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Adan MA, Psaros C, Chamberlin G, Zionts D, Iyer S, Platt L, Lopes MD, Medeiros S, O'Connor C, Bassett IV, Ard KL. Swiping right on PrEP: a qualitative study of MSM preferences for PrEP public health messaging on dating apps. AIDS Care 2024:1-13. [PMID: 38648528 DOI: 10.1080/09540121.2024.2343761] [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: 07/27/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV. Given that over 70% of MSM meet sexual partners via dating apps, such apps may be an effective platform for promoting HIV pre-exposure prophylaxis (PrEP) use. We aimed to describe preferences among MSM for PrEP advertisements displayed on dating apps. We conducted individual in-depth interviews with 16 MSM recruited from a mobile sexual health unit in Boston, Massachusetts. Two focus groups were also held: one with mobile unit staff (N = 3) and one with mobile unit users (N = 3). Content analysis was used to identify themes related to advertisement content and integration with app use. Mean participant age was 28 (SD 6.8); 37% identified as White and 63% as Latinx. 21% of interviews were conducted in Spanish. Preferences were organized around four themes: (1) relevant and relatable advertisements, (2) expansion of target audiences to promote access, (3) concise and captivating advertisements, and (4) PrEP advertisements and services as options, not obligations. MSM are supportive of receiving information about PrEP on dating apps, but feel that existing advertisements require modification to better engage viewers. Dating apps may be an underutilized tool for increasing PrEP awareness and knowledge among MSM.
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Affiliation(s)
- Matthew A Adan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dani Zionts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Platt
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin L Ard
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Lazarus JE, Green CV, Jerry MS, Germaine L, McEvoy DS, Dugdale CM, Hysell KM, Craig RL, Paras ML, Heller HM, Ard KL, Albin JS, Lee H, Shenoy ES. Separating the rash from the chaff: novel clinical decision support deployed during the mpox outbreak. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38561199 DOI: 10.1017/ice.2024.51] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A clinical decision support system, EvalMpox, was developed to apply person under investigation (PUI) criteria for patients presenting with rash and to recommend testing for PUIs. Of 668 patients evaluated, an EvalMpox recommendation for testing had a positive predictive value of 35% and a negative predictive value of 99% for a positive mpox test.
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Affiliation(s)
- Jacob E Lazarus
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chloe V Green
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle S Jerry
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Lindsay Germaine
- Clinical Informatics and Decision Support, Digital Health, Mass General Brigham, Somerville, MA, USA
| | - Dustin S McEvoy
- Clinical Informatics and Decision Support, Digital Health, Mass General Brigham, Somerville, MA, USA
| | - Caitlin M Dugdale
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristen M Hysell
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rebecca L Craig
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Infection Control, Mass General Brigham, Boston, MA, USA
| | - Molly L Paras
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Howard M Heller
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John S Albin
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hang Lee
- Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Erica S Shenoy
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
- Infection Control, Mass General Brigham, Boston, MA, USA
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Ross JJ, Ard KL. Septic Arthritis of the Spinal Facet Joint: Review of 117 Cases. Open Forum Infect Dis 2024; 11:ofae091. [PMID: 38449920 PMCID: PMC10917203 DOI: 10.1093/ofid/ofae091] [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: 11/25/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Background Septic arthritis of the spinal facet joints is increasingly recognized in the era of magnetic resonance imaging, but its epidemiology, clinical features, management, and prognosis are ill-defined. Methods We review 101 previously published cases and report 16 cases occurring at our institutions between 2006 and 2018. Results Most patients presented with fever (60%) and back or neck pain (86%). Radiation into the hip, buttock, or limb was present in 34%. The lumbosacral vertebral segments were involved in 78% of cases. Most cases (64%) were due to Staphylococcus aureus. Bacteremia was present in 66% and paraspinal muscle abscesses in 54%. While epidural abscesses were present in 56%, neurologic complications were seen in only 9%, likely because most abscesses arose below the conus medullaris. Neurologic complications were more common with cervical or thoracic involvement than lumbosacral (32% vs 2%, P < .0001). Extraspinal infection, such as endocarditis, was identified in only 22% of cases. An overall 98% of patients survived, with only 5% having neurologic sequelae. Conclusions Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine and is frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ard KL, Mayer KH. A Practical Approach to Sexually Transmitted Infection Screening for the Primary Care Clinician. Med Clin North Am 2024; 108:267-278. [PMID: 38331479 DOI: 10.1016/j.mcna.2023.08.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Sexually transmitted infections (STIs) are commonly encountered in primary care. The Centers for Disease Control and Prevention and the US Preventive Services Task Force have both issued guidelines about screening for chlamydia, gonorrhea, syphilis, and HIV. By eliciting a sexual history, understanding their patients' anatomy, and considering factors which may increase the likelihood of STIs and their sequelae, clinicians can implement a practical, evidence-based approach to STI screening.
