1
|
Si Y, Xue H, Liao H, Xie Y, Xu DR, Smith MK, Yip W, Cheng W, Tian J, Tang W, Sylvia S. The quality of telemedicine consultations for sexually transmitted infections in China. Health Policy Plan 2024; 39:307-317. [PMID: 38113375 DOI: 10.1093/heapol/czad119] [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: 02/09/2023] [Revised: 12/06/2023] [Accepted: 12/16/2023] [Indexed: 12/21/2023] Open
Abstract
The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed. However, the quality of STI care provided by telemedicine platforms remains unknown. After systemically identifying the universe of DTC telemedicine platforms providing on-demand consultations in China in 2019, we evaluated their quality using the method of unannounced standardized patients (SPs). SPs presented routine cases of syphilis and herpes. Of the 110 SP visits conducted, physicians made a correct diagnosis in 44.5% (95% CI: 35.1% to 54.0%) of SP visits, and correctly managed 10.9% (95% CI: 5.0% to 16.8%). Low rates of correct management were primarily attributable to the failure of physicians to refer patients for STI testing. Controlling for other factors, videoconference (vs SMS-based) consultation mode and the availability of public physician ratings were associated with higher-quality care. Our findings suggest a need for further research on the causal determinants of care quality on DTC telemedicine platforms and effective policy approaches to promote their potential to expand access to STI care in developing countries while limiting potential unintended consequences for patients.
Collapse
Affiliation(s)
- Yafei Si
- Centre for International Studies on Development and Governance, Zhejiang University, No. 688 Yuhangtang Road, Hangzhou, Zhejiang 310058, China
- School of Risk & Actuarial Studies and CEPAR, The University of New South Wales, 223 Anzac Parade, Kensington, NSW 2033, Australia
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue Kunshan, Jiangsu 215316, China
- University of North Carolina Project-China, No313 Huanshizhong Road Guangzhou, Guangdong 510000, China
| | - Hao Xue
- Stanford Center for China's Institutions and Economy, Stanford University, 616 Jane Stanford Way, Stanford, CA 94305, USA
| | - Huipeng Liao
- University of North Carolina Project-China, No313 Huanshizhong Road Guangzhou, Guangdong 510000, China
| | - Yewei Xie
- University of North Carolina Project-China, No313 Huanshizhong Road Guangzhou, Guangdong 510000, China
- Programme for Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Dong Roman Xu
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, 1023 South Shatai Road, Guangzhou, Guangdong 510515, China
- Acacia Labs, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), 1023 South Shatai Road, Guangzhou, Guangdong 510515, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN 55454, USA
| | - Winnie Yip
- Department of Global Health and Population, Harvard University, 665 Huntington Ave, Cambridge, MA 02115, USA
| | - Weibin Cheng
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No. 466 Xingangzhong Road, Guangzhou, Guangdong 510330, China
- School of Data Science, City University of Hong Kong, Tat Chee Avenue Kowloon, Hong Kong 0000, China
| | - Junzhang Tian
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No. 466 Xingangzhong Road, Guangzhou, Guangdong 510330, China
| | - Weiming Tang
- University of North Carolina Project-China, No313 Huanshizhong Road Guangzhou, Guangdong 510000, China
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No. 466 Xingangzhong Road, Guangzhou, Guangdong 510330, China
- Institute for Global Health and Infectious Disease, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA
| | - Sean Sylvia
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, Chapel Hill, NC 27516, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 25 M.L.K. Jr Blvd, Chapel Hill, NC 27516, USA
| |
Collapse
|
2
|
Smith MK, Ehresmann KR, Knowlton GS, LaFrance AB, Vazquez Benitez G, Quadri NS, DeFor TA, Mann EM, Alpern JD, Stauffer WM. Understanding COVID-19 Health Disparities With Birth Country and Language Data. Am J Prev Med 2023; 65:993-1002. [PMID: 37406745 DOI: 10.1016/j.amepre.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Understanding of COVID-19-related disparities in the U.S. is largely informed by traditional race/ethnicity categories that mask important social group differences. This analysis utilizes granular information on patients' country of birth and preferred language from a large health system to provide more nuanced insights into health disparities. METHODS Data from patients seeking care from a large Midwestern health system between January 1, 2019 and July 31, 2021 and COVID-19-related events occurring from March 18, 2020 to July 31, 2021 were used to describe COVID-19 disparities. Statistics were performed between January 1, 2022 and March 15, 2023. Age-adjusted generalized linear models estimated RR across race/ethnicity, country of birth grouping, preferred language, and multiple stratified groups. RESULTS The majority of the 1,114,895 patients were born in western advanced economies (58.6%). Those who were Hispanic/Latino, were born in Latin America and the Caribbean, and preferred Spanish language had highest RRs of infection and hospitalization. Black-identifying patients born in sub-Saharan African countries had a higher risk of infection than their western advanced economies counterparts. Subanalyses revealed elevated hospitalization and death risk for White-identifying patients from Eastern Europe and Central Asia and Asian-identifying patients from Southeast Asia and the Pacific. All non-English languages had a higher risk of all COVID-19 outcomes, most notably Hmong and languages from Burma/Myanmar. CONCLUSIONS Stratifications by country of birth grouping and preferred language identified culturally distinct groups whose vulnerability to COVID-19 would have otherwise been masked by traditional racial/ethnic labels. Routine collection of these data is critical for identifying social groups at high risk and for informing linguistically and culturally relevant interventions.
Collapse
Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | | | - Nasreen S Quadri
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | - Erin M Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan D Alpern
- HealthPartners Institute, Bloomington, Minnesota; Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - William M Stauffer
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota; Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| |
Collapse
|
3
|
Rosser BS, Weideman BC, Rider GN, Jatoi A, Ecklund AM, Wheldon CW, Talley KM, Kulasingam S, Smith MK, Jacobs DR, Mitteldorf D, West W, Alley R, Ross MW. Sexual and Gender Minority Invisibility in Cancer Studies: A Call for Effective Recruitment Methods to Address Cancer Disparities. J Clin Oncol 2023; 41:5093-5098. [PMID: 37725780 PMCID: PMC10666979 DOI: 10.1200/jco.23.00655] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023] Open
Abstract
#LGBTQ+ people with cancer are invisibilized: A call for #intersectional cancer research (link here) #healthequity
Collapse
Affiliation(s)
- B.R. Simon Rosser
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ben C.D. Weideman
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - G. Nic Rider
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Alexandra M. Ecklund
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christopher W. Wheldon
- Department of Social and Behavioural Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Kristine M.C. Talley
- Adult and Geriatric Health, University of Minnesota School of Nursing, Minneapolis, MN
| | - Shalini Kulasingam
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN
| | - Rhea Alley
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael W. Ross
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
4
|
Smith MK, Luo D, Meng S, Fei Y, Zhang W, Tucker J, Wei C, Tang W, Yang L, Joyner BL, Huang S, Wang C, Yang B, Sylvia SY. An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma. medRxiv 2023:2023.08.21.23294305. [PMID: 37662413 PMCID: PMC10473797 DOI: 10.1101/2023.08.21.23294305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Consistent evidence highlights the role of stigma in impairing healthcare access in people living with HIV (PLWH), men who have sex with men (MSM), and people with both identities. We developed an incognito standardized patient (SP) approach to obtain observations of providers to inform a tailored, relevant, and culturally appropriate stigma reduction training. Our pilot cluster randomized control trial assessed the feasibility, acceptability, and preliminary effects of an intervention to reduce HIV stigma, anti-gay stigma, and intersectional stigma. Methods Design of the intervention was informed by the results of a baseline round of incognito visits in which SPs presented standardized cases to consenting doctors. The HIV status and sexual orientation of each case was randomly varied, and stigma was quantified as differences in care across scenarios. Care quality was measured in terms of diagnostic testing, diagnostic effort, and patient-centered care. Impact of the training, which consisted of didactic, experiential, and discussion-based modules, was assessed by analyzing results of a follow-up round of SP visits using linear fixed effects regression models. Results Feasibility and acceptability among the 55 provider participants was high. We had a 87.3% recruitment rate and 74.5% completion rate of planned visits (N=238) with no adverse events. Every participant found the training content "highly useful" or "useful." Preliminary effects suggest that, relative to the referent case (HIV negative straight man), the intervention positively impacted testing for HIV negative MSM (0.05 percentage points [PP], 95% CI,-0.24, 0.33) and diagnostic effort in HIV positive MSM (0.23 standard deviation [SD] improvement, 95% CI, -0.92, 1.37). Patient-centered care only improved for HIV positive straight cases post-training relative to the referent group (SD, 0.57; 95% CI, -0.39, 1.53). All estimates lacked statistical precision, an expected outcome of a pilot RCT. Conclusions Our pilot RCT demonstrated high feasibility, acceptability, and several areas of impact for an intervention to reduce enacted healthcare stigma in a low-/middle-income country setting. The relatively lower impact of our intervention on care outcomes for PLWH suggests that future trainings should include more clinical content to boost provider confidence in the safe and respectful management of patients with HIV.
Collapse
|
5
|
Thomas CM, Yun K, Mudenge NU, Abudiab S, de Acosta D, Fredkove WM, Garcia Y, Hoffman SJ, Karim S, Mann E, Smith MK, Yu K, Dawson-Hahn E. Experiences of American Health Departments, Health Systems, and Community Organizations in COVID-19 Vaccine Provision for Refugee, Immigrant, and Migrant Communities. Am J Trop Med Hyg 2023; 109:471-479. [PMID: 37429571 PMCID: PMC10397449 DOI: 10.4269/ajtmh.23-0034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023] Open
Abstract
Effective provision of COVID-19 vaccines could mitigate the disproportionate impact of the COVID-19 pandemic experienced by many immigrant communities. To describe organizational experiences in using COVID-19 vaccination programs, qualitative interviews were conducted from September 2020 to April 2021 with representatives from public health, health system, and community organizations responding to the COVID-19 pandemic among immigrant communities across the United States. Interviews followed a semistructured interview guide and were audio recorded, transcribed, and coded. A latent thematic analysis was facilitated by Dedoose software. Interviews representative of 18 public health departments, 20 healthcare systems, and 18 community organizations were included in the analysis. Five identified themes referenced the importance of 1) appreciating community and individual heterogeneity in health priorities and attitudes; 2) addressing vaccine fears with trustworthy messages; 3) ensuring equitable access to vaccine opportunities; 4) making substantive investments in community partnerships and outreach; and 5) adapting to meet new needs. It is essential that vaccine efforts consider community heterogeneity, communicate in a trustworthy and culturally and linguistically appropriate manner, strive for equitable provision of care, build partnerships, and learn from prior experiences.
Collapse
Affiliation(s)
- Christine M. Thomas
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Katherine Yun
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nadège U. Mudenge
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Community Leadership Board, National Resource Center for Refugees, Immigrants, and Migrants, Minneapolis, Minnesota
| | - Seja Abudiab
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Diego de Acosta
- National Resource Center for Refugees, Immigrants, and Migrants, Minneapolis, Minnesota
| | - Windy M. Fredkove
- National Resource Center for Refugees, Immigrants, and Migrants, Minneapolis, Minnesota
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota
| | - Yesenia Garcia
- Seattle Children’s Research Institute, Seattle, Washington
| | - Sarah J. Hoffman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Sayyeda Karim
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota
| | - Erin Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, Minnesota
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Kimberly Yu
- National Resource Center for Refugees, Immigrants, and Migrants, Minneapolis, Minnesota
| | | |
Collapse
|
6
|
Smith MK, Latkin CA, Hutton HE, Chander G, Enns EA, Ha TV, Frangakis C, Sripaipan T, Go VF. Longitudinal Trajectories of Alcohol Use in Vietnamese Adults with Hazardous Alcohol Use and HIV. AIDS Behav 2023; 27:1972-1980. [PMID: 36409386 DOI: 10.1007/s10461-022-03930-z] [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: 11/06/2022] [Indexed: 11/22/2022]
Abstract
A three-armed drinking cessation trial in Vietnam found that both a brief and intensive version of an intervention effectively reduced hazardous drinking in people living with HIV. We used group-based trajectory modeling (GBTM) to assess the extent to which findings may vary by latent subgroups distinguished by their unique responses to the intervention. Using data on drinking patterns collected over the 12 months, GBTM identified five trajectory groups, three of which were suboptimal ["non-response" (17.2%); "non-sustained response" (15.7%), "slow response" (13.1%)] and two optimal ["abstinent" (36.4%); "fast response" (17.6%)]. Multinomial logistic regression was used to determine that those randomized to any intervention arm were less likely to be in a suboptimal trajectory group, even more so if randomized to the brief (vs. intensive) intervention. Older age and higher baseline coping skills protected against membership in suboptimal trajectory groups; higher scores for readiness to quit drinking were predictive of it. GBTM revealed substantial heterogeneity in participants' response to a cessation intervention and may help identify subgroups who may benefit from more specialized services within the context of the larger intervention.
