation(s)
- Lakeshia Watson
- University of Maryland College Park, School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Zanetta Gant
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., Mailstop E-47, Atlanta, GA, 30329, USA
| | - Xiaohong Hu
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., Mailstop E-47, Atlanta, GA, 30329, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Rd., Mailstop E-47, Atlanta, GA, 30329, USA
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11
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Belot A, Ndiaye A, Luque-Fernandez MA, Kipourou DK, Maringe C, Rubio FJ, Rachet B. Summarizing and communicating on survival data according to the audience: a tutorial on different measures illustrated with population-based cancer registry data. Clin Epidemiol 2019; 11:53-65. [PMID: 30655705 PMCID: PMC6322561 DOI: 10.2147/clep.s173523] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Survival data analysis results are usually communicated through the overall survival probability. Alternative measures provide additional insights and may help in communicating the results to a wider audience. We describe these alternative measures in two data settings, the overall survival setting and the relative survival setting, the latter corresponding to the particular competing risk setting in which the cause of death is unavailable or unreliable. In the overall survival setting, we describe the overall survival probability, the conditional survival probability and the restricted mean survival time (restricted to a prespecified time window). In the relative survival setting, we describe the net survival probability, the conditional net survival probability, the restricted mean net survival time, the crude probability of death due to each cause and the number of life years lost due to each cause over a prespecified time window. These measures describe survival data either on a probability scale or on a timescale. The clinical or population health purpose of each measure is detailed, and their advantages and drawbacks are discussed. We then illustrate their use analyzing England population-based registry data of men 15-80 years old diagnosed with colon cancer in 2001-2003, aiming to describe the deprivation disparities in survival. We believe that both the provision of a detailed example of the interpretation of each measure and the software implementation will help in generalizing their use.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Aminata Ndiaye
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Miguel-Angel Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Dimitra-Kleio Kipourou
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Francisco Javier Rubio
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable DiseaseEpidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK,
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Hallowell BD, Robb SW, Kintziger KW. Comparing the geographic distribution and location characteristics of HIV-seropositive and HIV-seronegative individuals with a diagnosis of cancer living in the southeast US. Spat Spatiotemporal Epidemiol 2017; 24:11-18. [PMID: 29413710 DOI: 10.1016/j.sste.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/24/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
Abstract
As HIV-seropositive individuals live longer, they are more likely to acquire conditions seen in the general population. Excluding AIDS-defining malignancies, HIV-seropositive individuals are more likely to develop cancer than individuals in the general population. In order to better inform future screening and prevention efforts in this population, we compared the geographic distribution and location characteristics of HIV-seropositive and HIV-seronegative cancer cases in South Carolina (SC). To do this we obtained linked HIV and cancer data from the SC enhanced HIV/AIDS Reporting System and Central Cancer Registry. Location-related information on SC residents (e.g., employment status, income levels, race of householder, and educational attainment) was obtained from the 2000 US Census. Hotspot analyses were used to analyze the geographic distribution of HIV-seropositive and HIV-seronegative cancer cases using the Getis-Ord Gi* statistic. Poisson regression analyses assessed if county demographic and geographic characteristics were associated with HIV-positive cancer case rates.
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Affiliation(s)
- Benjamin D Hallowell
- University of Georgia School of Public Health, Department of Epidemiology and Biostatistics, Miller Hall, Office 123, 101 Buck Road, Athens GA 30606, United States.
| | - Sara W Robb
- University of Georgia School of Public Health, Department of Epidemiology and Biostatistics, Miller Hall, Office 234, 101 Buck Road, Athens GA 30606, United States.
| | - Kristina W Kintziger
- Department of Medicine, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, United States.
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13
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Ghiam MK, Rebeiro PF, Turner M, Rogers WB, Bebawy SS, Raffanti SP, Person AK, Pettit AC. Trends in HIV Continuum of Care Outcomes over Ten Years of Follow-Up at a Large HIV Primary Medical Home in the Southeastern United States. AIDS Res Hum Retroviruses 2017; 33:1027-1034. [PMID: 28462622 DOI: 10.1089/aid.2017.0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Longitudinal studies of retention in care (RIC) and viral suppression (VS) in the southeastern United States (US), a region disproportionately affected by HIV infection, are lacking. HIV-infected adults with ≥1 medical visit at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee) from 2004 to 2013 were included. RIC was ≥2 (a) laboratory dates [CD4+ counts or HIV-1 viral loads (VLs)] or (b) provider encounters and/or laboratory dates in the year of interest, ≥90 days apart. VS was a VL of <200 copies/ml at last measurement in the year of interest. Modified Poisson regression estimated relative risk (RR) of RIC and VS, adjusting for age, race, sex, HIV transmission risk, and socioeconomic status (SES). Among 4,641 persons, 76.8% achieved RIC and 70.2% achieved VS. RIC and VS increased from 2004 to 2013 (p < .001 each). For lack of RIC, younger patients (RR = 1.2 and RR = 1.1, 18-24 and 25-34 vs. 35-44 year-olds, respectively), Blacks (RR = 1.3 vs. Whites), and injection drug users (IDUs) (RR = 1.2 vs. heterosexual contact [Hetero]) fared worse (p < .05 each); those with male-to-male sexual contact fared better (RR = 0.8 vs. Hetero, p < .05). For lack of VS, younger patients (RR = 1.3 and RR = 1.2, 18-24 and 25-34 vs. 35-44 year olds, respectively), Blacks (RR 1.3 vs. Whites), Females (RR = 1.1 vs. Males), IDUs (RR 1.3 vs. Hetero), and those with low SES (RR = 1.1 vs. not low SES) fared worse (p < .05, each). RIC and VS increased over time, suggesting that efforts to improve outcomes have been effective. However, disparities persist and resources should focus on groups most at risk.
