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Rich SN, Richards VL, Mavian CN, Switzer WM, Rife Magalis B, Poschman K, Geary S, Broadway SE, Bennett SB, Blanton J, Leitner T, Boatwright JL, Stetten NE, Cook RL, Spencer EC, Salemi M, Prosperi M. Employing Molecular Phylodynamic Methods to Identify and Forecast HIV Transmission Clusters in Public Health Settings: A Qualitative Study. Viruses 2020; 12:E921. [PMID: 32842636 PMCID: PMC7551766 DOI: 10.3390/v12090921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/19/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/19/2023] Open
Abstract
Molecular HIV surveillance is a promising public health strategy for curbing the HIV epidemic. Clustering technologies used by health departments to date are limited in their ability to infer/forecast cluster growth trajectories. Resolution of the spatiotemporal dynamics of clusters, through phylodynamic and phylogeographic modelling, is one potential strategy to develop a forecasting tool; however, the projected utility of this approach needs assessment. Prior to incorporating novel phylodynamic-based molecular surveillance tools, we sought to identify possible issues related to their feasibility, acceptability, interpretation, and utility. Qualitative data were collected via focus groups among field experts (n = 17, 52.9% female) using semi-structured, open-ended questions. Data were coded using an iterative process, first through the development of provisional themes and subthemes, followed by independent line-by-line coding by two coders. Most participants routinely used molecular methods for HIV surveillance. All agreed that linking molecular sequences to epidemiological data is important for improving HIV surveillance. We found that, in addition to methodological challenges, a variety of implementation barriers are expected in relation to the uptake of phylodynamic methods for HIV surveillance. The participants identified several opportunities to enhance current methods, as well as increase the usability and utility of promising works-in-progress.
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Affiliation(s)
- Shannan N. Rich
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA; (V.L.R.); (N.E.S.); (R.L.C.); (M.P.)
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
| | - Veronica L. Richards
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA; (V.L.R.); (N.E.S.); (R.L.C.); (M.P.)
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
| | - Carla N. Mavian
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - William M. Switzer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA; (W.M.S.); (K.P.)
| | - Brittany Rife Magalis
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Karalee Poschman
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA; (W.M.S.); (K.P.)
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL 32399, USA; (S.E.B.); (E.C.S.)
| | - Shana Geary
- Division of Public Health, Injury and Violence Prevention Branch, North Carolina Department of Health and Human Services, Raleigh, NC 27699, USA;
| | - Steven E. Broadway
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL 32399, USA; (S.E.B.); (E.C.S.)
| | - Spencer B. Bennett
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, FL 32202, USA; (S.B.B.); (J.B.)
| | - Jason Blanton
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, FL 32202, USA; (S.B.B.); (J.B.)
| | - Thomas Leitner
- Theoretical Biology & Biophysics Group, Los Alamos National Laboratory, Los Alamos, NM 87545, USA;
| | - J. Lucas Boatwright
- Department of Plant and Environmental Sciences, Clemson University, Clemson, SC 29634, USA;
- Advanced Plant Technology Program, Clemson University, Clemson, SC 29634, USA
| | - Nichole E. Stetten
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA; (V.L.R.); (N.E.S.); (R.L.C.); (M.P.)
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA; (V.L.R.); (N.E.S.); (R.L.C.); (M.P.)
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
| | - Emma C. Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, HIV/AIDS Section, Tallahassee, FL 32399, USA; (S.E.B.); (E.C.S.)
| | - Marco Salemi
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA; (C.N.M.); (B.R.M.); (M.S.)
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL 32610, USA; (V.L.R.); (N.E.S.); (R.L.C.); (M.P.)
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Nasrullah M, Wesolowski LG, Ethridge SF, Cranston K, Pentella M, Myers RA, Rudrik JT, Hutchinson AB, Bennett SB, Werner BG. Acute infections, cost and time to reporting of HIV test results in three U.S. State Public Health Laboratories. J Infect 2016; 73:164-72. [PMID: 27237366 DOI: 10.1016/j.jinf.2016.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/02/2016] [Revised: 05/10/2016] [Accepted: 05/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In three U.S. State Public Health Laboratories (PHLs) using a fourth-generation immunoassay (IA), an HIV-1/HIV-2 differentiation antibody IA and a nucleic acid test (NAT), we characterized the yield and time to reporting of acute infections, and cost per positive specimen. METHODS Routine HIV testing data were collected from July 1, 2012-June 30, 2013 for Massachusetts and Maryland PHLs, and from November 27, 2012-June 30, 2013 for Michigan PHL. Massachusetts and Michigan used fourth-generation and differentiation IAs with NAT conducted by a referral laboratory. In Maryland, fourth-generation IA repeatedly reactive specimens were followed by a Western blot (WB), and those with negative or indeterminate results were tested with a differentiation IA and HIV-1 NAT, and if positive by NAT, confirmed by a different HIV-1 NAT. Specimens from WB-positive persons at risk for HIV-2 were tested with a differentiation IA and, if positive, with an HIV-2 WB and/or differential HIV-1/HIV-2 proviral DNA polymerase chain reaction. RESULTS Among 7914 specimens from Massachusetts PHL, 6069 from Michigan PHL, and 36,266 from Maryland PHL, 0.10%, 0.02% and 0.05% acute infections were identified, respectively. Massachusetts and Maryland PHLs each had 1 HIV-2 positive specimen. The median time from specimen receipt to laboratory reporting of results for acute infections at Massachusetts, Michigan and Maryland PHLs was 8, 11, and 7 days respectively. The laboratory cost per HIV positive specimen was $336 (Massachusetts), $263 (Michigan) and $210 (Maryland). CONCLUSIONS Acute and established infections were found by PHLs using fourth-generation IA in conjunction with antibody tests and NAT. Time to reporting of acute HIV test results to clients was suboptimal, and needs to be streamlined to expedite treatment and interrupt transmission.