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Affiliation(s)
- Kevin L Ard
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Kenneth H Mayer
- Division of Infectious Diseases, The Fenway Institute, Fenway Health, Harvard Medical School, Beth Israel Deaconess Medical Center, 1340 Boylston Street, Boston, MA 02215, USA
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Ard KL, MacDonald-Ly A, Demidont AC. Sexual Health Care for Transgender and Gender Diverse People. Med Clin North Am 2024; 108:393-402. [PMID: 38331487 DOI: 10.1016/j.mcna.2023.10.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The proportion of people who identify as transgender and gender diverse (TGD) is increasing. Health care for TGD people, including sexual health care, must affirm and respect patients' gender identities and expressions. Here, the authors outline strategies to make health care settings more welcoming to and inclusive of TGD people and describe concrete steps to improve sexual health care for TGD populations.
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Affiliation(s)
- Kevin L Ard
- Harvard Medical School; Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Andrew MacDonald-Ly
- Gilead Sciences, Inc, HIV Global Medical Affairs, 333 Lakeside Drive, Foster City, CA 94404, USA
| | - A C Demidont
- Gilead Sciences, Inc, HIV Treatment Medical Affairs, 333 Lakeside Drive, Foster City, CA 94404, USA
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Iyer S, Zionts DL, Psaros C, Tyagi A, Jarolimova J, Platt L, Kalweit AH, Ard KL, Bassett IV. Electronic Partner Notification for Sexually Transmitted Infections: A Qualitative Assessment of Patient, Clinical Staff, and State Field Epidemiologist Perspectives. AIDS Patient Care STDS 2024; 38:82-92. [PMID: 38381947 PMCID: PMC10890957 DOI: 10.1089/apc.2023.0184] [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: 02/23/2024] Open
Abstract
In Massachusetts (MA), partner notification is routinely offered for new HIV and infectious syphilis cases, but there are no formal partner notification services for gonorrhea and chlamydia. Electronic partner notification (ePN), which allows patients to anonymously notify their partners of sexually transmitted infection exposure, could fill this gap. We evaluated the acceptability of and ideal characteristics for a statewide ePN service in MA. We performed semistructured interviews with patients at a Boston area sexual health clinic and conducted focus groups with clinicians and Massachusetts Department of Public Health Field Epidemiologists (FEs). We developed a codebook and thematically analyzed interview and focus group data; 25% of interviews were double coded. We identified six main themes from our data: (1) partner notification is a relational process and (2) partner notification is situation dependent. There are three pairs of challenges and core values for an effective ePN system: (3) stigmatization versus inclusivity, (4) trust versus mistrust, and (5) privacy versus helpful information sharing. Therefore, (6) a statewide ePN platform must be customizable at each possible step. Although ePN was acceptable across all three groups, the likelihood of individual use was grounded in a patient's sociocultural context, interpersonal relationships, trust in the platform and health authorities, desire to avoid stigmatization, and privacy needs. These factors are best accommodated by a platform that adapts to users' preferences and needs. ePN presents an opportunity to link partners at risk for gonorrhea or chlamydia to clinical care that is complementary to the more labor-intensive FE role.
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Affiliation(s)
- Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dani L. Zionts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anisha Tyagi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jana Jarolimova
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Laura Platt
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Andrew H. Kalweit
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Kevin L. Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
| | - Ingrid V. Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, USA
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Schubert SL, Miele K, Quilter LAS, Agnew-Brune C, Coor A, Kachur R, Lewis F, Ard KL, Wendel K, Anderson T, Nagendra G, Tromble E. Understanding the Impact of Mpox on Sexual Health Clinical Services: A National Knowledge, Attitudes, and Practices Survey-United States, 2022. Sex Transm Dis 2024; 51:38-46. [PMID: 37889929 DOI: 10.1097/olq.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership with the Centers for Disease Control and Prevention, conducted a survey of US sexual health clinics and programs to assess knowledge, practices, and experiences around mpox to inform a future public health response. METHODS Between August 31 and September 13, 2022, the National Network of STD Clinical Prevention Training Centers facilitated a web-based survey. Descriptive statistics were generated in R. RESULTS Among 168 responses by clinicians (n = 131, 78%) and program staff (n = 37, 22%), more than half (51%) reported at least somewhat significant mpox-related clinical disruptions including burdensome paperwork requirements for mpox testing (40%) and tecovirimat use (88%). Long clinic visits (51%) added additional burden, and the median mpox-related visit lasted 1 hour. Few clinicians felt comfortable with advanced pain management, and clinicians felt most uninformed about preexposure (19%) and postexposure (24%) prophylaxis. Of 89 respondents involved in vaccination, 61% reported using equity strategies; however, accounts of these strategies revealed a focus on guideline or risk factor-based screenings instead of equity activities. CONCLUSIONS These findings highlight the substantial impact of the 2022 mpox outbreak on sexual health care in the United States. Critical gaps and barriers were identified that may inform additional mpox training and technical assistance, including challenges with testing, diagnosis, and management as well as a disconnect between programs' stated goal of equity and operationalization of strategies to achieve equity.