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Affiliation(s)
| | - Peter F. Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Megan Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William B. Rogers
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sally S. Bebawy
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephen P. Raffanti
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Comprehensive Care Clinic, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna K. Person
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Comprehensive Care Clinic, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - April C. Pettit
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt Comprehensive Care Clinic, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Ransome Y, Kawachi I, Dean LT. Neighborhood Social Capital in Relation to Late HIV Diagnosis, Linkage to HIV Care, and HIV Care Engagement. AIDS Behav 2017; 21:891-904. [PMID: 27752875 PMCID: PMC5306234 DOI: 10.1007/s10461-016-1581-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
High neighborhood social capital could facilitate earlier diagnosis of HIV and higher rates of linkage and HIV care engagement. Multivariate analysis was used to examine whether social capital (social cohesion, social participation, and collective engagement) in 2004/2006 was associated with lower 5-year average (2007-2011) prevalence of (a) late HIV diagnosis, (b) linked to HIV care, and (c) engaged in HIV care within Philadelphia, PA, United States. Census tracts (N = 332). Higher average neighborhood social participation was associated with higher prevalence of late HIV diagnosis (b = 1.37, se = 0.32, p < 0.001), linked to HIV care (b = 1.13, se = 0.20, p < 0.001) and lower prevalence of engaged in HIV care (b = -1.16, se = 0.30, p < 0.001). Higher collective engagement was associated with lower prevalence of linked to HIV care (b = -0.62, se = 0.32, p < 0.05).The findings of different directions of associations among social capital indicators and HIV-related outcomes underscore the need for more nuanced research on the topic that include longitudinal assessment across key populations.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA, 02115, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Fray NA, Caldwell KL. Communication Between Middle SES Black Women and Healthcare Providers About HIV Testing. J Natl Med Assoc 2017; 109:115-125. [PMID: 28599753 DOI: 10.1016/j.jnma.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE This article explores the impact of patient and healthcare provider communication (PPC) on the HIV testing behaviors of middle socioeconomic status (SES) Black women in North Carolina. We explore how PPC about STIs and HIV (or the lack thereof) affects the provision of STI/HIV testing by either confirming the need for middle SES Black women to test routinely or potentially deterring women from feeling they need to be tested. METHODS/FINDINGS After conducting 15 qualitative interviews with middle SES Black women between 25 and 45 years of age, we uncovered the role of patient self-advocacy in promoting HIV testing among middle SES Black women when they communicate with their healthcare providers. CONCLUSIONS We discuss the importance of healthcare providers engaging their middle SES Black female patients in routine discussions about sexual health and sexual risk reduction, regardless of providers' perceptions of their potential STI/HIV risk. We recommend including SES as a variable in data collection and research in order to better understand how social class, race, and gender affect sexual health behavior and the provision of STI and HIV/AIDS prevention to diverse populations.
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Affiliation(s)
- Niasha A Fray
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Clinical Oncology Research Program, 101 East Weaver Street, CB# 7294, Carrboro, NC 27510, United States.
| | - Kia Lilly Caldwell
- Department of African, African American, and Diaspora Studies, University of North Carolina at Chapel Hill, CB #3395, 208 Battle Hall, Chapel Hill, NC 27599, United States
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Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016; 42:148-158. [PMID: 27770671 PMCID: PMC5584790 DOI: 10.1016/j.healthplace.2016.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 01/14/2023]
Abstract
In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.
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Affiliation(s)
- Yusuf Ransome
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Denis Nash
- City University of New York (CUNY) Institute for Implementation Science in Population Health, NY, USA
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Sagaon-Teyssier L, Fressard L, Mora M, Maradan G, Guagliardo V, Suzan-Monti M, Dray-Spira R, Spire B. Larger is not necessarily better! Impact of HIV care unit characteristics on virological success: results from the French national representative ANRS-VESPA2 study. Health Policy 2016; 120:936-47. [PMID: 27450774 DOI: 10.1016/j.healthpol.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 06/28/2016] [Accepted: 07/03/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the impact of hospital caseload size on HIV virological success when taking into account individual patient characteristics. METHODS Data from the ANRS-VESPA2 survey representative of people living with HIV in France was used. Analyses were carried out on the 2612 (86.4% out of 3022) individuals receiving antiretroviral (ARV) treatment for at least one year. Outcomes correspond to two definitions of virological success (VS1 and VS2 respectively) and were analyzed under a multi-level modeling framework with a special focus on the effect of the caseload size on VS. RESULTS Structures with caseloads <1700 patients were more likely to have increased the proportion of patients achieving virological success (59% and 81% for VS1 and VS2, respectively) than structures whose caseloads numbered ≥1700 patients. Our results highlight that patients in the 11 largest care units in the sample were exposed to a context where their VS was potentially compromised by care unit characteristics, independently of both their individual characteristics and their own HIV treatment adherence behavior. CONCLUSIONS Our results suggest that - at least in the case of HIV care - in France large care units are not necessarily better. This result serves as an evidence-based warning to public authorities to ensure that health outcomes are guaranteed in an era when the French hospital sector is being substantially restructured.