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Affiliation(s)
- Muazzam Nasrullah
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Laura G Wesolowski
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven F Ethridge
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin Cranston
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Robert A Myers
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | - James T Rudrik
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Angela B Hutchinson
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wesolowski LG, Wroblewski K, Bennett SB, Parker MM, Hagan C, Ethridge SF, Rhodes J, Sullivan TJ, Ignacio-Hernando I, Werner BG, Owen SM. Nucleic acid testing by public health referral laboratories for public health laboratories using the U.S. HIV diagnostic testing algorithm. J Clin Virol 2015; 65:6-10. [PMID: 25766979 DOI: 10.1016/j.jcv.2015.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Many public health laboratories adopting the U.S. HIV laboratory testing algorithm do not have a nucleic acid test (NAT), which is needed when the third- or fourth-generation HIV screening immunoassay is reactive and the antibody-based supplemental test is non-reactive or indeterminate. OBJECTIVES Among public health laboratories utilizing public health referral laboratories for NAT conducted as part of the algorithm, we evaluated the percentage of screening immunoassays needing NAT, the number of specimens not meeting APTIMA (NAT) specifications, time to APTIMA result, the proportion of acute infections (i.e., reactive APTIMA) among total infections, and screening immunoassay specificity. STUDY DESIGN From August 2012 to April 2013, 22 laboratories enrolled to receive free APTIMA (NAT) at New York or Florida public health referral laboratories. Data were analyzed for testing conducted until June 2013. RESULTS Submitting laboratories conducted a median of 4778 screening immunoassays; 0-1.3% (median 0.2%) needed NAT. Of 140 specimens received, 9 (6.4%) did not meet NAT specifications. The median time from specimen collection to reporting the 11 reactive NAT results was ten days, including six days from receipt in the submitting laboratory to shipment to the referral laboratory. Acute infections ranged from 0 to 12.5% (median 0%) of total infections. Third- and fourth-generation immunoassays met package insert specificity values. CONCLUSIONS Public health referral laboratories provide a feasible option for conducting NAT. Reducing the time from specimen collection to submission of specimens for NAT is an important step toward maximizing the public health impact of identifying acute infections.
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Affiliation(s)
- Laura G Wesolowski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS E-46, Atlanta, GA 30333, USA.
| | - Kelly Wroblewski
- Association of Public Health Laboratories, 8515 Georgia Ave #700, Silver Spring, MD 20910, USA
| | - Spencer B Bennett
- Florida Department of Health, Bureau of Public Health Laboratories, 1217 N. Pearl St., Jacksonville, FL 32202, USA
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave. Albany, NY 12208, USA
| | - Celia Hagan
- Association of Public Health Laboratories, 8515 Georgia Ave #700, Silver Spring, MD 20910, USA
| | - Steven F Ethridge
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS E-46, Atlanta, GA 30333, USA
| | - Jeselyn Rhodes
- ICF International, Inc. 3 Corporate Blvd. NE #370, Atlanta, GA 30329, USA
| | - Timothy J Sullivan
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave. Albany, NY 12208, USA
| | - Imelda Ignacio-Hernando
- Florida Department of Health, Bureau of Public Health Laboratories, 1217 N. Pearl St., Jacksonville, FL 32202, USA
| | - Barbara G Werner
- Bureau of Infectious Disease, MA Department of Public Health, 305 South Street, Jamaica Plain, MA 02130, USA
| | - S Michele Owen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS E-46, Atlanta, GA 30333, USA
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Bennett SB, Pescatello LS. A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position. J Cardiopulm Rehabil 1997; 17:92-102. [PMID: 9101386 DOI: 10.1097/00008483-199703000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospital-based CR personnel were surveyed by staff position to determine their adherence to these guidelines. METHODS The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. RESULTS Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. CONCLUSIONS Overall, compliance of New England hospital-based CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.
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Affiliation(s)
- S B Bennett
- New Britain General Hospital, Connecticut 06050, USA
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