Collapse
Affiliation(s)
- M Kumi Smith
- School of Public Health, University of Minnesota, Twin Cities, 1300 2Nd Ave S, Suite 300, Minneapolis, MN, USA.
| | - Carl A Latkin
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Eva A Enns
- School of Public Health, University of Minnesota, Twin Cities, 1300 2Nd Ave S, Suite 300, Minneapolis, MN, USA
| | - Tran Viet Ha
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Teerada Sripaipan
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Vivian F Go
- School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
7
|
Quadri NS, Knowlton G, Vazquez Benitez G, Ehresmann KR, LaFrance AB, DeFor TA, Smith MK, Mann EM, Alpern JD, Stauffer WM. Evaluation of Preferred Language and Timing of COVID-19 Vaccine Uptake and Disease Outcomes. JAMA Netw Open 2023; 6:e237877. [PMID: 37043199 PMCID: PMC10099068 DOI: 10.1001/jamanetworkopen.2023.7877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Importance Beyond traditional race and ethnicity demographic characteristics, additional discrete data variables are needed for informed health interventions in the US. Objective To examine whether COVID-19 vaccine uptake patterns and associated disease outcomes differ among language preference groups. Design, Setting, and Participants A cohort study of 851 410 individuals aged 18 years or older in a large multispecialty health system in Minnesota and western Wisconsin was conducted between December 15, 2020, and March 31, 2022. Exposure Self-identified language preference and limited English proficiency (LEP) as measured by interpreter need were used to create subgroups using US census categories and attention to capture languages known to represent refugee groups. Main Outcomes and Measures The primary outcome was COVID-19 vaccination uptake rates and time to first vaccine. Secondary outcomes were rates of COVID-19-associated hospitalization and death. Results Most of the 851 410 participants (women, 493 910 [58.0%]; median age, 29 [IQR, 35-64] years) were US-born English speakers; 7.5% were born in other countries, 4.0% had a language preference other than English (LPOE), and 3.0% indicated LEP as measured by interpreter need. Marked temporal clusters were observed for COVID-19 vaccination uptake, hospitalizations, and deaths associated with primary series vaccine eligibility, booster availability, and COVID-19 variants. Delayed first-dose vaccine was observed with LPOE (hazard ratio [HR], 0.83; 95% CI, 0.82-0.84) and interpreter need (HR, 0.81; 95% CI, 0.80-0.82) compared with those with English language preference and proficiency. Patients with LPOE were approximately twice as likely to be hospitalized (rate ratio [RR], 1.85; 95% CI, 1.63-2.08) or die (RR, 2.13; 95% CI, 1.65-2.69). Patients with LEP experienced even higher rates of hospitalization (RR, 1.98; 95% CI, 1.73-2.25) and COVID-19-associated death (RR, 2.32; 95% CI, 1.79-2.95). Outcomes varied for individual language preference groups. Conclusions and Relevance In this study, delayed time to first-dose vaccine was associated with increased COVID-19 hospitalization and death rates for specific LPOE and LEP groups. The findings suggest that data collection of language preference and interpreter need provides actionable health intervention information. Standardized system-level data collection, including at a national level, may improve efficient identification of social groups with disproportionate health disparities and provide key information on improving health equity in the US.
Collapse
Affiliation(s)
- Nasreen S Quadri
- Department of Medicine, University of Minnesota, Minneapolis
- Departments of Medicine and Pediatrics, Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis
| | | | | | | | | | | | - M Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Erin M Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Jonathan D Alpern
- Department of Medicine, University of Minnesota, Minneapolis
- HealthPartners Institute, Bloomington, Minnesota
| | - William M Stauffer
- Department of Medicine, University of Minnesota, Minneapolis
- Departments of Medicine and Pediatrics, Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis
| |
Collapse
|
8
|
Abudiab S, de Acosta D, Shafaq S, Yun K, Thomas C, Fredkove W, Garcia Y, Hoffman SJ, Karim S, Mann E, Yu K, Smith MK, Coker T, Dawson-Hahn E. "Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States. Front Public Health 2023; 11:1078980. [PMID: 37064664 PMCID: PMC10097984 DOI: 10.3389/fpubh.2023.1078980] [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: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. Methods This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Results Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Conclusion Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.
Collapse
Affiliation(s)
- Seja Abudiab
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Sheeba Shafaq
- Community Leadership Board, National Resource Center for Refugees, Immigrants and Migrants, San Francisco, CA, United States
| | - Katherine Yun
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Christine Thomas
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Windy Fredkove
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Yesenia Garcia
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Sarah J. Hoffman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Sayyeda Karim
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Erin Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Kimberly Yu
- Independent Consultant, Seattle, WA, United States
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Tumaini Coker
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | |
Collapse
|
9
|
Smith MK, Laidlaw C, Abraldes JG, Bhanji R. A237 STATIN USE IN LIVER TRANSPLANT: INDICATION, USE, AND IMPACT OF STATIN THERAPY ON PATIENT OUTCOMES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991204 DOI: 10.1093/jcag/gwac036.237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Cardiovascular and metabolic diseases are prevalent among patients with chronic liver disease (CLD) and contribute to adverse outcomes and mortality. Prior studies have hypothesized statin therapy improves liver transplant (LT) survival due to anti-inflammatory properties and reduced cardiac risk. Evidence for use of statins in this population is limited as acute liver failure or decompensated cirrhosis is considered a contraindication. Despite evidence supporting statin therapy in CLD their use remains inconsistent. Purpose Our study aimed to evaluate the indication and rate of statin use in patients both pre- and post-LT, as well as the impact on post-LT patient survival, graft failure, and post-LT cardiovascular and metabolic disease. Method This was a retrospective cohort study of adult LT recipients at the University of Alberta, Edmonton, Canada between 2005 and 2020. Exclusion criteria included pre-transplant acute liver failure, multi-visceral transplant, and re-transplant. Demographic, pharmaceutical and clinical data was collected through review of electronic medical records. Primary endpoints included rate of statin use, post-LT patient survival, and graft failure; secondary endpoints included development of cardiac disease, dyslipidemia, and metabolic syndrome post-LT. Result(s) We identified 868 patients meeting inclusion criteria; 596 (68.7%) were male, 713 (82.3%) were Caucasian, and median age at transplant was 55. The most common indication for LT was hepatocellular carcinoma in 291 patients (33.5%), followed by Hepatitis C Virus (24.0%), and alcohol liver disease (16.9%). There were no significant demographic differences between those who were and were not on statin therapy. In the pre-LT period only 3% of patients were on statins, despite 7% of patients having dyslipidemia and 24% having diabetes. A total of 261 patients (29.9%) were placed on statins post-LT. The use of statins post-LT was associated with decreased mortality (OR 0.433, 95% CI [0.302-0.622], p<0.001) and decreased graft failure (OR 0.398, 95% CI [0.276-0.574], p<0.001), however it was also associated with increased graft rejection (OR 1.40, 95% CI [1.02-1.93], p=0.039). There were no significant differences in the development of dyslipidemia, metabolic syndrome or cardiac events in post-LT patients regardless of statin use. Conclusion(s) In our study we identified an association between statin use in the post-LT setting and improved mortality and graft survival. We did not find an association with improved cardiac or metabolic outcomes. The negative association between statin use and post-LT rejection may reflect detection bias as patients with rejection are closely monitored. We also identified a discrepancy between the number of patients with indication for statin use and those who were on statins both pre and post LT, reflecting underutilization consistent with prior literature. Additional studies are required to elucidate the role of statin medications in the transplant hepatologists armamentarium. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | | | - J G Abraldes
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - R Bhanji
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| |
Collapse
|
10
|
Smith MK, Graham M, Harripersaud K, Zhu Q, Lan G, Shen Z, Tang S. Sexual mixing patterns in men who have sex with men: network approaches for smart resource allocation. Sex Health 2023; 20:126-133. [PMID: 36843009 DOI: 10.1071/sh22163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Age-based sexual mixing patterns in men who have sex with men (MSM) can greatly inform strategic allocation of intervention resources to subsets of the population for the purpose of preventing the greatest number of new HIV infections. METHODS Egocentric network data collected from MSM participating in annual HIV sentinel surveillance surveys were used to assess age-dependent mixing and to explore its epidemiological implications on the risk of HIV transmission risk (among those HIV-infected) and HIV acquisition risk (among those not infected). RESULTS Mixing in this sample of 1605 Chinese MSM is relatively age assortative (the average of values expressing the degree of preferential mixing were 2.01 in diagonal cells vs 0.87 in off-diagonal cells). Expected numbers of HIV acquisition were highest in the 20-24years age group; those for HIV transmissions were highest among 25-29year olds. The risk of both acquisition and transmission was highest in age groups that immediately follow the most commonly reported ages of sexual debut in this population (i.e. age 20). CONCLUSIONS These findings suggest that combination prevention resources should be targeted at younger MSM who are at higher risk of both transmission and acquisition. Programs may also do well to target even younger age groups who have not yet debuted in order to establish prevention effects before risky sexual behaviours begin. More research on optimal strategies to access these harder-to-reach subsets of the MSM population is needed. Findings also support ongoing efforts for public health practitioners to collect network data in key populations to support more empirically driven strategies to target prevention resources.
Collapse
Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Matthew Graham
- Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
| | - Katherine Harripersaud
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Qiuying Zhu
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Guanghua Lan
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shuai Tang
- Guangxi Center for Disease Control and Prevention, Nanning, China
| |
Collapse
|
11
|
Groene EA, Boraas CM, Smith MK, Lofgren SM, Rothenberger MK, Enns EA. Evaluation of Strategies to Improve Uptake of Expedited Partner Therapy for Chlamydia trachomatis Treatment in Minnesota: A Decision Analytic Model. MDM Policy Pract 2023; 8:23814683221150446. [PMID: 36714792 PMCID: PMC9880578 DOI: 10.1177/23814683221150446] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background. Despite the established effectiveness of expedited partner therapy (EPT) in partner treatment of bacterial sexually transmitted infections (STI), the practice is underutilized. Objective. To estimate the relative effectiveness of strategies to increase EPT uptake (numbers of partners treated for chlamydia). Methods. We developed a care cascade model of cumulative probabilities to estimate the number of partners treated under strategies to increase EPT uptake in Minnesota. The care cascade model used data from clinical trials, population-based studies, and Minnesota chlamydia surveillance as well as in-depth interviews of health providers who regularly treat STI patients and a statewide survey of health providers across Minnesota. Results. Several strategies could improve EPT uptake among providers, including facilitating treatment payment (additional 1,932 partners treated) and implementing electronic health record reminders (additional 1,755 partners treated). Addressing concerns about liability would have the greatest effect, resulting in 2,187 additional partners treated. Conclusions. Providers expressed openness to offering EPT under several scenarios, which reflect differences in knowledge about EPT, its legality, and potential risks to patients. While addressing concerns about provider liability would have the greatest effect on number of partners treated, provider education and procedural changes could make a substantial impact. Highlights Addressing provider concerns about expedited partner therapy (EPT) legality and its potential risks would result in the most partners treated for chlamydia.EPT alerts and electronic EPT prescriptions may also streamline partner treatment.Provider education about the legality of EPT and its potential risks and training in counseling patients on EPT could also increase uptake.