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Rautenberg TA, Ng SK, George G, Moosa MYS, McCluskey SM, Gilbert RF, Pillay S, Aturinda I, Ard KL, Muyindike WR, Musinguzi N, Masette G, Pillay M, Moodley P, Brijkumar J, Gandhi RT, Johnson B, Sunpath H, Bwana MB, Marconi VC, Siedner MJ. Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa. Health Qual Life Outcomes 2023; 21:94. [PMID: 37605150 PMCID: PMC10441724 DOI: 10.1186/s12955-023-02179-x] [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: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa. METHODS We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression. RESULTS In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL. CONCLUSION Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure. TRIAL REGISTRATION ClinicalTrials.gov: NCT02787499.
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Affiliation(s)
- Tamlyn A Rautenberg
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Australia (Sir Samuel Griffith Centre N78 Room 2.34), Nathan campus, QLD, 4111, Australia.
- Menzies Health Institute Queensland, Southport, Australia.
- Metro North Hospital and Health Service Queensland, Herston, Australia.
| | - Shu Kay Ng
- School of Medicine and Dentistry, Centre for Applied Health Economics, Griffith University, Australia (Sir Samuel Griffith Centre N78 Room 2.34), Nathan campus, QLD, 4111, Australia
- Menzies Health Institute Queensland, Southport, Australia
| | - Gavin George
- Health Economics and HIV Research Division, University of KwaZulu-Natal, Durban, South Africa
- Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | | | - Suzanne M McCluskey
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rebecca F Gilbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Selvan Pillay
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Isaac Aturinda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kevin L Ard
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Winnie R Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Musinguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Masette
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Pravi Moodley
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Health Laboratory Service, Durban, South Africa
| | - Jaysingh Brijkumar
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajesh T Gandhi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Brent Johnson
- Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA
| | - Henry Sunpath
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mwebesa B Bwana
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vincent C Marconi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Mark J Siedner
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
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Gupta A, Ashour D, Shebl FM, Platt L, Chiosi JJ, Nelson SB, Ard KL, Kim AY, Bassett IV. Evaluation of Hepatitis C Treatment Outcomes Among Patients Enrolled in Outpatient Parenteral Antibiotic Therapy-Boston, Massachusetts, 2016-2021. Open Forum Infect Dis 2023; 10:ofad342. [PMID: 37496604 PMCID: PMC10368317 DOI: 10.1093/ofid/ofad342] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
In our Boston-based outpatient parenteral antibiotic therapy (OPAT) program between 2016 and 2021, we found that a low proportion of patients with active hepatitis C virus (HCV) were prescribed HCV treatment by their OPAT provider and few achieved sustained virologic response. Clinicians should consider concurrent HCV treatment during OPAT.
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Affiliation(s)
- Akash Gupta
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dina Ashour
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Laura Platt
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - John J Chiosi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra B Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin L Ard
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ard KL, Bruno J, Uzoeghelu U, Lambert C, Khan T, Davis JA, Mayer KH, Keuroghlian AS. PrEP Echo: A National Interdisciplinary Telementoring Program for HIV Prevention Through Practice Transformation. AIDS Educ Prev 2023; 35:247-253. [PMID: 37410373 DOI: 10.1521/aeap.2023.35.3.247] [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] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective, but PrEP use has been suboptimal. We describe a telementoring program for clinics in high-HIV burden areas, focusing on systems-level practice transformation and care for populations disproportionately affected by HIV. We developed and delivered a telementoring program for U.S. health centers. We analyzed participants' baseline and post-session surveys to ascertain experiences providing PrEP and caring for people disproportionately affected by HIV, comparing responses between medical and behavioral health clinicians. Forty-eight people from 16 health centers participated. Medical clinicians were more likely than behavioral health clinicians to care for people taking PrEP, but the groups did not differ in self-rated capacity to counsel about PrEP or care for populations disproportionately affected by HIV. Virtual training on practice transformation for PrEP, involving medical and behavioral health clinicians, is feasible and acceptable. PrEP training and delivery efforts should include behavioral health clinicians.
