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McKay VR, Cambey CL, Combs TB, Stubbs AW, Pichon LC, Gaur AH. Using a Modeling-Based Approach to Assess and Optimize HIV Linkage to Care Services. AIDS Behav 2021; 25:886-896. [PMID: 33000356 PMCID: PMC7887057 DOI: 10.1007/s10461-020-03051-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/31/2022]
Abstract
Evidence-based linkage to care interventions (LTCs) help recently diagnosed HIV+ individuals engage in care in a timely manner yet are heavily impacted by the systems in which they are embedded. We developed a prototype agent-based model informed by data from an established LTC program targeting youth and young adults aged 13-24 in Memphis, Tennessee. We then tested two interventions to improve LTC in a simulated environment: expanding testing sites versus using current testing sites but improving direct referral to LTC staff from organizations providing testing, to understand the impact on timely linkage to care. Improving direct referral to the LTC program decreased days to successful linkage from an average of 30 to 23 days but expanding testing sites increased average days to 31 days unless those sites also made direct referrals. We demonstrated how LTC is impacted by the system and interventions for shortening days to linkage to care.
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Affiliation(s)
- V R McKay
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus Box #1196, St. Louis, MO, 63130, USA.
| | - C L Cambey
- Department of Biology, Vassar College, Poughkeepsie, NY, USA
| | - T B Combs
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, 1 Brookings Drive, Campus Box #1196, St. Louis, MO, 63130, USA
| | - A W Stubbs
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - L C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - A H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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Griffith DC, Farmer C, Gebo KA, Berry SA, Aberg J, Moore RD, Gaur AH, Mathews WC, Beil R, Korthuis PT, Nijhawan AE, Rutstein RM, Agwu AL. Uptake and virological outcomes of single- versus multi-tablet antiretroviral regimens among treatment-naïve youth in the HIV Research Network. HIV Med 2018; 20:169-174. [PMID: 30561888 DOI: 10.1111/hiv.12695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Several single-tablet regimens (STRs) are now available and are recommended for first-line antiretroviral therapy (ART); however, STR use for youth with HIV (YHIV) has not been systematically studied. We examined the characteristics associated with initiation of STRs versus multi-tablet regimens (MTRs) and the virological outcomes for youth with nonperinatally acquired HIV (nPHIV). METHODS A retrospective cohort study of nPHIV youth aged 13-24 years initiating ART between 2006 and 2014 at 18 US HIV clinical sites in the HIV Research Network was performed. The outcomes measured were initiation of STRs versus MTRs, virological suppression (VS) at 12 months, and time to VS. Demographic and clinical factors associated with initiation of STR versus MTR ART and VS (< 400 HIV-1 RNA copies/mL) at 12 months after initiation were assessed using multivariable logistic regression. Cox proportional hazards regression was used to assess VS within the first year. RESULTS Of 987 youth, 67% initiated STRs. Of the 589 who had viral load data at 1 year, 84% of those on STRs versus 67% of those on MTRs achieved VS (P < 0.01). VS was associated with STR use [adjusted odds ratio (AOR) 1.61; 95% confidence interval (CI) 1.01-2.58], white (AOR 2.41; 95% CI 1.13-5.13) or Hispanic (AOR 2.38; 95% CI 1.32-4.27) race/ethnicity, and baseline CD4 count 351-500 cells/μL (AOR 1.94; 95% CI 1.18-3.19) and > 500 cells/μL (AOR 1.76; 95% CI 1.0-3.10). STR use was not associated with a shorter time to VS compared with MTR use [hazard ratio (HR) 1.07; 95% CI 0.90-1.28]. CONCLUSIONS Use of STR was associated with a greater likelihood of sustained VS 12 months after ART initiation in YHIV.