Collapse
Affiliation(s)
- Emily A. Groene
- Emily A. Groene, Division of Epidemiology
and Community Health, University of Minnesota School of Public Health, 1300
South 2nd Street, Suite 300, Minneapolis, MN 55454, USA;
()
| | - Christy M. Boraas
- Department of Obstetrics, Gynecology and
Women’s Health, University of Minnesota Medical School, Minneapolis, MN,
USA
| | - M. Kumi Smith
- Division of Epidemiology and Community Health,
University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Sarah M. Lofgren
- Division of Infectious Diseases and
International Medicine, University of Minnesota Medical School, Minneapolis,
MN, USA
| | - Meghan K. Rothenberger
- Division of Infectious Diseases and
International Medicine, University of Minnesota Medical School, Minneapolis,
MN, USA
| | - Eva A. Enns
- Division of Health Policy and Management,
University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
12
|
Tang W, Si Y, Xue H, Liao H, Xie Y, Xu D(R, Smith MK, Yip W, Cheng W, Tian J, Sylvia S. The quality of direct-to-consumer telemedicine consultations for sexually transmitted infections in China: An analysis of visits by standardized patients (Preprint). Interact J Med Res 2022. [DOI: 10.2196/44190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
13
|
Stangl AL, Atkins K, Leddy AM, Sievwright KM, Sevelius JM, Lippman SA, Veras MA, Zamudio-Haas S, Smith MK, Pachankis JE, Logie CH, Rao D, Weiser S, Nyblade L. What do we know about interventions to reduce intersectional stigma and discrimination in the context of HIV? A systematic review. Stigma and Health 2022. [DOI: 10.1037/sah0000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Groene EA, Boraas CM, Smith MK, Lofgren SM, Rothenberger MK, Enns EA. A Statewide Mixed-Methods Study of Provider Knowledge and Behavior Administering Expedited Partner Therapy for Chlamydia and Gonorrhea. Sex Transm Dis 2022; 49:601-609. [PMID: 35796238 PMCID: PMC9378509 DOI: 10.1097/olq.0000000000001668] [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: 11/26/2022]
Abstract
BACKGROUND Expedited partner therapy (EPT) refers to the practice of having patients diagnosed with chlamydia or gonorrhea deliver medication directly to their partner(s) to treat them presumptively for infection. Although EPT facilitates timely treatment and prevents reinfection, it remains underused. We used findings from key informant interviews to design and implement a statewide survey to estimate knowledge and utilization of EPT and to identify barriers and facilitators to EPT among Minnesota providers. METHODS From November to December 2020, we carried out 15 interviews with health providers who currently provide EPT and coded interviews by recurring themes. We then conducted a statewide online survey on sexually transmitted infection treatment and barriers to EPT, from December 2020 to March 2021. We disseminated the survey to all licensed Minnesota health providers, and those who reported treating bacterial sexually transmitted infections in the past year were included in the study. RESULTS Interview themes included the importance of direct provision of partner medication, administrative/pharmacy barriers to treatment, inclusive EPT eligibility, and patient counseling. Of the 623 health providers who completed the online survey, only 70% thought EPT was legal and only 37% currently offer EPT. Of those who did not provide EPT, 78% said they would under certain circumstances. Barriers included concerns about safety/liability of prescribing without a medical examination, administrative concerns about prescriptions, and patient acceptance. CONCLUSIONS Given that over a quarter of respondents did not know expedited partner therapy (EPT)'s legal status, improving provider education may increase EPT provision. More research is needed on system-level barriers and patient acceptance of solutions identified in this study.
Collapse
Affiliation(s)
- Emily A Groene
- From the Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Christy M Boraas
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School
| | - M Kumi Smith
- From the Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Sarah M Lofgren
- Division of Infectious Disease and International Medicine, University of Minnesota Medical School
| | - Meghan K Rothenberger
- Division of Infectious Disease and International Medicine, University of Minnesota Medical School
| | - Eva A Enns
- School of Public Health, Division of Health Policy and Management, Minneapolis, MN
| |
Collapse
|
15
|
Ong JJ, Xiong M, Tucker JD, Wang Y, Smith MK, Tang W, Fu H, Zheng H, Yang B, Wang C. Sexualized Drug Use Among Female Sex Workers from Eight Cities in China: A Cross-Sectional Study. Arch Sex Behav 2022; 51:2689-2698. [PMID: 34786656 PMCID: PMC8594644 DOI: 10.1007/s10508-021-02117-2] [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] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
There is a rich literature on sexualized drug use (i.e., drug use before or during sex) for men who have sex with men but less data from female sex workers (FSW), particularly from low- and middle-income countries. We describe the sexual and reproductive health outcomes in FSW reporting sexualized drug use. In 2019, we conducted a cross-sectional study in eight cities from seven provinces in China. We recruited FSW through community organizations working with sex workers and included those aged 18 years or above, exchanged sex at least once for money or goods in the past three months, and had traded sex for longer than a year. Multivariable logistic regression models were used. In total, 650 women participated: average age was 38.8 years (SD 10.2), 57.1% reported a monthly income over 5000 RMB ($USD 707), and 12.8% completed high school or above. Among participants, 65 (10.0%, 95% confidence interval (CI) 7.8-12.6) reported a history of sexualized drug use. Compared to FSW who never reported a history of sexualized drug use, FSW who reported a history of sexualized drug use had greater odds of working for a manager compared to being self-employed (adjusted odds ratio (AOR) 4.04, 95% CI 2.12-7.69), work in a sauna (AOR 2.43, 95% CI 1.09-5.41), charging a higher price for vaginal sex (AOR 2.15, 95% CI 1.14-4.06), and ever diagnosed with STIs (AOR 4.51, 95% CI 2.61-7.80). One in ten FSW reported sexualized drug use. Although they had similar risk profiles in terms of consistency of condom use and reproductive health outcomes, these women were more likely to report past STIs than those who reported no sexualized drug use. Health workers who work with substance users should devote attention to the sexual practices of their clients to make sure that they have safer sex.
Collapse
Affiliation(s)
- Jason J Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Mingzhou Xiong
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yajie Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota, Twin Cities, MN, USA
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, No. 2 Lujing Road, Yuexiu District, Guangzhou, 510095, China.
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
| |
Collapse
|
16
|
Sievwright KM, Stangl AL, Nyblade L, Lippman SA, Logie CH, Veras MADSM, Zamudio-Haas S, Poteat T, Rao D, Pachankis JE, Kumi Smith M, Weiser SD, Brooks RA, Sevelius JM. An Expanded Definition of Intersectional Stigma for Public Health Research and Praxis. Am J Public Health 2022; 112:S356-S361. [PMID: 35763723 PMCID: PMC9241457 DOI: 10.2105/ajph.2022.306718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Kirsty M Sievwright
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Anne L Stangl
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Laura Nyblade
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sheri A Lippman
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Carmen H Logie
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Maria Amélia de Sousa Mascena Veras
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sophia Zamudio-Haas
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Tonia Poteat
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Deepa Rao
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - John E Pachankis
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - M Kumi Smith
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Sheri D Weiser
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Ronald A Brooks
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jae M Sevelius
- Kirsty M. Sievwright and Anne Stangl are with the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Laura Nyblade is with the Global Health Division, International Development Group, RTI International, Washington, DC. Sheri A. Lippman, Sophia Zamudio-Haas, Sheri Weiser, and Jae M. Sevelius are with the Department of Medicine, University of California, San Francisco. Carmen H. Logie is with the Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Maria Amélia Veras is with the Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. Tonia Poteat is with the Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill. Deepa Rao is with the Department of Global Health, University of Washington, Seattle. John E. Pachankis is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. M. Kumi Smith is with the Department of Epidemiology & Community Health, University of Minnesota Twin Cities, Minneapolis. Ronald Brooks is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| |
Collapse
|
17
|
Tarr GAM, Morris KJ, Harding AB, Jacobs S, Smith MK, Church TR, Berman JD, Rau A, Ashida S, Ramirez MR. Cognitive factors influenced physical distancing adherence during the COVID-19 pandemic in a population-specific way. PLoS One 2022; 17:e0267261. [PMID: 35503754 PMCID: PMC9064111 DOI: 10.1371/journal.pone.0267261] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/05/2022] [Indexed: 01/25/2023] Open
Abstract
Even early in the COVID-19 pandemic, adherence to physical distancing measures was variable, exposing some communities to elevated risk. While cognitive factors from the Health Belief Model (HBM) and resilience correlate with compliance with physical distancing, external conditions may preclude full compliance with physical distancing guidelines. Our objective was to identify HBM and resilience constructs that could be used to improve adherence to physical distancing even when full compliance is not possible. We examined adherence as expressed through 7-day non-work, non-household contact rates in two cohorts: 1) adults in households with children from Minnesota and Iowa; and 2) adults ≥50 years-old from Minnesota, one-third of whom had Parkinson's disease. We identified multiple cognitive factors associated with physical distancing adherence, specifically perceived severity, benefits, self-efficacy, and barriers. However, the magnitude, and occasionally the direction, of these associations was population-dependent. In Cohort 1, perceived self-efficacy for remaining 6-feet from others was associated with a 29% lower contact rate (RR 0.71; 95% CI 0.65, 0.77). This finding was consistent across all race/ethnicity and income groups we examined. The barriers to adherence of having a child in childcare and having financial concerns had the largest effects among individuals from marginalized racial and ethnic groups and high-income households. In Cohort 2, self-efficacy to quarantine/isolate was associated with a 23% decrease in contacts (RR 0.77; 95% CI 0.66, 0.89), but upon stratification by education level, the association was only present for those with at least a Bachelor's degree. Education also modified the effect of the barrier to adherence leaving home for work, increasing contacts among those with a Bachelor's degree and reducing contacts among those without. Our findings suggest that public health messaging tailored to the identified cognitive factors has the potential to improve physical distancing adherence, but population-specific needs must be considered to maximize effectiveness.
Collapse
Affiliation(s)
- Gillian A. M. Tarr
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Keeley J. Morris
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Alyson B. Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Samuel Jacobs
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Timothy R. Church
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Jesse D. Berman
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Austin Rau
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Sato Ashida
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Marizen R. Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| |
Collapse
|
18
|
Smith MK, Chow J, Huang R, Omar M, Ebadi M, Wong P, Huard G, Yoshida EM, Peretz D, Brahmania M, Montano-Loza AJ, Bhanji R. A224 COVID-19 INFECTION IN LIVER TRANSPLANT RECIPIENTS: CLINICAL FEATURES, HOSPITALIZATION, AND MORTALITY FROM A CANADIAN MULTICENTRE COHORT. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859339 DOI: 10.1093/jcag/gwab049.223] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada.
Aims
Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada.
Methods
We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death.
Results
A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF); median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection; either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization.
Conclusions
In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19; the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes.
Funding Agencies
None
Collapse
Affiliation(s)
- M K Smith
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - J Chow
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - R Huang
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - M Omar
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | - M Ebadi
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - P Wong
- Gastroenterology, McGill University, Brossard, QC, Canada
| | - G Huard
- Liver diseases, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - E M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
| | - D Peretz
- University of Manitoba, Winnipeg, MB, Canada
| | | | - A J Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - R Bhanji
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
19
|
Anthony AK, Niu CY, Wang RS, Wieske J, Brown KW, Chajecki Z, Lynch WG, Ayyad Y, Barney J, Baumann T, Bazin D, Beceiro-Novo S, Boza J, Chen J, Cook KJ, Cortesi M, Ginter T, Mittig W, Pype A, Smith MK, Soto C, Sumithrarachchi C, Swaim J, Sweany S, Teh FCE, Tsang CY, Tsang MB, Watwood N, Wuosmaa AH. Beam particle identification and tagging of incompletely stripped heavy beams with HEIST. Rev Sci Instrum 2022; 93:013306. [PMID: 35104937 DOI: 10.1063/5.0068180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
A challenge preventing successful inverse kinematics measurements with heavy nuclei that are not fully stripped is identifying and tagging the beam particles. For this purpose, the HEavy ISotope Tagger (HEIST) has been developed. HEIST utilizes two micro-channel plate timing detectors to measure the time-of-flight, a multi-sampling ion chamber to measure energy loss, and a high-purity germanium detector to identify isomer decays and calibrate the isotope identification system. HEIST has successfully identified 198Pb and other nearby nuclei at energies of about 75 MeV/A. In the experiment discussed, a typical cut containing 89% of all 198Pb80+ in the beam had a purity of 86%. We examine the issues of charge state contamination. The observed charge state populations of these ions are presented and, using an adjusted beam energy, are well described by the charge state model GLOBAL.