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Affiliation(s)
- Kevin L Ard
- The Fenway Institute, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jack Bruno
- The Fenway Institute, Boston, Massachusetts
| | | | | | | | - John A Davis
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alex S Keuroghlian
- The Fenway Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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11
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Chamberlin G, Lopes MD, Iyer S, Psaros C, Bassett IV, Medeiros S, O'Connor C, Ard KL. "That was our afterparty": a qualitative study of mobile, venue-based PrEP for MSM. BMC Health Serv Res 2023; 23:504. [PMID: 37198608 DOI: 10.1186/s12913-023-09475-8] [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: 12/23/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND HIV preexposure prophylaxis (PrEP) uptake among men who have sex with men (MSM), a group disproportionately impacted by HIV, is not commensurate with need. Settings which reduce or remove barriers to accessing care are promising venues to support PrEP uptake. PrEP provision at mobile clinics represents a novel strategy to increase PrEP access; however, the acceptability and feasibility of this approach have not been well studied. METHODS Our objective was to understand patient and staff experiences of a mobile clinic van offering PrEP and sexual health services in Boston, Massachusetts, USA. We interviewed mobile unit users and conducted focus groups with mobile unit staff and users. Data were organized using Dedoose software, and content analysis was used to identify themes of access, community, and stigma. RESULTS Nineteen individuals (16 patients and 3 staff members) participated in interviews (N = 13) or focus groups (N = 6). All patients identified as MSM, 63% were Hispanic or Latino, and 21% of patient interviews were conducted in Spanish. Logistical and psychological convenience facilitated service use, while the community-oriented environment improved satisfaction with care. Overall, participants supported expansion of mobile unit services and recommended changes to improve access to longitudinal care. However, some barriers to PrEP persisted, including low HIV risk perception and stigma about sexual behavior. CONCLUSIONS Mobile units can promote sexual health and PrEP uptake, particularly for populations facing social and logistical barriers to care in traditional settings.
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Affiliation(s)
- Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin L Ard
- Harvard Medical School, Boston, MA, USA.
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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12
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Rautenberg TA, Ng SK, George G, Moosa MYS, McCluskey SM, Gilbert RF, Pillay S, Aturinda I, Ard KL, Muyindike W, Musinguzi N, Masette G, Pillay M, Moodley P, Brijkumar J, Gandhi RT, Johnson B, Sunpath H, Bwana MB, Marconi VC, Siedner MJ. Seemingly Unrelated Regression Analysis of the Cost and Health-Related Quality of Life Outcomes of the REVAMP Randomized Clinical Trial. Value Health Reg Issues 2023; 35:42-47. [PMID: 36863066 PMCID: PMC10256267 DOI: 10.1016/j.vhri.2022.12.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 12/17/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This study aimed to evaluate the 9-month cost and health-related quality of life (HRQOL) outcomes of resistance versus viral load testing strategies to manage virological failure in low-middle income countries. METHODS We analyzed secondary outcomes from the REVAMP clinical trial: a pragmatic, open label, parallel-arm randomized trial investigating resistance versus viral load testing for individuals failing first-line treatment in South Africa and Uganda. We collected resource data, valued according to local cost data and used the 3-level version of EQ-5D to measure HRQOL at baseline and 9 months. We applied seemingly unrelated regression equations to account for the correlation between cost and HRQOL. We conducted intention-to-treat analyses with multiple imputation using chained equations for missing data and performed sensitivity analyses using complete cases. RESULTS For South Africa, resistance testing and opportunistic infections were associated with statistically significantly higher total costs, and virological suppression was associated with lower total cost. Higher baseline utility, higher cluster of differentiation 4 (CD4) count, and virological suppression were associated with better HRQOL. For Uganda, resistance testing and switching to second-line treatment were associated with higher total cost, and higher CD4 was associated with lower total cost. Higher baseline utility, higher CD4 count, and virological suppression were associated with better HRQOL. Sensitivity analyses of the complete-case analysis confirmed the overall results. CONCLUSION Resistance testing showed no cost or HRQOL advantage in South Africa or Uganda over the 9-month REVAMP clinical trial.
