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Floyd N, Hassan MT, Tang Z, Krivoš M, Blatnik M, Cude-Woods C, Clayton SM, Holley AT, Ito TM, Johnson BA, Liu CY, Makela M, Morris CL, Navazo ASC, O'Shaughnessy CM, Renner EL, Pattie RW, Young AR. Scintillation characteristics of the EJ-299-02H scintillator. Rev Sci Instrum 2024; 95:045108. [PMID: 38573050 DOI: 10.1063/5.0179451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
A study of the dead layer thickness and quenching factor of a plastic scintillator for use in ultracold neutron (UCN) experiments is described. Alpha spectroscopy was used to determine the thickness of a thin surface dead layer to be 630 ± 110 nm. The relative light outputs from the decay of 241Am and Compton scattering of electrons were used to extract Birks' law coefficient, yielding a kB value of 0.087 ± 0.003 mm/MeV, consistent with some previous reports for other polystyrene-based scintillators. The results from these measurements are incorporated into the simulation to show that an energy threshold of (∼9 keV) can be achieved for the UCNProBe experiment. This low threshold enables high beta particle detection efficiency and the indirect measurement of UCN. The ability to make the scintillator deuterated, accompanied by its relatively thin dead layer, gives rise to unique applications in a wide range of UCN experiments, where it can be used to trap UCN and detect charged particles in situ.
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Affiliation(s)
- N Floyd
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Krivoš
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Blatnik
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - C Cude-Woods
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B A Johnson
- Indiana University, Bloomington, Indiana 47405, USA
| | - C-Y Liu
- University of Illinois, Champaign, Illinois 61820, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A S C Navazo
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - E L Renner
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
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2
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Birbeck GL, Mwenechanya M, Ume‐Ezeoke I, Mathews M, Bositis CM, Kalungwana L, Bearden D, Elafros M, Gelbard HA, Theodore WH, Koralnik IJ, Okulicz JF, Johnson BA, Musonda N, Siddiqi OK, Potchen MJ, Sikazwe I. Long-term outcomes after new onset seizure in children living with HIV: A cohort study. Epilepsia Open 2024; 9:750-757. [PMID: 38366961 PMCID: PMC10984287 DOI: 10.1002/epi4.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 12/15/2023] [Revised: 01/17/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVE To determine the long-term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. METHODS Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30-day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. RESULTS Among 73 children enrolled, 28 died (38%), 22 within 30-days of the index seizure. Median follow-up was 533 days (IQR 18-957) with 5% (4/73) lost to follow-up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30-days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86-269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. SIGNIFICANCE Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co-usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. PLAIN LANGUAGE SUMMARY This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.
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Affiliation(s)
- Gretchen L. Birbeck
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
- Chikankata Epilepsy Care TeamMazabukaZambia
| | | | | | - Manoj Mathews
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Christopher M. Bositis
- Department of Family and Community MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - David Bearden
- Department of NeurologyUniversity of RochesterRochesterNew YorkUSA
- University Teaching Hospitals Children's HospitalLusakaZambia
| | - Melissa Elafros
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
| | | | | | - Igor J. Koralnik
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jason F. Okulicz
- Department of MedicineSan Antonio Military Medical CenterSan AntonioTexasUSA
| | - Brent A. Johnson
- Department of BiostatisticsUniversity of RochesterRochesterNew YorkUSA
| | - Namwiya Musonda
- University Teaching Hospitals Neurology Research OfficeLusakaZambia
| | - Omar K. Siddiqi
- University Teaching Hospitals Children's HospitalLusakaZambia
- Department of NeurologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Michael J. Potchen
- Department of Imaging SciencesUniversity of RochesterRochesterNew YorkUSA
- Zambian College of Medicine and SurgeryLusakaZambia
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3
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in Cortically Blinded Fields Appears to Confer Patient-Specific Benefit Against Retinal Thinning. Invest Ophthalmol Vis Sci 2024; 65:29. [PMID: 38635245 PMCID: PMC11033601 DOI: 10.1167/iovs.65.4.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of transsynaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography data in 48 participants with unilateral V1 stroke and homonymous visual defects who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layer (GCL-IPL) and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ∼6 months of daily motion discrimination training in the intact or blind field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pretraining, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact field exhibited increased LIGCL-IPL. Those trained in their blind field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, United States
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, United States
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4
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Bearden DR, Mwanza-Kabaghe S, Bositis CM, Dallah I, Johnson BA, Siddiqi OK, Elafros MA, Gelbard HA, Okulicz JF, Kalungwana L, Musonda N, Theodore WH, Mwenechanya M, Mathews M, Sikazwe IT, Birbeck GL. Early Initiation of Antiretroviral Therapy is Protective Against Seizures in Children With HIV in Zambia: A Prospective Case-Control Study. J Acquir Immune Defic Syndr 2024; 95:291-296. [PMID: 38032746 PMCID: PMC10922319 DOI: 10.1097/qai.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/06/2023] [Accepted: 09/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Seizures are relatively common among children with HIV in low- and middle-income countries and are associated with significant morbidity and mortality. Early treatment with antiretroviral therapy (ART) may reduce this risk by decreasing rates of central nervous system infections and HIV encephalopathy. METHODS We conducted a prospective, unmatched case-control study. We enrolled children with new-onset seizure from University Teaching Hospital in Lusaka, Zambia and 2 regional hospitals in rural Zambia. Controls were children with HIV and no history of seizures. Recruitment took place from 2016 to 2019. Early treatment was defined as initiation of ART before 12 months of age, at a CD4 percentage >15% in children aged 12-60 months or a CD4 count >350 cells/mm 3 for children aged 60 months or older. Logistic regression models were used to evaluate the association between potential risk factors and seizures. RESULTS We identified 73 children with new-onset seizure and compared them with 254 control children with HIV but no seizures. Early treatment with ART was associated with a significant reduction in the odds of seizures [odds ratio (OR) 0.04, 95% confidence interval: 0.02 to 0.09; P < 0.001]. Having an undetectable viral load at the time of enrollment was strongly protective against seizures (OR 0.03, P < 0.001), whereas history of World Health Organization Stage 4 disease (OR 2.2, P = 0.05) or CD4 count <200 cells/mm 3 (OR 3.6, P < 0.001) increased risk of seizures. CONCLUSIONS Early initiation of ART and successful viral suppression would likely reduce much of the excess seizure burden in children with HIV.
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Affiliation(s)
- David R Bearden
- Department of Neurology, University of Rochester, Rochester, NY
- University of Zambia School of Medicine, Lusaka, Zambia
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia
| | | | | | - Ifunanya Dallah
- University of Rochester, Center for Health and Technology, Rochester, NY
| | - Brent A Johnson
- Department of Biostatistics, University of Rochester, Rochester, NY
| | - Omar K Siddiqi
- Department of Neurology, Beth Israel Deaconess Medical Center, Global Neurology Program, Boston, MA
- University of Zambia, University Teaching Hospitals, Lusaka, Zambia
| | | | | | - Jason F Okulicz
- San Antonio Military Medical Center, Infectious Diseases Service, HIV Medical Evaluation Unit, San Antonio, TX
| | - Lisa Kalungwana
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Nkhoma Musonda
- Department of Neurology, University of Rochester, Rochester, NY
- University of Rochester, Center for Health and Technology, Rochester, NY
| | | | | | - Manoj Mathews
- University of Zambia, University Teaching Hospitals, Lusaka, Zambia
| | | | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY
- University of Zambia School of Medicine, Lusaka, Zambia
- University of Rochester, Center for Health and Technology, Rochester, NY
- University of Zambia, University Teaching Hospitals, Lusaka, Zambia
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5
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in cortically-blind fields confers patient-specific benefit against retinal thinning after occipital stroke. medRxiv 2023:2023.12.19.23298260. [PMID: 38196617 PMCID: PMC10775322 DOI: 10.1101/2023.12.19.23298260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of trans-synaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness, and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography (OCT) data in 48 participants with unilateral V1 stroke and homonymous visual defects, who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layers (GCL-IPL), and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ~6 months of daily motion discrimination training in the intact- or blind-field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pre-training, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact-field exhibited increased LIGCL-IPL. Those trained in their blind-field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training, but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
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6
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An P, Awe C, Barbeau PS, Becker B, Belov V, Bernardi I, Bock C, Bolozdynya A, Bouabid R, Brown A, Browning J, Cabrera-Palmer B, Cervantes M, Conley E, Daughhetee J, Detwiler J, Ding K, Durand MR, Efremenko Y, Elliott SR, Fabris L, Febbraro M, Gallo Rosso A, Galindo-Uribarri A, Germer AC, Green MP, Hakenmüller J, Heath MR, Hedges S, Hughes M, Johnson BA, Johnson T, Khromov A, Konovalov A, Kozlova E, Kumpan A, Kyzylova O, Li L, Link JM, Liu J, Mahoney M, Major A, Mann K, Markoff DM, Mastroberti J, Mattingly J, Mueller PE, Newby J, Parno DS, Penttila SI, Pershey D, Prior CG, Rapp R, Ray H, Raybern J, Razuvaeva O, Reyna D, Rich GC, Ross J, Rudik D, Runge J, Salvat DJ, Sander J, Scholberg K, Shakirov A, Simakov G, Sinev G, Skuse C, Snow WM, Sosnovtsev V, Subedi T, Suh B, Tayloe R, Tellez-Giron-Flores K, Tsai YT, Ujah E, Vanderwerp J, van Nieuwenhuizen EE, Varner RL, Virtue CJ, Visser G, Walkup K, Ward EM, Wongjirad T, Yoo J, Yu CH, Zawada A, Zettlemoyer J, Zderic A. Measurement of Electron-Neutrino Charged-Current Cross Sections on ^{127}I with the COHERENT NaIνE Detector. Phys Rev Lett 2023; 131:221801. [PMID: 38101357 DOI: 10.1103/physrevlett.131.221801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
Using an 185-kg NaI[Tl] array, COHERENT has measured the inclusive electron-neutrino charged-current cross section on ^{127}I with pion decay-at-rest neutrinos produced by the Spallation Neutron Source at Oak Ridge National Laboratory. Iodine is one the heaviest targets for which low-energy (≤50 MeV) inelastic neutrino-nucleus processes have been measured, and this is the first measurement of its inclusive cross section. After a five-year detector exposure, COHERENT reports a flux-averaged cross section for electron neutrinos of 9.2_{-1.8}^{+2.1}×10^{-40} cm^{2}. This corresponds to a value that is ∼41% lower than predicted using the MARLEY event generator with a measured Gamow-Teller strength distribution. In addition, the observed visible spectrum from charged-current scattering on ^{127}I has been measured between 10 and 55 MeV, and the exclusive zero-neutron and one-or-more-neutron emission cross sections are measured to be 5.2_{-3.1}^{+3.4}×10^{-40} and 2.2_{-0.5}^{+0.4}×10^{-40} cm^{2}, respectively.