Collapse
Affiliation(s)
- A K Anthony
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Y Niu
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - R S Wang
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Wieske
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - K W Brown
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - Z Chajecki
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - W G Lynch
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - Y Ayyad
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Barney
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - T Baumann
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - D Bazin
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - S Beceiro-Novo
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Boza
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - J Chen
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - K J Cook
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - M Cortesi
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - T Ginter
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - W Mittig
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Pype
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - M K Smith
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Soto
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - C Sumithrarachchi
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Swaim
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - S Sweany
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - F C E Teh
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Y Tsang
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - M B Tsang
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - N Watwood
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - A H Wuosmaa
- Department of Physics, University of Connecticut, Storrs, Connecticut 06269, USA
| |
Collapse
|
20
|
Erayil SE, Smith MK, Gebreslasse T, Walker PF, Mann EM, Wilkins S, Stauffer WM. The Value and Interpretation of Race and Ethnicity Data in the Era of Global Migration: A Change Is in Order. Am J Trop Med Hyg 2021; 105:1453-1455. [PMID: 34634768 PMCID: PMC8641339 DOI: 10.4269/ajtmh.21-0665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 11/07/2022] Open
Abstract
Human migration and travel are leading to increasingly diverse populations throughout the world. Data collection practices need to adapt to these changes to expand our understanding of health disparities and to optimize the efforts to address health equity, particularly during public health emergencies such as the current COVID-19 pandemic. Race and ethnicity classifications in the United States have failed to evolve since the 1970s despite an increasingly diverse population. Current commonly collected categories are inadequate to accurately describe the economic, educational, and sociopolitical circumstances of different groups. Further, these categories lend little practical information to inform health policy. More predictive and actionable variables should be routinely collected to improve appropriateness and timeliness of health interventions. The immediate adoption of the collection of primary/preferred language and country of birth/origin by public health organizations, health systems, and clinical providers would be a concrete and valuable first step.
Collapse
Affiliation(s)
- Serin Edwin Erayil
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, Minnesota.,Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - M Kumi Smith
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Tsige Gebreslasse
- Global Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Patricia F Walker
- Global Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,HealthPartners Institute, Bloomington, Minnesota
| | - Erin M Mann
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Syreeta Wilkins
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, Minnesota
| | - William M Stauffer
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, Minnesota.,Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Global Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
21
|
Smith MK, Searle KM, Yang W, Rapheal E, Wang C, Zhao P, Yang L, Huang S, Yang B. Spatiotemporal analysis of 11 years of Chlamydia trachomatis data from southern China. Lancet Reg Health West Pac 2021; 11:100143. [PMID: 34327356 PMCID: PMC8315467 DOI: 10.1016/j.lanwpc.2021.100143] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Abstract
Background Urogenital Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally. Reviews suggest high and persistently endemic STI epidemics in low and middle income countries. However population-based prevalence estimates in these settings are less common, underscoring the need for analyses of available data to characterize patterns of disease burden. We identified spatio-temporal clusters and key behavioral, social, or environmental factors contribution to transmission in order to inform the prioritization and targeting of evidence based interventions. Methods Using 11 years of data (2006-2016) from the chlamydia case report system of Guangdong, China, we identified county level spatio-temporal hot and cold spots using the Getis-Ord Gi* statistic and discrete Poisson models in SaTScan 9.6. We also estimated associations between observed distribution patterns and area-level demographic, social, and economic factors using quasi-Poisson regression models that controlled for annual counts of certified laboratories to account for fluctuations in location-specific detection capacity. Findings Cluster analysis indicates an expanding chlamydia epidemic in Guangdong, with cases clustered in regions of greatest economic activity. Greater male-to-female sex ratio (RR, 3.63; 95% CI, 1.41-9.45) and greater urbanicity (RR, 2.44; 95% CI, 1.98-2.99) were predictive of higher chlamydia case occurrence. Interpretation We found that chlamydia case occurrence in Guangdong province has been accelerating over the past 11 years and that its expansion is tied to indicators of social and economic development. These estimates not only identify high prevalence regions to target but also areas where data gaps potentially remain. The salience of sex ratios and urbanicity may best be understood through the lens of China's modern history of labor migration which has reshaped the gender dynamics and health access landscape of urban China. Future chlamydia control efforts will require a population-based approach focused on reengaging sexually active adults of diverse economic and migratory backgrounds. Funding This was an unfunded study using routinely collected public health data.
Collapse
Affiliation(s)
- M. Kumi Smith
- Division of Epidemiology & Community Health, University of Minnesota Twin Cities, 1300 South 2 Street, Ste 300, Minneapolis, MN, USA
| | - Kelly M. Searle
- Division of Epidemiology & Community Health, University of Minnesota Twin Cities, 1300 South 2 Street, Ste 300, Minneapolis, MN, USA
| | - Wenyue Yang
- College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou, China
| | - Erica Rapheal
- Division of Epidemiology & Community Health, University of Minnesota Twin Cities, 1300 South 2 Street, Ste 300, Minneapolis, MN, USA
| | - Cheng Wang
- Dermatology Hospital of the Southern Medical University, No. 2 Lujing Road, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital of the Southern Medical University, No. 2 Lujing Road, Guangzhou, China
| | - Ligang Yang
- Dermatology Hospital of the Southern Medical University, No. 2 Lujing Road, Guangzhou, China
| | - Shujie Huang
- Dermatology Hospital of the Southern Medical University, No. 2 Lujing Road, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of the Southern Medical University, No. 2 Lujing Road, Guangzhou, China
- Corresponding author.
| |
Collapse
|
22
|
Bai L, Lu H, Hu H, Smith MK, Harripersaud K, Lipkova V, Wen Y, Guo X, Peng W, Liu C, Shen M, Shen AC, Zhang L. Evaluation of work resumption strategies after COVID-19 reopening in the Chinese city of Shenzhen: a mathematical modeling study. Public Health 2021; 193:17-22. [PMID: 33706208 PMCID: PMC7857120 DOI: 10.1016/j.puhe.2020.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES As China is facing a potential second wave of the epidemic, we reviewed and evaluated the intervention measures implemented in a major metropolitan city, Shenzhen, during the early phase of Wuhan lockdown. STUDY DESIGN Based on the classic SEITR model and combined with population mobility, a compartmental model was constructed to simulate the transmission of COVID-19 and disease progression in the Shenzhen population. METHODS Based on published epidemiological data on COVID-19 and population mobility data from Baidu Qianxi, we constructed a compartmental model to evaluate the impact of work and traffic resumption on the epidemic in Shenzhen in various scenarios. RESULTS Imported cases account for most (58.6%) of the early reported cases in Shenzhen. We demonstrated that with strict inflow population control and a high level of mask usage after work resumption, various resumptions resulted in only an insignificant difference in the number of cumulative infections. Shenzhen may experience this second wave of infections approximately two weeks after the traffic resumption if the incidence risk in Hubei is high at the moment of resumption. CONCLUSION Regardless of the work resumption strategy adopted in Shenzhen, the risk of a resurgence of COVID-19 after its reopening was limited. The strict control of imported cases and extensive use of facial masks play a key role in COVID-19 prevention.
Collapse
Affiliation(s)
- Lu Bai
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Haonan Lu
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Hailin Hu
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Twin Cities, United States
| | | | - Veronika Lipkova
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Yujin Wen
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Xiuyan Guo
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Wei Peng
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Chenwei Liu
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Alfred Chixiong Shen
- AI Application Research Center, Huawei Technologies Co., Ltd. Shenzhen, Guangdong, 518000, PR China
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| |
Collapse
|
23
|
Ong JJ, Fu H, Baggaley RC, Wi TE, Tucker JD, Smith MK, Rafael S, Falconer J, Terris-Prestholt F, Mameletzis I, Mayaud P. Missed opportunities for sexually transmitted infections testing for HIV pre-exposure prophylaxis users: a systematic review. J Int AIDS Soc 2021; 24:e25673. [PMID: 33605081 PMCID: PMC7893146 DOI: 10.1002/jia2.25673] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/09/2021] [Accepted: 01/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Given the synergistic relationship between HIV and sexually transmitted infections (STI), the integration of services has the potential to reduce the incidence of both HIV and STIs. We explored the extent to which STI testing has been offered within HIV pre-exposure prophylaxis (PrEP) programmes worldwide. METHODS We conducted a systematic review of PrEP programmes implementing STI testing services in nine databases. We approached PrEP implementers for additional unpublished data and implementation details. Descriptive statistics were used to present the characteristics of STI testing within PrEP programmes. Content analysis of the input from PrEP implementers was conducted to summarize the barriers to and facilitators of STI testing. RESULTS Of 9,161 citations, 91 studies conducted in 32 countries were included: 69% from high-income countries (HICs) and 64% from programmes targeting men who have sex with men (MSM) and transgender women (TGW) only. The majority of programmes (70%, 64/91) conducted STI testing before the initiation of PrEP. The most common STIs tested were gonorrhoea (86%, 78/91), chlamydia (84%, 76/91) and syphilis (84%, 76/91). The majority provided STI testing at three-month intervals (70%, 53/76, for syphilis; 70% 53/78, for chlamydia; 68%, 53/78, for gonorrhoea). Relative to low- and middle-income countries (LMICs), a higher proportion of PrEP programmes in HICs offered testing for gonorrhoea (92% vs. 71%, p < 0.05), chlamydia (92% vs. 64%, p < 0.01), syphilis (87% vs. 75%, p < 0.05), hepatitis A (18% vs. 4%, p < 0.05) and hepatitis C (43% vs. 21%, p < 0.05); offered testing for a higher number of STIs (mean 3.75 vs. 3.04, p < 0.05); and offered triple (throat, genital/urine and anorectal) anatomical site screening (54% vs. 18%, p < 0.001). Common implementation challenges included costs, access to STI diagnostics, programme logistics of integrating STI testing into PrEP delivery models and lack of capacity building for staff involved in PrEP provision. CONCLUSIONS Significant gaps and challenges remain in the provision of STI testing services within HIV PrEP programmes. We recommend more active integration of STI testing and management into PrEP programmes, supported by standardized practice guidelines, staff capacity building training and adequate funding. This could lead to improved sexual health and HIV outcomes in key populations.
Collapse
Affiliation(s)
- Jason J Ong
- London School of Hygiene and Tropical Medicine, London, UK.,Monash University, Melbourne, Australia
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | | | - Joseph D Tucker
- London School of Hygiene and Tropical Medicine, London, UK.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Sabrina Rafael
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | |
Collapse
|
24
|
Li C, Giovenco D, Dong W, Smith MK, Golin CE, Fisher EB, Lei G, Jiang H, Tang PY, Muessig KE. Understanding How Gay, Bisexual, and Other Men Who Have Sex With Men in China Cope With HIV Care-Related Stressors. AIDS Educ Prev 2021; 33:46-61. [PMID: 33617323 PMCID: PMC10552686 DOI: 10.1521/aeap.2021.33.1.46] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Understanding how Chinese gay, bisexual, and other men who have sex with men (GBMSM) cope with HIV care-related stressors could improve their care engagement. Qualitative semistructured interviews were conducted with 30 GBMSM living with HIV recruited through clinics and a community-based organization (CBO) in Chengdu, China. Interviews focused on treatment-related stress, coping strategies, social support, and well-being. Half reported symptoms consistent with mild or moderate depression as measured by the PHQ-9 scale. HIV care-related stressors included side effects, difficulty with adherence, and fear of drug resistance. Challenges to coping include navigating contradictory information about HIV and treatment, experiencing stigma and discrimination within medical and nonmedical settings, and managing financial concerns. CBOs, peer groups, and providers were salient sources of social support benefitting coping. To improve sustained HIV care that meets the needs of Chinese GBMSM living with HIV, tailored interventions that address the above-mentioned stressors and coping challenges are likely needed.
