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Zeno EE, Obala AA, Pence B, Freedman E, Mangeni JN, Lin JT, Abel L, Edwards JK, Gower EW, Taylor SM. Risk of Malaria Following Untreated Subpatent Plasmodium falciparum Infections: Results Over 4 Years From a Cohort in a High-Transmission Area in Western Kenya. J Infect Dis 2024; 229:969-978. [PMID: 37713614 PMCID: PMC11011184 DOI: 10.1093/infdis/jiad398] [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: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND People with suspected malaria may harbor Plasmodium falciparum undetected by rapid diagnostic test (RDT). The impact of these subpatent infections on the risk of developing clinical malaria is not fully understood. METHODS We analyzed subpatent P. falciparum infections using a longitudinal cohort in a high-transmission site in Kenya. Weighted Kaplan-Meier models estimated the risk difference (RD) for clinical malaria during the 60 days following a symptomatic subpatent infection. Stratum-specific estimates by age and transmission season assessed modification. RESULTS Over 54 months, we observed 1128 symptomatic RDT-negative suspected malaria episodes, of which 400 (35.5%) harbored subpatent P. falciparum. Overall, the 60-day risk of developing clinical malaria was low following all episodes (8.6% [95% confidence interval, 6.7%-10.4%]). In the low-transmission season, the risk of clinical malaria was slightly higher in those with subpatent infection, whereas the opposite was true in the high-transmission season (low-transmission season RD, 2.3% [95% confidence interval, .4%-4.2%]; high-transmission season RD, -4.8% [-9.5% to -.05%]). CONCLUSIONS The risk of developing clinical malaria among people with undetected subpatent infections is low. A slightly elevated risk in the low-transmission season may merit alternate management, but RDTs identify clinically relevant infections in the high-transmission season.
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Affiliation(s)
- Erica E Zeno
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Andrew A Obala
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Elizabeth Freedman
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Judith N Mangeni
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Jessica T Lin
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Emily W Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Steve M Taylor
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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LeMasters K, Delamater P, Brinkley-Rubinstein L, Edwards JK, Robinson WR, Pence B. Mass probation: Temporal and geographic correlation of county-level probation rates & mental health in North Carolina. SSM Ment Health 2023; 3:100189. [PMID: 36936811 PMCID: PMC10022749 DOI: 10.1016/j.ssmmh.2023.100189] [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] [Indexed: 01/21/2023] Open
Abstract
High community incarceration rates are associated with worse community mental health. However, it remains unknown whether higher rates of probation, a form of criminal legal community supervision, are similarly associated with worse community mental health. Our objective was to evaluate temporal and geographic correlations of county-level probation and mental health rates separately and to assess the association between county-level probation and mental health rates, measured by self-inflicted injury and suicide. We performed ecological analyses using North Carolina administrative data (2009-2019) and used repeated cross-section, multivariable spatial error models. From 2009 to 2019, probation rates trended downward while self-inflicted injury and suicide remained stable. We found positive spatial autocorrelation suggesting that there are spatial determinants of probation and self-harm, though less so for suicide. Hot spot analyses showed local variation with high self-harm and suicide rates being clustered in rural Western North Carolina and high probation rates being clustered in rural Eastern North Carolina. Probation was positively associated with self-inflicted injury and suicide. For example, in 2018, a 1 percentage point increase in probation was associated with a 0.05 percentage point increase in self-harm in 2019 (95% CI: 0.03, 0.06), meaning that in a county of 100,000 people, an increase in 1000 county residents being on probation would be associated with an increase in 50 self-harm injuries. High county-level probation rates may exert collateral damage on the mental health of those living in areas with much of the population under state control. These findings emphasize that the criminal legal system is not separate from communities and that future public health research and advocacy must consider these collateral consequences of probation on communities.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Paul Delamater
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
- Department of Geography, University of North Carolina at Chapel Hill, United States
| | - Lauren Brinkley-Rubinstein
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States
| | - Jesse K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Whitney R. Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
- Carolina Population Center, University of North Carolina at Chapel Hill, United States
- Division of Women’s Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, United States
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
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Mphonda S, Dussault J, Bengtson A, Gaynes BN, Go V, Hosseinipour MC, Kulisewa K, Kutengule A, Meltzer-Brody S, Udedi M, Pence B. Preferences for enhanced treatment options to address HIV care engagement among women living with HIV and perinatal depression in Malawi. BMC Public Health 2023; 23:1922. [PMID: 37794350 PMCID: PMC10552213 DOI: 10.1186/s12889-023-16835-w] [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: 11/03/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Option B + offers lifelong ART to pregnant or breastfeeding mothers, but postpartum loss to HIV care, partially driven by perinatal depression (PND), threatens the impact of this policy. This study aims to understand women's and providers' preferences for developing a feasible intervention to address PND and support engagement in HIV care among women living with PND and HIV. METHODS We conducted a total of 6 focus group discussions (FGDs) involving 4 clinics in Lilongwe District from December 2018 through February 2019. We conducted 2 FGDs each among 3 stakeholder groups: clinical staff, prenatal women, and postnatal women. Perinatal participants were living with HIV and screened positively for PND using the validated Edinburgh Postnatal Depression Scale (EPDS). Clinical staff were nurses who were trained antiretroviral therapy (ART) providers. Interviewers led FGDs in Chichewa using a semi-structured guide. Data were analyzed using deductive and inductive coding in NVivo 12 software. RESULTS Women favored ART linkage services, but providers said they already offered such services, with mixed results. Individual counselling was universally supported. A perceived benefit of group counselling was peer support, but there were concerns among women regarding confidentiality and stigma. Women liked mobile appointment reminders but identified low phone ownership as a barrier. Participants recommended home visits as an additional care engagement strategy. Women consistently discussed the need for social support from family members and friends to address PND and support engagement in HIV care. CONCLUSION This study highlights the importance of peer encouragement to support perinatal HIV care engagement among women with HIV and PND. The results from this study can be used to support intervention development to increase HIV care engagement and improve long-term HIV outcomes in women with PND.