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Affiliation(s)
- P An
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - C Awe
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - P S Barbeau
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - B Becker
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - V Belov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - I Bernardi
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Bock
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - A Bolozdynya
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - R Bouabid
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Brown
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Browning
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | | | - M Cervantes
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - E Conley
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - J Daughhetee
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Detwiler
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K Ding
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M R Durand
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - Y Efremenko
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S R Elliott
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Fabris
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Febbraro
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Gallo Rosso
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - A Galindo-Uribarri
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A C Germer
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - M P Green
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Hakenmüller
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - M R Heath
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S Hedges
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - M Hughes
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - B A Johnson
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - T Johnson
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Khromov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Konovalov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - E Kozlova
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Kumpan
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - O Kyzylova
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - L Li
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - J Liu
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Mahoney
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - A Major
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - K Mann
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Mastroberti
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Mattingly
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - P E Mueller
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Newby
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D S Parno
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - S I Penttila
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D Pershey
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C G Prior
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R Rapp
- Washington & Jefferson College, Washington, Pennsylvania 15301, USA
| | - H Ray
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - J Raybern
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - O Razuvaeva
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - D Reyna
- Sandia National Laboratories, Livermore, California 94550, USA
| | - G C Rich
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Ross
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - D Rudik
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - J Runge
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - D J Salvat
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Scholberg
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - A Shakirov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - G Simakov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - G Sinev
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C Skuse
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - W M Snow
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - V Sosnovtsev
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - T Subedi
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
- Department of Physical and Environmental Sciences, Concord University, Athens, West Virginia 24712, USA
| | - B Suh
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - R Tayloe
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | | | - Y-T Tsai
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - E Ujah
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Vanderwerp
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - E E van Nieuwenhuizen
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R L Varner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C J Virtue
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Visser
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - K Walkup
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - E M Ward
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - T Wongjirad
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts 02155, USA
| | - J Yoo
- Department of Physics and Astronomy, Seoul National University, Seoul, 08826, Korea
| | - C-H Yu
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Zawada
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Zettlemoyer
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - A Zderic
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
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7
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Fiscella KA, Sass E, Sridhar SB, Maguire JA, Lashway K, Wong G, Thien A, Thomas M, Bisognano JD, Rosenberg T, Sanders MR, Johnson BA, Polgreen LA. Team-based home blood pressure monitoring for blood pressure equity a protocol for a stepped wedge cluster randomized trial. Contemp Clin Trials 2023; 134:107332. [PMID: 37722482 PMCID: PMC10725081 DOI: 10.1016/j.cct.2023.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/31/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Home Blood Pressure Monitoring (HBPM) that includes a team with a clinical pharmacist is an evidence-based intervention that improves blood pressure (BP). Yet, strategies for promoting its adoption in primary care are lacking. We developed potentially feasible and sustainable implementation strategies to improve hypertension control and BP equity. METHODS We assessed barriers and facilitators to HBPM and iteratively adapted implementation strategies through key informative interviews and guidance from a multistakeholder stakeholder team involving investigators, clinicians, and practice administration. RESULTS Strategies include: 1) pro-active outreach to patients; 2) provision of BP devices; 3) deployment of automated bidirectional texting to support patients through education messages for patients to transmit their readings to the clinical team; 3) a hypertension visit note template; 4) monthly audit and feedback reports on progress to the team; and 5) training to the patients and teams. We will use a stepped wedge randomized trial to assess RE-AIM outcomes. These are defined as follows Reach: the proportion of eligible patients who agree to participate in the BP texting; Effectiveness: the proportion of eligible patients with their last BP reading <140/90 (six months); Adoption: the proportion of patients invited to the BP texting; Implementation: patients who text their BP reading ≥10 of days per month; and Maintenance: sustained BP control post-intervention (twelve months). We will also examine RE-AIM metrics stratified by race and ethnicity. CONCLUSIONS Findings will inform the impact of strategies for the adoption of team-based HPBM and the impact of the intervention on hypertension control and equity. REGISTRATION DETAILS www. CLINICALTRIALS gov Identifier: NCT05488795.
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Affiliation(s)
- Kevin A Fiscella
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America.
| | - Emma Sass
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - Soumya B Sridhar
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Jennifer A Maguire
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Katie Lashway
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Geoff Wong
- Nuffield Department of Primary Care, Medical Sciences Division, University of Oxford, United Kingdom
| | - Amy Thien
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Marie Thomas
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - John D Bisognano
- Department of Medicine, Cardiology Division, University of Michigan, 24 Frank Lloyd Wright Dr. Ste 1300, Lobby A, Ann Arbor, MI 48106, United States of America
| | - Tziporah Rosenberg
- Department of Family Medicine, Highland Hospital, University of Rochester Medical Center, 777 S. Clinton Ave, Rochester, NY 14620, United States of America
| | - Mechelle R Sanders
- Department of Family Medicine Research, Highland Hospital, University of Rochester Medical Center, 1381 South Ave, Rochester, NY 14620, United States of America
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY 14642, United States of America
| | - Linnea A Polgreen
- College of Pharmacy, Iowa University, 340 College of Pharmacy Building, 180 S Grand Ave, Iowa City, IA 5224, United States of America
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8
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Huang DT, Gosev I, Wood KL, Vidula H, Stevenson W, Marchlinski F, Supple G, Zalawadiya SK, Weiss JP, Tung R, Tzou WS, Moss JD, Kancharla K, Chaudhry S, Patel PJ, Khan AM, Schuger C, Rozen G, Kiernan MS, Couper GS, Leacche M, Molina EJ, Shah AD, Lloyd M, Sroubek J, Soltesz E, Shivkumar K, White C, Tankut S, Johnson BA, McNitt S, Kutyifa V, Zareba W, Goldenberg I. Design and characteristics of the prophylactic intra-operative ventricular arrhythmia ablation in high-risk LVAD candidates (PIVATAL) trial. Ann Noninvasive Electrocardiol 2023; 28:e13073. [PMID: 37515396 PMCID: PMC10475893 DOI: 10.1111/anec.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The use of a Left Ventricular Assist Device (LVAD) in patients with advanced heart failure refractory to optimal medical management has progressed steadily over the past two decades. Data have demonstrated reduced LVAD efficacy, worse clinical outcome, and higher mortality for patients who experience significant ventricular tachyarrhythmia (VTA). We hypothesize that a novel prophylactic intra-operative VTA ablation protocol at the time of LVAD implantation may reduce the recurrent VTA and adverse events postimplant. METHODS We designed a prospective, multicenter, open-label, randomized-controlled clinical trial enrolling 100 patients who are LVAD candidates with a history of VTA in the previous 5 years. Enrolled patients will be randomized in a 1:1 fashion to intra-operative VTA ablation (n = 50) versus conventional medical management (n = 50) with LVAD implant. Arrhythmia outcomes data will be captured by an implantable cardioverter defibrillator (ICD) to monitor VTA events, with a uniform ICD programming protocol. Patients will be followed prospectively over a mean of 18 months (with a minimum of 9 months) after LVAD implantation to evaluate recurrent VTA, adverse events, and procedural outcomes. Secondary endpoints include right heart function/hemodynamics, healthcare utilization, and quality of life. CONCLUSION The primary aim of this first-ever randomized trial is to assess the efficacy of intra-operative ablation during LVAD surgery in reducing VTA recurrence and improving clinical outcomes for patients with a history of VTA.
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Affiliation(s)
- David T. Huang
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Igor Gosev
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Katherine L. Wood
- Division of Cardiothoracic SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hima Vidula
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - William Stevenson
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Frank Marchlinski
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Gregory Supple
- Division of CardiologyUniversity of Pennsylvania Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sandip K. Zalawadiya
- Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - J. Peter Weiss
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Roderick Tung
- The University of Arizona College of Medicine‐Phoenix, Banner University Medical CenterPhoenixArizonaUSA
| | - Wendy S. Tzou
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Joshua D. Moss
- Division of CardiologyUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
| | - Krishna Kancharla
- Department of MedicineHeart and Vascular Institute, University of Pittsburgh Medical Center and School of MedicinePittsburghPennsylvaniaUSA
| | - Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Parin J. Patel
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIndianaUSA
- Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIndianaUSA
| | - Arfaat M. Khan
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Claudio Schuger
- Henry Ford Heart and Vascular Institute, Henry Ford HospitalDetroitMichiganUSA
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical CenterBostonMassachusettsUSA
| | | | | | - Marzia Leacche
- Department of Cardiothoracic SurgerySpectrum HealthGrand RapidsMichiganUSA
| | - Ezequiel J. Molina
- Department of Cardiothoracic SurgeryPiedmont Heart InstituteAtlantaGeorgiaUSA
| | - Anand D. Shah
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Michael Lloyd
- Section of Cardiac ElectrophysiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jakub Sroubek
- Heart Vascular and Thoracic Institute, Cleveland ClinicClevelandOhioUSA
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandOhioUSA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Casey White
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sinan Tankut
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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9
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Bhattacharya I, Ertefaie A, Lynch KG, McKay JR, Johnson BA. Nonparametric Bayesian Q-learning for optimization of dynamic treatment regimes in the presence of partial compliance. Stat Methods Med Res 2023; 32:1649-1663. [PMID: 37322885 DOI: 10.1177/09622802231181223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 06/17/2023]
Abstract
Existing methods for estimation of dynamic treatment regimes are mostly limited to intention-to-treat analyses-which estimate the effect of randomization to a particular treatment regime without considering the compliance behavior of patients. In this article, we propose a novel nonparametric Bayesian Q-learning approach to construct optimal sequential treatment regimes that adjust for partial compliance. We consider the popular potential compliance framework, where some potential compliances are latent and need to be imputed. The key challenge is learning the joint distribution of the potential compliances, which we accomplish using a Dirichlet process mixture model. Our approach provides two kinds of treatment regimes: (1) conditional regimes that depend on the potential compliance values; and (2) marginal regimes where the potential compliances are marginalized. Extensive simulation studies highlight the usefulness of our method compared to intention-to-treat analyses. We apply our method to the Adaptive Treatment for Alcohol and Cocaine Dependence (ENGAGE) study , where the goal is to construct optimal treatment regimes to engage patients in therapy.
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Affiliation(s)
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester, USA
| | - Kevin G Lynch
- Department of Psychiatry, University of Pennsylvania, USA
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, USA
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10
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Hirsh ML, Edwards JA, Robichaux C, Brijkumar J, Moosa MYS, Ofotokun I, Johnson BA, Pillay S, Pillay M, Moodley P, Sun YV, Liu C, Dudgeon MR, Ordoñez C, Kuritzkes DR, Sunpath H, Morrow M, Anderson PL, Ellison L, Bushman LR, Marconi VC, Castillo-Mancilla JR. Food Insecurity Is Associated With Low Tenofovir Diphosphate in Dried Blood Spots in South African Persons With HIV. Open Forum Infect Dis 2023; 10:ofad360. [PMID: 37469618 PMCID: PMC10352648 DOI: 10.1093/ofid/ofad360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 07/21/2023] Open
Abstract
Background Food insecurity has been linked to suboptimal antiretroviral therapy (ART) adherence in persons with HIV (PWH). This association has not been evaluated using tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs), a biomarker of cumulative ART adherence and exposure. Methods Within a prospective South African cohort of treatment-naive PWH initiating ART, a subset of participants with measured TFV-DP in DBS values was assessed for food insecurity status. Bivariate and multivariate median-based regression analysis compared the association between food insecurity and TFV-DP concentrations in DBSs adjusting for age, sex, ethnicity, medication possession ratio (MPR), and estimated glomerular filtration rate. Results Drug concentrations were available for 285 study participants. Overall, 62 (22%) PWH reported worrying about food insecurity and 44 (15%) reported not having enough food to eat in the last month. The crude median concentrations of TFV-DP in DBSs differed significantly between those who expressed food insecurity worry versus those who did not (599 [interquartile range {IQR}, 417-783] fmol/punch vs 716 [IQR, 453-957] fmol/punch; P = .032). In adjusted median-based regression, those with food insecurity worry had concentrations of TFV-DP that were 155 (95% confidence interval, -275 to -35; P = .012) fmol/punch lower than those who did not report food insecurity worry. Age and MPR remained significantly associated with TFV-DP. Conclusions In this study, food insecurity worry is associated with lower TFV-DP concentrations in South African PWH. This highlights the role of food insecurity as a social determinant of HIV outcomes including ART failure and resistance.