Collapse
Affiliation(s)
- Chunyan Li
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Danielle Giovenco
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Willa Dong
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Kumi Smith
- University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Carol E Golin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edwin B Fisher
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gang Lei
- Aibai Culture and Education Center, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine and Sichuan Provincial People's Hospital and Sichuan Academy of Medical Sciences, Chengdu, China
| | - Patrick Y Tang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathryn E Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
25
|
Wang C, Cheng W, Li C, Tang W, Ong JJ, Smith MK, Fu H, Marks M, Nie J, Zheng H, Tucker JD, Yang B. Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China. Clin Infect Dis 2021; 70:2178-2186. [PMID: 31260513 DOI: 10.1093/cid/ciz603] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 03/20/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing. METHODS A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing. RESULTS Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32-2.73), reporting 2-5 male sexual partners (aOR, 1.81; 95% CI, 1.04-3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00-93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86-4.72). Self-reported harms associated with syphilis self-testing were minimal. CONCLUSIONS Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services.
Collapse
Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Changchang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Central Clinical School, Monash University, Melbourne, Australia
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Juan Nie
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| |
Collapse
|
26
|
Huang W, Wu D, Ong JJ, Smith MK, Pan S, Yang F, Fu H, Tang W, Tucker JD. Correction to: Prepared for PrEP: preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey. BMC Infect Dis 2020; 20:183. [PMID: 32106820 PMCID: PMC7047371 DOI: 10.1186/s12879-020-4906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
After publication of the original article [1], the authors would like to add a co-author, Dr. Stephen Pan, who contributed sufficiently to this manuscript.
Collapse
|
27
|
Pan SW, Smith MK, Carpiano RM, Fu H, Ong JJ, Huang W, Tang W, Tucker JD. Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China. Int J Behav Med 2020; 27:602-608. [PMID: 32415590 DOI: 10.1007/s12529-020-09883-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China. METHOD In 2017, an online survey was distributed nationwide throughout China by gay community-based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3-15). RESULTS Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13-0.75). CONCLUSION Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.
Collapse
Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences - ES345, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Road, Suzhou Dushu Lake Higher Education Town, Suzhou, 215123, Jiangsu, China. .,UNC-Project China, Guangzhou, China.
| | - M Kumi Smith
- UNC-Project China, Guangzhou, China.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, CA, USA.,Department of Sociology, University of California, Riverside, CA, USA.,Center for Healthy Communities, University of California, Riverside, CA, USA
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jason J Ong
- UNC-Project China, Guangzhou, China.,Central Clinical School, Monash University, Clayton, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Weiming Tang
- UNC-Project China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
28
|
Wang C, Wang YJ, Tucker JD, Xiong MZ, Fu HY, Smith MK, Tang WM, Ong JJ, Zheng HP, Yang B. Correlates of HIV self-testing among female sex workers in China: implications for expanding HIV screening. Infect Dis Poverty 2020; 9:147. [PMID: 33092641 PMCID: PMC7583185 DOI: 10.1186/s40249-020-00765-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/26/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) self-testing may help improve test uptake among female sex workers. China has implemented many HIV self-testing programs among men who have sex with men, creating an opportunity for promotion among female sex workers. However, there is a limited literature on examining HIV self-testing among female sex workers. This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China. Methods A venue-based, cross-sectional study was conducted among Chinese female sex workers in 2019. Participants completed a survey including social-demographic characteristics, sexual behaviors, and HIV self-testing history, the distribution of which were analyzed using descriptive analysis. Multivariable logistic regression was conducted to identify associations with HIV self-testing. Results Among 1287 Chinese female sex workers, 1072 (83.3%, 95% confidence interval [CI] 81.2–85.3%) had ever tested for HIV, and 103 (8.0%, 95% CI 6.6–9.6%) had ever used HIV self-testing. More than half reported that the self-test was their first HIV test (59.2%, 61/103), around one-fifth reported HIV self-testing results influenced the price of sex (21.4%, 22/103). A minority of individuals reported ever experiencing pressure to undertake HIV self-testing (6.8%, 7/103). After adjusting for covariates, HIV self-testing was positively associated with receiving anal sex in the past month (adjusted odds ratio [aOR] = 2.2, 95% CI 1.4–3.5), using drugs before or during sex (aOR = 2.8, 95% CI 1.8–4.5), injecting drugs in the past 6 months (aOR = 2.6, 95% CI 1.2–6.0), being diagnosed with other sexually transmitted infections (aOR = 1.6, 95% CI 1.0–2.5), tested for other sexually transmitted infections in the past six months (aOR = 3.4, 95% CI 2.1–5.5), ever tested in the hospital (aOR = 3.4, 95% CI 2.0–5.6), and ever tested in the community (aOR = 1.5, 95% CI 1.2–1.9). Conclusions Our findings suggest that HIV self-testing could expand overall HIV testing uptake, increase HIV testing frequency, reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers. HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.
Collapse
Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China. .,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
| | - Ya-Jie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Ming-Zhou Xiong
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Hong-Yun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - Wei-Ming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Victoria, Melbourne, Australia
| | - He-Ping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| |
Collapse
|
29
|
Jin X, Xiao D, Xu JJ, Smith MK, Xiu XF, Ding ZW, Cao NX, Bao YG. Factors Affected HIV Testing and HIV Infection among Internet-based Self-testing MSM Who Never Tested for HIV in Beijing, China. Biomed Environ Sci 2020; 33:775-779. [PMID: 33228837 DOI: 10.3967/bes2020.103] [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] [Received: 01/19/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Xia Jin
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China;AIDS Healthcare Foundation (AHF) China, Beijing 100021, China
| | - Dong Xiao
- Tongzhi Welfare Group, Beijing 100021, China
| | - Jun Jie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - M Kumi Smith
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, 55455, United States
| | - Xiang Fei Xiu
- AIDS Healthcare Foundation (AHF) China, Beijing 100021, China
| | - Zheng Wei Ding
- AIDS Healthcare Foundation (AHF) China, Beijing 100021, China
| | - Ning Xiao Cao
- Chinese Academy of Medical Sciences, Hospital for Skin Diseases and STI Control, Nanjing 210042, Jiangsu, China
| | - Yu Gang Bao
- AIDS Healthcare Foundation (AHF) China, Beijing 100021, China
| |
Collapse
|
30
|
Smith MK, Xu RH, Hunt SL, Wei C, Tucker JD, Tang W, Luo D, Xue H, Wang C, Yang L, Yang B, Li L, Joyner BL, Sylvia SY. Combating HIV stigma in low- and middle-income healthcare settings: a scoping review. J Int AIDS Soc 2020; 23:e25553. [PMID: 32844580 PMCID: PMC7448195 DOI: 10.1002/jia2.25553] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Nearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research. METHODS We conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews. RESULTS AND DISCUSSION Our search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings. CONCLUSIONS Combating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.
Collapse
Affiliation(s)
- M. Kumi Smith
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Richie H. Xu
- Division of Epidemiology & Community HealthUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Shanda L. Hunt
- Health Sciences LibrariesUniversity of Minnesota Twin CitiesMinneapolisMNUSA
| | - Chongyi Wei
- Department of Health Behavior, Society and PolicyRutgers UniversityNew BrunswickNYUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
- London School of Hygiene and Tropical MedicineLondonUK
| | - Weiming Tang
- Institute for Global Health and Infectious DiseasesSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | | | - Hao Xue
- Freeman Spogli Institute for International StudiesStanford UniversityStanfordCAUSA
| | - Cheng Wang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Ligang Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Bin Yang
- Dermatology Hospital of Southern Medical UniversityGuangzhouChina
| | - Li Li
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
| | - Benny L. Joyner
- Division of Pediatric Critical Care MedicineSchool of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Sean Y. Sylvia
- Department of Health Policy & ManagementUniversity of North CarolinaChapel HillNCUSA
| |
Collapse
|
31
|
Wang C, Zhao P, Tang W, Smith MK, Ong JJ, Wong NS, Fu H, Tucker JD, Zheng H, Luo Z, Yang B. Partner Notification Among Persons With Early Syphilis in Shenzhen, China, 2011-2017: Implications for Practice and Policy. Sex Transm Dis 2020; 47:232-237. [PMID: 32011419 PMCID: PMC8190519 DOI: 10.1097/olq.0000000000001135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Partner notification (PN) is an essential component of syphilis control and is recommended by Chinese Sexually Transmitted Disease guidelines. However, in China, studies examining local practice are limited. This study evaluated PN outcomes among persons with early syphilis infection in an urban district in China. METHODS From 2011 to 2017, persons diagnosed with early syphilis were asked to participate in an evaluation of supportive patient referral partner services for all recent sex partners, and the contact and case finding indices were determined in Nanshan District, Shenzhen, China. RESULTS During the study period, 642 index patients with early syphilis reported 1749 sex partners. Of those partners, 678 were potentially contactable and 525 (30%) were contacted. The overall contact index was 0.82. Among the 1749 partners reported, 1108 (63%) were described as casual partners, and only 37 (3%) were contacted (contact index 0.13) compared with 641 partners who were either spouses and regular partners (contact index, 1.37). Among those 525 partners contacted, 418 (80%) were tested, and 205 (39%) were diagnosed with and treated for syphilis. Among those, 9 (4%) were primary, 26 (13%) were secondary, 16 (8%) were early latent, and 154 (49%) were other syphilis infections. The overall case finding index was 0.29. CONCLUSIONS There is a need to improve PN practices in China, which include developing operational guidelines of PN and to develop and evaluate novel PN ways like using Internet-based strategy.
Collapse
Affiliation(s)
- Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Victoria, Melbourne, Australia
| | - Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Institute for Global Health and Sexually Transmitted Disease, Southern Medical University, Guangzhou, China
| |
Collapse
|
32
|
Huang R, Luo G, Duan Q, Zhang L, Zhang Q, Tang W, Smith MK, Li J, Zou H. Using Baidu search index to monitor and predict newly diagnosed cases of HIV/AIDS, syphilis and gonorrhea in China: estimates from a vector autoregressive (VAR) model. BMJ Open 2020; 10:e036098. [PMID: 32209633 PMCID: PMC7202716 DOI: 10.1136/bmjopen-2019-036098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Internet search engine data have been widely used to monitor and predict infectious diseases. Existing studies have found correlations between search data and HIV/AIDS epidemics. We aimed to extend the literature through exploring the feasibility of using search data to monitor and predict the number of newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China. METHODS This paper used vector autoregressive model to combine the number of newly diagnosed cases with Baidu search index to predict monthly newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China. The procedures included: (1) keywords selection and filtering; (2) construction of composite search index; (3) modelling with training data from January 2011 to October 2016 and calculating the prediction performance with validation data from November 2016 to October 2017. RESULTS The analysis showed that there was a close correlation between the monthly number of newly diagnosed cases and the composite search index (the Spearman's rank correlation coefficients were 0.777 for HIV/AIDS, 0.590 for syphilis and 0.633 for gonorrhoea, p<0.05 for all). The R2 were all more than 85% and the mean absolute percentage errors were less than 11%, showing the good fitting effect and prediction performance of vector autoregressive model in this field. CONCLUSIONS Our study indicated the potential feasibility of using Baidu search data to monitor and predict the number of newly diagnosed cases of HIV/AIDS, syphilis and gonorrhoea in China.