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Affiliation(s)
- Steve Mphonda
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.
| | - Josée Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Angela Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Bradley N Gaynes
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kazione Kulisewa
- Department of Psychiatry and Mental health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Udedi
- Department of Psychiatry and Mental health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Ministry of Health, Lilongwe, Malawi
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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LeMasters K, Renson A, Edwards JK, Robinson WR, Brinkley-Rubinstein L, Delamater P, Pence B. Inequities in life course criminal legal system sanctions: measuring cumulative involvement. Ann Epidemiol 2022; 76:83-90. [PMID: 36273701 PMCID: PMC10075343 DOI: 10.1016/j.annepidem.2022.10.007] [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: 06/21/2022] [Revised: 09/12/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The impact of incarceration on health is well known. Yet, most studies measure incarceration alone and miss additional exposure to the criminal legal system over time. We evaluated adult criminal legal sanctions - inclusive of arrests, charges, probation, incarceration - from ages 18-35 and inequities by juvenile sanctions and race. METHODS Using the National Longitudinal Survey on Youth 1997, a nationally representative data set of adolescents followed into their mid-thirties (1997-2017), we calculated the mean cumulative count, or the average number of criminal legal events per person per study visit, stratified by juvenile sanctions and race. RESULTS Of 7024 participants, 1679 experienced 3,075 encounters. There were seven arrests, 30 charges, nine probation encounters, and 13 incarceration events /100 participants by age 35. Juvenile sanctions were most common for Black individuals. Among those experiencing juvenile sanctions, Black and White individuals had similar numbers of encounters, but Black individuals had more arrests and incarceration stays. For those without juvenile encounters, Black individuals had more encounters than White individuals. CONCLUSIONS Research on health effects of criminal legal sanctions must consider encounters beyond incarceration and focus on life course trajectories and racial inequities.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Audrey Renson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jesse K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Lauren Brinkley-Rubinstein
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul Delamater
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Igudesman D, Crandell J, Corbin K, Muntis F, Zaharieva D, Thomas J, Bulik C, Carroll I, Pence B, Pratley R, Kosorok M, Maahs D, Mayer-Davis E. The Gut Microbiota and Short-Chain Fatty Acids in Association With Glycemia and Adiposity in Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study. Curr Dev Nutr 2022. [PMCID: PMC9193984 DOI: 10.1093/cdn/nzac069.018] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Co-managing glycemia and adiposity is the cornerstone of cardiometabolic risk reduction among people with type 1 diabetes (T1D) but targets are often not met. The gut microbiota and microbiota-derived short-chain fatty acids (SFCA) influence glycemia and adiposity but have not been sufficiently investigated in longstanding T1D. We hypothesized that an increased abundance of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity were associated with improved glycemia but increased adiposity among young adults with longstanding T1D. Methods Participants provided stool samples at up to four time points. 16S rRNA gene sequencing determined the abundance of SCFA-producing gut microbes. Gas-chromatography mass-spectrometry determined total and specific SCFA (acetate, butyrate, and propionate). Dual-energy x-ray absorptiometry (% body fat or lean mass) and anthropometrics (body mass index [BMI]) measured adiposity. Continuous glucose monitoring (time in range [70–180 mg/dl], above range [>180 mg/dl], and below range [54–69 mg/dl]) and hemoglobin A1c assessed glycemia. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of SCFA-producing gut microbes, fecal SCFA, and gut microbial diversity with glycemia and adiposity. COVID-19 interrupted data collection, so models were repeated with restriction to pre-COVID visits. Results Data were available for up to 45 participants at 101 visits, including 40 participants at 54 visits pre-COVID. The abundance of Eubacterium hallii was associated inversely with BMI (all data). Pre-COVID, increased fecal propionate was associated with increased time above range and reduced time in target and below range; and the increased abundance of four SCFA-producing intestinal microbes (Ruminococcus gnavus, Ruminococcus 2, Eubacterium ventriosum, and Lachnospira) was associated with reduced adiposity (% body fat or BMI), of which two microbes were also associated with increased % lean mass. Conclusions Unexpectedly, fecal propionate was associated with detriment to glycemia, while several SCFA-producing gut microbes were associated with benefit to adiposity. Future mechanistic studies may determine whether these associations have causal linkages in T1D. Funding Sources National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David Maahs