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Affiliation(s)
- Molly L Hirsh
- Augusta University/University of Georgia Medical Partnership, Medical College of Georgia, Athens, Georgia, USA
| | - Jonathan A Edwards
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Chad Robichaux
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jaysingh Brijkumar
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Selvan Pillay
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Melendhran Pillay
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
| | - Pravi Moodley
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mathew R Dudgeon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Claudia Ordoñez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henry Sunpath
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Morrow
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lucas Ellison
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lane R Bushman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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11
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Bhattacharya I, Johnson BA, Artman WJ, Wilson A, Lynch KG, McKay JR, Ertefaie A. A non-parametric Bayesian approach for adjusting partial compliance in sequential decision making. Stat Med 2023. [PMID: 37037602 DOI: 10.1002/sim.9742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/16/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
Existing methods for estimating the mean outcome under a given sequential treatment rule often rely on intention-to-treat analyses, which estimate the effect of following a certain treatment rule regardless of compliance behavior of patients. There are two major concerns with intention-to-treat analyses: (1) the estimated effects are often biased toward the null effect; (2) the results are not generalizable and reproducible due to the potentially differential compliance behavior. These are particularly problematic in settings with a high level of non-compliance, such as substance use disorder studies. Our work is motivated by the Adaptive Treatment for Alcohol and Cocaine Dependence study (ENGAGE), which is a multi-stage trial that aimed to construct optimal treatment strategies to engage patients in therapy. Due to the relatively low level of compliance in this trial, intention-to-treat analyses essentially estimate the effect of being randomized to a certain treatment, instead of the actual effect of the treatment. We obviate this challenge by defining the target parameter as the mean outcome under a dynamic treatment regime conditional on a potential compliance stratum. We propose a flexible non-parametric Bayesian approach based on principal stratification, which consists of a Gaussian copula model for the joint distribution of the potential compliances, and a Dirichlet process mixture model for the treatment sequence specific outcomes. We conduct extensive simulation studies which highlight the utility of our approach in the context of multi-stage randomized trials. We show robustness of our estimator to non-linear and non-Gaussian settings as well.
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Affiliation(s)
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - William J Artman
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Andrew Wilson
- Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Kevin G Lynch
- Center for Clinical Epidemiology and Biostatistics and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
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12
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Rosero S, Weinstein J, Seabury J, Zizzi C, Wagner E, Varma A, Heatwole J, Alexandrou D, Ms ND, Johnson BA, Heatwole C. Disease Burden in Children With Spinal Muscular Atrophy: Results From a Large Cross-Sectional Study. J Child Neurol 2022; 38:52-63. [PMID: 36537125 DOI: 10.1177/08830738221135918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:To facilitate advances in spinal muscular atrophy therapeutic research, it is important to determine the impact and prevalence of symptoms experienced by children with spinal muscular atrophy. Methods: We conducted qualitative interviews with caregivers of children with spinal muscular atrophy. From these interviews, we generated a survey inquiring about 260 symptoms of importance grouped into 17 symptomatic themes. Results: Sixteen caregivers of children with spinal muscular atrophy aged from 4 months to 12 years participated in initial interviews, and 77 caregivers completed the survey. Higher symptom prevalence was associated with spinal muscular atrophy type, SMN2 copy number, and functional status. Hip, thigh, or knee weakness had the greatest reported impact on the lives of children with spinal muscular atrophy. Conclusions: This research provides one of the largest data sets regarding disease burden in children with spinal muscular atrophy. The most prevalent symptoms are not identical to those with the greatest impact. This unique insight into the most impactful symptoms will help focus therapeutic development in spinal muscular atrophy.
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Affiliation(s)
- Spencer Rosero
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Jennifer Weinstein
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Jamison Seabury
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Christine Zizzi
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA.,6740Princeton University, Princeton, NJ, USA
| | - Ellen Wagner
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Anika Varma
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - John Heatwole
- 321918Pittsford Sutherland High School, Pittsford, NY, USA
| | - Danae Alexandrou
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA
| | - Nuran Dilek Ms
- Department of Biostatistics and Computational Biology, 6927The University of Rochester, Rochester, NY, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, 6927The University of Rochester, Rochester, NY, USA
| | - Chad Heatwole
- Center for Health and Technology, 6927The University of Rochester, Rochester, NY, USA.,Department of Neurology, 6927The University of Rochester, Rochester, NY, USA
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13
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Sun H, Ertefaie A, Johnson BA. Estimating mean potential outcome under adaptive treatment length strategies in continuous time. Biometrics 2022; 78:1503-1514. [PMID: 34086345 PMCID: PMC9482146 DOI: 10.1111/biom.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 01/28/2023]
Abstract
An adaptive treatment length strategy is a sequential stage-wise treatment strategy where a subject's treatment begins at baseline and one chooses to stop or continue treatment at each stage provided the subject has been continuously treated. The effects of treatment are assumed to be cumulative and, therefore, the effect of treatment length on clinical endpoint, measured at the end of the study, is of primary scientific interest. At the same time, adverse treatment-terminating events may occur during the course of treatment that require treatment be stopped immediately. Because the presence of a treatment-terminating event may be strongly associated with the study outcome, the treatment-terminating event is informative. In observational studies, decisions to stop or continue treatment depend on covariate history that confounds the relationship between treatment length on outcome. We propose a new risk-set weighted estimator of the mean potential outcome under the condition that time-dependent covariates update at a set of common landmarks. We show that our proposed estimator is asymptotically linear given mild assumptions and correctly specified working models. Specifically, we study the theoretical properties of our estimator when the nuisance parameters are modeled using either parametric or semiparametric methods. The finite sample performance and theoretical results of the proposed estimator are evaluated through simulation studies and demonstrated by application to the Enhanced Suppression of the Platelet Receptor IIb/IIIa with Integrilin Therapy (ESPRIT) infusion trial data.
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Affiliation(s)
- Hao Sun
- Department of Biostatistics and Computational Biology University of Rochester Rochester New York
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology University of Rochester Rochester New York
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology University of Rochester Rochester New York
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14
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Fernandez ID, Johnson BA, Wixom N, Kautz A, Janciuras J, Prevost S, Luo J, Ramchandran RS. Longitudinal trends in produce purchasing behavior: a descriptive study of transaction level data from loyalty card households. Nutr J 2022; 21:67. [DOI: 10.1186/s12937-022-00814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Household food purchases (HFP) are in the pathway between the community food environment and the foods available in households for consumption. As such, HFP data have emerged as alternatives to monitor population dietary trends over-time. In this paper, we investigate the use of loyalty card datasets as unexplored sources of continuously collected HFP data to describe temporal trends in household produce purchases.
Methods
We partnered with a grocery store chain to obtain a loyalty card database with grocery transactions by household from January 2016-October 2018. We included households in an urban county with complete observations for head of household age group, household income group, and family size. Data were summarized as weighted averages (95% CI) of percent produce purchased out of all foods purchased by household per month. We modeled seasonal and linear trends in the proportion of produce purchases by age group and income while accounting for repeated observations per household using generalized estimating equations.
Results
There are 290,098 households in the database (88% of all county households). At baseline, the smallest and largest percent produce purchases are observed among the youngest and lowest income (12.2%, CI 11.1; 13.3) and the oldest and highest income households (19.3, CI 18.9; 19.6); respectively. The seasonal variations are consistent in all age and income groups with an April-June peak gradually descending until December. However, the average linear change in percent produce purchased per household per year varies by age and income being the steepest among the youngest households at each income level (from 1.42%, CI 0.98;1.8 to 0.69%, CI 0.42;0.95) while the oldest households experience almost no annual change.
Conclusions
We explored the potential of a collaboration with a food retailer to use continuously collected loyalty card data for public health nutrition purposes. Our findings suggest a trend towards a healthier pattern in long-term food purchases and household food availability among the youngest households that may lessen the population chronic disease burden if sustained. Understanding the foods available for consumption within households allows public health advocates to develop and evaluate policies and programs promoting foods and nutrients along the life course.
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15
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Patil G, Mbewe EG, Kabundula PP, Smith H, Mwanza-Kabaghe S, Buda A, Adams HR, Potchen MJ, Mweemba M, Johnson BA, Schifitto G, Gelbard H, Birbeck GL, Bearden DR. Longitudinal Cognitive Outcomes in Children With HIV in Zambia: 2-Year Outcomes From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study. J Acquir Immune Defic Syndr 2022; 91:217-225. [PMID: 36094489 PMCID: PMC9480865 DOI: 10.1097/qai.0000000000003052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe longitudinal outcomes and predictors of cognitive outcomes in children with HIV in Zambia. BACKGROUND Multiple studies have shown that children with HIV are at risk for impaired cognition. However, there are limited data on longitudinal cognitive outcomes in children with HIV. METHODS We conducted a prospective cohort study of 208 perinatally infected children with HIV ages 8-17 years, all treated with antiretroviral therapy, and 208 HIV-exposed uninfected controls. Participants were followed for 2 years. Cognition was assessed with a custom NIH Toolbox Cognition Battery, and tests were combined to generate a Summary Cognition Score (SCS). The contribution of potential risk factors to outcomes was explored using regression models and group-based trajectory modeling. RESULTS HIV was strongly associated with lower SCS at baseline [β-14, 95% confidence interval (CI): -20 to -7, P < 0.001]. Change scores over time were similar between groups, but poorer average performance in children with HIV persisted at the 2-year follow-up visit (adjusted β = -11, 95% CI: -22 to -0.3, P = 0.04). Other than HIV, the strongest predictors of baseline SCS included socioeconomic status index (β =3, 95% CI: 1, 5, P = 0.004), history of growth stunting (β=-14, 95% CI: -23 to -6, P = 0.001), history of CD4 count below 200 (β = -19, 95% CI: -35 to -2, P = 0.02), and history of World Health Organization stage 4 disease (β = -10, 95% CI: -19 to -0.2, P = 0.04). In the group-based trajectory model, HIV+ status predicted membership in the lowest performing trajectory group (odds ratio 2.5, 95% CI: 1.2 to 5.1, P = 0.01). CONCLUSIONS Children with HIV are at risk of poor cognitive outcomes, despite chronic treatment with antiretroviral therapy.
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Affiliation(s)
- Gauri Patil
- University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Esau G Mbewe
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia
| | | | - Hannah Smith
- University of Rochester School of Medicine & Dentistry, Rochester, NY
| | | | - Alexandra Buda
- University of Rochester School of Medicine & Dentistry, Rochester, NY
| | - Heather R Adams
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michael J Potchen
- Department of Imaging Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
- Lusaka Apex Medical University, Lusaka, Zambia
| | - Milimo Mweemba
- University Teaching Hospital, Neurology Research Office, Lusaka, Zambia
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Giovanni Schifitto
- Department of Imaging Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Handy Gelbard
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Gretchen L Birbeck
- University Teaching Hospital, Neurology Research Office, Lusaka, Zambia
- University of Zambia School of Medicine, Lusaka, Zambia; and
- Division of Epilepsy, Department of Neurology, Rochester, NY
| | - David R Bearden
- Department of Educational Psychology, University of Zambia, Lusaka, Zambia
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY
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16
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Rice JD, Johnson BA, Strawderman RL. Screening for chronic diseases: optimizing lead time through balancing prescribed frequency and individual adherence. Lifetime Data Anal 2022; 28:605-636. [PMID: 35739436 DOI: 10.1007/s10985-022-09563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
Screening for chronic diseases, such as cancer, is an important public health priority, but traditionally only the frequency or rate of screening has received attention. In this work, we study the importance of adhering to recommended screening policies and develop new methodology to better optimize screening policies when adherence is imperfect. We consider a progressive disease model with four states (healthy, undetectable preclinical, detectable preclinical, clinical), and overlay this with a stochastic screening-behavior model using the theory of renewal processes that allows us to capture imperfect adherence to screening programs in a transparent way. We show that decreased adherence leads to reduced efficacy of screening programs, quantified here using elements of the lead time distribution (i.e., the time between screening diagnosis and when diagnosis would have occurred clinically in the absence of screening). Under the assumption of an inverse relationship between prescribed screening frequency and individual adherence, we show that the optimal screening frequency generally decreases with increasing levels of non-adherence. We apply this model to an example in breast cancer screening, demonstrating how accounting for imperfect adherence affects the recommended screening frequency.
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Affiliation(s)
- John D Rice
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Robert L Strawderman
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA.