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Affiliation(s)
- Luis Sagaon-Teyssier
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Lisa Fressard
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Marion Mora
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Gwenaëlle Maradan
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Valérie Guagliardo
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Marie Suzan-Monti
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
| | - Rosemary Dray-Spira
- INSERM, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in social epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S1136, Pierre Louis Institute of Epidemiology and Public Health, Team Research in Social Epidemiology, F-75013, Paris, France.
| | - Bruno Spire
- INSERM, UMR912 "Economics and Social Sciences Applied to Health & Analysis of Medical Information" (SESSTIM), Marseille, France; Aix Marseille University, UMR_S912, IRD, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
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Abstract
HIV prevalence and socio-demographic data were analyzed to assess the alignment of CDC-funded HIV testing activity in 2012 with its high-impact prevention approach. CDC-funded HIV-testing was conducted in counties with high HIV prevalence and in places potentially more affected by HIV as measured by urbanicity, percent black, percent poverty, and percent uninsured. The percent Hispanic/Latino was associated with a lower probability of HIV testing activity. Higher percentages of black and Hispanic/Latino in the population was positively associated with new HIV diagnoses. Analyzing county-level data confirmed the appropriateness of CDC-funded HIV testing activities under a high-impact prevention approach but also suggested areas for possible improvement.
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20
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Ireland ME, Chen Q, Schwartz HA, Ungar LH, Albarracin D. Action Tweets Linked to Reduced County-Level HIV Prevalence in the United States: Online Messages and Structural Determinants. AIDS Behav 2016; 20:1256-64. [PMID: 26650382 DOI: 10.1007/s10461-015-1252-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV is uncommon in most US counties but travels quickly through vulnerable communities when it strikes. Tracking behavior through social media may provide an unobtrusive, naturalistic means of predicting HIV outbreaks and understanding the behavioral and psychological factors that increase communities' risk. General action goals, or the motivation to engage in cognitive and motor activity, may support protective health behavior (e.g., using condoms) or encourage activity indiscriminately (e.g., risky sex), resulting in mixed health effects. We explored these opposing hypotheses by regressing county-level HIV prevalence on action language (e.g., work, plan) in over 150 million tweets mapped to US counties. Controlling for demographic and structural predictors of HIV, more active language was associated with lower HIV rates. By leveraging language used on social media to improve existing predictive models of geographic variation in HIV, future targeted HIV-prevention interventions may have a better chance of reaching high-risk communities before outbreaks occur.
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Affiliation(s)
- Molly E Ireland
- Department of Psychological Sciences, Texas Tech University, MS 2051, Lubbock, TX, 79409, USA.
- University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Qijia Chen
- University of Pennsylvania, Philadelphia, PA, USA
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - H Andrew Schwartz
- University of Pennsylvania, Philadelphia, PA, USA
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Department of Computer Sciences, Stony Brook University, Stony Brook, NY, USA
| | - Lyle H Ungar
- University of Pennsylvania, Philadelphia, PA, USA
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Dolores Albarracin
- University of Pennsylvania, Philadelphia, PA, USA
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Trepka MJ, Fennie KP, Sheehan DM, Niyonsenga T, Lieb S, Maddox LM. Racial-ethnic differences in all-cause and HIV mortality, Florida, 2000-2011. Ann Epidemiol 2016; 26:176-82.e1. [PMID: 26948103 DOI: 10.1016/j.annepidem.2016.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE We compared all-cause and human immunodeficiency virus (HIV) mortality in a population-based, HIV-infected cohort. METHODS Using records of people diagnosed with HIV during 2000-2009 from the Florida Enhanced HIV-acquired immunodeficiency syndrome (AIDS) Reporting System, we conducted a proportional hazards analysis for all-cause mortality and a competing risk analysis for HIV mortality through 2011 controlling for individual-level factors, neighborhood poverty, and rural-urban status and stratifying by concurrent AIDS status (AIDS within 3 months of HIV diagnosis). RESULTS Of 59,880 HIV-infected people, 32.2% had concurrent AIDS and 19.3% died. Adjusting for period of diagnosis, age group, sex, country of birth, HIV transmission mode, area-level poverty, and rural-urban status, non-Hispanic black (NHB) and Hispanic people had an elevated adjusted hazards ratio (aHR) for HIV mortality relative to non-Hispanic whites (NHB concurrent AIDS: aHR 1.34, 95% confidence interval [CI], 1.23-1.47; NHB without concurrent AIDS: aHR 1.41, 95% CI 1.26-1.57; Hispanic concurrent AIDS: aHR 1.18, 95% CI 1.05-1.32; Hispanic without concurrent AIDS: aHR 1.18, 95% CI 1.03-1.36). CONCLUSIONS Considering competing causes of death, NHB and Hispanic people had a higher risk of HIV mortality even among those without concurrent AIDS, indicating a need to identify and address barriers to HIV care in these populations.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami.
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami
| | - Theophile Niyonsenga
- Centre for Population Health Research, School of Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Spencer Lieb
- Florida Consortium for HIV/AIDS Research, The AIDS Institute, Tampa
| | - Lorene M Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, Tallahassee
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An Q, Song R, Hernandez A, Hall HI. Trends and Differences Among Three New Indicators of HIV Infection Progression. Public Health Rep 2015; 130:468-74. [PMID: 26327725 DOI: 10.1177/003335491513000510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study proposes three indicators of, and assesses the disparities and trends in, the risk of HIV infection progression among people living with diagnosed HIV infection in the United States. METHODS Using data reported to national HIV surveillance through June 2012, we calculated the AIDS diagnosis hazard, HIV (including AIDS) death hazard, and AIDS death hazard for people living with diagnosed HIV infection for each calendar year from 1997 to 2010. We also calculated a stratified hazard in 2010 by age, race/ethnicity, mode of transmission, region of residence at diagnosis, and year of diagnosis. RESULTS The risk of HIV infection progression among people living with diagnosed HIV infection decreased significantly from 1997 to 2010. The risks of progression to AIDS and death in 2010 were higher among African Americans and people of multiple races, males exposed through injection drug use (IDU) or heterosexual contact, females exposed through IDU, people residing in the South at diagnosis, and people diagnosed in 2009 compared with white individuals, men who have sex with men, females with infection attributed to heterosexual contact, those residing in the Northeast, and those diagnosed in previous years, respectively. People aged 15-29 years had the highest AIDS diagnosis hazard in 2010. CONCLUSION Continued efforts are needed to ensure early HIV diagnosis as well as initial linkage to and continued engagement in HIV medical care among all people living with HIV. Targeted interventions are needed to improve health-care and supportive services for those with worse health outcomes.