- AdventHealth Translational Research Institute
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Igudesman D, Crandell J, Corbin K, Hooper J, Thomas J, Bulik C, Carroll I, Pence B, Pratley R, Kosorok M, Maahs D, Mayer-Davis E. Associations of Diet With the Intestinal Microbiota and Short-Chain Fatty Acids Among Young Adults With Type 1 Diabetes: The ACT1ON Ancillary Gut Microbiome Pilot Study. Curr Dev Nutr 2022. [PMCID: PMC9194115 DOI: 10.1093/cdn/nzac069.017] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Diet, a key component of type 1 diabetes (T1D) management, modulates the intestinal microbiota and its metabolically active byproducts, short-chain fatty acids (SCFA), via fermentation of dietary carbohydrates such as fiber. The relationships among diet, the intestinal microbiota, and SCFA have been studied proximal to T1D onset, but remain largely unexplored in longstanding T1D. We hypothesized that increased carbohydrate intake, including fiber, was associated with increased SCFA-producing microbes, fecal SCFA, and gut microbial diversity among adults with longstanding T1D and overweight or obesity. Methods Participants provided stool samples at up to four time points. Trained interviewers collected 24-hour dietary recalls. 16S rRNA gene sequencing determined the abundance of SCFA-producing intestinal microbes. Gas-chromatography mass-spectrometry computed total and specific fecal SCFA (acetate, butyrate, and propionate) levels. Adjusted and Bonferroni-corrected generalized estimating equations modeled the associations of dietary fiber and carbohydrate with the abundance of SCFA-producing microbes, fecal SCFA, and gut microbial diversity. Data collection was interrupted by COVID-19; therefore, analyses were repeated with restriction to pre-COVID visits. Results Data were available for 44 participants at 99 visits, including 42 participants with 57 visits pre-COVID. Intake of soluble fiber (all data) and available carbohydrates (pre-COVID) were inversely associated with the genus Bacteroides and Eubacterium alistipes. Pre-COVID, total and soluble fiber and available carbohydrates were positively associated with total SCFA and acetate levels, and available carbohydrates were positively associated with the genus Roseburia and Eubacterium ventriosum. Conclusions In our sample of young adults with longstanding T1D, increased carbohydrate intake, including fiber, was associated with both reduced and increased SCFA-producing microbes but increased total fecal SCFA and acetate, which might influence lipid metabolism and weight. Mechanistic studies may examine how a diet designed to modulate the SCFA-producing capacity of the intestinal microbiota influences metabolism and energy balance in the metabolically unique setting of T1D. Funding Sources National Institute of Diabetes and Digestive and Kidney Diseases.
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Shangase N, Edwards J, Pence B, Aiello A, Hussong A, Gómez-Olivé X, Kahn K, Stoner M, Pettifor A. Effect of Quality of Caregiver-Adolescent Relationship on Sexual Debut, Transactional Sex, and on Age-Disparate Relationships Among Young Women in Rural South Africa Enrolled in HPTN 068. J Acquir Immune Defic Syndr 2022; 89:366-373. [PMID: 35202045 PMCID: PMC8887792 DOI: 10.1097/qai.0000000000002890] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent girls and young women (AGYW) remain burdened by the HIV epidemic. Positive caregiver-child relationships are associated with safe sexual behaviors in young people; yet, this literature often highlights the role of parent-child communication and parental monitoring, neglecting the importance of emotional relationships between a caregiver and adolescent. SETTING We used longitudinal data from HIV Prevention Trial Network 068-conducted among 2533 AGYW (13-20 years) over a period of 5 years in Agincourt, South Africa. METHOD Kaplan-Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on sexual debut, and log-binomial models with generalized estimating equations were used to examine the relationship between our exposures and transactional sex and age-disparate relationships. RESULTS Sexual debut was delayed among those who reported high levels of caregiver caring [hazard ratio: 0.80, 95% confidence interval (CI): 0.69 to 0.93] and caregiver closeness (hazard ratio: 0.80, 95% CI: 0.68 to 0.95). AGYW who reported high quality caregiver-adolescent relationships had a lower risk of transactional sex [caring: risk ratio (RR): 0.67, 95% CI: 0.58 to 0.78; closeness: RR: 0.58; 95% CI: 0.50 to 0.67]. Similarly, those with high-quality caregiver-adolescent relationships were less likely to be in an age-disparate relationship (caring: RR: 0.68, 95% CI: 0.58 to 0.79; closeness: RR: 0.77, 95% CI: 0.66 to 0.90). CONCLUSIONS Findings indicate high-quality caregiver-adolescent relationships are associated with delayed sexual debut, a lower risk of transactional sex, and having an older partner. Family-centered interventions are needed to improve relationships between AGYW and caregivers.