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17
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Brijkumar J, Edwards JA, Johnson BA, Ordonez C, Sunpath H, Lee M, Dudgeon MR, Rautman L, Pillay S, Moodley P, Sun YV, Castillo-Mancilla J, Li JZ, Kuritzkes DR, Moosa MYS, Marconi VC. Comparing effectiveness of first-line antiretroviral therapy between peri-urban and rural clinics in KwaZulu-Natal, South Africa. HIV Med 2022; 23:727-737. [PMID: 35023287 PMCID: PMC9353676 DOI: 10.1111/hiv.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Viral suppression (VS) is the hallmark of successful antiretroviral therapy (ART) programmes. We sought to compare clinic retention, virological outcomes, drug resistance and mortality between peri-urban and rural settings in South Africa after first-line ART. METHODS Beginning in July 2014, 1000 (500 peri-urban and 500 rural) ART-naïve patients with HIV were enrolled and managed according to local standard of care. Clinic retention, virological suppression, virological failure (VF), genotypic drug resistance and mortality were assessed. The definition of VS was a viral load ≤1000 copies/ml. Time to event analyses were stratified by site, median age and gender. Kaplan-Meier curves were calculated and graphed with log-rank modelling to compare curves. RESULTS Based on 2741 patient-years of follow-up, retention and mortality did not differ between sites. Among all 1000 participants, 47%, 84% and 91% had achieved VS by 6, 12 and 24 months, respectively, which was observed earlier in the peri-urban site. At both sites, men aged < 32 years had the highest proportion of VF (15.5%), while women aged > 32 years had the lowest, at 7.1% (p = 0.018). Among 55 genotypes, 42 (76.4%) had at one or more resistance mutations, which did not differ by site. K103N (59%) and M184V (52%) were the most common mutations, followed by V106M and K65R (31% each). Overall, death was infrequent (< 4%). CONCLUSIONS No significant differences in treatment outcomes between peri-urban and rural clinics were observed. In both settings, young men were especially susceptible to clinic attrition and VF. More effective adherence support for this important demographic group is needed to achieve UNAIDS targets.
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Affiliation(s)
- Jaysingh Brijkumar
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Johnathan A. Edwards
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA,Emory University School of Medicine, Atlanta, Georgia, USA,University of Lincoln, School of Health and Social Care, Lincoln International Institute for Rural Health, Lincoln, UK
| | | | - Claudia Ordonez
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Henry Sunpath
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Mitch Lee
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Mathew R. Dudgeon
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lydia Rautman
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Selvan Pillay
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Pravi Moodley
- University of KwaZulu-Natal, School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service, Durban, South Africa
| | - Y. V. Sun
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Jonathan Z. Li
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel R. Kuritzkes
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Y. S. Moosa
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Vincent Charles Marconi
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA,Emory University School of Medicine, Atlanta, Georgia, USA,Emory Vaccine Center, Atlanta, Georgia, USA
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18
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Stephenson R, Sullivan SP, Mitchell JW, Johnson BA, Sullvian PS. Efficacy of a Telehealth Delivered Couples' HIV Counseling and Testing (CHTC) Intervention to Improve Formation and Adherence to Safer Sexual Agreements Among Male Couples in the US: Results from a Randomized Control Trial. AIDS Behav 2022; 26:2813-2824. [PMID: 35194698 PMCID: PMC8863094 DOI: 10.1007/s10461-022-03619-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/04/2022]
Abstract
This paper reports the results of a randomized controlled trial (RCT) to assess the efficacy of Nexus, a telehealth delivered intervention that combines Couples' HIV counseling and testing (CHTC) with home-based HIV-testing, examining the impact of the intervention on the couples' formation and adherence to safer sexual agreements. Between 2016 and 2018, 424 couples were recruited online from the U.S and randomized to the intervention arm (a telehealth delivered CHTC session with two home HIV-testing kits) or a control arm (two home HIV-testing kits), with study assessments at baseline, 3 and 6 months. Outcomes were the formation and adherence to safer sexual agreements, dyadic discordance in sexual agreements, breakage of sexual agreements, and perceptions of PrEP. Couples in the intervention arm had significantly greater odds of reporting a safer sexual agreement (3 months OR 1.87, p-value 0.005, and 6 months OR 1.84, p-value 0.007), lower odds of reporting discordant sexual agreements at 6 months (OR 0.62, p-value 0.048), and a significantly lower odds of reporting breaking their sexual agreement (3 months OR 0.51, p-value 0.035, and 6 months OR 0.23, p-value 0.000). By 6 months, couples in the intervention arm were less likely to say PrEP was beneficial to one (RRR 0.33, P = 0.000) or both of them (RRR 0.29, P = 0.000) than being beneficial to neither of the partners. The high levels of acceptability and efficacy of the intervention demonstrate strong potential for the scale-up of this efficacious intervention that is delivered through a low-cost telehealth platform.
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Affiliation(s)
- Rob Stephenson
- The Center for Sexuality and Health Disparities, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA.
| | - Stephen P Sullivan
- The Center for Sexuality and Health Disparities, Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Brent A Johnson
- Department of Biostatistics and Computional Biology, University of Rochestor Medical Center, Rochester, NY, USA
| | - Patrick S Sullvian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Ravishankar M, Dallah I, Mathews M, Bositis CM, Mwenechanya M, Kalungwana‐Mambwe L, Bearden D, Navis A, Elafros MA, Gelbard H, Theodore WH, Koralnik IJ, Okulicz JF, Johnson BA, Belessiotis C, Ciccone O, Thornton N, Tsuboyama M, Siddiqi OK, Potchen MJ, Sikazwe I, Birbeck GL. Clinical characteristics and outcomes after new-onset seizure among Zambian children with HIV during the antiretroviral therapy era. Epilepsia Open 2022; 7:315-324. [PMID: 35305291 PMCID: PMC9159241 DOI: 10.1002/epi4.12595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new-onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30-day mortality and cause of death are also reported. METHODS Children living with HIV (CLWHIV) with new-onset seizures were prospectively evaluated at one large urban teaching hospital and two non-urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients' care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed. RESULTS From April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2-10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non-accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty-two (30%) children died within 30 days of the index seizure. SIGNIFICANCE Despite widespread ART roll out in Zambia, new-onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.
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Affiliation(s)
| | - Ifunanya Dallah
- Center for Health + TechnologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Manoj Mathews
- University Teaching Hospitals Children's HospitalLusakaZambia
| | | | | | | | - David Bearden
- University of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - Harris Gelbard
- University of Rochester Medical CenterRochesterNew YorkUSA
| | | | - Igor J. Koralnik
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | | | | | | | - Ornella Ciccone
- University Teaching Hospitals Children's HospitalLusakaZambia
- University of ZambiaLusakaZambia
| | | | | | | | - Michael J. Potchen
- University of Rochester Medical CenterRochesterNew YorkUSA
- Zambian College of Medicine & SurgeryLusakaZambia
| | | | - Gretchen L. Birbeck
- University Teaching Hospitals Children's HospitalLusakaZambia
- Epilepsy DivisionDepartment of NeurologyUniversity of RochesterRochesterNew YorkUSA
- Epilepsy Care TeamChikankata HospitalMazabukaZambia
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20
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Leeman S, Wang L, Johnson BA, Fortuna RJ, Ramchandran RS. Criteria-Based Assessment of a Teleophthalmology Diabetic Retinopathy Evaluation Program in a Primary Care Setting. Telemed J E Health 2022; 28:865-872. [PMID: 34788158 DOI: 10.1089/tmj.2021.0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Background:Studies have shown that teleophthalmology programs using a nonmydriatic camera in primary care settings can improve rates of diabetic retinopathy (DR) screening. However, such programs are not yet widespread due to common challenges in sustainability.Purpose:To comprehensively evaluate clinical and operational measures of an urban primary care clinic's 1-year pilot teleophthalmology DR evaluation program.Materials and Methods:This retrospective analysis used five metrics to evaluate the program: clinical diabetic retinal exam (DRE) rate, visual acuity and pathology, camera utilization, billing and insurance reimbursements, and outcomes of follow-up referrals.Results:Two hundred eleven patients were screened over 14 months. The DRE rate had more than doubled (34-75%). Of the patients, 55.9% had vision better than 20/50 in each eye and 21% with at least 1 eye worse than or equal to 20/70. DR was noted in 11% of patients. The program's first few months saw greatest camera use. Government and Medicare Advantage insurers were significantly (p < 0.001) less likely to reimburse than commercial insurers. Twenty-seven percent of patients screened had documented follow-up with an eye care provider within 16 months of their screening. Patients diagnosed with DR or recommended follow-up within 1 month were significantly (p < 0.001) more likely to schedule an appointment.Discussion:Challenges to program sustainability include efficient utilization, reimbursement from governmental insurers, and adherence to follow-up recommendations.Conclusions:Assessing teleophthalmology programs with the aforementioned five metrics allows for a comprehensive evaluation of impact and sustainability. This may be utilized to standardize the implementation and evaluation of such programs across diverse settings.
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Affiliation(s)
- Samuel Leeman
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert J Fortuna
- Primary Care Network, Department of Medicine, University of Rochester, Rochester, New York, USA
- Primary Care Network, Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Rajeev S Ramchandran
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York, USA
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21
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Neary MT, Johnson BA. Traumatic Wounds of the Foot and Ankle: The Landstuhl Regional Medical Center Experience and Historical Perspectives. J Foot Ankle Surg 2022; 61:663-667. [PMID: 35031188 DOI: 10.1053/j.jfas.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
As this is more of a reference article, I chose not to have an abstract similar to the paper I wrote in 2016 regarding flat feet in the military.
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22
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Artman WJ, Johnson BA, Lynch KG, McKay JR, Ertefaie A. Bayesian set of best dynamic treatment regimes: Construction and sample size calculation for SMARTs with binary outcomes. Stat Med 2022; 41:1688-1708. [DOI: 10.1002/sim.9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/06/2021] [Accepted: 01/02/2022] [Indexed: 11/08/2022]
Affiliation(s)
- William J. Artman
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
| | - Kevin G. Lynch
- Center for Clinical Epidemiology and Biostatistics (CCEB) and Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania USA
| | - James R. McKay
- Department of Psychiatry, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology University of Rochester Medical Center Rochester New York USA
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23
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Siedner MJ, Moosa MYS, McCluskey S, Gilbert RF, Pillay S, Aturinda I, Ard K, Muyindike W, Musinguzi N, Masette G, Pillay M, Moodley P, Brijkumar J, Rautenberg T, George G, Gandhi RT, Johnson BA, Sunpath H, Bwana MB, Marconi VC. Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa : An Unblinded Randomized Controlled Trial. Ann Intern Med 2021; 174:1683-1692. [PMID: 34698502 PMCID: PMC8688215 DOI: 10.7326/m21-2229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Virologic failure in HIV predicts the development of drug resistance and mortality. Genotypic resistance testing (GRT), which is the standard of care after virologic failure in high-income settings, is rarely implemented in sub-Saharan Africa. OBJECTIVE To estimate the effectiveness of GRT for improving virologic suppression rates among people with HIV in sub-Saharan Africa for whom first-line therapy fails. DESIGN Pragmatic, unblinded, randomized controlled trial. (ClinicalTrials.gov: NCT02787499). SETTING Ambulatory HIV clinics in the public sector in Uganda and South Africa. PATIENTS Adults receiving first-line antiretroviral therapy with a recent HIV RNA viral load of 1000 copies/mL or higher. INTERVENTION Participants were randomly assigned to receive standard of care (SOC), including adherence counseling sessions and repeated viral load testing, or immediate GRT. MEASUREMENTS The primary outcome of interest was achievement of an HIV RNA viral load below 200 copies/mL 9 months after enrollment. RESULTS The trial enrolled 840 persons, divided equally between countries. Approximately half (51%) were women. Most (72%) were receiving a regimen of tenofovir, emtricitabine, and efavirenz at enrollment. The rate of virologic suppression did not differ 9 months after enrollment between the GRT group (63% [263 of 417]) and SOC group (61% [256 of 423]; odds ratio [OR], 1.11 [95% CI, 0.83 to 1.49]; P = 0.46). Among participants with persistent failure (HIV RNA viral load ≥1000 copies/mL) at 9 months, the prevalence of drug resistance was higher in the SOC group (76% [78 of 103] vs. 59% [48 of 82]; OR, 2.30 [CI, 1.22 to 4.35]; P = 0.014). Other secondary outcomes, including 9-month survival and retention in care, were similar between groups. LIMITATION Participants were receiving nonnucleoside reverse transcriptase inhibitor-based therapy at enrollment, limiting the generalizability of the findings. CONCLUSION The addition of GRT to routine care after first-line virologic failure in Uganda and South Africa did not improve rates of resuppression. PRIMARY FUNDING SOURCE The President's Emergency Plan for AIDS Relief and the National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Mark J Siedner
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, Mbarara University of Science and Technology, Mbarara, Uganda, Africa Health Research Institute, KwaZulu-Natal, South Africa, and University of KwaZulu-Natal, Durban, South Africa (M.J.S.)
| | | | - Suzanne McCluskey
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (S.M., K.A., R.T.G.)
| | | | - Selvan Pillay
- University of KwaZulu-Natal, Durban, South Africa (M.S.M., S.P., J.B., G.G., H.S.)
| | - Isaac Aturinda
- Mbarara University of Science and Technology, Mbarara, Uganda (I.A., W.M., N.M., G.M., M.B.B.)
| | - Kevin Ard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (S.M., K.A., R.T.G.)