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Affiliation(s)
- Tamlyn A Rautenberg
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Allied Health Services, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
| | - Shu Kay Ng
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Gavin George
- Health Economics and HIV Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Division of Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Mahomed-Yunus S Moosa
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Suzanne M McCluskey
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rebecca F Gilbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Selvan Pillay
- School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Isaac Aturinda
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kevin L Ard
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nicholas Musinguzi
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Masette
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Melendhran Pillay
- Department of Virology, National Health Laboratory Service, Durban, South Africa
| | - Pravi Moodley
- Department of Virology, National Health Laboratory Service, Durban, South Africa; Department of Virology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Jaysingh Brijkumar
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Rajesh T Gandhi
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Brent Johnson
- Department of Biostatistics and Computation Biology, University of Rochester, Rochester, NY, USA
| | - Henry Sunpath
- Department of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Mwebesa B Bwana
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vincent C Marconi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; Africa Health Research Institute, KwaZulu-Natal, South Africa
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13
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Ard KL, Goldhammer H, Almazan AN, Michael T, O'Donnell D, Bender S, Roman M, Greene RE, Keuroghlian AS. A Pilot Sexual and Gender Minority Health Curriculum for the Largest Public Health Care System in the United States. Acad Med 2022; 97:1489-1493. [PMID: 35263300 DOI: 10.1097/acm.0000000000004657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PROBLEM Sexual and gender minority (SGM) people face multiple health disparities. Clinicians often lack adequate training to address health needs of SGM people. In this setting, some health care organizations have sought to develop system-wide curricula to build clinician knowledge and capacity around SGM health. APPROACH NYC Health + Hospitals partnered with the National LGBTQIA+ [lesbian, gay, bisexual, transgender, queer, intersex, asexual] Health Education Center at The Fenway Institute to design and implement a novel SGM health care curriculum, offered from 2017 to 2020. The pilot program featured a 90-minute live introductory session, a pretest, a post-test, and six 45-minute online modules focusing on a range of topics in SGM health care. OUTCOMES Of approximately 35,000 employees from a range of settings and professional roles across NYC Health + Hospitals, 792 participated in the pilot program; most were clinicians at acute care hospitals, with the single largest group being attending clinicians. The proportion of eligible employees completing each component of the curriculum varied: 544 of 792 (68.7%) completed the online pretest, while 373 of 792 (47.1%) completed the module on behavioral health. Of 373 participants who completed both the pre- and post-tests, mean scores rose significantly from 60.9 on the pretest to 81.9 on the post-test ( P < .001). NEXT STEPS Future efforts should focus on increasing staff participation in the curriculum through scale-up efforts across the health care system, as well as measuring patient outcomes to assess the clinical impact of the initiative.
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Affiliation(s)
- Kevin L Ard
- K.L. Ard is medical director, National LGBTQIA+ Health Education Center, The Fenway Institute, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - Hilary Goldhammer
- H. Goldhammer is a technical writer, National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts
| | - Anthony N Almazan
- A.N. Almazan was a student, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, at the time this initiative was conducted
| | - Timothy Michael
- T. Michael was program coordinator, National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, at the time this initiative was conducted
| | - Deirdre O'Donnell
- D. O'Donnell was program coordinator, National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, at the time this initiative was conducted
| | - Sarah Bender
- S. Bender was associate director of gender equity, NYC Health + Hospitals, New York, New York
| | - Matilde Roman
- M. Roman is chief diversity and inclusion officer, NYC Health + Hospitals, New York, New York
| | - Richard E Greene
- R.E. Greene is associate professor of medicine, New York University Grossman School of Medicine, New York, New York
| | - Alex S Keuroghlian
- A.S. Keuroghlian is principal investigator, National LGBTQIA+ Health Education Center, The Fenway Institute, and associate professor of psychiatry, Harvard Medical School, Boston, Massachusetts
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14
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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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15
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Ard KL, Uzoeghelu U, Bruno J, Lambert C, Mayer KH, Davis JA, Keuroghlian AS. Readiness of US Federally Qualified Health Centers to Provide HIV Pre-exposure Prophylaxis. Open Forum Infect Dis 2021; 8:ofab447. [PMID: 34738023 PMCID: PMC8561245 DOI: 10.1093/ofid/ofab447] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 12/02/2022] Open
Abstract
We report the results of a survey on HIV pre-exposure prophylaxis (PrEP) perceptions, capacity, and barriers at federally qualified health centers (FQHCs) in high–HIV burden jurisdictions in the United States. Health care workers at FQHCs identified multiple barriers to, and strategies for, improving PrEP implementation.