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Affiliation(s)
- Nosipho Shangase
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jess Edwards
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Brian Pence
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Allison Aiello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Andrea Hussong
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marie Stoner
- Women’s Global Health Imperative, RTI International, San Francisco, California, USA
| | - Audrey Pettifor
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Parcesepe AM, Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Wainberg M, Pence B, Pefura-Yone E, Yotebieng M, Nsame D, Anastos K, Nash D. Gender, Mental Health, and Entry Into Care with Advanced HIV Among People Living with HIV in Cameroon Under a National 'Treat All' Policy. AIDS Behav 2021; 25:4018-4028. [PMID: 34091803 DOI: 10.1007/s10461-021-03328-3] [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] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Delays in diagnosis and linkage to HIV care persist among people living with HIV (PLWH), even after expanded access to ART worldwide. Mental health may influence timely linkage to HIV care. Greater understanding of the relationship among gender, mental health, and delayed linkage to HIV care can inform strategies to improve the health of PLWH. We interviewed 426 PLWH initiating HIV care in Cameroon between June 2019 and March 2020 to estimate the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) and the association between mental health and entry into care with advanced HIV. Separate multivariable log binomial regression models were used to estimate the association between mental health exposure and entry into HIV care with advanced HIV. Stratified analyses were used to assess effect modification by gender. Approximately 20, 15, and 12% of participants reported symptoms of depression, PTSD, and anxiety, respectively. The prevalence of mental health symptoms did not vary significantly by gender. Overall, 53% of participants enrolled in HIV care with advanced HIV: 51% of men and 54% of women. Screening positive for one of the mental health disorders assessed was associated with greater prevalence of enrollment with advanced HIV among men, but not among women. Future research should examine gender-specific pathways between mental health symptoms and entry into care with advanced HIV, particularly for men in Cameroon. The extent to which untreated mental health symptoms drive gender disparities throughout the HIV care continuum should be explored further.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27599, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lindsey M Filiatreau
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Milton Wainberg
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denis Nash
- Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Reif S, Wilson E, McAllaster C, Pence B, Cooper H. The relationship between social support and experienced and internalized HIV-related stigma among people living with HIV in the Deep South. Stigma and Health 2021. [DOI: 10.1037/sah0000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Albert LM, Edwards J, Pence B, Speizer IS, Hillis S, Kahn K, Gómez-Olivé FX, Wagner RG, Twine R, Pettifor A. Associations of Father and Adult Male Presence with First Pregnancy and HIV Infection: Longitudinal Evidence from Adolescent Girls and Young Women in Rural South Africa (HPTN 068). AIDS Behav 2021; 25:2177-2194. [PMID: 33417105 PMCID: PMC8580262 DOI: 10.1007/s10461-020-03147-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
This study, a secondary analysis of the HPTN 068 randomized control trial, aimed to quantify the association of father and male presence with HIV incidence and first pregnancy among 2533 school-going adolescent girls and young women (AGYW) in rural South Africa participating in the trial between March 2011 and April 2017. Participants' ages ranged from 13-20 years at study enrollment and 17-25 at the post-intervention visit. HIV and pregnancy incidence rates were calculated for each level of the exposure variables using Poisson regression, adjusted for age using restricted quadratic spline variables, and, in the case of pregnancy, also adjusted for whether the household received a social grant. Our study found that AGYW whose fathers were deceased and adult males were absent from the household were most at risk for incidence of first pregnancy and HIV (pregnancy: aIRR = 1.30, Wald 95% CI 1.05, 1.61, Wald chi-square p = 0.016; HIV: aIRR = 1.27, Wald 95% CI 0.84, 1.91, Wald chi-square p = 0.263) as compared to AGYW whose biological fathers resided with them. For AGYW whose fathers were deceased, having other adult males present as household members seemed to attenuate the incidence (pregnancy: aIRR = 0.92, Wald 95% CI 0.74, 1.15, Wald chi-square p = 0.462; HIV: aIRR = 0.90, Wald 95% CI 0.58, 1.39, Wald chi-square p = 0.623) such that it was similar, and therefore not statistically significantly different, to AGYW whose fathers were present in the household.