Collapse
Affiliation(s)
- Ruonan Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Qibin Duan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseass, School of Public Health, Xi'an Jiaotong University, Xi'an, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong
| | - Weiming Tang
- University of North Carolina Project China, Guangzhou, China
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
33
|
Smith MK, Wei C, Liu C, Pan SW, Ong JJ, Tucker JD. Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis. Arch Sex Behav 2020; 49:721-731. [PMID: 31571020 PMCID: PMC7035172 DOI: 10.1007/s10508-019-01481-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 06/10/2023]
Abstract
Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a "bridge population" of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. In total, 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. Model fit indicated a population structure made up of four classes that we characterized as "Gender nonconforming" (4.3%), "Closeted-unmarried" (29.9%), "Closeted-married" (24.6%), and "Out" (41.2%). Members of the "gender nonconforming" class were more likely to report HIV-related risk behaviors, and "Closeted-unmarried" class members were less likely to report health-seeking behaviors, both relative to "Out" members. The largest latent class was made up of members of the "Out" class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of "closeted" classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.
Collapse
Affiliation(s)
- M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, 1300 South 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
- University of North Carolina Project-China, Guangzhou, China.
| | - Chongyi Wei
- University of North Carolina Project-China, Guangzhou, China
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, New Brunswick, NJ, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Department of Sociology, University of California San Diego, San Diego, CA, USA
| | - Stephen W Pan
- University of North Carolina Project-China, Guangzhou, China
- Xi'an Jiatong-Liverpool University, Suzhou, China
| | - Jason J Ong
- University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
34
|
Pan SW, Carpiano RM, Smith MK, Ong JJ, Fu H, Huang W, Tang W, Tucker JD. Supernatural explanatory models of health and illness and healthcare use in China among men who have sex with men. Glob Public Health 2020; 15:83-96. [PMID: 31378138 PMCID: PMC6934899 DOI: 10.1080/17441692.2019.1649445] [Citation(s) in RCA: 2] [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: 01/04/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
People's beliefs in supernatural explanatory models of health and illness - beliefs in divine and/or supernatural forces to inform how they perceive, interpret, and respond to health and illness - may have important implications for their use of healthcare services, especially among individuals with lower socioeconomic status (SES). However, the relevance of such research for contexts with strong Confucian and Buddhist traditions and sexual minority subpopulations remains unclear. We conducted a nation-wide survey in China of 503 men who have sex with men (MSM) to test hypotheses examining how supernatural beliefs impact commitment to a primary healthcare provider and testing history for HIV and syphilis. We also tested hypotheses regarding how SES may moderate such effects. Results indicate that strength of supernatural beliefs is associated with less commitment to a primary care provider and lower likelihood of HIV testing, particularly among men with lower educational attainment. However, among men with low income, supernatural belief was associated with higher likelihood of testing for HIV and syphilis. Belief in supernatural explanatory models of health and illness may have substantial influence on healthcare use among MSM in China. As religion and spirituality evolves within China, additional research concerning supernatural beliefs and healthcare use is warranted.
Collapse
Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences, Xi’an Jiaotong-Liverpool University, Suzhou, China
- UNC-Project China, Guangzhou, China
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, CA, USA
- Department of Sociology, University of California, Riverside, CA, USA
- Center for Healthy Communities, University of California, Riverside, CA, USA
| | - M. Kumi Smith
- UNC-Project China, Guangzhou, China
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jason J Ong
- UNC-Project China, Guangzhou, China
- Central Clinical School, Monash University, Clayton, Victoria, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Wenting Huang
- UNC-Project China, Guangzhou, China
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Weiming Tang
- UNC-Project China, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
35
|
Huang W, Wu D, Ong JJ, Smith MK, Yang F, Fu H, Tang W, Tucker JD. Prepared for PrEP: preferences for HIV pre-exposure prophylaxis among Chinese men who have sex with men in an online national survey. BMC Infect Dis 2019; 19:1057. [PMID: 31842772 PMCID: PMC6916236 DOI: 10.1186/s12879-019-4692-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is not widely available in China. Previous studies reported low awareness and inconclusive findings on the acceptability of PrEP among Chinese men who have sex with men (MSM). METHODS We conducted a secondary analysis of an online national survey comparing preferences for oral and long-acting injectable PrEP among MSM and identifying correlates of preferences. The study did not collect detailed information about partner types that may influence negotiated safety and PrEP uptake. RESULTS Nine-hundred and seventy-nine men from the larger sample of 1045 men responded to the PrEP survey questions. Most men (81.9%) had never heard of PrEP, but reported interest in using PrEP. More participants chose injectable PrEP (36.3%) as their preferred formulation than oral PrEP (24.6%). Men who had at least two HIV tests (adjusted OR = 1.36, 95%CI 1.04, 1.78) more commonly preferred injectable PrEP. CONCLUSION Our findings may help inform PrEP messaging in areas where PrEP has yet to be scaled up.
Collapse
Affiliation(s)
- Wenting Huang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Jason J. Ong
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Twin Cities, USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Hongyun Fu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| |
Collapse
|
36
|
Ong JJ, Baggaley RC, Wi TE, Tucker JD, Fu H, Smith MK, Rafael S, Anglade V, Falconer J, Ofori-Asenso R, Terris-Prestholt F, Hodges-Mameletzis I, Mayaud P. Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1917134. [PMID: 31825501 PMCID: PMC6991203 DOI: 10.1001/jamanetworkopen.2019.17134] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Despite a global increase in sexually transmitted infections (STIs), there is limited focus and investment in STI management within HIV programs, in which risks for STIs are likely to be elevated. OBJECTIVE To estimate the prevalence of STIs at initiation of HIV preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate) and the incidence of STIs during PrEP use. DATA SOURCES Nine databases were searched up to November 20, 2018, without language restrictions. The implementers of PrEP were also approached for additional unpublished data. STUDY SELECTION Studies reporting STI prevalence and/or incidence among PrEP users were included. DATA EXTRACTION AND SYNTHESIS Data were extracted independently by at least 2 reviewers. The methodological quality of studies was assessed using the Joanna Briggs Institute critical assessment tool for prevalence and incidence studies. Random-effects meta-analysis was performed. MAIN OUTCOMES AND MEASURES Pooled STI prevalence (ie, within 3 months of PrEP initiation) and STI incidence (ie, during PrEP use, after 3 months). RESULTS Of the 3325 articles identified, 88 were included (71 published and 17 unpublished). Data came from 26 countries; 62 studies (70%) were from high-income countries, and 58 studies (66%) were from programs only for men who have sex with men. In studies reporting a composite outcome of chlamydia, gonorrhea, and early syphilis, the pooled prevalence was 23.9% (95% CI, 18.6%-29.6%) before starting PrEP. The prevalence of the STI pathogen by anatomical site showed that prevalence was highest in the anorectum (chlamydia, 8.5% [95% CI, 6.3%-11.0%]; gonorrhea, 9.3% [95% CI, 4.7%-15.2%]) compared with genital sites (chlamydia, 4.0% [95% CI, 2.0%-6.6%]; gonorrhea, 2.1% [95% CI, 0.9%-3.7%]) and oropharyngeal sites (chlamydia, 2.4% [95% CI, 0.9%-4.5%]; gonorrhea, 4.9% [95% CI, 1.9%-9.1%]). The pooled incidence of studies reporting the composite outcome of chlamydia, gonorrhea, and early syphilis was 72.2 per 100 person-years (95% CI, 60.5-86.2 per 100 person-years). CONCLUSIONS AND RELEVANCE Given the high burden of STIs among individuals initiating PrEP as well as persistent users of PrEP, this study highlights the need for active integration of HIV and STI services for an at-risk and underserved population.
Collapse
Affiliation(s)
- Jason J. Ong
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Teodora E. Wi
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Joseph D. Tucker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hongyun Fu
- Community Health and Research Division, Eastern Virginia Medical School, Norfolk
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis
| | - Sabrina Rafael
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vanessa Anglade
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Falconer
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Fern Terris-Prestholt
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
37
|
Wang C, Tang W, Zhao P, Tucker J, Chen L, Smith MK, Wong NS, Dong W, Yang B, Zheng H. Rapid increase of gonorrhoea cases in Guangdong Province, China, 2014-2017: a review of surveillance data. BMJ Open 2019; 9:e031578. [PMID: 31712340 PMCID: PMC6858213 DOI: 10.1136/bmjopen-2019-031578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES An increased trend in the number of reported gonorrhoea cases has been observed between 2014 and 2017 in China. This study aims to describe the reported epidemic of gonorrhoea and potential driving forces in Guangdong Province, China. DESIGN A review of surveillance data. PARTICIPANTS Three different sources of data from Guangdong Province were analysed: gonorrhoea cases reported to the Chinese sexually transmitted infections (STI) case report system (CRS); a clinic-based retrospective study conducted to collect information on annual gonorrhoea screening coverage and data from the Guangdong governmental sentinel surveillance network (SSN) to examine the gonorrhoea prevalence among males attending STI clinics. OUTCOME MEASURES Reported incidence of gonorrhoea, number of reported gonorrhoea cases, number of screening tests for gonorrhoea and gonorrhoea prevalence. RESULTS The STI CRS data showed that the reported incidence of gonorrhoea has increased rapidly from 15.7 cases per 100 000 population in 2014 to 27.3 cases per 100 000 in 2017 in Guangdong (p<0.001). Regions with a reported incidence of gonorrhoea cases of more than 10 cases per 100 000 expanded from 7 cities in 2014 to 13 cities in 2017. The SSN data showed that the gonorrhoea prevalence among males attending STI clinics increased from 2.7% in 2015 to 3.6% in 2017 (p=0.14). The retrospective study showed that the increased rate of screening for gonorrhoea between 2014 and 2017 was 35.0%, which was much lower than the increased rate of the number of reported gonorrhoea cases (123.3%). CONCLUSIONS The number of gonococcal infections is rapidly rising in Guangdong, China. Expanded screening coverage, use of more sensitive diagnostics and increase of gonorrhoea prevalence are three potential contributors to the epidemic. Additional targeted intervention strategies are necessary in the future to control the epidemic.
Collapse
Affiliation(s)
- Cheng Wang
- STD Control, Dermatology Hospital of Southern Medical University, Guangzhou, China
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
| | - Weiming Tang
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
- Project-China, University of North Carolina, Guangzhou, China
| | - Peizhen Zhao
- STD Control, Dermatology Hospital of Southern Medical University, Guangzhou, China
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
| | - Joseph Tucker
- Project-China, University of North Carolina, Guangzhou, China
| | - Lei Chen
- STD Control, Dermatology Hospital of Southern Medical University, Guangzhou, China
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
| | - M Kumi Smith
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Ngai Sze Wong
- Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Willa Dong
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bin Yang
- STD Control, Dermatology Hospital of Southern Medical University, Guangzhou, China
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
| | - Heping Zheng
- STD Control, Dermatology Hospital of Southern Medical University, Guangzhou, China
- STD Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, China
| |
Collapse
|
38
|
Ong JJ, Li CC, Fu H, Nie J, Tang W, Chang W, Smith MK, Marks M, Yang B, Wang C, Tucker J. Risk attitudes, risky sexual behaviours and willingness to test negative for syphilis using lottery-based financial incentives among Chinese men who have sex with men. Sex Transm Infect 2019; 96:355-357. [PMID: 31653680 DOI: 10.1136/sextrans-2019-054072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Individuals with risk-loving attitudes may be more likely to participate in high-risk sex and gambling. We investigated whether a lottery-based financial incentive to have a negative syphilis test may attract Chinese men who have sex with men (MSM) who practised risky sexual behaviours. METHODS In July 2018, a national online cross-sectional survey was conducted in China. We collected information on willingness to participate in a lottery-based financial incentive where men were eligible if they tested negative for syphilis, and the minimum prize that would attract them to participate. We used a validated risk attitude scale which asked about the willingness to take risks in six domains, ranging from 0 (avoids taking risk) to 10 (fully prepared to take risks). To avoid multicollinearity, we used principal components analysis to create a 'risk attitude index'. Bivariable and multivariable logistic regression explored factors associated with willingness to test negative for syphilis. RESULTS 699 MSM enrolled with a median age of 26 years (IQR: 23-30). 70% self-identified as gay and 52% reported ever testing for syphilis. 64% stated they were likely or very likely to test for syphilis linked with a lottery-based incentive. The median desired amount for the lottery had an expected value of ¥10 (US$1.50, IQR: ¥5-¥30). Men who had greater odds of willingness to participate in the lottery-based incentive were those scoring highest on the risk attitude index (adjusted OR (AOR) 2.6, 95% CI 1.5 to 4.3), those reporting more than one sexual partner in the last 3 months (AOR 1.7, 95% CI 1.2 to 2.4), those who had not used condoms during their last sex (AOR 1.5, 95% CI 1.0 to 2.2) and those who ever had group sex (AOR 1.5, 95% CI 1.0 to 2.2). CONCLUSION Chinese MSM with higher risk attitudes and who reported riskier sexual behaviours indicated greater interest in the concept of a lottery-based incentive for syphilis testing. A lottery-based incentive may be a promising strategy for promoting condom use among risk-loving men.