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda (I.A., W.M., N.M., G.M., M.B.B.)
| | - Nicholas Musinguzi
- Mbarara University of Science and Technology, Mbarara, Uganda (I.A., W.M., N.M., G.M., M.B.B.)
| | - Godfrey Masette
- Mbarara University of Science and Technology, Mbarara, Uganda (I.A., W.M., N.M., G.M., M.B.B.)
| | - Melendhran Pillay
- National Health Laboratory Service, Durban, South Africa (M.P., P.M.)
| | | | - Jaysingh Brijkumar
- University of KwaZulu-Natal, Durban, South Africa (M.S.M., S.P., J.B., G.G., H.S.)
| | | | - Gavin George
- University of KwaZulu-Natal, Durban, South Africa (M.S.M., S.P., J.B., G.G., H.S.)
| | - Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (S.M., K.A., R.T.G.)
| | | | - Henry Sunpath
- University of KwaZulu-Natal, Durban, South Africa (M.S.M., S.P., J.B., G.G., H.S.)
| | - Mwebesa B Bwana
- Mbarara University of Science and Technology, Mbarara, Uganda (I.A., W.M., N.M., G.M., M.B.B.)
| | - Vincent C Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia (V.C.M.)
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24
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Castillo‐Mancilla JR, Edwards JA, Brijkumar J, Moosa M, Zhao Y, Ofotokun I, Johnson BA, Lee MH, Pillay S, Pillay M, Moodley P, Kuritzkes DR, Sunpath H, Bushman LR, Ellison L, Anderson PL, Marconi VC. Tenofovir diphosphate levels in dried blood spots are associated with virologic failure and resistance to first-line therapy in South Africa: a case-control cohort study. J Int AIDS Soc 2021; 24:e25849. [PMID: 34910844 PMCID: PMC8673924 DOI: 10.1002/jia2.25849] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/02/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), a measure of cumulative antiretroviral therapy (ART) adherence, is associated with viral suppression and predicts future viremia in persons with HIV (PWH). However, its utility to identify those at risk for virologic failure (VF) and drug resistance is unknown. To address this, we aimed to establish the association between this adherence biomarker and VF with drug resistance in a cohort of PWH initiating first-line ART in KwaZulu-Natal, South Africa. METHODS PWH initiating TFV disoproxil fumarate (TDF)-based ART within a parent prospective cohort were evaluated. Using a nested design, DBS for TFV-DP were collected from cases who developed VF (HIV-1 RNA ≥1000 copies/ml) after ≥5 months on ART versus controls, matched 1:2 by site, age, gender, race and ART duration. Cases were categorized as having VF with or without resistance using genotyping. One-way analysis of variance (ANOVA) was used to compare TFV-DP for controls, cases with VF and resistance, and cases with VF without resistance. Data are presented as mean (standard deviation, SD) or geometric mean [95% confidence interval, 95% CI]. RESULTS AND DISCUSSION One thousand participants were enrolled in the parent study between 2014 and 2016, of which 288 (29%) had DBS available. Of these, 94 (33%) were cases and 194 (67%) were controls; 59% were women. Mean age of our population was 33 (SD 8) years. Genotyping was available in 50 (53%) of the 94 cases. Geometric mean TFV-DP in DBS from controls was 708 [95% CI; 647-773] fmol/punch, which was higher compared to participants having VF with resistance (n = 36), 386 [95% CI; 241-617] fmol/punch and VF without resistance (n = 14), 61 [95% CI; 22-164] fmol/punch; p<0.001. Genotype could not be obtained in 44 (47%) cases. CONCLUSIONS TFV-DP in DBS showed a stepwise association with VF and drug resistance in South African PWH. Participants having VF with resistance had mid-range concentrations of TFV-DP, which were higher than those for PWH without resistance. Future research on the clinical utility of TFV-DP concentrations in DBS to predict and prevent the development of VF and drug resistance is needed.
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Affiliation(s)
- Jose R. Castillo‐Mancilla
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Johnathan A. Edwards
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- School of Health and Social CareUniversity of LincolnLincolnUK
| | | | | | - Yuan Zhao
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Igho Ofotokun
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brent A. Johnson
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Mitchell H. Lee
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Selvan Pillay
- National Health Laboratory ServiceDurbanSouth Africa
| | | | - Pravi Moodley
- National Health Laboratory ServiceDurbanSouth Africa
- University of KwaZulu‐NatalDurbanSouth Africa
| | - Daniel R. Kuritzkes
- Divison of Infectious DiseasesBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Henry Sunpath
- National Health Laboratory ServiceDurbanSouth Africa
| | - Lane R. Bushman
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Lucas Ellison
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Peter L. Anderson
- Division of Infectious DiseasesDepartment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Vincent C. Marconi
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Emory Vaccine CenterEmory UniversityAtlantaGeorgiaUSA
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25
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Reynolds Z, McCluskey SM, Moosa MYS, Gilbert RF, Pillay S, Aturinda I, Ard KL, Muyindike W, Musinguzi N, Masette G, Moodley P, Brijkumar J, Rautenberg T, George G, Johnson BA, Gandhi RT, Sunpath H, Marconi VC, Bwana MB, Siedner MJ. Who's slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first-line HIV treatment in Uganda and South Africa. HIV Med 2021; 23:474-484. [PMID: 34755438 PMCID: PMC9010349 DOI: 10.1111/hiv.13203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV virological failure remains a major threat to programme success in sub-Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first-line antiretroviral therapy (ART). METHODS We enrolled a cohort of adults in HIV care experiencing virological failure on first-line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. RESULTS Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49-56%] stated that they had > 90% adherence and 75% (95% CI 72-77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86-92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. CONCLUSIONS Patients failing first-line ART in sub-Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic.
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Affiliation(s)
| | - Suzanne M McCluskey
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Isaac Aturinda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kevin L Ard
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Godfrey Masette
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Pravi Moodley
- University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Service, KwaZulu-Natal, Durban, South Africa
| | | | | | - Gavin George
- University of KwaZulu-Natal, Durban, South Africa
| | - Brent A Johnson
- Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA
| | - Rajesh T Gandhi
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Vincent C Marconi
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Global Health, Emory University, Atlanta, GA, USA.,Emory Vaccine Center, Atlanta, GA, USA
| | | | - Mark J Siedner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,University of KwaZulu-Natal, Durban, South Africa.,Mbarara University of Science and Technology, Mbarara, Uganda.,Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
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26
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Tang Z, Watkins EB, Clayton SM, Currie SA, Fellers DE, Hassan MT, Hooks DE, Ito TM, Lawrence SK, MacDonald SWT, Makela M, Morris CL, Neukirch LP, Saunders A, O'Shaughnessy CM, Cude-Woods C, Choi JH, Young AR, Zeck BA, Gonzalez F, Liu CY, Floyd NC, Hickerson KP, Holley AT, Johnson BA, Lambert JC, Pattie RW. Ultracold neutron properties of the Eljen-299-02D deuterated scintillator. Rev Sci Instrum 2021; 92:023305. [PMID: 33648127 DOI: 10.1063/5.0030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
In this paper, we report studies of the Fermi potential and loss per bounce of ultracold neutrons (UCNs) on a deuterated scintillator (Eljen-299-02D). These UCN properties of the scintillator enable its use in a wide variety of applications in fundamental neutron research.
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Affiliation(s)
- Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E B Watkins
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S A Currie
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Fellers
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Hooks
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S K Lawrence
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S W T MacDonald
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L P Neukirch
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Saunders
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - C Cude-Woods
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - J H Choi
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - B A Zeck
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - F Gonzalez
- Indiana University, Bloomington, Indiana 47405, USA
| | - C Y Liu
- Indiana University, Bloomington, Indiana 47405, USA
| | - N C Floyd
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - K P Hickerson
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - B A Johnson
- Utah State University, Logan, Utah 84322, USA
| | - J C Lambert
- Utah State University, Logan, Utah 84322, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
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27
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Brijkumar J, Johnson BA, Zhao Y, Edwards J, Moodley P, Pathan K, Pillay S, Castro KG, Sunpath H, Kuritzkes DR, Moosa MYS, Marconi VC. A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa. BMC Infect Dis 2020; 20:836. [PMID: 33176715 PMCID: PMC7659110 DOI: 10.1186/s12879-020-05576-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
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Affiliation(s)
- J Brijkumar
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Y Zhao
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Edwards
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - P Moodley
- School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - K Pathan
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - S Pillay
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - K G Castro
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - H Sunpath
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - D R Kuritzkes
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Y S Moosa
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - V C Marconi
- Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Atlanta, USA.
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28
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Navis A, Dallah I, Mabeta C, Musukuma K, Siddiqi OK, Bositis CM, Koralnik IJ, Gelbard HA, Theodore WH, Okulicz JF, Johnson BA, Sikazwe I, Bearden DR, Birbeck GL. Evaluating the impact of antiretroviral and antiseizure medication interactions on treatment effectiveness among outpatient clinic attendees with HIV in Zambia. Epilepsia 2020; 61:2705-2711. [PMID: 33084053 DOI: 10.1111/epi.16723] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Interactions between enzyme-inducing anti-seizure medications (EI-ASMs) and antiretroviral drugs (ARVs) can lead to decreased ARV levels and may increase the likelihood of viral resistance. We conducted a study to determine if co-usage of ARVs and EI-ASMs is associated with ARV-resistant human immunodeficiency virus (HIV) among people living with HIV in Zambia. METHODS Eligible participants were ≥18 years of age and concurrently taking ASMs and ARVs for at least 1 month of the prior 6-month period. Data were obtained regarding medication and HIV history. CD4 counts, plasma viral loads (pVLs), and HIV genotype and resistance profile in participants with a pVL >1000 copies/mL were obtained. Pearson's test of independence was used to determine whether treatment with EI-ASM was associated with pVL >1000/mL copies. RESULTS Of 50 participants, 41 (82%) were taking carbamazepine (37 on monotherapy), and all had stable regimens in the prior 6 months. Among the 13 ARV regimens used, 68% had a tenofovir/lamivudine backbone. The majority (94%) were on a stable ARV regimen for >6 months. Median CD4 nadir was 205 cells/mm3 (interquartile range [IQR] 88-389), and 60% of participants had commenced ARV treatment before advanced disease occurred. Mean CD4 count at enrollment was 464 cells/mm3 (SD 226.3). Seven participants (14%) had a CD4 count <200 cells/mm3 . Four (8%) had a pVL >1000 copies/mL; all were on carbamazepine. Three participants with elevated pVL had a CD4 count <200 cells/mm3 . None had documented adherence concerns by providers; however, two had events concerning for clinical failure. HIV genotype testing showed mutations in three participants. Carbamazepine was not found to correlate with elevated pVL (P = .58). SIGNIFICANCE EI-ASMs are commonly used in sub-Saharan Africa. Despite concurrent use of EI-ASMs and ARVs, the majority of participants showed CD4 counts >200 cells/mm3 and were virally suppressed. Carbamazepine was not associated with an increased risk of virological failure or ARV-resistant HIV.