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Affiliation(s)
- Lisa M Albert
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA.
- Palladium, Washington, D.C, USA.
| | - Jess Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA
| | - Ilene S Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan Hillis
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7435, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Medical Research Council/Wits University Rural Public Health and Health Transitions Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence B, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 2021; 21:293. [PMID: 34090367 PMCID: PMC8180128 DOI: 10.1186/s12888-021-03306-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon. METHODS We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression. RESULTS Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80). CONCLUSIONS Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
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Affiliation(s)
- Lindsey M. Filiatreau
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian Pence
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Milton Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Denis Nash
- grid.212340.60000000122985718Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Marcel Yotebieng
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn Anastos
- grid.251993.50000000121791997Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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12
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Shangase N, Pence B, Lippman SA, Dufour MSK, Kabudula CW, Gómez-Olivé FX, Kahn K, Pettifor A. Built Environment and HIV Linkage to Care in Rural South Africa. Int Q Community Health Educ 2021; 43:133-141. [PMID: 33818211 PMCID: PMC9684657 DOI: 10.1177/0272684x211006590] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background We assessed built environment (residential density, landuse mix and
aesthetics) and HIV linkage to care (LTC) among 1,681 (18–49 years-old)
residents of 15 Mpumalanga villages, South Africa. Methods Multilevel models (linear-binomial) were used for the association between
built environment, measured using NEWS for Africa, and LTC from a clinical
database of 9 facilities (2015–2018). Additionally, we assessed
effect-measure modification by universal test-and-treat policy (UTT). Results We observed, a significant association in the adjusted 3-month probability of
LTC for residential density (risk difference (RD)%: 5.6, 95%CI: 1.2–10.1),
however, no association for land-use mix (RD%: 2.4, 95%CI: −0.4, 5.2) and
aesthetics (RD%: −1.2, 95%CI: −4.5–2.2). Among those diagnosed after UTT,
residents of high land-use villages were more likely to link-to-care than
those of low land-use villages at 12 months (RD%: 4.6, 95%CI: 1.1–8.1,
p < 0.04), however, not at 3 months (RD%: 3.0, 95%CI: −2.1–8.0,
p > 0.10). Conclusion Findings suggest, better built environment conditions (adequate
infrastructure, proximity to services etc.) help facilitate LTC. Moreover,
UTT appears to have a protective effect on LTC.
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Affiliation(s)
- Nosipho Shangase
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, California, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mi-Suk Kang Dufour
- Department of Medicine, University of California, San Francisco, California, United States
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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LeMasters K, Dussault J, Barrington C, Bengtson A, Gaynes B, Go V, Hosseinipour MC, Kulisewa K, Kutengule A, Meltzer-Brody S, Midiani D, Mphonda S, Udedi M, Pence B. "Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi. PLoS One 2020; 15:e0227935. [PMID: 32502150 PMCID: PMC7274419 DOI: 10.1371/journal.pone.0227935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/01/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. METHODS We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis. RESULTS Women experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support. CONCLUSIONS These findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Josée Dussault
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Clare Barrington
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Bengtson
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Bradley Gaynes
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mina C. Hosseinipour
- UNC-Project Malawi, Lilongwe, Malawi
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | - Samantha Meltzer-Brody
- Department of Psychiatry, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | | | - Michael Udedi
- College of Medicine, University of Malawi, Lilongwe, Malawi
- Ministry of Health, Lilongwe, Malawi
| | - Brian Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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14
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Akiba CF, Zimba CC, Thom A, Matewere M, Go V, Pence B, Gaynes BN, Masiye J. The role of patient-provider communication: a qualitative study of patient attitudes regarding co-occurring depression and chronic diseases in Malawi. BMC Psychiatry 2020; 20:243. [PMID: 32429877 PMCID: PMC7236218 DOI: 10.1186/s12888-020-02657-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients' attitudes and perceptions towards depression integration into routine NCD services. METHODS Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N = 20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. RESULTS While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients' respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider's communication in shaping a patient's feelings about depression. CONCLUSIONS Training and interventions that facilitate providers' abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. TRIAL REGISTRATION This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018.