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Affiliation(s)
- Kevin L Ard
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jack Bruno
- The Fenway Institute, Boston, Massachusetts, USA
| | - Cei Lambert
- The Fenway Institute, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - John A Davis
- University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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16
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Platt L, Shebl FM, Qian Y, Bunda B, Ard KL, Bassett IV. Urban Sexual Health Clinic Patients With "Undetermined Risk" for HIV Are Less Likely to Receive Preexposure Prophylaxis. Sex Transm Dis 2021; 48:881-886. [PMID: 33938518 PMCID: PMC8505145 DOI: 10.1097/olq.0000000000001460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND New diagnoses of HIV increasingly occur among people who fall outside traditional transmission risk categories. This group remains poorly defined, and HIV prevention efforts for this group lag behind efforts for patients in other risk groups. METHODS We conducted a retrospective review of patient visits at sexual health clinics in Boston, MA, over a 14-month period. Patients were classified into Centers for Disease Control and Prevention-defined HIV transmission risk categories. We compared frequencies of sexually transmitted infections (STIs), HIV, preexposure prophylaxis (PrEP) indications, and PrEP prescriptions. Predictors of HIV or STI among patients in the undetermined risk category were assessed with logistic regression. RESULTS There were 4723 clinic visits during the study period. Patients in the undetermined risk group constituted the largest proportion (55.8%), followed by men who have sex with men (MSM; 42.7%). The proportion of visits by patients in the undetermined risk group with an indication for PrEP was low (28.0%) compared with MSM (91.3%) and MSM who also inject drugs (93.8%); however, the absolute number was high (737). Among patients with an indication for PrEP, those in the undetermined risk group were least likely to receive a prescription. Behavioral risk factors were poorly predictive of STI or HIV among patients in the undetermined risk group. CONCLUSIONS Patients with undetermined risk for HIV constituted a large proportion of clinic visits and had a large volume of sexual health needs but rarely received PrEP when indicated. To end the HIV epidemic in the United States, prevention efforts must include people who fall outside traditional risk categories.
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Affiliation(s)
- Laura Platt
- From the Division of Infectious Diseases
- Medical Practice Evaluation Center, Massachusetts General Hospital
| | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital
| | - Yiqi Qian
- Medical Practice Evaluation Center, Massachusetts General Hospital
| | - Bridget Bunda
- Medical Practice Evaluation Center, Massachusetts General Hospital
| | - Kevin L. Ard
- From the Division of Infectious Diseases
- Harvard Medical School
| | - Ingrid V. Bassett
- From the Division of Infectious Diseases
- Medical Practice Evaluation Center, Massachusetts General Hospital
- Harvard Medical School
- Harvard University Center for AIDS Research, Harvard University, Boston, MA
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17
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Affiliation(s)
- Howard M Heller
- From the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Massachusetts General Hospital, and the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Massachusetts General Hospital, and the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Harvard Medical School - both in Boston
| | - Brian L Edlow
- From the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Massachusetts General Hospital, and the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Harvard Medical School - both in Boston
| | - Kevin L Ard
- From the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Massachusetts General Hospital, and the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Harvard Medical School - both in Boston
| | - Tasos Gogakos
- From the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Massachusetts General Hospital, and the Departments of Medicine (H.M.H., K.L.A.), Radiology (R.G.G.), Neurology (B.L.E.), and Pathology (T.G.), Harvard Medical School - both in Boston
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18
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Affiliation(s)
- Kevin L Ard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.L.A., R.P.W.)
| | - Rochelle P Walensky
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.L.A., R.P.W.)
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19
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Affiliation(s)
- Shibani S Mukerji
- From the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - Kevin L Ard
- From the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - Pamela W Schaefer
- From the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
| | - John A Branda
- From the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Neurology (S.S.M.), Medicine (K.L.A.), Radiology (P.W.S.), and Pathology (J.A.B.), Harvard Medical School - both in Boston
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20
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Napoleon SC, Maynard MA, Almonte A, Cormier K, Bertrand T, Ard KL, Chan PA. Considerations for STI Clinics During the COVID-19 Pandemic. Sex Transm Dis 2020; 47:431-433. [PMID: 32355107 PMCID: PMC7448715 DOI: 10.1097/olq.0000000000001192] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
Coronavirus disease (COVID-19) is responsible for a global pandemic. It is important to balance the need for access to healthcare services, including testing and treatment for sexually transmitted infections. Sexually transmitted infection programs must consider how to use limited resources and implement novel approaches to provide continued access to care.
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Affiliation(s)
| | | | | | | | | | - Kevin L. Ard
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Philip A. Chan
- From the Department of Medicine, Brown University
- Department of Health, Providence, RI
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21
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Ard KL, Edelstein ZR, Bolduc P, Daskalakis D, Gandhi AD, Krakower DS, Myers JE, Keuroghlian AS. Public Health Detailing for Human Immunodeficiency Virus Pre-exposure Prophylaxis. Clin Infect Dis 2020; 68:860-864. [PMID: 30020422 DOI: 10.1093/cid/ciy573] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/23/2018] [Accepted: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
Despite the promise of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP), PrEP remains underutilized, often due to clinician factors. Academic or public health detailing is a process by which university and/or government groups employ the marketing practices of pharmaceutical companies to improve clinical practice. We describe the novel application of detailing to increase PrEP prescribing and related care in New York City and New England. Detailing can play a crucial role in PrEP implementation.