Collapse
Affiliation(s)
- Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Chang Chang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - HongYun Fu
- University of North Carolina Project China, Guangzhou, China.,Community Health and Research Division, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Juan Nie
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - WeiBin Chang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China .,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,University of North Carolina Project China, Guangzhou, China
| |
Collapse
|
39
|
Jin X, Xu J, Smith MK, Xiao D, Rapheal ER, Xiu X, Ding Z, Zhang Y, Jie Y, Liao Y, Cao N, Wu H, Bao Y. An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China. J Med Internet Res 2019; 21:e11854. [PMID: 31094339 PMCID: PMC6540722 DOI: 10.2196/11854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/06/2018] [Accepted: 03/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background With China’s explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. Objective This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. Methods A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. Results A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ23=55.0; P<.001). Conclusions The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China.
Collapse
Affiliation(s)
- Xia Jin
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Junjie Xu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - M Kumi Smith
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | | | - Erica R Rapheal
- School of Public Health, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Xiangfei Xiu
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Zhengwei Ding
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Yang Zhang
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Yang Jie
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Ying Liao
- AIDS Healthcare Foundation China Program, Beijing, China
| | - Ningxiao Cao
- Chinese Academy of Medical Sciences, Hospital for Skin Diseases and STI Control, Nanjing, China
| | - Hao Wu
- Beijing Youan hospital, Beijing, China
| | - Yugang Bao
- AIDS Healthcare Foundation China Program, Beijing, China
| |
Collapse
|
40
|
Smith MK, Stein G, Cheng W, Miller WC, Tucker JD. Correction to: Identifying high risk subgroups of MSM: a latent class analysis using two samples. BMC Infect Dis 2019; 19:284. [PMID: 30914046 PMCID: PMC6434628 DOI: 10.1186/s12879-019-3886-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN, 55454, USA.
| | - Gabriella Stein
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599, USA
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, 1 Jiaochang E Rd., Guangzhou Shi, 510000, Guangdong Sheng, China
| | - William C Miller
- Division of Epidemiology, The Ohio State University, College of Public Health, 1841 Neal, Ave., 302 Cunz Hall, Columbus, OH, 43210, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC, 27599, USA
| |
Collapse
|
41
|
Smith MK, Stein G, Cheng W, Miller WC, Tucker JD. Identifying high risk subgroups of MSM: a latent class analysis using two samples. BMC Infect Dis 2019; 19:213. [PMID: 30832592 PMCID: PMC6399860 DOI: 10.1186/s12879-019-3700-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
Background Latent class analyses (LCA) are increasingly being used to target specialized HIV interventions, but generalizability of emergent population structures across settings has yet to be considered. We compare LCA performed on two online samples of HIV negative Chinese men who have sex with men (MSM) to detect more generalizable latent class structures and to assess the extent to which sampling considerations impact the validity of LCA results. Methods LCAs were performed on an 1) nationwide online survey which involved no in-person contact with study staff and a 2) sentinel surveillance survey in which participants underwent HIV and syphilis testing in the city of Guangzhou, both conducted in 2014. Models for each sample were informed by risk factors for HIV acquisition in MSM that were common to both datasets. Results An LCA of the Guangzhou sentinel surveillance data indicated the presence of two relatively similar classes, differing only by the greater tendency of one to report group sex. In contrast an LCA of the nationwide survey identified three classes, two of which shared many of the same features as those identified in the Guangzhou survey, including the fact that they were mainly distinguished by group sex behaviors. The final latent class in the nationwide survey was composed of members with notably few risk behaviors. Conclusions Comparisons of the latent class structures of each sample lead us to conclude that the nationwide online sample captured a larger, possibly more representative group of Chinese MSM comprised of a larger, higher risk group and a small yet distinct lower group with few reported behaviors. The absence of a lower risk group in the Guangzhou sentinel surveillance dataset suggests that MSM recruited into studies involving free HIV/STI testing may oversample MSM with higher risk behaviors and therefore greater risk perception. Lastly, two types of higher risk MSM were emergent across both samples distinguished largely by their recent group sex behaviors. Higher odds not only of self-reported HIV infection but also of closeted tendencies and gender fluid identities in this highest risk group suggest that interacting factors drive individual and structural facets of HIV risk.
Collapse
Affiliation(s)
- M Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota Twin Cities, 1300 South 2nd Street, Minneapolis, MN, 55454, USA.
| | - Gabriella Stein
- Department of Biostatistics, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420, Chapel Hill, NC, 27599, USA
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Department of AIDS/STD Control and Prevention, 1 Jiaochang E Rd, Guangzhou Shi, 510000, Guangdong Sheng, China
| | - William C Miller
- Division of Epidemiology, The Ohio State University, College of Public Health, 1841 Neal Ave., 302 Cunz Hall, Columbus, OH, 43210, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC, 27599, USA
| |
Collapse
|
42
|
Draper LA, Ryan FJ, Smith MK, Jalanka J, Mattila E, Arkkila PA, Ross RP, Satokari R, Hill C. Long-term colonisation with donor bacteriophages following successful faecal microbial transplantation. Microbiome 2018; 6:220. [PMID: 30526683 PMCID: PMC6288847 DOI: 10.1186/s40168-018-0598-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/18/2018] [Indexed: 05/07/2023]
Abstract
BACKGROUND Faecal microbiota transplantation (FMT) is used in the treatment of recurrent Clostridium difficile infection. Its success is typically attributed to the restoration of a diverse microbiota. Viruses (including bacteriophages) are the most numerically dominant and potentially the most diverse members of the microbiota, but their fate following FMT has not been well studied. RESULTS We studied viral transfer following FMT from 3 donors to 14 patients. Recipient viromes resembled those of their donors for up to 12 months. Tracking individual bacteriophage colonisation revealed that engraftment of individual bacteriophages was dependent on specific donor-recipient pairings. Specifically, multiple recipients from a single donor displayed highly individualised virus colonisation patterns. CONCLUSIONS The impact of viruses on long-term microbial dynamics is a factor that should be reviewed when considering FMT as a therapeutic option.
Collapse
Affiliation(s)
- L A Draper
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - F J Ryan
- APC Microbiome Institute, University College Cork, Cork, Ireland
- Present Address: South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia
| | - M K Smith
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - J Jalanka
- Immunobiology Research Program and Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - E Mattila
- Departments of Gastroenterology and Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - P A Arkkila
- Departments of Gastroenterology and Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - R P Ross
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - R Satokari
- Immunobiology Research Program and Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - C Hill
- APC Microbiome Institute, University College Cork, Cork, Ireland.
| |
Collapse
|
43
|
Tang W, Wei C, Cao B, Wu D, Li KT, Lu H, Ma W, Kang D, Li H, Liao M, Mollan KR, Hudgens MG, Liu C, Huang W, Liu A, Zhang Y, Smith MK, Mitchell KM, Ong JJ, Fu H, Vickerman P, Yang L, Wang C, Zheng H, Yang B, Tucker JD. Crowdsourcing to expand HIV testing among men who have sex with men in China: A closed cohort stepped wedge cluster randomized controlled trial. PLoS Med 2018; 15:e1002645. [PMID: 30153265 PMCID: PMC6112627 DOI: 10.1371/journal.pmed.1002645] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND HIV testing rates are suboptimal among at-risk men. Crowdsourcing may be a useful tool for designing innovative, community-based HIV testing strategies to increase HIV testing. The purpose of this study was to use a stepped wedge cluster randomized controlled trial (RCT) to evaluate the effect of a crowdsourced HIV intervention on HIV testing uptake among men who have sex with men (MSM) in eight Chinese cities. METHODS AND FINDINGS An HIV testing intervention was developed through a national image contest, a regional strategy designathon, and local message contests. The final intervention included a multimedia HIV testing campaign, an online HIV testing service, and local testing promotion campaigns tailored for MSM. This intervention was evaluated using a closed cohort stepped wedge cluster RCT in eight Chinese cities (Guangzhou, Shenzhen, Zhuhai, and Jiangmen in Guangdong province; Jinan, Qingdao, Yantai, and Jining in Shandong province) from August 2016 to August 2017. MSM were recruited through Blued, a social networking mobile application for MSM, from July 29 to August 21 of 2016. The primary outcome was self-reported HIV testing in the past 3 months. Secondary outcomes included HIV self-testing, facility-based HIV testing, condom use, and syphilis testing. Generalized linear mixed models (GLMMs) were used to analyze primary and secondary outcomes. We enrolled a total of 1,381 MSM. Most were ≤30 years old (82%), unmarried (86%), and had a college degree or higher (65%). The proportion of individuals receiving an HIV test during the intervention periods within a city was 8.9% (95% confidence interval [CI] 2.2-15.5) greater than during the control periods. In addition, the intention-to-treat analysis showed a higher probability of receiving an HIV test during the intervention periods as compared to the control periods (estimated risk ratio [RR] = 1.43, 95% CI 1.19-1.73). The intervention also increased HIV self-testing (RR = 1.89, 95% CI 1.50-2.38). There was no effect on facility-based HIV testing (RR = 1.00, 95% CI 0.79-1.26), condom use (RR = 1.00, 95% CI 0.86-1.17), or syphilis testing (RR = 0.92, 95% CI 0.70-1.21). A total of 48.6% (593/1,219) of participants reported that they received HIV self-testing. Among men who received two HIV tests, 32 individuals seroconverted during the 1-year study period. Study limitations include the use of self-reported HIV testing data among a subset of men and non-completion of the final survey by 23% of participants. Our study population was a young online group in urban China and the relevance of our findings to other populations will require further investigation. CONCLUSIONS In this setting, crowdsourcing was effective for developing and strengthening community-based HIV testing services for MSM. Crowdsourced interventions may be an important tool for the scale-up of HIV testing services among MSM in low- and middle-income countries (LMIC). TRIAL REGISTRATION ClinicalTrials.gov NCT02796963.
Collapse
Affiliation(s)
- Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Chongyi Wei
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Social and Behavioral Health Sciences, School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Bolin Cao
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Katherine T. Li
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Weill Cornell Medical College, New York, New York, United States of America
| | - Haidong Lu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wei Ma
- Shandong University School of Public Health, Jinan, China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Haochu Li
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Shandong University School of Public Health, Jinan, China
| | - Meizhen Liao
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Katie R. Mollan
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Michael G. Hudgens
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Department of Sociology, University of California San Diego, La Jolla, California, United States of America
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Aifeng Liu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Ye Zhang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - M. Kumi Smith
- Department of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States of America
| | - Kate M. Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Jason J. Ong
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Ligang Yang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
44
|
Hino S, Grodensky C, Rutstein SE, Golin C, Smith MK, Christmas L, Miller W, Phiri S, Massa C, Kamanga G, Pettifor A. HIV status disclosure during acute HIV infection in Malawi. PLoS One 2018; 13:e0201265. [PMID: 30048496 PMCID: PMC6062079 DOI: 10.1371/journal.pone.0201265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/06/2018] [Accepted: 06/13/2018] [Indexed: 01/05/2023] Open
Abstract
Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT01450189.