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Affiliation(s)
- Qian An
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, HIV Incidence and Case Surveillance Branch, Atlanta, GA
| | - Ruiguang Song
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Quantitative Science and Data Management Branch, Atlanta, GA
| | - Angela Hernandez
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, HIV Incidence and Case Surveillance Branch, Atlanta, GA
| | - H Irene Hall
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, HIV Incidence and Case Surveillance Branch, Atlanta, GA
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Gray SC, Massaro T, Chen I, Edholm CJ, Grotheer R, Zheng Y, Chang HH. A county-level analysis of persons living with HIV in the southern United States. AIDS Care 2015; 28:266-72. [PMID: 26332197 DOI: 10.1080/09540121.2015.1080793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study uses county-level surveillance data to systematically analyze geographic variation and clustering of persons living with diagnosed HIV (PLWH) in the southern United States in 2011. Clusters corresponding to large metropolitan areas - including Miami, Atlanta, and Baltimore - had HIV prevalence rates higher (p < .001) than the regional rate. Regression analysis within the counties included in these clusters determined that race was a significant indicator for PLWH. These results provide a general picture of the distribution of PLWH in the southern United States at the county level and provide insights for identifying local geographic areas with a high number of PLWH, as well as subpopulations that may have an increased risk of infection.
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Affiliation(s)
- Simone C Gray
- a Division of HIV/AIDS and Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Tyler Massaro
- b Department of Mathematics , The University of Tennessee , Knoxville , TN , USA
| | - Isabel Chen
- c Department of Mathematics , Emory University , Atlanta , GA , USA
| | - Christina J Edholm
- d Department of Mathematics , University of Nebraska-Lincoln , Lincoln , NE , USA
| | - Rachel Grotheer
- e Department of Mathematical Sciences , Clemson University , Clemson , SC , USA
| | - Yiqiang Zheng
- f Department of Mathematics , Purdue University , West Lafayette , IN , USA.,g Department of Statistics , Purdue University , West Lafayette , IN , USA
| | - Howard H Chang
- h Department of Biostatistics and Bioinformatics , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Herrera-Ibatá DM, Pazos A, Orbegozo-Medina RA, Romero-Durán FJ, González-Díaz H. Mapping chemical structure-activity information of HAART-drug cocktails over complex networks of AIDS epidemiology and socioeconomic data of U.S. counties. Biosystems 2015; 132-133:20-34. [PMID: 25916548 DOI: 10.1016/j.biosystems.2015.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/08/2015] [Accepted: 04/22/2015] [Indexed: 12/13/2022]
Abstract
Using computational algorithms to design tailored drug cocktails for highly active antiretroviral therapy (HAART) on specific populations is a goal of major importance for both pharmaceutical industry and public health policy institutions. New combinations of compounds need to be predicted in order to design HAART cocktails. On the one hand, there are the biomolecular factors related to the drugs in the cocktail (experimental measure, chemical structure, drug target, assay organisms, etc.); on the other hand, there are the socioeconomic factors of the specific population (income inequalities, employment levels, fiscal pressure, education, migration, population structure, etc.) to study the relationship between the socioeconomic status and the disease. In this context, machine learning algorithms, able to seek models for problems with multi-source data, have to be used. In this work, the first artificial neural network (ANN) model is proposed for the prediction of HAART cocktails, to halt AIDS on epidemic networks of U.S. counties using information indices that codify both biomolecular and several socioeconomic factors. The data was obtained from at least three major sources. The first dataset included assays of anti-HIV chemical compounds released to ChEMBL. The second dataset is the AIDSVu database of Emory University. AIDSVu compiled AIDS prevalence for >2300 U.S. counties. The third data set included socioeconomic data from the U.S. Census Bureau. Three scales or levels were employed to group the counties according to the location or population structure codes: state, rural urban continuum code (RUCC) and urban influence code (UIC). An analysis of >130,000 pairs (network links) was performed, corresponding to AIDS prevalence in 2310 counties in U.S. vs. drug cocktails made up of combinations of ChEMBL results for 21,582 unique drugs, 9 viral or human protein targets, 4856 protocols, and 10 possible experimental measures. The best model found with the original data was a linear neural network (LNN) with AUROC>0.80 and accuracy, specificity, and sensitivity≈77% in training and external validation series. The change of the spatial and population structure scale (State, UIC, or RUCC codes) does not affect the quality of the model. Unbalance was detected in all the models found comparing positive/negative cases and linear/non-linear model accuracy ratios. Using synthetic minority over-sampling technique (SMOTE), data pre-processing and machine-learning algorithms implemented into the WEKA software, more balanced models were found. In particular, a multilayer perceptron (MLP) with AUROC=97.4% and precision, recall, and F-measure >90% was found.