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Affiliation(s)
- Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ifunanya Dallah
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | | | - Kalo Musukuma
- University Teaching Hospitals Children's Hospital, Lusaka, Zambia
| | - Omar K Siddiqi
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Igor J Koralnik
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Harris A Gelbard
- Departments of Neurology, Pediatrics, Neuroscience and Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA
| | - William H Theodore
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jason F Okulicz
- Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio-Ft Sam Houston, Houston, TX, USA
| | - Brent A Johnson
- Department of Biostatistics, Center for AIDS Research, University of Rochester, Rochester, NY, USA
| | - Izukanji Sikazwe
- Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - David R Bearden
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Chikankata Epilepsy Care Team, Mazabuka, Zambia.,University Teaching Hospitals Children's Hospital, Lusaka, Zambia
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29
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30
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Williams SK, Johnson BA, Tobin JN, Luque AE, Sanders M, Carroll JK, Cassells A, Holder T, Fiscella K. Protocol paper: Stepped wedge cluster randomized trial translating the ABCS into optimizing cardiovascular care for people living with HIV. Prog Cardiovasc Dis 2020; 63:125-133. [PMID: 32035124 DOI: 10.1016/j.pcad.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/29/2022]
Abstract
People living with HIV (PWH) are at higher risk for cardiovascular disease (CVD) and stroke in comparison to their non-infected counterparts. The ABCS (aspirin-blood pressure control-cholesterol control-smoking cessation) reduce atherosclerotic (ASCVD) risk in the general population, but little is known regarding strategies for promoting the ABCS among PWH. Guided by the Consolidated Framework for Implementation Research (CFIR), we designed multilevel implementation strategies that target PWH and their clinicians to promote appropriate use of the ABCS based on a 10-year estimated ASCVD risk. Implementation strategies include patient coaching, automated texting, peer phone support, academic detailing and audit and feedback for the patient's clinician. We are evaluating implementation through a stepped wedge cluster randomized trial based on the Reach-Effectiveness-Adoption-Maintenance/Qualitative-Evaluation-for-Systematic-Translation (RE-AIM/QuEST) mixed methods framework that integrates quantitative and qualitative assessments. The primary outcome is change in ASCVD risk. Findings will have important implications regarding strategies for reducing ASCVD risk among PWH.
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Affiliation(s)
- Stephen K Williams
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY
| | - Amneris Esther Luque
- Infectious Diseases and Geographic Medicine, HIV Program at Parkland Health and Hospital System, Community Prevention and Intervention Unit, UT Southwestern Medical Center, Dallas, TX
| | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, NY
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY.
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31
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Chen YN, Coker D, Kramer MR, Johnson BA, Wall KM, Ordóñez CE, McDaniel D, Edwards A, Hare AQ, Sunpath H, Marconi VC. The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa. AIDS Behav 2019; 23:2558-2575. [PMID: 31049812 DOI: 10.1007/s10461-019-02523-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/30/2022]
Abstract
Using a case-control study of patients receiving antiretroviral treatment (ART) in 2010-2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients' risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with socioeconomic status (SES) and geographic access to care. We then determined whether neighborhood-level poverty modifies the association between individual-level SES and VF. Automobile ownership for men and having non-spouse family members pay medical care for women remained independently associated with increased odds of VF for patients dwelling in moderately and severely poor neighborhoods. Closer geographic proximity to medical care was positively associated with VF among men, while higher neighborhood-level poverty was positively associated with VF among women. The programmatic implications of our findings include developing ART adherence interventions that address the role of gender in both the socioeconomic and geographical contexts.
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Affiliation(s)
- Yi-No Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Daniella Coker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Claudia E Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Darius McDaniel
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Q Hare
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Henry Sunpath
- Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vincent C Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
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32
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Rice JD, Johnson BA, Strawderman RL. Modeling the rate of HIV testing from repeated binary data amidst potential never-testers. Biostatistics 2019; 20:183-198. [PMID: 29315363 DOI: 10.1093/biostatistics/kxx071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/10/2017] [Indexed: 11/14/2022] Open
Abstract
Many longitudinal studies with a binary outcome measure involve a fraction of subjects with a homogeneous response profile. In our motivating data set, a study on the rate of human immunodeficiency virus (HIV) self-testing in a population of men who have sex with men (MSM), a substantial proportion of the subjects did not self-test during the follow-up study. The observed data in this context consist of a binary sequence for each subject indicating whether or not that subject experienced any events between consecutive observation time points, so subjects who never self-tested were observed to have a response vector consisting entirely of zeros. Conventional longitudinal analysis is not equipped to handle questions regarding the rate of events (as opposed to the odds, as in the classical logistic regression model). With the exception of discrete mixture models, such methods are also not equipped to handle settings in which there may exist a group of subjects for whom no events will ever occur, i.e. a so-called "never-responder" group. In this article, we model the observed data assuming that events occur according to some unobserved continuous-time stochastic process. In particular, we consider the underlying subject-specific processes to be Poisson conditional on some unobserved frailty, leading to a natural focus on modeling event rates. Specifically, we propose to use the power variance function (PVF) family of frailty distributions, which contains both the gamma and inverse Gaussian distributions as special cases and allows for the existence of a class of subjects having zero frailty. We generalize a computational algorithm developed for a log-gamma random intercept model (Conaway, 1990. A random effects model for binary data. Biometrics46, 317-328) to compute the exact marginal likelihood, which is then maximized to obtain estimates of model parameters. We conduct simulation studies, exploring the performance of the proposed method in comparison with competitors. Applying the PVF as well as a Gaussian random intercept model and a corresponding discrete mixture model to our motivating data set, we conclude that the group assigned to receive follow-up messages via SMS was self-testing at a significantly lower rate than the control group, but that there is no evidence to support the existence of a group of never-testers.
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Affiliation(s)
- John D Rice
- University of Rochester Medical Center, Biostatistics and Computational Biology, 265 Crittenden Blvd., Box 630, Rochester, NY 14642, USA
| | - Brent A Johnson
- University of Rochester, Biostatistics and Computational Biology, Rochester, NY, USA
| | - Robert L Strawderman
- University of Rochester, Biostatistics and Computational Biology, Rochester, NY, USA
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Elafros MA, Johnson BA, Siddiqi OK, Okulicz JF, Sikazwe I, Bositis CM, Potchen MJ, Koralnik IJ, Theodore WH, Kalungwana L, Birbeck GL. Mortality & recurrent seizure risk after new-onset seizure in HIV-positive Zambian adults. BMC Neurol 2018; 18:201. [PMID: 30522451 PMCID: PMC6284303 DOI: 10.1186/s12883-018-1205-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recurrent seizure risks in HIV-positive people with new-onset seizure are largely unknown, making it challenging to offer optimal recommendations regarding antiepileptic drug (AED) initiation. Existing outcomes data is limited, and risk factor identification requires a diagnostic assessment, which is often unavailable in regions heavily effected by HIV, like sub-Saharan Africa. METHODS HIV-positive Zambian adults with new-onset seizure were enrolled in a prospective cohort study to determine seizure recurrence and risk factors for recurrence. Seizure etiology was evaluated, and recurrent seizures and medication usage were assessed during clinic visits. Due to unexpectedly high mortality rates, predictors of death were evaluated using proportional hazards with Gray's test to compare cumulative incidence functions for recurrent seizure across groups adjusting for the competing outcome of death. RESULTS 95 patients were enrolled (mean age 37 years, 43% female, 83% with Karnofsky > 50) and followed for a mean of 293 days (median 241 (IQR: 29-532)). At presentation, 50 (53%) were in status epilepticus. The majority (91, 85%) had advanced HIV disease and 65 (68%) were not on combined antiretroviral therapy (cART). After extensive workup, seizure etiology remained unknown in 16 (17%). Average time to cART initiation after enrollment was 61 days. During follow up, 37 (39%) died and 23 (24%) had recurrent seizure. Most deaths (25/37, 68%) occurred in the first 60 days post-index seizure. Individuals with advanced HIV were more likely to die (HR: 19.1 [95% CI: 1.1-333.4]) as were those whose seizure etiology remained unknown (HR: 2.2 [95% CI: 1.1-4.4]). Among participants that survived from enrolment to the end of data collection on 10 May 2013 (n = 58), 20 (34%) experienced recurrent seizures. CONCLUSIONS New-onset seizure among HIV-positive Zambian adults is associated with high mortality despite good functional status prior to presentation. Advanced HIV infection and failure to identify an underlying seizure etiology are associated with greater mortality. Recurrent seizures occur in over a third of survivors within only 2 years of follow-up. This provides evidence to support AED initiation after first seizure in HIV-positive individuals with advanced HIV disease at the time of presentation though the risks of AED-cART interactions remain a concern and warrant further study.
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Affiliation(s)
- Melissa A. Elafros
- Department of Neurology, Johns Hopkins Hospital, Sheik Zayed Tower, Room 6005, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, 265 Crittenden Boulevard, CU 420-630, Rochester, NY 14642-0630 USA
| | - Omar K. Siddiqi
- Global Neurology Program, Division of Neuroimmunology, Department of Neurology, E/CLS 1017B Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Jason F. Okulicz
- Infectious Disease Service, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
| | - Izukanji Sikazwe
- Center for Infectious Disease Research in Zambia, 5032 Great North Road, P.O. Box 34681, Lusaka, Zambia
| | | | - Michael J. Potchen
- Neuroradiology Division, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642 USA
| | - Igor J. Koralnik
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1106, Chicago, IL 60612 USA
| | - William H. Theodore
- Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, NINDS NIH Building 10 Room 7D-43, Bethesda, MD 20892 USA
| | - Lisa Kalungwana
- Department of Psychology, University of Zambia, P.O. BOX 32379, 10101 Lusaka, Zambia
| | - Gretchen L. Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, CU420694, Rochester, NY 14642–0694 USA
- Epilepsy Care Team, Chikankata Hospital, Private Bag S2, Mazabuka, Zambia
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Vidula H, Kutyifa V, Johnson BA, Strawderman RL, Harrington D, Polonsky B, Papernov A, Alexis JD. Readmission Patterns During Long-Term Follow-Up After Left Ventricular Assist Device Implantation. Am J Cardiol 2018; 122:1021-1027. [PMID: 30064855 DOI: 10.1016/j.amjcard.2018.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 01/06/2023]
Abstract
As more patients are supported for longer periods by a left ventricular assist device (LVAD), hospital readmission is becoming a growing problem. However, data about temporal changes in readmission rates and causes for patients with prolonged LVAD support are limited. We aimed to evaluate rates, causes, and predictors of any and long-term readmission after LVAD placement at our institution. We followed 177 HeartMate II LVAD patients for a mean of 1.90 ± 1.33 years post initial discharge after implantation. A marginal rate model was used to evaluate readmission rates, accounting for mortality. During the first year, the readmission rate was 1.79 (95% confidence interval 1.51 to 2.10) readmissions per year. The readmission rate was 1.54 (95% confidence interval 1.07 to 1.93) 2 to 3 years after initial discharge. There was a further decrease in readmission rate in the 3- to 4-year interval. The most common causes of readmission during the first year and even after 3 to 4 years of LVAD support were bleeding (excluding intracranial bleeding) and infection. Female gender was associated with an increased risk of readmission in multivariable analyses, while blood urea nitrogen was predictive of long-term readmissions. In conclusion, readmission after LVAD implantation is common, but readmission rates decrease during long-term follow-up. Bleeding and infection remain leading causes of readmission during longer follow-up and strategies to decrease these complications may reduce readmission rates. Female patients and patients with renal dysfunction have increased risk of readmission and further studies are needed to improve outcomes in these groups.
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Johnson BA. Nonparametric Two-Sample Tests of the Marginal Mark Distribution with Censored Marks. Scand Stat Theory Appl 2018; 44:545-562. [PMID: 30008509 DOI: 10.1111/sjos.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Occasionally, investigators collect auxiliary marks at the time of failure in a clinical study. Because the failure event may be censored at the end of the follow-up period, these marked endpoints are subject to induced censoring. We propose two new families of two-sample tests for the null hypothesis of no difference in mark-scale distribution that allows for arbitrary associations between mark and time. One family of proposed tests is a nonparametric extension of an existing semi-parametric linear test of the same null hypothesis while a second family of tests is based on novel marked rank processes. Simulation studies indicate that the proposed tests have the desired size and possess adequate statistical power to reject the null hypothesis under a simple change of location in the marginal mark distribution. When the marginal mark distribution has heavy tails, the proposed rank-based tests can be nearly twice as powerful as linear tests.