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Affiliation(s)
- D C Griffith
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Farmer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K A Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S A Berry
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Aberg
- Mount Sinai School of Medicine, New York, NY, USA
| | - R D Moore
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A H Gaur
- St. Jude's Children's Research Hospital, Memphis, TN, USA
| | - W C Mathews
- University of California at San Diego, San Diego, CA, USA
| | - R Beil
- Montefiore Medical Group, New York, NY, USA
| | - P T Korthuis
- Oregon Health & Sciences University, Portland, OR, USA
| | - A E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R M Rutstein
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gammal RS, Court MH, Haidar CE, Iwuchukwu OF, Gaur AH, Alvarellos M, Guillemette C, Lennox JL, Whirl-Carrillo M, Brummel SS, Ratain MJ, Klein TE, Schackman BR, Caudle KE, Haas DW. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for UGT1A1 and Atazanavir Prescribing. Clin Pharmacol Ther 2015; 99:363-9. [PMID: 26417955 DOI: 10.1002/cpt.269] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/24/2015] [Indexed: 01/09/2023]
Abstract
The antiretroviral protease inhibitor atazanavir inhibits hepatic uridine diphosphate glucuronosyltransferase (UGT) 1A1, thereby preventing the glucuronidation and elimination of bilirubin. Resultant indirect hyperbilirubinemia with jaundice can cause premature discontinuation of atazanavir. Risk for bilirubin-related discontinuation is highest among individuals who carry two UGT1A1 decreased function alleles (UGT1A1*28 or *37). We summarize published literature that supports this association and provide recommendations for atazanavir prescribing when UGT1A1 genotype is known (updates at www.pharmgkb.org).
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Affiliation(s)
- R S Gammal
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - M H Court
- Individualized Medicine Program, Department of Veterinary Clinical Sciences, Washington State University College of Veterinary Medicine, Pullman, Washington, USA
| | - C E Haidar
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - O F Iwuchukwu
- Division of Pharmaceutical Sciences, Fairleigh Dickinson University School of Pharmacy, Florham Park, New Jersey, USA.,Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - A H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - M Alvarellos
- Department of Genetics, Stanford University, Stanford, California, USA
| | - C Guillemette
- Laval University CHU de Québec Research Center, Quebec, Quebec, Canada
| | - J L Lennox
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - M Whirl-Carrillo
- Department of Genetics, Stanford University, Stanford, California, USA
| | - S S Brummel
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - M J Ratain
- Center for Personalized Therapeutics, Comprehensive Cancer Center, The University of Chicago, Chicago, Illinois, USA
| | - T E Klein
- Department of Genetics, Stanford University, Stanford, California, USA
| | - B R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - K E Caudle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - D W Haas
- Departments of Medicine, Pharmacology, Pathology, Microbiology & Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Gaur AH, Patrick CC, McCullers JA, Flynn PM, Pearson TA, Razzouk BI, Thompson SJ, Shenep JL. Bacillus cereus bacteremia and meningitis in immunocompromised children. Clin Infect Dis 2001; 32:1456-62. [PMID: 11317247 DOI: 10.1086/320154] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2000] [Revised: 10/12/2000] [Indexed: 11/03/2022] Open
Abstract
Two cases of Bacillus cereus meningitis in immunocompromised children at our hospital within a 2-month period prompted us to review B. cereus--related invasive disease. We identified 12 patients with B. cereus isolated in blood cultures from September 1988 through August 2000 at our institution. Three of these patients also had B. cereus isolated from CSF specimens; 1 additional patient had possible CNS involvement (33%, group A), whereas 8 patients had no evidence of CNS involvement (67%, group B). Patients in group A were more likely to have neutropenia at the onset of sepsis and were more likely to have an unfavorable outcome. They were also more likely to have received intrathecal chemotherapy in the week before the onset of their illness. Two patients from group A died. One survived with severe sequelae. The fourth patient had mild sequelae at follow-up. No sequelae or deaths occurred among patients in group B. In patients with unfavorable outcomes, the interval from the time of recognition of illness to irreversible damage or death was short, which demonstrates a need for increased awareness, early diagnosis, and more-effective therapy, particularly that which addresses B. cereus toxins.
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Affiliation(s)
- A H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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