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Affiliation(s)
- Diana María Herrera-Ibatá
- Department of Information and Communication Technologies, University of A Coruña (UDC), 15071 A Coruña, Spain.
| | - Alejandro Pazos
- Department of Information and Communication Technologies, University of A Coruña (UDC), 15071 A Coruña, Spain
| | - Ricardo Alfredo Orbegozo-Medina
- Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | | | - Humberto González-Díaz
- Department of Organic Chemistry II, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; IKERBASQUE, Basque Foundation for Science, 48011 Bilbao, Spain.
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Protopopescu C, Raffi F, Spire B, Hardel L, Michelet C, Cheneau C, Le Moing V, Leport C, Carrieri MP. Twelve-year mortality in HIV-infected patients receiving antiretroviral therapy: the role of social vulnerability. The ANRS CO8 APROCO-COPILOTE cohort. Antivir Ther 2015; 20:763-72. [PMID: 25859625 DOI: 10.3851/imp2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort. METHODS The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997-1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8-12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout. RESULTS Over a median (IQR) follow-up of 7.9 (3.0-11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors. CONCLUSIONS Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
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Neighbourhood socio-economic position, late presentation and outcomes in people living with HIV in Switzerland. AIDS 2015; 29:231-8. [PMID: 25396262 DOI: 10.1097/qad.0000000000000524] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Inequalities and inequities in health are an important public health concern. In Switzerland, mortality in the general population varies according to the socio-economic position (SEP) of neighbourhoods. We examined the influence of neighbourhood SEP on presentation and outcomes in HIV-positive individuals in the era of combination antiretroviral therapy (cART). METHODS The neighbourhood SEP of patients followed in the Swiss HIV Cohort Study (SHCS) 2000-2013 was obtained on the basis of 2000 census data on the 50 nearest households (education and occupation of household head, rent, mean number of persons per room). We used Cox and logistic regression models to examine the probability of late presentation, virologic response to cART, loss to follow-up and death across quintiles of neighbourhood SEP. RESULTS A total of 4489 SHCS participants were included. Presentation with advanced disease [CD4⁺ cell count <200 cells/μl or AIDS] and with AIDS was less common in neighbourhoods of higher SEP: the age and sex-adjusted odds ratio (OR) comparing the highest with the lowest quintile of SEP was 0.71 [95% confidence interval (95% CI) 0.58-0.87] and 0.59 (95% CI 0.45-0.77), respectively. An undetectable viral load at 6 months of cART was more common in the highest than in the lowest quintile (OR 1.52; 95% CI 1.14-2.04). Loss to follow-up, mortality and causes of death were not associated with neighbourhood SEP. CONCLUSION Late presentation was more common and virologic response to cART less common in HIV-positive individuals living in neighbourhoods of lower SEP, but in contrast to the general population, there was no clear trend for mortality.
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Abstract
OBJECTIVE HIV infection is a major problem in New York City (NYC), with more than 100,000 living HIV-infected persons. Novel public health approaches are needed to control the epidemic. The NYC Department of Health and Mental Hygiene (DOHMH) analysed community viral load (CVL) for a baseline to monitor the population-level impact of HIV control interventions. DESIGN A cross-sectional study using routinely collected surveillance data. METHODS All HIV-infected persons reported to the NYC HIV Registry who were at least 13 years of age, with at least one viral load test result in 2008, and alive at the end of 31 December 2008 were included. CVL was defined as the mean of individual viral load means reported between January and December 2008. Detectable viral load was defined as an individual mean of more than 400 copies/ml. Differences in CVL and proportion undetectable were computed by socio-demographic characteristics and summary measures were mapped. RESULTS New York City CVL was 21,318 copies/ml overall (N=62,550) and 44,749 copies/ml (N=28,366) among persons with detectable mean viral loads. CVL varied by demographic and clinical characteristics, with statistically significant differences (P<0.001) in all groups except race/ethnicity (P=0.16). Men, persons aged 20-49 years, MSM, persons with AIDS, those with a CD4 cell count of 200 cells/μl or less and persons diagnosed after 2006 had higher mean viral load. Overall, 54.7% of HIV-infected persons had a suppressed mean viral load, with individual and neighbourhood variations (P<0.0001). CONCLUSION This analysis showed strong disparities in reported CVL by individual characteristics and neighbourhoods. CVL patterns can be utilized to target interventions and track their impact.
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Trepka MJ, Niyonsenga T, Maddox LM, Lieb S. Rural AIDS diagnoses in Florida: changing demographics and factors associated with survival. J Rural Health 2013; 29:266-80. [PMID: 23802929 PMCID: PMC3695411 DOI: 10.1111/j.1748-0361.2012.00449.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents. METHODS Florida surveillance data for people diagnosed with AIDS during 1993-2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTAs). Rural status was classified based on the ZCTA's rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. FINDINGS Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993-1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival. CONCLUSIONS In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida 33199, USA.