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Affiliation(s)
- Christopher F Akiba
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Chifundo C Zimba
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Annie Thom
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Maureen Matewere
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Vivian Go
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Brian Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 2103C McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Jones Masiye
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
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15
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Udedi M, Pence B, Kauye F, Muula AS. The effect of depression management on diabetes and hypertension outcomes in low- and middle-income countries: a systematic review protocol. Syst Rev 2018; 7:223. [PMID: 30518434 PMCID: PMC6280497 DOI: 10.1186/s13643-018-0896-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/23/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression and non-communicable diseases (NCDs) account for a growing burden on health systems in low- and middle-income countries (LMICs). Depression is generally associated with the outcomes of NCDs and is an important barrier to consistent NCD care management. There is great need to understand the efficacy of interventions to treat depression for people with NCDs, but there is a paucity of evidence of the efficacy of the interventions in LMICs. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of depression management among patients with diabetes and hypertension to improve outcomes. METHODS This is a systematic review to assess the evidence of the effect of depression management in diabetic and hypertensive patients on diabetes and hypertension outcomes in LMICs. Two independent reviewers will search articles on PubMed, EMBASE, PsycINFO, and Global Index Medicus. Two reviewers will then screen the articles independently based on predefined criteria. We will use standard methods as recommended by the Cochrane Collaboration of assessing quality of evidence and publish our report using the PRISMA guidelines. DISCUSSION The findings from this review will provide evidence to be used in guiding practice and policy on how to integrate depression management in diabetes and hypertension clinics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017068257.
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Affiliation(s)
- Michael Udedi
- College of Medicine, University of Malawi, P/Bag 360, Chichiri, Blantyre, 3 Malawi
| | - Brian Pence
- Department of Epidemiology, University of North Carolina-Chapel Hill, McGavran-Greenberg, 2103C Campus Box 7435, UNC-Chapel Hill, Chapel Hill, NC 27599-7435 USA
| | - Felix Kauye
- College of Medicine, University of Malawi, P/Bag 360, Chichiri, Blantyre, 3 Malawi
| | - Adamson S. Muula
- College of Medicine, University of Malawi, P/Bag 360, Chichiri, Blantyre, 3 Malawi
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16
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Pence B, Yarbro J. AGING ALTERS RESPIRATORY BUT NOT GLYCOLYTIC CAPACITY IN HUMAN MONOCYTES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.347] [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] [Indexed: 11/15/2022] Open
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17
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Ostermann J, Pence B, Whetten K, Yao J, Itemba D, Maro V, Reddy E, Thielman N. HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania. AIDS Care 2018; 27 Suppl 1:59-64. [PMID: 26616126 PMCID: PMC4685596 DOI: 10.1080/09540121.2015.1090534] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
HIV serostatus disclosure plays an important role in HIV transmission risk reduction and is positively associated with HIV medication adherence and treatment outcomes. However, to date, no study has quantified the role of disclosure across the HIV treatment cascade, particularly in Sub-Saharan Africa. We used data from a cohort of HIV-infected adults in Northern Tanzania to describe associations between disclosure and engagement and retention in the HIV treatment cascade. Between 2008 and 2009, the Coping with HIV/AIDS in Tanzania (CHAT) study enrolled 260 clients newly diagnosed with HIV and 492 HIV-infected patients in established HIV care in two large HIV care and treatment centers in Northern Tanzania. Participants aged 18 and older completed annual clinical assessments and twice-annual in-person interviews for 3.5 years. Using logistic regression models, we assessed sociodemographic correlates of HIV serostatus disclosure to at least one household member, and associations between this disclosure measure and linkage to care, evaluation for antiretroviral therapy (ART) eligibility, ART coverage, and rates of undetectable HIV RNA levels during the follow-up period. Married individuals and those diagnosed earlier were more likely to have disclosed their HIV infection to at least one household member. During follow-up, HIV serostatus disclosure was associated with higher rates of linkage to care, evaluation for ART eligibility, and ART coverage. No significant association was observed with rates of undetectable viral loads. Marginal effects estimates suggest that a 10 percentage-point lower probability of linkage to care for those who did not disclose their HIV serostatus (86% vs. 96%; p = 0.035) was compounded by an 18 percentage-point lower probability of ever receiving a CD4 count (62% vs. 80%; p = .039), and a 20 percentage-point lower probability of ever receiving ART (55% vs. 75%; p = .029). If causal, these findings suggest an important role for disclosure assistance efforts across the HIV treatment cascade.