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Affiliation(s)
- Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester
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Brust JCM, Shah NS, Mlisana K, Moodley P, Allana S, Campbell A, Johnson BA, Master I, Mthiyane T, Lachman S, Larkan LM, Ning Y, Malik A, Smith JP, Gandhi NR. Improved Survival and Cure Rates With Concurrent Treatment for Multidrug-Resistant Tuberculosis-Human Immunodeficiency Virus Coinfection in South Africa. Clin Infect Dis 2018; 66:1246-1253. [PMID: 29293906 PMCID: PMC5888963 DOI: 10.1093/cid/cix1125] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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] [Received: 08/20/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Mortality in multidrug-resistant (MDR) tuberculosis-human immunodeficiency virus (HIV) coinfection has historically been high, but most studies predated the availability of antiretroviral therapy (ART). We prospectively compared survival and treatment outcomes in MDR tuberculosis-HIV-coinfected patients on ART to those in patients with MDR tuberculosis alone. Methods This observational study enrolled culture-confirmed MDR tuberculosis patients with and without HIV in South Africa between 2011 and 2013. Participants received standardized MDR tuberculosis and HIV regimens and were followed monthly for treatment response, adverse events, and adherence. The primary outcome was survival. Results Among 206 participants, 150 were HIV infected, 131 (64%) were female, and the median age was 33 years (interquartile range [IQR], 26-41). Of the 191 participants with a final MDR tuberculosis outcome, 130 (73%) were cured or completed treatment, which did not differ by HIV status (P = .50). After 2 years, CD4 count increased a median of 140 cells/mm3 (P = .005), and 64% had an undetectable HIV viral load. HIV-infected and HIV-uninfected participants had high rates of survival (86% and 94%, respectively; P = .34). The strongest risk factor for mortality was having a CD4 count ≤100 cells/mm3 (adjusted hazards ratio, 15.6; 95% confidence interval, 4.4-55.6). Conclusions Survival and treatment outcomes among MDR tuberculosis-HIV individuals receiving concurrent ART approached those of HIV-uninfected patients. The greatest risk of death was among HIV-infected individuals with CD4 counts ≤100 cells/mm3. These findings provide critical evidence to support concurrent treatment of MDR tuberculosis and HIV.
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Affiliation(s)
- James C M Brust
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - N Sarita Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koleka Mlisana
- University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Durban, South Africa
| | - Pravi Moodley
- University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Services, Durban, South Africa
| | - Salim Allana
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Angela Campbell
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | | | | | | | | | - Yuming Ning
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Amyn Malik
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jonathan P Smith
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Neel R Gandhi
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- Emory School of Medicine, Emory University, Atlanta, Georgia
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Xue Y, Kannan V, Greener E, Smith JA, Brasch J, Johnson BA, Spetz J. Full Scope-of-Practice Regulation Is Associated With Higher Supply of Nurse Practitioners in Rural and Primary Care Health Professional Shortage Counties. Journal of Nursing Regulation 2018. [DOI: 10.1016/s2155-8256(17)30176-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rice JD, Strawderman RL, Johnson BA. Regularity of a renewal process estimated from binary data. Biometrics 2017; 74:566-574. [PMID: 28991366 DOI: 10.1111/biom.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 11/28/2022]
Abstract
Assessment of the regularity of a sequence of events over time is important for clinical decision-making as well as informing public health policy. Our motivating example involves determining the effect of an intervention on the regularity of HIV self-testing behavior among high-risk individuals when exact self-testing times are not recorded. Assuming that these unobserved testing times follow a renewal process, the goals of this work are to develop suitable methods for estimating its distributional parameters when only the presence or absence of at least one event per subject in each of several observation windows is recorded. We propose two approaches to estimation and inference: a likelihood-based discrete survival model using only time to first event; and a potentially more efficient quasi-likelihood approach based on the forward recurrence time distribution using all available data. Regularity is quantified and estimated by the coefficient of variation (CV) of the interevent time distribution. Focusing on the gamma renewal process, where the shape parameter of the corresponding interevent time distribution has a monotone relationship with its CV, we conduct simulation studies to evaluate the performance of the proposed methods. We then apply them to our motivating example, concluding that the use of text message reminders significantly improves the regularity of self-testing, but not its frequency. A discussion on interesting directions for further research is provided.
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Affiliation(s)
- John D Rice
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, U.S.A
| | - Robert L Strawderman
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, U.S.A
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, U.S.A
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McIntyre J, Johnson BA, Rappaport SM. Monte Carlo methods for nonparametric regression with heteroscedastic measurement error. Biometrics 2017; 74:498-505. [PMID: 28914966 DOI: 10.1111/biom.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 12/01/2022]
Abstract
Nonparametric regression is a fundamental problem in statistics but challenging when the independent variable is measured with error. Among the first approaches was an extension of deconvoluting kernel density estimators for homescedastic measurement error. The main contribution of this article is to propose a new simulation-based nonparametric regression estimator for the heteroscedastic measurement error case. Similar to some earlier proposals, our estimator is built on principles underlying deconvoluting kernel density estimators. However, the proposed estimation procedure uses Monte Carlo methods for estimating nonlinear functions of a normal mean, which is different than any previous estimator. We show that the estimator has desirable operating characteristics in both large and small samples and apply the method to a study of benzene exposure in Chinese factory workers.
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Affiliation(s)
- Julie McIntyre
- Department of Mathematics and Statistics, University of Alaska Fairbanks, Fairbanks, Alaska 99775, U.S.A
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York 14642, U.S.A
| | - Stephen M Rappaport
- Department of Environmental Health Sciences, University of California, Berkeley, California 94720, U.S.A
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40
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Rudofker EW, Sherazi S, Rice JD, Johnson BA, Alexis JD. Increased Risk of Thromboembolic Events Following Gastrointestinal Bleeds among Left Ventricular Assist Device Patients. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stephenson R, Freeland R, Sullivan SP, Riley E, Johnson BA, Mitchell J, McFarland D, Sullivan PS. Home-Based HIV Testing and Counseling for Male Couples (Project Nexus): A Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e101. [PMID: 28559225 PMCID: PMC5470011 DOI: 10.2196/resprot.7341] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND HIV prevalence remains high among men who have sex with men (MSM) in the United States, yet the majority of research has focused on MSM as individuals, not as dyads, and has discussed HIV risks primarily in the context of casual sex. Nexus is an online prevention program that combines home-based HIV testing and couples HIV testing and counseling (CHTC). It allows partners in dyadic MSM relationships to receive HIV testing and care in the comfort of their designated residence, via video-based chat. By using video-based technologies (eg, VSee video chat), male couples receive counseling and support from a remote online counselor, while testing for HIV at home. OBJECTIVE This randomized control trial (RCT) aims to examine the effects of video-based counseling combined with home-based HIV testing on couples' management of HIV risk, formation and adherence to explicit sexual agreements, and sexual risk-taking. METHODS The research implements a prospective RCT of 400 online-recruited male couples: 200 self-reported concordant-negative couples and 200 self-reported discordant couples. Couples in the control arm will receive one or two home-based HIV self-testing kits and will be asked to report their results via the study's website. Couples in the experimental arm will receive one or two home-based HIV self-testing kits and will conduct these tests together under the facilitation of a remotely located counselor during a prescheduled VSee-based video CHTC session. Study assessments are taken at baseline, as well as at 3- and 6-month follow-up sessions. RESULTS Project Nexus was launched in April 2016 and is ongoing. To date, 219 eligible couples have been enrolled and randomized. CONCLUSIONS Combining home-based HIV testing with video-based counseling creates an opportunity to expand CHTC to male couples who (1) live outside metro areas, (2) live in rural areas without access to testing services or LGBTQ resources, or (3) feel that current clinic-based testing is not for them (eg, due to fears of discrimination associated with HIV and/or sexuality). TRIAL REGISTRATION ClinicalTrials.gov NCT02335138; https://clinicaltrials.gov/ct2/show/NCT02335138 (Archived by WebCite at http://www.webcitation.org/6qHxtNIdW).
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Affiliation(s)
- Rob Stephenson
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Ryan Freeland
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Stephen P Sullivan
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Erin Riley
- School of Nursing, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Brent A Johnson
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Jason Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Deborah McFarland
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States.,Rollins School of Public Health, Department of Health Policy and Management, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, United States
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Feinstein BA, Johnson BA, Parsons JT, Mustanski B. Reactions to Testing HIV Negative: Measurement and Associations with Sexual Risk Behaviour Among Young MSM Who Recently Tested HIV Negative. AIDS Behav 2017; 21:1467-1477. [PMID: 27557984 DOI: 10.1007/s10461-016-1525-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Receiving an HIV-positive test result is associated with reduced condomless anal sex (CAS), but little is known about negative test results. The recent development of the Inventory of Reactions to Testing HIV Negative confirmed that there are diverse reactions to receiving a negative test result, which have implications for risk behaviour. The goals of the current study were to validate the measure in a sample of young men who have sex with men who recently tested HIV-negative (N = 1113) and to examine its associations with CAS. Factor analysis identified four factors, three of which were the same as the original factors (Reinforced Safety, Luck, and Invulnerability) and one that was novel (Reinforced Risk). Construct validity was demonstrated with associations between subscales and constructs from the IMB model of HIV prevention. Lower Reinforced Safety and higher Luck and Reinforced Risk were associated with more CAS. Associations between Reinforced Safety and Luck with CAS were stronger for those who reported more lifetime HIV tests. Findings highlight the importance of reactions to testing HIV-negative and suggest that they become more important with repeated testing.
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Mustanski B, Madkins K, Greene GJ, Parsons JT, Johnson BA, Sullivan P, Bass M, Abel R. Internet-Based HIV Prevention With At-Home Sexually Transmitted Infection Testing for Young Men Having Sex With Men: Study Protocol of a Randomized Controlled Trial of Keep It Up! 2.0. JMIR Res Protoc 2017; 6:e1. [PMID: 28062389 PMCID: PMC5251167 DOI: 10.2196/resprot.5740] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/26/2016] [Accepted: 11/23/2016] [Indexed: 12/03/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infections are increasing among young men who have sex with men (YMSM), yet few HIV prevention programs have studied this population. Keep It Up! (KIU!), an online HIV prevention program tailored to diverse YMSM, was developed to fill this gap. The KIU! 2.0 randomized controlled trial (RCT) was launched to establish intervention efficacy. Objective The objective of the KIU! study is to advance scientific knowledge of technology-based behavioral HIV prevention, as well as improve public health by establishing the efficacy of an innovative electronic health (eHealth) prevention program for ethnically and racially diverse YMSM. The intervention is initiated upon receipt of a negative HIV test result, based on the theory that testing negative is a teachable moment for future prevention behaviors. Methods This is a two-group, active-control RCT of the online KIU! intervention. The intervention condition includes modules that use videos, animation, games, and interactive exercises to address HIV knowledge, motivation for safer behaviors, self-efficacy, and behavioral skills. The control condition reflects HIV information that is readily available on many websites, with the aim to understand how the KIU! intervention improves upon information that is currently available online. Follow-up assessments are administered at 3, 6, and 12 months for each arm. Testing for urethral and rectal sexually transmitted infections (STIs) is completed at baseline and at 12-month follow-up for all participants, and at 3- and 6-month follow-ups for participants who test positive at baseline. The primary behavioral outcome is unprotected anal sex at all follow-up points, and the primary biomedical outcome is incident STIs at 12-month follow-up. Results Consistent with study aims, the KIU! technology has been successfully integrated into a widely-used health technology platform. Baseline enrollment for the RCT was completed on December 30, 2015 (N=901), and assessment of intervention outcomes is ongoing at 3-, 6-, and 12-month time points. Upon collection of all data, and after the efficacy of the intervention has been evaluated, we will explore whether the KIU! intervention has differential efficacy across subgroups of YMSM based on ethnicity/race and relationship status. Conclusions Our approach is innovative in linking an eHealth solution to HIV and STI home testing, as well as serving as a model for integrating scalable behavioral prevention into other biomedical prevention strategies. Trial Registration Clinicaltrials.gov NCT01836445; https://clinicaltrials.gov/ct2/show/NCT01836445 (Archived by WebCite at http://www.webcitation.org/6myMFlxnC)
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Affiliation(s)
- Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.,Graduate Center of the City University, New York, NY, United States
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Patrick Sullivan
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Michael Bass
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rebekah Abel
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Zhao Y, Chung M, Johnson BA, Moreno CS, Long Q. Hierarchical Feature Selection Incorporating Known and Novel Biological Information: Identifying Genomic Features Related to Prostate Cancer Recurrence. J Am Stat Assoc 2017; 111:1427-1439. [PMID: 28435175 DOI: 10.1080/01621459.2016.1164051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Our work is motivated by a prostate cancer study aimed at identifying mRNA and miRNA biomarkers that are predictive of cancer recurrence after prostatectomy. It has been shown in the literature that incorporating known biological information on pathway memberships and interactions among biomarkers improves feature selection of high-dimensional biomarkers in relation to disease risk. Biological information is often represented by graphs or networks, in which biomarkers are represented by nodes and interactions among them are represented by edges; however, biological information is often not fully known. For example, the role of microRNAs (miRNAs) in regulating gene expression is not fully understood and the miRNA regulatory network is not fully established, in which case new strategies are needed for feature selection. To this end, we treat unknown biological information as missing data (i.e., missing edges in graphs), different from commonly encountered missing data problems where variable values are missing. We propose a new concept of imputing unknown biological information based on observed data and define the imputed information as the novel biological information. In addition, we propose a hierarchical group penalty to encourage sparsity and feature selection at both the pathway level and the within-pathway level, which, combined with the imputation step, allows for incorporation of known and novel biological information. While it is applicable to general regression settings, we develop and investigate the proposed approach in the context of semiparametric accelerated failure time models motivated by our data example. Data application and simulation studies show that incorporation of novel biological information improves performance in risk prediction and feature selection and the proposed penalty outperforms the extensions of several existing penalties.