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Beard CJ, Travis LB, Chen MH, Arvold ND, Nguyen PL, Martin NE, Kuban DA, Ng AK, Hoffman KE. Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer 2013; 119:2771-7. [PMID: 23633409 DOI: 10.1002/cncr.28086] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Few studies have quantified temporal patterns of cause-specific mortality in contemporary cohorts of men with early-stage seminoma. Given that several management strategies can be applied in these patients, each resulting in excellent long-term survival, it is important to evaluate associated long-term sequelae. In particular, data describing long-term risks of cardiovascular disease (CVD) are conflicting. METHODS We identified 9193 men diagnosed with stage I seminoma (ages 15-70 years) in the population-based SEER registries (1973-2001). We calculated survival estimates, standardized mortality ratios (SMRs), and adjusted hazard rates (AHRs). RESULTS During 121,037 person-years of follow-up (median, 12.3 years), 915 deaths (SMR, 1.23; 95% CI, 1.16-1.32) were reported, with significant excesses for suicide (n = 39; SMR, 1.45; 95% CI, 1.06-1.98), infection (n = 58; SMR, 2.32; 95% CI, 1.80-3.00), and second malignant neoplasms (SMNs; n = 291; SMR, 1.81; 95% CI, 1.61-2.03), but not CVD (n = 201; SMR, 0.91; 95% CI, 0.80-1.05). After radiotherapy (78% patients), CVD deaths were not increased (n = 158; SMR, 0.89; 95% CI, 0.76-1.04), in contrast to SMN deaths (n = 246; SMR, 1.89; 95% CI, 1.67-2.14). SMN mortality was higher among patients administered radiotherapy than among those not given radiotherapy (AHR, 1.36; 95% CI, 0.99-1.88; P = .059), with a cumulative 15-year risk of 2.64% (95% CI, 2.19-3.16). Suicide, although rare, accounted for 1 in 230 deaths. CONCLUSIONS Modern radiotherapy as applied in this large population-based study is not associated with excess CVD mortality. Although increased all-cause mortality exists, cumulative SMN risk is considerably smaller than reported in historical series, but additional follow-up will be required to characterize long-term trends. The increased risk of suicide, previously unreported in men with stage I seminoma, requires confirmation.
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Affiliation(s)
- Clair J Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA.
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Trepka MJ, Niyonsenga T, Maddox L, Lieb S, Lutfi K, Pavlova-McCalla E. Community poverty and trends in racial/ethnic survival disparities among people diagnosed with AIDS in Florida, 1993-2004. Am J Public Health 2013; 103:717-26. [PMID: 23409892 DOI: 10.2105/ajph.2012.300930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described the racial/ethnic disparities in survival among people diagnosed with AIDS in Florida from 1993 to 2004, as the availability of highly active antiretroviral therapy (HAART) became widespread. We determined whether these disparities decreased after controlling for measures of community-level socioeconomic status. METHODS We compared survival from all causes between non-Hispanic Blacks and non-Hispanic Whites vis-a-vis survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level poverty factors. RESULTS Racial/ethnic disparities in survival peaked for those diagnosed during the early implementation of HAART (1996-1998) with a Black-to-White hazard ratio (HR) of 1.72 (95% confidence interval [CI] = 1.62, 1.83) for males and 1.40 (95% CI = 1.24, 1.59) for females. These HRs declined significantly to 1.48 (95% CI = 1.35, 1.64) for males and nonsignificantly to 1.25 (95% CI = 1.05, 1.48) for females in the 2002 to 2004 diagnosis cohort. Disparities decreased significantly for males but not females when controlling for baseline demographic factors and CD4 count and percentage, and became nonsignificant in the 2002 to 2004 cohort after controlling for area poverty. CONCLUSIONS Area poverty appears to play a role in racial/ethnic disparities even after controlling for demographic factors and CD4 count and percentage.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
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Abstract
Low socioeconomic status (SES) influences the risk of acquiring human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and thus should be considered when analyzing HIV/AIDS surveillance data. Most surveillance systems do not collect individual level SES data but do collect residential ZIP code. We developed SES deprivation indices at the ZIP code tabulation area and assessed their predictive validity for AIDS incidence relative to individual neighborhood-level indicators in Florida using reliability analysis, factor analysis with principal component factorization, and structural equation modeling. For urban areas an index of poverty performed best, although the single factor poverty also performed well. For rural areas no index performed well, but the individual indicators of no access to a car and crowding performed well. In rural areas poverty was not associated with increased AIDS incidence. Users of HIV/AIDS surveillance data should consider urban and rural areas separately when assessing the impact of SES on AIDS incidence.
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Malat J, Timberlake JM. County-level Unemployment Change and Trends in Self-rated Health. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/00380237.2013.740990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Román-Montoya Y, Bueno-Cavanillas A, Lara-Porras AM. Evolution of HIV incubation times in AIDS patients. AIDS Care 2012; 25:1051-61. [PMID: 23244645 DOI: 10.1080/09540121.2012.748876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Since introduction of highly active antiretroviral therapy (HAART), the incidence of AIDS has gradually declined, although the incidence of HIV infection is largely unknown. We have studied a sample with 10,571 patients whose data were recorded by Spain's public health system, in the Andalusian Register of Cases of AIDS. The diagnoses correspond to the period January 1981 to June 2008. For this period, AIDS incubation times were analyzed by means of the survival and risk functions, using R survival and DTDA libraries. We have studied the evolution of incubation mean times according to specific variables from database. The obtained results show that the mean times of viral incubation presented a growing trend that was greater among women when the study was limited to heterosexual transmission. Stratifying by category of transmission, the longest incubation period was seen for intravenous drug users (IDU). Both gender and IDU transmission were associated with significantly greater survival without AIDS. In contrast, heterosexual transmission or pneumonia diagnosis were associated with lower survival without AIDS.
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Affiliation(s)
- Y Román-Montoya
- Statistics and Operational Research, University of Granada, Campus de Fuentenueva, Spain.