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Affiliation(s)
- Kevin L Ard
- The National LGBT Health Education Center, The Fenway Institute, Boston.,Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | | | - Philip Bolduc
- Department of Family Medicine and Community Health, University of Massachusetts, Worcester
| | | | | | - Douglas S Krakower
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Julie E Myers
- New York City Department of Health and Mental Hygiene.,Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
| | - Alex S Keuroghlian
- The National LGBT Health Education Center, The Fenway Institute, Boston.,Department of Psychiatry, Massachusetts General Hospital, Boston
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22
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Ross JJ, Ard KL, Carlile N. Septic Arthritis and the Opioid Epidemic: 1465 Cases of Culture-Positive Native Joint Septic Arthritis From 1990-2018. Open Forum Infect Dis 2020; 7:ofaa089. [PMID: 32258206 PMCID: PMC7100530 DOI: 10.1093/ofid/ofaa089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/23/2019] [Accepted: 03/06/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The clinical spectrum of septic arthritis in the era of the opioid crisis is ill-defined. METHODS This is a retrospective chart review of 1465 cases of culture-positive native joint septic arthritis at Boston teaching hospitals between 1990 and 2018. RESULTS Between 1990-2008 and 2009-2018, the proportion of septic arthritis cases involving people who inject drugs (PWID) rose from 10.3% to 20% (P < .0000005). Overall, methicillin-sensitive Staphylococcus aureus (MSSA) caused 41.5% of cases, and methicillin-resistant Staphylococcus aureus (MRSA) caused 17.9%. Gram-negative rods caused only 6.2% of cases. Predictors of MRSA septic arthritis included injection drug use (P < .001), bacteremia (P < .001), health care exposure (P < .001), and advancing age (P = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P < .00001), as were infections with MRSA (24% vs 16.8%; P = .01) and Serratia sp. (4% vs 0.4%; P = .002). Septic arthritis in the setting of injection drug use was significantly more likely to involve the sacroiliac, acromioclavicular, and facet joints; 36.8% of patients had initial synovial fluid cell counts of <50 000 cells/mm3. CONCLUSIONS Injection drug use has become the most common risk factor for septic arthritis in our patient population. Septic arthritis in PWID is more often caused by MRSA, MSSA, and Serratia sp., and is more prone to involve the sacroiliac, acromioclavicular, sternoclavicular, and facet joints. Synovial fluid cell counts of <50 000 cells/mm3 are common in culture-positive septic arthritis.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Correspondence: J. Ross MD, FIDSA, 15 Francis St., PBB-420, Brigham and Women’s Hospital, Boston, MA 02115 ()
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Narath Carlile
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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23
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Ard KL, Krakower DS, Keuroghlian AS. What do we say about condoms in 2019? Lancet HIV 2019; 7:e82-e83. [PMID: 31473168 DOI: 10.1016/s2352-3018(19)30237-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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24
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Keuroghlian AS, Ard KL, Makadon HJ. Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sex Health 2019; 14:119-122. [PMID: 28160786 DOI: 10.1071/sh16145] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/09/2017] [Indexed: 11/23/2022]
Abstract
Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.
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Affiliation(s)
- Alex S Keuroghlian
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Kevin L Ard
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Harvey J Makadon
- The National LGBT Health Education Center at The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA
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Affiliation(s)
- Kevin L Ard
- From the National LGBT Health Education Center, the Fenway Institute (K.L.A., A.S.K.), and the Division of Infectious Diseases (K.L.A.) and Department of Psychiatry (A.S.K), Massachusetts General Hospital - all in Boston
| | - Alex S Keuroghlian
- From the National LGBT Health Education Center, the Fenway Institute (K.L.A., A.S.K.), and the Division of Infectious Diseases (K.L.A.) and Department of Psychiatry (A.S.K), Massachusetts General Hospital - all in Boston
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D'Couto HT, Robbins GK, Ard KL, Wakeman SE, Alves J, Nelson SB. Outcomes According to Discharge Location for Persons Who Inject Drugs Receiving Outpatient Parenteral Antimicrobial Therapy. Open Forum Infect Dis 2018; 5:ofy056. [PMID: 29766017 PMCID: PMC5941140 DOI: 10.1093/ofid/ofy056] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/14/2018] [Accepted: 03/20/2018] [Indexed: 11/14/2022] Open
Abstract
Background Opioid use disorder poses a significant public health risk. Persons who inject drugs (PWID) suffer from high mortality and morbidity secondary to serious infectious diseases, often requiring prolonged courses of outpatient parenteral antibiotics. The goal of this study was to determine the outcomes of PWID discharged to home or to a skilled nursing or rehabilitation facility (SNF/rehab) with parenteral antibiotic treatment under an outpatient parenteral antimicrobial therapy (OPAT) program. Methods This is a retrospective observational study. The study population was identified via hospital and OPAT databases using substance use disorder diagnoses and confirmed through chart review. The study population included hospitalized PWID with injection drug use in the preceding 2 years who were discharged between 2010 and 2015 to complete at least 2 weeks of parenteral antibiotics and monitored by the OPAT program. Retrospective chart review was used to describe patient characteristics and outcomes. Results Fifty-two patients met inclusion criteria, 21 of whom were discharged to home and 31 were discharged to a SNF/rehab. Of the patients discharged to home, 17 (81%) completed their planned antibiotic courses without complication. Twenty (64%) patients discharged to a SNF/rehab completed the antibiotic courses without complication. Six (11%) patients had line infections, 6 (11%) had injection drug use relapse, and 12 (23%) required readmission. Conclusions Persons who inject drugs discharged home were not more likely to have complications than those discharged to a SNF/rehab. Home OPAT may be a safe discharge option in carefully selected patients.