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Affiliation(s)
- Yize Zhao
- Postdoctoral Fellow, Statistical and Applied Mathematical Sciences Institute, Research Triangle Park, NC 27709
| | - Matthias Chung
- Assistant Professor, Department of Mathematics, Virginia Tech, Blacksburg, VA 24061
| | - Brent A Johnson
- Associate Professor, Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY 14642
| | - Carlos S Moreno
- Associate Professor, Department of Pathology and Laboratory Medicine
| | - Qi Long
- Associate Professor, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322
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Lu X, Johnson BA. Direct estimation for adaptive treatment length policies: Methods and application to evaluating the effect of delayed PEG insertion. Biometrics 2016; 73:981-989. [PMID: 28009454 DOI: 10.1111/biom.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022]
Abstract
Dysphagia is a primary cause of death among patients diagnosed with amyotrophic lateral sclerosis (ALS), and percutaneous endoscopic gastrostomy (PEG) is a procedure to insert a tube into the stomach to assist or replace oral feeding. It is believed that PEG is beneficial and, generally, earlier insertion is preferable to later. However, gathering clinical evidence to support these beliefs on the use and timing of PEG is challenging because controlled clinical trials are not feasible and clinical endpoints are confounded with PEG in observational data. Moreover, the confounders are time-varying and time to PEG insertion may be only partially observed. We show how one can view this problem as an adaptive treatment length policy and propose a new estimator via g-computation. We show that our estimator is consistent and asymptotically normal for the causal estimand and explore its finite sample properties in simulation studies. Finally, using more than 10 years of data from Emory ALS clinic registry, we found no evidence to suggest that earlier PEG reduced 4-year mortality; thus, our results do not support the hypothesis and belief that initiating palliative care earlier extends life, on average. At the same, we cannot be certain that all important confounding variables are collected and observed to ensure our modeling assumptions are correct, so more work is needed to address these important end-of-life questions for ALS patients.
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Affiliation(s)
- Xin Lu
- Department of Biostatistics and Programming, Sanofi, Bridgewater, New Jersey 08807, U.S.A
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York 14642, U.S.A
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Johnson BA, McKenney J, Ricca AV, Rosenberg ES, Liu C, Sharma A, Sullivan PS. Risk Factors Associated With Repeated HIV Testing Among Internet-Using Men Who Have Sex With Men. AIDS Educ Prev 2016; 28:511-523. [PMID: 27925484 PMCID: PMC5726263 DOI: 10.1521/aeap.2016.28.6.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Men who have sex with men (MSM) represent a disproportionately impacted risk group for HIV incidence among at-risk U.S. POPULATIONS Few studies have identified risk factors associated with HIV testing frequency both within and outside of traditional health care settings. MSM enrolled in a prospective cohort were mailed at-home specimen collection kits and followed for a year. Incidence density rate ratios (IDRR) of testing were calculated, and generalized estimating equations were used to analyze the association between HIV testing and behavioral factors. The incidence rate of testing was higher among Black MSM than White MSM (IDRR: 1.3, 95% confidence interval CI [1.1, 1.5]) and higher among MSM who reported 3+ condomless anal intercourse partners (CAI) than MSM who reported no CAI (IDRR: 1.6, 95% CI [1.3, 2.0]). Increasing availability of HIV testing outside traditional health care settings, including at-home testing kits, in conjunction with targeted behavioral interventions and biomedical treatment preventions is needed.
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Affiliation(s)
- Brent A. Johnson
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Jennie McKenney
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Alexandra V. Ricca
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Eli S. Rosenberg
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Chang Liu
- University of Rochester, Rochester, New York, USA, Department of Biostatistics and Computational Biology, School of Medicine and Dentistry
| | - Akshay Sharma
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
| | - Patrick S. Sullivan
- Emory University, Atlanta, Georgia, USA, Department of Epidemiology, Rollins School of Public Health
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Mishra-Kalyani PS, Johnson BA, Glass JD, Long Q. Estimating the palliative effect of percutaneous endoscopic gastrostomy in an observational registry using principal stratification and generalized propensity scores. Sci Rep 2016; 6:33431. [PMID: 27640365 PMCID: PMC5027570 DOI: 10.1038/srep33431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/26/2016] [Indexed: 11/09/2022] Open
Abstract
Clinical disease registries offer a rich collection of valuable patient information but also pose challenges that require special care and attention in statistical analyses. The goal of this paper is to propose a statistical framework that allows for estimating the effect of surgical insertion of a percutaneous endogastrostomy (PEG) tube for patients living with amyotrophic lateral sclerosis (ALS) using data from a clinical registry. Although all ALS patients are informed about PEG, only some patients agree to the procedure which, leads to the potential for selection bias. Assessing the effect of PEG is further complicated by the aggressively fatal disease, such that time to death competes directly with both the opportunity to receive PEG and clinical outcome measurements. Our proposed methodology handles the "censoring by death" phenomenon through principal stratification and selection bias for PEG treatment through generalized propensity scores. We develop a fully Bayesian modeling approach to estimate the survivor average causal effect (SACE) of PEG on BMI, a surrogate outcome measure of nutrition and quality of life. The use of propensity score methods within the principal stratification framework demonstrates a significant and positive effect of PEG treatment, particularly when time of treatment is included in the treatment definition.
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Affiliation(s)
| | - Brent A. Johnson
- University of Rochester, Department of Biostatistics and Computational Biology, Rochester, 14642, USA
| | | | - Qi Long
- Emory University, Department of Biostatistics and Bioinformatics, Atlanta, 30322, USA
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Braverman JM, Hamilton MB, Johnson BA. Patterns of Substitution Rate Variation at Many Nuclear Loci in Two Species Trios in the Brassicaceae Partitioned with ANOVA. J Mol Evol 2016; 83:97-109. [PMID: 27592229 DOI: 10.1007/s00239-016-9752-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/14/2016] [Indexed: 01/09/2023]
Abstract
There are marked variations among loci and among lineages in rates of nucleotide substitution. The generation time hypothesis (GTH) is a neutral explanation for substitution rate heterogeneity that has genomewide application, predicting that species with shorter generation times accumulate DNA sequence substitutions faster than species with longer generation times do since faster genome replication provides more opportunities for mutations to occur and reach fixation by genetic drift. Relatively few studies have rigorously evaluated the GTH in plants, and there are numerous alternative hypotheses for plant substitution rate variation. One major challenge has been finding pairs of closely related plant species with contrasting generation times and appropriate outgroup taxa that all also have DNA sequence data for numerous loci. To test for causes of rate variation, we obtained sequence data for 256 genes for Arabidopsis thaliana, normally reproducing every year, and the biennial Arabidopsis lyrata with three closely related outgroup taxa (Brassica rapa, Capsella grandiflora, and Neslia paniculata) as well as the biennial Brassica oleracea and the annual B. rapa lineage with the outgroup N. paniculata. A sign test indicated that more loci than expected by chance have faster rates of substitution on the branch leading to the annual than to the perennial for one three-species trio but not another. Tajima's 1D and 2D tests, and a likelihood ratio test that incorporated saturation correction, rejected rate homogeneity for up to 26 genes (up to 14 genes when correcting for multiple tests), consistently showing faster rates for the annual lineage in the Arabidopsis species trio. ANOVA showed significant rate heterogeneity between the Arabidopsis and Brassica species trios (about 6 % of rate variation) and among loci (about 26-32 % of rate variation). The lineage-by-locus interaction which would be caused by locus- and lineage-specific natural selection explained about 13 % of substitution rate variation in one ANOVA model using substitution rates from genes partitioned into odd and even codons but was not a significant effect without partitioned genes. Annual/perennial lineage and species trio by annual/perennial lineage each explained about 1 % of substitution rate variation.
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Affiliation(s)
- John M Braverman
- Department of Biology, Saint Joseph's University, Philadelphia, PA, USA.
| | | | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
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Wall KM, Kilembe W, Vwalika B, Ravindhran P, Khu NH, Brill I, Chomba E, Johnson BA, Haddad LB, Tichacek A, Allen S. Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012. J Infect Dis 2016; 214:1063-71. [PMID: 27462093 PMCID: PMC5021237 DOI: 10.1093/infdis/jiw322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/20/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting. METHODS Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M-F+) was evaluated. RESULTS Among 1601 M-F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5-6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4-1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3-2.1), nor implant (aHR, 0.8; 95% CI, .5-1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions. CONCLUSIONS Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Epidemiology, Rollins School of Public Health and Laney Graduate School
| | - William Kilembe
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health
| | - Bellington Vwalika
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Gynecology and Obstetrics, School of Medicine, University of Zambia
| | - Preeti Ravindhran
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School
| | - Naw Htee Khu
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health
| | - Ilene Brill
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham
| | - Elwyn Chomba
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, New York
| | - Lisa B Haddad
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health
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John S, Kearns R, Johnson BA, Ordóñez CE, Wu B, Hare A, Wu P, Sullivan P, Sunpath H, Marconi VC. Religious Beliefs and Depression: Psychosocial Factors Affecting HIV Treatment Outcomes in South Africa. New Voices Psychol 2016; 12:2-20. [PMID: 29937923 PMCID: PMC6011752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Analyzing factors associated with virological failure (VF) may improve antiretroviral therapy (ART) outcomes for individuals living with HIV. The Risk Factors for Virological Failure (RFVF) study compared 158 cases with VF (viral load, VL, >1,000 copies/mL) and 300 controls with virological suppression (VL ≤1,000 copies/mL) after ≥5 months on their first ART regimen at McCord Hospital in Durban, South Africa between October 2010 and June 2012. RFVF participants completed a battery of various psychosocial measures. Using multivariate logistic regression stratified for gender, the association of various psychosocial factors with VF was assessed. It was found that not all factors were equally significant for both genders. The factors that were significantly associated with VF for both genders were younger age, shorter treatment duration and reporting depressive symptoms. The factors associated with VF that differed by gender were religious inactivity, having HIV+ family members, and status disclosure to friends.
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Affiliation(s)
| | | | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, USA
| | | | - Baohua Wu
- Rollins School of Public Health, Emory University, USA
| | - Anna Hare
- School of Medicine, Emory University, USA
| | - Peng Wu
- Rollins School of Public Health, Emory University, USA
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