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Pearce D, Ani C, Espinosa-Silva Y, Clark R, Fatima K, Rahman M, Diebolt E, Ovbiagele B. Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals. Am J Cardiol 2012; 110:1078-84. [PMID: 22762716 DOI: 10.1016/j.amjcard.2012.05.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 12/01/2022]
Abstract
Few studies have explored hospitalization outcome differences between patients who are seropositive for human immunodeficiency virus (HIV) compared to HIV-seronegative patients with acute myocardial infarctions (AMIs). The aim of this study was to explore in-hospital AMI mortality risk in seropositive and seronegative patients. A secondary analysis of the Nationwide Inpatient Sample from 1997 to 2006 was conducted. This sample allows the approximation of all United States hospitalizations. All AMI encounters with and without co-occurring HIV were identified using appropriate International Classification of Diseases and procedure codes. Descriptive and Cox proportional-hazards analyses were then conducted to estimate mortality differences between seropositive and seronegative patients while adjusting for demographic, clinical, hospital, and care factors. The results demonstrated higher AMI hospitalization mortality hazard in seropositive compared to seronegative patients after adjustment for age, gender, ethnicity, medical co-morbidities, hospital type, and number of in-hospital procedures (HR 1.38, 95% confidence interval 1.01 to 1.87, p = 0.04). Stratified analysis demonstrated greater although not statistically significant mortality hazard for non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction in seropositive compared to seronegative patients. Typical AMI care procedures occurred at significantly lower rates in seropositive versus seronegative patients, including thrombolytic and anticoagulant agents (18% vs 22%), coronary arteriography (48% vs 63%), left cardiac catheterization (52% vs 66%), and coronary artery bypass graft (6% vs 14%). In conclusion, additional mortality burden and lower procedure rates occur for HIV-seropositive patients receiving AMI care. Health care providers should be alert to the increased mortality burden when treating seropositive patients with AMI.
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Affiliation(s)
- Daniel Pearce
- Department of Internal Medicine, Loma Linda University, California, USA.
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Pavlova-McCalla E, Trepka MJ, Ramirez G, Niyonsenga T. Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review. JOURNAL OF AIDS & CLINICAL RESEARCH 2012; 3:1000163. [PMID: 24575328 PMCID: PMC3933225 DOI: 10.4172/2155-6113.1000163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Human immunodeficiency virus/acquired immunodeficiency disease syndrome-associated mortality contributes considerably to overall mortality rates among adults in the United States. The purpose of this review is to systematically examine conceptual approaches that have been used to evaluate the association between socioeconomic status of people infected with human immunodeficiency virus and their survival and summarize existing evidence regarding the association between socioeconomic status and mortality due to human immunodeficiency virus/acquired immunodeficiency disease syndrome. METHODS We systematically retrieved neighborhood and individual-level studies of acquired immunodeficiency disease syndrome-related or all-cause mortality among patients diagnosed with human immunodeficiency virus that reported original data and analyzed socioeconomic status as a predictor of mortality. RESULTS We included 21 studies (19 cohort and 2 case-control studies). Heterogeneity in both the conceptual approaches to socioeconomic status measurements and selection of variables for the adjustment of the measure of association precluded meta-analysis of the results. Six studies observing populations before the introduction of highly active antiretroviral therapy found that socioeconomic status was not associated with human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality. In the post- highly active antiretroviral therapy period socioeconomic status was inconsistently associated with Human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality risk in studies adjusting for highly active antiretroviral therapy use. CONCLUSION Further studies considering multilevel socioeconomic status measurements and controlling for treatment and clinical variables are needed to enhance understanding of the role of socioeconomic gradients on human immunodeficiency virus outcomes.
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Affiliation(s)
- Elena Pavlova-McCalla
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Gilbert Ramirez
- Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
| | - Theophile Niyonsenga
- Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA
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Keiser O, Spycher B, Rauch A, Calmy A, Cavassini M, Glass TR, Nicca D, Ledergerber B, Egger M. Outcomes of antiretroviral therapy in the Swiss HIV Cohort Study: latent class analysis. AIDS Behav 2012; 16:245-55. [PMID: 21630013 DOI: 10.1007/s10461-011-9971-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An in-depth understanding of the different groups that make up the HIV-infected population should inform prevention and care. Using latent class analysis (LCA) we identified seven groups with similar socio-demographic and behavioral characteristics at enrolment in the Swiss HIV Cohort Study: older gay men, younger gay men, older heterosexual men, injection drug users, single migrants, migrant women in partnerships and heterosexual men and women. Outcomes of combination antiretroviral therapy (ART) were analyzed in 1,633 patients starting ART. Compared to older gay men, the probability of a virologic response to ART was reduced in single migrants, in older heterosexual men and in IDUs. Loss to follow-up was higher in single migrants and IDUs, and mortality was increased in older heterosexual men and IDUs. Socio-behavioral groups identified by LCA allow insights above what can be gleaned from traditional transmission groups, and may identify patients who could benefit from targeted interventions.
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Abstract
OBJECTIVE To examine interstate variation in US HIV case-fatality rates, and compare them with corresponding conventional HIV death rates. DESIGN Cross-sectional analysis using data on deaths due to HIV infection from the National Vital Statistics System and data on persons 15 years or older living with HIV infection in 2001-2007 in 37 US states from the national HIV/AIDS Reporting System. METHODS State rankings by age-adjusted HIV case-fatality rates (with HIV-infected population denominators) were compared with rankings by conventional death rates (with general population denominators). Negative binomial regression determined case-fatality rate ratios among states, adjusted for age, sex, race/ethnicity, year, and state-level markers of late HIV diagnosis. RESULTS On the basis of 3,096,729 HIV-infected person-years, the overall HIV case-fatality rate was 20.6 per 1000 person-years [95% confidence interval (CI) 20.3-20.9]. Age-adjusted rates by state ranged from 9.6 (95% CI 6.8-12.4) in Idaho to 32.9 (95% CI 29.8-36.0) in Mississippi, demonstrating significant differences across states, even after adjusting for race/ethnicity (P < 0.0001). Many states with low conventional death rates had high case-fatality rates. Nine of the 10 states with the highest case-fatality rates were located in the southern United States. CONCLUSION Case-fatality rates complement and are not entirely concordant with conventional death rates. Interstate differences in these rates may reflect differences in secondary and tertiary prevention of HIV-related mortality among infected persons. These data suggest that state-specific contextual barriers to care may impede improvements in quality and disparities of healthcare without targeted interventions.