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Affiliation(s)
- Jan Ostermann
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,c Department of Health Services Policy and Management , University of South Carolina , Columbia , SC , USA
| | - Brian Pence
- b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,d Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Kathryn Whetten
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,e Duke Sanford School of Public Policy , Duke University , Durham , NC , USA
| | - Jia Yao
- b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,f ADAPT Center for Cognitive/Affective Symptom Science , Duke University , Durham , NC , USA
| | | | - Venance Maro
- h Kilimanjaro Christian Medical Center , Moshi , Tanzania
| | | | - Nathan Thielman
- a Duke Global Health Institute , Duke University , Durham , NC , USA.,b Center for Health Policy and Inequalities Research , Duke University , Durham , NC , USA.,j School of Medicine , Duke University , Durham , NC , USA
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18
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Cholera R, Gaynes B, Pence B, Bassett J, Qangule N, Macphail C, Bernhardt S, Pettifor A, Miller W. Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord 2014; 167:160-6. [PMID: 24972364 PMCID: PMC4264106 DOI: 10.1016/j.jad.2014.06.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [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: 12/10/2013] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Integration of depression screening into primary care may increase access to mental health services in sub-Saharan Africa, but this approach requires validated screening instruments. We sought to validate the Patient Health Questionnaire-9 (PHQ-9) as a depression screening tool at a high HIV-burden primary care clinic in Johannesburg, South Africa. METHODS We conducted a validation study of an interviewer-administered PHQ-9 among 397 patients. Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard; receiver operating characteristic (ROC) curve analyses were performed. RESULTS The prevalence of depression was 11.8%. One-third of participants tested positive for HIV. HIV-infected patients were more likely to be depressed (15%) than uninfected patients (9%; p=0.08). Using the standard cutoff score of ≥10, the PHQ-9 had a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2). The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test performance did not vary by HIV status or language. In sensitivity analyses, reference test bias associated with the MINI appeared unlikely. LIMITATIONS We were unable to conduct qualitative work to adapt the PHQ-9 to this cultural context. CONCLUSION This is the first validation study of the PHQ-9 in a primary care clinic in sub-Saharan Africa. It highlights the potential for using primary care as an access point for identifying depressive symptoms during routine HIV testing. The PHQ-9 showed reasonable accuracy in classifying cases of depression, was easily implemented by lay health workers, and is a useful screening tool in this setting.
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Affiliation(s)
- Rushina Cholera
- Department of Epidemiology, UNC Gillings School of Global Public Health
| | | | - Brian Pence
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Jean Bassett
- Witkoppen Health and Welfare Center, Johannesburg, South Africa
| | | | - Catherine Macphail
- Collaborative Research Network for Mental Health and Well-being in Rural Communities, University of New England, Armidale, Australia & Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Audrey Pettifor
- Department of Epidemiology, UNC Gillings School of Global Public Health
| | - William Miller
- Department of Medicine, UNC School of Medicine; Department of Epidemiology, UNC Gillings School of Global Public Health
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19
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Ostermann J, Whetten K, Reddy E, Pence B, Weinhold A, Itemba D, Maro V, Mosille E, Thielman N. Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania. AIDS Care 2014; 26:1352-8. [PMID: 24517083 DOI: 10.1080/09540121.2014.882493] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 10/25/2022]
Abstract
Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and treatment centers (CTCs) from hospitals to local health centers. Between November 2008 and June 2009, 492 HIV-infected patients in established care at two referral hospitals in Moshi, Tanzania, and 262 persons newly diagnosed with HIV were selected for participation in a prospective cohort study entitled Coping with HIV/AIDS in Tanzania. Clinical records and participant self-reports, collected between June and November 2012, were used to describe retention in care and transitions between CTCs during the study period. After a mean follow-up period of 3.5 years, 10% of participants had died, 9% were lost to follow-up, and 11% had moved. Of the remaining participants enrolled from CTCs, more than 90% reported at least one CTC visit during the previous six months, with 98% still in care at the CTC at which they were enrolled. Nearly three out of four newly diagnosed clients listed a referral hospital as their primary CTC. Fewer than 10% of participants ever sought care at another CTC in the study area; nearly 90% of those in care bypassed their closest CTC. Administrative data from all facilities in the study area indicate that new clients, even after the scale-up from 8 CTCs in 2006 to 21 CTCs in 2008, disproportionately selected established CTCs, and client volume at newly approved facilities was highly variable. Despite the decentralization of HIV care and treatment in this setting, many patients continue to bypass their closest CTC to seek care at established facilities. Patient preferences for decentralized HIV care, which may inform optimal resource utilization, are largely unknown and warrant further investigation.