Collapse
Affiliation(s)
- Sayaka Hino
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Catherine Grodensky
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah E. Rutstein
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Carol Golin
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- * E-mail:
| | - M. Kumi Smith
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Lawrenson Christmas
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - William Miller
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | | | - Cecilia Massa
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Gift Kamanga
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Audrey Pettifor
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| |
Collapse
|
45
|
Smith MK, Solomon SS, Cummings DAT, Srikrishnan AK, Kumar MS, Vasudevan CK, McFall AM, Lucas GM, Celentano DD, Mehta SH. Overlap between harm reduction and HIV service utilisation among PWID in India: Implications for HIV combination prevention. Int J Drug Policy 2018; 57:111-118. [PMID: 29730586 PMCID: PMC6430979 DOI: 10.1016/j.drugpo.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours. METHODS Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3% and 5.0% of full sample, respectively). We considered both recent (prior year) and ever use of services. RESULTS Overall, 42.3% reported prior HIV testing and 57.9% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants. CONCLUSIONS Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.
Collapse
Affiliation(s)
- M Kumi Smith
- Johns Hopkins University Bloomberg School of Public Health,615 N Wolfe Street, Baltimore, MD, USA; University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, USA.
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.
| | - Derek A T Cummings
- Emerging Pathogens Institute, University of Florida at Gainesville, Gainesville, USA.
| | - Aylur K Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
| | - M Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
| | - C K Vasudevan
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
| | - Allison M McFall
- Johns Hopkins University Bloomberg School of Public Health,615 N Wolfe Street, Baltimore, MD, USA.
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.
| | - David D Celentano
- Johns Hopkins University Bloomberg School of Public Health,615 N Wolfe Street, Baltimore, MD, USA.
| | - Shruti H Mehta
- Johns Hopkins University Bloomberg School of Public Health,615 N Wolfe Street, Baltimore, MD, USA.
| |
Collapse
|
46
|
Abstract
INTRODUCTION Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.
Collapse
Affiliation(s)
- Jason J. Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Central Clinical School, Monash University, Victoria, Australia
| | - Hongyun Fu
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- Eastern Virginia Medical School, Norfolk, USA
| | - M. Kumi Smith
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina at Chapel Hill, North Carolina, USA
| |
Collapse
|
47
|
Stains M, Harshman J, Barker MK, Chasteen SV, Cole R, DeChenne-Peters SE, Eagan MK, Esson JM, Knight JK, Laski FA, Levis-Fitzgerald M, Lee CJ, Lo SM, McDonnell LM, McKay TA, Michelotti N, Musgrove A, Palmer MS, Plank KM, Rodela TM, Sanders ER, Schimpf NG, Schulte PM, Smith MK, Stetzer M, Van Valkenburgh B, Vinson E, Weir LK, Wendel PJ, Wheeler LB, Young AM. Anatomy of STEM teaching in North American universities. Science 2018; 359:1468-1470. [PMID: 29599232 PMCID: PMC6310123 DOI: 10.1126/science.aap8892] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
National and local initiatives focused on the transformation of STEM teaching in higher education have multiplied over the last decade. These initiatives often focus on measuring change in instructional practices, but it is difficult to monitor such change without a national picture of STEM educational practices, especially as characterized by common observational instruments. We characterized a snapshot of this landscape by conducting the first large scale observation-based study. We found that lecturing was prominent throughout the undergraduate STEM curriculum, even in classrooms with infrastructure designed to support active learning, indicating that further work is required to reform STEM education. Additionally, we established that STEM faculty’s instructional practices can vary substantially within a course, invalidating the commonly-used teaching evaluations based on a one-time observation. Although lecture is prominent throughout the undergraduate STEM curriculum, STEM faculty employ varied teaching practices within the same course.
Collapse
Affiliation(s)
- M Stains
- The list of author affiliations is provided in the supplementary materials.
| | - J Harshman
- The list of author affiliations is provided in the supplementary materials
| | - M K Barker
- The list of author affiliations is provided in the supplementary materials
| | - S V Chasteen
- The list of author affiliations is provided in the supplementary materials
| | - R Cole
- The list of author affiliations is provided in the supplementary materials
| | | | - M K Eagan
- The list of author affiliations is provided in the supplementary materials
| | - J M Esson
- The list of author affiliations is provided in the supplementary materials
| | - J K Knight
- The list of author affiliations is provided in the supplementary materials
| | - F A Laski
- The list of author affiliations is provided in the supplementary materials
| | - M Levis-Fitzgerald
- The list of author affiliations is provided in the supplementary materials
| | - C J Lee
- The list of author affiliations is provided in the supplementary materials
| | - S M Lo
- The list of author affiliations is provided in the supplementary materials
| | - L M McDonnell
- The list of author affiliations is provided in the supplementary materials
| | - T A McKay
- The list of author affiliations is provided in the supplementary materials
| | - N Michelotti
- The list of author affiliations is provided in the supplementary materials
| | - A Musgrove
- The list of author affiliations is provided in the supplementary materials
| | - M S Palmer
- The list of author affiliations is provided in the supplementary materials
| | - K M Plank
- The list of author affiliations is provided in the supplementary materials
| | - T M Rodela
- The list of author affiliations is provided in the supplementary materials
| | - E R Sanders
- The list of author affiliations is provided in the supplementary materials
| | - N G Schimpf
- The list of author affiliations is provided in the supplementary materials
| | - P M Schulte
- The list of author affiliations is provided in the supplementary materials
| | - M K Smith
- The list of author affiliations is provided in the supplementary materials
| | - M Stetzer
- The list of author affiliations is provided in the supplementary materials
| | - B Van Valkenburgh
- The list of author affiliations is provided in the supplementary materials
| | - E Vinson
- The list of author affiliations is provided in the supplementary materials
| | - L K Weir
- The list of author affiliations is provided in the supplementary materials
| | - P J Wendel
- The list of author affiliations is provided in the supplementary materials
| | - L B Wheeler
- The list of author affiliations is provided in the supplementary materials
| | - A M Young
- The list of author affiliations is provided in the supplementary materials
| |
Collapse
|
48
|
Liu C, Fu R, Tang W, Cao B, Pan SW, Wei C, Tucker JD, Kumi Smith M. Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas. J Int AIDS Soc 2018; 21:e25039. [PMID: 29327442 PMCID: PMC5810344 DOI: 10.1002/jia2.25039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/08/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Migration of men who have sex with men (MSM) from rural to urban areas is common across low- and middle-income countries and is widely believed to contribute to elevated HIV risk among migrant MSM in urban areas. Little consensus exists on whether their risk is due to their transplantation or their being from resource-constrained rural areas. This study seeks to clarify the relationship between migration and HIV risks by comparing differences in HIV-related risky sexual behaviours and healthcare utilization across competing conceptualizations of migratory statuses. METHODS In July 2016, MSM ≥16 years old currently residing in one of eight urban cities in China were recruited for an online cross-sectional survey, which collected information on socio-demographics, sexual behaviours, HIV care-seeking behaviours, and healthcare utilization. Based on a question about residency status, each participant was classified as an urban local resident, urban transplant, or rural transplant. Multivariable multinomial logistic regression was used to examine the associations between risky behaviours and healthcare utilization among these three groups. RESULTS Among 2007 MSM, the proportion of local, urban transplant and rural transplant were 32% (648/2007), 24% (478/2007), and 44% (881/2007), respectively. Compared with urban local resident MSM, urban transplant MSM were more likely to have ever tested for HIV (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.08 to 1.80). Compared with urban transplant MSM, rural transplant MSM were less likely to have utilized any governmental sexual health services in the past three months (aOR = 0.75, 95% CI: 0.60 to 0.93), ever tested for HIV (aOR = 0.77, 95% CI: 0.61 to 0.96), ever initiated antiretroviral therapy (ART) (aOR = 0.16, 95% CI: 0.05 to 0.52), and ever purchased sex (aOR = 0.57, 95% CI: 0.38 to 0.85). No other significant differences were found in sexual behaviours among three groups. CONCLUSIONS The widely used local/migrant categorization obscures important differences in HIV risk present between urban/rural subgroups among them. Previous studies of HIV risks in Chinese "migrant" may have failed to consider the role of structural factors such as discrimination or barriers to healthcare when interpreting their findings of higher HIV prevalence in this population. Low ART uptake among rural transplant MSM in this study is particularly concerning and underscore the need for HIV-related interventions tailored for this group.
Collapse
Affiliation(s)
- Chuncheng Liu
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
- Department of SociologyUniversity of CaliforniaSan DiegoCAUSA
| | - Rong Fu
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Bolin Cao
- School of Media and CommunicationShenzhen UniversityShenzhenChina
| | - Stephen W Pan
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
- Department of Public HealthXi'an Jiaotong‐Liverpool UniversitySuzhouChina
| | - Chongyi Wei
- School of Public HealthRutgers UniversityNew BrunswickNJUSA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - M. Kumi Smith
- University of North Carolina at Chapel Hill Project‐ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| |
Collapse
|
49
|
Kumi Smith M, Jewell BL, Hallett TB, Cohen MS. Treatment of HIV for the Prevention of Transmission in Discordant Couples and at the Population Level. Adv Exp Med Biol 2018; 1075:125-162. [PMID: 30030792 DOI: 10.1007/978-981-13-0484-2_6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The scientific breakthrough proving that antiretroviral therapy (ART) can halt heterosexual HIV transmission came in the form of a landmark clinical trial conducted among serodiscordant couples. Study findings immediately informed global recommendations for the use of treatment as prevention in serodiscordant couples. The extent to which these findings are generalizable to other key populations or to groups exposed to HIV through nonsexual transmission routes (i.e., anal intercourse or unsafe injection of drugs) has since driven a large body of research. This review explores the history of HIV research in serodiscordant couples, the implications for management of couples, subsequent research on treatment as prevention in other key populations, and challenges in community implementation of these strategies.
Collapse
Affiliation(s)
- M Kumi Smith
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Myron S Cohen
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
50
|
Le DP, Smith MK, Aitken EAB. Genetic variation in Pythium myriotylum based on SNP typing and development of a PCR-RFLP detection of isolates recovered from Pythium soft rot ginger. Lett Appl Microbiol 2017; 65:319-326. [PMID: 28736938 DOI: 10.1111/lam.12779] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Abstract
Pythium myriotylum is responsible for severe losses in both capsicum and ginger crops in Australia under different regimes. Intraspecific genomic variation within the pathogen might explain the differences in aggressiveness and pathogenicity on diverse hosts. In this study, whole genome data of four P. myriotylum isolates recovered from three hosts and one Pythium zingiberis isolate were derived and analysed for sequence diversity based on single nucleotide polymorphisms (SNPs). A higher number of true and unique SNPs occurred in P. myriotylum isolates obtained from ginger with symptoms of Pythium soft rot (PSR) in Australia compared to other P. myriotylum isolates. Overall, SNPs were discovered more in the mitochondrial genome than those in the nuclear genome. Among the SNPs, a single substitution from the cytosine (C) to the thymine (T) in the partially sequenced CoxII gene of 14 representatives of PSR P. myriotylum isolates was within a restriction site of HinP1I enzyme which was used in the PCR-RFLP for detection and identification of the isolates without sequencing. The PCR-RFLP was also sensitive to detect PSR P. myriotylum strains from artificially infected ginger without the need for isolation for pure cultures. SIGNIFICANCE AND IMPACT OF THE STUDY This is the first study of intraspecific variants of Pythium myriotylum isolates recovered from different hosts and origins based on single nucleotide polymorphism (SNP) genotyping of multiple genes. The SNPs discovered provide valuable makers for detection and identification of P. myriotylum strains initially isolated from Pythium soft rot (PSR) ginger by using PCR-RFLP of the CoxII locus. The PCR-RFLP was also sensitive to detect P. myriotylum directly from PSR ginger sampled from pot trials without the need of isolation for pure cultures.
Collapse
Affiliation(s)
- D P Le
- School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - M K Smith
- Maroochy Research Station, Queensland Department of Agriculture and Fisheries, Nambour, QLD, Australia
| | - E A B Aitken
- School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|