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Kobeissi L, El Kak FH, Khawaja M, Khoshnood K. HIV/AIDS-Related Knowledge and Its Association With Socioeconomic Status Among Women. Asia Pac J Public Health 2011; 27:NP734-45. [DOI: 10.1177/1010539511431299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article assesses the association of women’s HIV/AIDS knowledge of transmission and prevention with socioeconomic status (SES). Data from the 2004 Lebanese PAPFAM (Pan-Arab Project for Family Health) survey were used. The survey was based on a representative household sample (n = 5532 households; n = 3315 women) of ever-married women aged 15 to 55 years. Adjusted analysis revolved around multivariate logistic regression models. 18% of women were knowledgeable of HIV/AIDS transmission methods and 21% of prevention methods. Income and education were significantly related to women’s transmission and prevention knowledge. Significant differences were also found by region and media exposure. Women in the richest income quintile were 4 times (95% confidence interval [CI] = 2.43-6.42) more likely to be knowledgeable than those in the poorest. Women with the highest education were 2.57 times more likely (95% CI = 1.98-3.34) to be knowledgeable than those with elementary education or less. These results suggest the need for incorporating contextual regional and population differences for more effective HIV/AIDS awareness campaigns in Lebanon.
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Affiliation(s)
- Loulou Kobeissi
- University of California Los Angeles School of Public Health, Beirut, Lebanon
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Beltran VM, Harrison KM, Hall HI, Dean HD. Collection of social determinant of health measures in U.S. national surveillance systems for HIV, viral hepatitis, STDs, and TB. Public Health Rep 2011; 126 Suppl 3:41-53. [PMID: 21836737 DOI: 10.1177/00333549111260s309] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Challenges exist in the study of social determinants of health (SDH) because of limited comparability of population-based U.S. data on SDH. This limitation is due to differences in disparity or equity measurements, as well as general data quality and availability. We reviewed the current SDH variables collected for HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis at the Centers for Disease Control and Prevention through its population-based surveillance systems and assessed specific system attributes. Results were used to provide recommendations for a core set of SDH variables to collect that are both feasible and useful. We also conducted an environmental literature scan to determine the status of knowledge of SDH as underlying causes of disease and to inform the recommended core set of SDH variables.
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Affiliation(s)
- Victoria M Beltran
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, Office of Health Equity, Atlanta, GA 30333, USA.
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Abstract
Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878 HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL, hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness, and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly, and should be a target of health policy in this population.
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Late HIV Diagnosis and Survival Within 1 Year Following the First Positive HIV Test in a Limited-Resource Region. J Assoc Nurses AIDS Care 2011; 22:313-9. [DOI: 10.1016/j.jana.2010.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 11/15/2010] [Indexed: 11/18/2022]
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Sahajian F, Bailly F, Vanhems P, Fantino B, Vannier-Nitenberg C, Fabry J, Trepo C. A randomized trial of viral hepatitis prevention among underprivileged people in the Lyon area of France. J Public Health (Oxf) 2010; 33:182-92. [DOI: 10.1093/pubmed/fdq071] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sharpe TT, Harrison KM, Dean HD. Summary of CDC consultation to address social determinants of health for prevention of disparities in HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis. December 9-10, 2008. Public Health Rep 2010; 125 Suppl 4:11-5. [PMID: 20626189 PMCID: PMC2882970 DOI: 10.1177/00333549101250s404] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In December 2008, the Centers for Disease Control and Prevention (CDC) convened a meeting of national public health partners to identify priorities for addressing social determinants of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB). The consultants were divided into four working groups: (1) public health policy, (2) data systems, (3) agency partnerships and prevention capacity building, and (4) prevention research and evaluation. Groups focused on identifying top priorities; describing activities, methods, and metrics to implement priorities; and identifying partnerships and resources required to implement priorities. The meeting resulted in priorities for public health policy, improving data collection methods, enhancing existing and expanding future partnerships, and improving selection criteria and evaluation of evidence-based interventions. CDC is developing a national communications plan to guide and inspire action for keeping social determinants of HIV/AIDS, viral hepatitis, STDs, and TB in the forefront of public health activities.
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Affiliation(s)
- Tanya Telfair Sharpe
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, MS E-07, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
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Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr 2010; 53:124-30. [PMID: 19730109 DOI: 10.1097/qai.0b013e3181b563e7] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We estimate life expectancy and average years of life lost (AYLL) after an HIV diagnosis using population-based surveillance data from 25 states that have had name-based HIV surveillance since 1996. METHODS We used US national HIV surveillance data (cases > or = 13 years old) to model life expectancy after an HIV diagnosis using the life table approach. We then compared life expectancy at HIV diagnosis with that in the general population of the same age, sex, and race/ethnicity in the same calendar year using vital statistics data to estimate the AYLL due to an HIV diagnosis. RESULTS Average life expectancy after HIV diagnosis increased from 10.5 to 22.5 years from 1996 to 2005. Life expectancy (years) was better for females than for males but improved less for females (females: 12.6-23.6 and males: 9.9-22.0). In 2005, life expectancy for black males was shortest, followed by Hispanic males and then white males. AYLL for cases diagnosed in 2005 was 21.1 years (males: 19.1 and females: 22.7) compared with 32.9 years in 1996. CONCLUSIONS Disparity in life expectancy for females and both black and Hispanic males, compared with males and white males, respectively, persists and should be addressed.
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