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Affiliation(s)
- Jan Ostermann
- a Duke Global Health Institute , Duke University , Durham , NC , USA
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20
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O'Donnell K, Yao J, Ostermann J, Thielman N, Reddy E, Whetten R, Maro V, Itemba D, Pence B, Dow D, Whetten K. Low rates of child testing for HIV persist in a high-risk area of East Africa. AIDS Care 2013; 26:326-31. [PMID: 23875966 DOI: 10.1080/09540121.2013.819405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Children in low- and middle-income countries (LMIC) are the least touched by recent successes in the diagnosis and treatment of HIV/AIDS globally. Early treatment is essential for a child's longer and higher quality of life; however, by 2011, only a small proportion of HIV-seropositive children in LMIC countries were receiving treatment, in part because of persisting low rates of diagnosis. This study of the prevalence and characteristics of children tested for HIV was embedded in the Coping with HIV/AIDS in Tanzania (CHAT) study in which HIV-seropositive and HIV-seronegative adults, and adults with unknown HIV status were asked about HIV testing for their children. Data were gathered from November 2009 to August 2010 during the scale-up of Prevention of Mother To Child Transmission and Early Infant Diagnosis programs in the region. Reports on 1776 children indicate that 31.7% of all children were reported to have been tested, including only 42.9% of children with an HIV-seropositive caregiver. In general, children more likely to be HIV tested were biological children of study participants, younger, of widowed adults, living in urban areas, and of HIV-seropositive parents/caregivers. Children belonging to the two indigenous tribes, Chagga and Pare, were more likely to be tested than those from other tribes. Rates of testing among children less than two years old were low, even for the HIV-seropositive caregiver group. The persistence of low testing rates is discussed in terms of the accessibility and acceptability of child testing in resource poor settings.
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Affiliation(s)
- Karen O'Donnell
- a Center for Health Policy and Inequalities Research, Duke Global Health Institute , Duke University , Durham , NC , USA
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Abstract
Summary.In South Asia women are often the primary decision-makers regarding child health care, family health and nutrition. This paper examines the proposition that constraints on women’s status adversely affect the survival of their children. Survey data are used to construct indices of women’s household autonomy and authority, which are then linked to longitudinal data on survival of their children. Proportional hazard models indicate that enhanced autonomy significantly decreases post-neonatal mortality. Enhanced household authority significantly decreases child mortality. A simulation based on estimated effects of eliminating gender inequality suggests that achieving complete gender equality could reduce child mortality by nearly fifty per cent and post-neonatal mortality by one-third.
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Affiliation(s)
- Mian B Hossain
- School of Public Health and Policy, Morgan State University, Baltimore, MD, USA
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Abstract
Accurate data are always needed to inform health policy, but are especially critical in tackling health inequities. The growing number of field research stations in sub-Saharan Africa are well-placed to generate relevant data and so support health policy action. Over the past 60 years, demographic surveillance systems have been crucial research tools for the evaluation of health interventions aimed at reducing socioeconomic differentials in mortality and morbidity in sub-Saharan Africa. The bulk of such work has been carried out by field research sites, often operating in remote, resource-constrained settings. The present paper reviews what we have learned since the pioneering work carried out in the field sites of Pholela (South Africa) and Niakhar (Senegal). It then focuses on current efforts to address health equity through INDEPTH, the international network of field sites with continuous demographic evaluation of population and their health in developing countries.
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Affiliation(s)
- P Ngom
- African Population and Health Research Centre, Population Council, Nairobi, Kenya.
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Phillips JF, Macleod BB, Pence B. The Household Registration System: computer software for the rapid dissemination of demographic surveillance systems. Demogr Res 2000; 2:[40] p.. [PMID: 12178153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Although longitudinal experimental community health research is crucial to testing hypotheses about the demographic impact of health technologies, longitudinal demographic research field stations are rare, owing to the complexity and high cost of developing requisite computer software systems. This paper describes the Household Registration System (HRS), a software package that has been used for the rapid development of eleven surveillance systems in sub-Saharan Africa and Asia. Features of the HRS automate software generation for a family surveillance applications, obviating the need for new and complex computer software systems for each new longitudinal demographic study.
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Abstract
Clinical experiences for the past 9 years have demonstrated the practicability of the O-ring coping attachment, a modification of the telescopic crown-and-sleeve coping retainers, for removable partial dentures. A circumferential groove placed in the primary coping receives an elastomeric O-ring that fits into a corresponding groove made in the internal surface of the telescopic crown. The O-ring not only provides controllable retention but also acts as a shock absorber. Long-term retention of the prostheses can be easily maintained by periodic replacements of the O-rings. Sophisticated procedures and expensive machines are not required to make the prostheses. Excellent patient acceptance and the versatility in clinical applications make this system one of the winning designs for removable partial prosthodontics.
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Affiliation(s)
- M W Lee
- International Dentist Program, Loma Linda University School of Dentistry, Calif., USA
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Pence B, Lee MW, Baum L. Transitional dentures: a better immediate prosthesis leads to successful restoration. Gen Dent 1992; 40:319-23. [PMID: 1397996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- B Pence
- Loma Linda University School of Dentistry
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