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Affiliation(s)
- Helen T D'Couto
- Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Gregory K Robbins
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Kevin L Ard
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Justin Alves
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Sandra B Nelson
- Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston.,Department of Medicine, Massachusetts General Hospital, Boston
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Affiliation(s)
- Kevin L Ard
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Hillary R Kelly
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Rajesh T Gandhi
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
| | - Abner Louissaint
- From the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Massachusetts General Hospital, the Departments of Medicine (K.L.A., R.T.G.), Radiology (H.R.K.), and Pathology (A.L.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston
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Brown RT, Miao Y, Mitchell SL, Bharel M, Patel M, Ard KL, Grande LJ, Blazey-Martin D, Floru D, Steinman MA. Health Outcomes of Obtaining Housing Among Older Homeless Adults. Am J Public Health 2015; 105:1482-8. [PMID: 25973822 DOI: 10.2105/ajph.2014.302539] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the impact of obtaining housing on geriatric conditions and acute care utilization among older homeless adults. METHODS We conducted a 12-month prospective cohort study of 250 older homeless adults recruited from shelters in Boston, Massachusetts, between January and June 2010. We determined housing status at follow-up, determined number of emergency department visits and hospitalizations over 12 months, and examined 4 measures of geriatric conditions at baseline and 12 months. Using multivariable regression models, we evaluated the association between obtaining housing and our outcomes of interest. RESULTS At 12-month follow-up, 41% of participants had obtained housing. Compared with participants who remained homeless, those with housing had fewer depressive symptoms. Other measures of health status did not differ by housing status. Participants who obtained housing had a lower rate of acute care use, with an adjusted annualized rate of acute care visits of 2.5 per year among participants who obtained housing and 5.3 per year among participants who remained homeless. CONCLUSIONS Older homeless adults who obtained housing experienced improved depressive symptoms and reduced acute care utilization compared with those who remained homeless.
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Affiliation(s)
- Rebecca T Brown
- Rebecca T. Brown and Michael A. Steinman are with the Division of Geriatrics, University of California, San Francisco. Yinghui Miao is with the San Francisco Veterans Affairs Medical Center, San Francisco, CA. Susan L. Mitchell is with the Hebrew SeniorLife Institute for Aging Research, Boston, MA. Monica Bharel is with the Boston Health Care for the Homeless Program, Boston. Kevin L. Ard is with the Department of Medicine, Brigham and Women's Hospital, Boston. Mitkumar Patel is with the Department of Medicine, St. Elizabeth's Medical Center, Boston. Laura J. Grande is with the Psychology Service, Veterans Affairs Boston Healthcare System, Boston. Deborah Blazey-Martin is with the Department of Medicine, Tufts Medical Center, Boston. Daniella Floru is with the Division of Geriatric Medicine, Lemuel Shattuck Hospital, Boston
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Ard KL, Makadon HJ. Addressing intimate partner violence in lesbian, gay, bisexual, and transgender patients. J Gen Intern Med 2011; 26:930-3. [PMID: 21448753 PMCID: PMC3138983 DOI: 10.1007/s11606-011-1697-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [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: 01/04/2011] [Revised: 03/07/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
Abstract
The medical community's efforts to address intimate partner violence (IPV) have often neglected members of the lesbian, gay, bisexual, and transgender (LGBT) population. Heterosexual women are primarily targeted for IPV screening and intervention despite the similar prevalence of IPV in LGBT individuals and its detrimental health effects. Here, we highlight the burden of IPV in LGBT relationships, discuss how LGBT and heterosexual IPV differ, and outline steps clinicians can take to address IPV in their LGBT patients.
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Affiliation(s)
- Kevin L Ard
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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