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Schaefer AJ, Mackie T, Veerakumar ES, Sheldrick RC, Moore Simas TA, Valentine J, Cowley D, Bhat A, Davis W, Byatt N. Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model. Health Aff (Millwood) 2024; 43:557-566. [PMID: 38560809 DOI: 10.1377/hlthaff.2023.01439] [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] [Indexed: 04/04/2024]
Abstract
Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.
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Affiliation(s)
- Ana J Schaefer
- Ana J. Schaefer , Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | | | - Deborah Cowley
- Deborah Cowley, University of Washington, Seattle, Washington
| | | | - Wendy Davis
- Wendy Davis, Postpartum Support International, Portland, Oregon
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Davis TME, Peters KE, Davis W. Use of a type 1 genetic risk score for classification of diabetes type in young Australian adults: the Fremantle Diabetes Study Phase II. Intern Med J 2024; 54:494-498. [PMID: 38224531 DOI: 10.1111/imj.16328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024]
Abstract
The applicability of a UK-validated genetic risk score (GRS) was assessed in 158 participants in the Fremantle Diabetes Study Phase II diagnosed between 20 and <40 years of age with type 1 or type 2 diabetes or latent autoimmune diabetes of adults (LADA). For type 1 versus type 2/LADA, the area under the receiver operating characteristic curve (AUC) was highest for serum C-peptide (0.93) and lowest for the GRS (0.66). Adding age at diagnosis and body mass index to C-peptide increased the AUC minimally (0.96). The GRS appears of modest diabetes diagnostic value in young Australians.
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Affiliation(s)
- Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley and Fremantle Hospitals Group, Perth, Western Australia, Australia
| | - Kirsten E Peters
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
- Proteomics International, Perth, Western Australia, Australia
| | - Wendy Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Kerrigan D, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Beckham SW, Karver TS, Mantsios A, Galai N. Individual and Collective Forms of Stigma Resistance: Pathways Between HIV and Sex Work Stigma and Viral Suppression Among Female Sex Workers in the Dominican Republic. AIDS Behav 2024; 28:357-366. [PMID: 37725235 DOI: 10.1007/s10461-023-04169-y] [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: 09/08/2023] [Indexed: 09/21/2023]
Abstract
Intersecting forms of stigma including both HIV and sex work stigma have been known to impede HIV prevention and optimal treatment outcomes among FSW. Recent research has indicated that intersectional stigma can be resisted at the community and individual level. We assessed pathways between HIV stigma, sex work stigma, social cohesion and viral suppression among a cohort of 210 FSW living with HIV in the Dominican Republic. Through Poisson regression we explored the relationship between HIV outcomes and internalized, anticipated and enacted HIV and sex work stigma, and resisted sex work stigma. We employed structural equation modeling to explore the direct effect of various forms of stigma on HIV outcomes, and the mediating effects of multi-level stigma resistance including social cohesion at the community level and occupational dignity at the individual level. 76.2% of FSW were virally suppressed and 28.1% had stopped ART at least once in the last 6 months. ART interruption had a significant negative direct effect on viral suppression (OR = 0.26, p < 0.001, 95% CI: 0.13-0.51). Social cohesion had a significant positive direct effect on viral suppression (OR = 2.07, p = 0.046, 95% CI: 1.01-4.25). Anticipated HIV stigma had a significant negative effect on viral suppression (OR = 0.34, p = 0.055, 95% CI: 0.11-1.02). This effect was mediated by the interaction between cohesion and dignity which rendered the impact of HIV stigma on viral suppression not significant. Findings demonstrate that while HIV stigma has a negative impact on viral suppression among FSW, it can be resisted through individual and collective means. Results reinforce the importance of community-driven, multi-level interventions.
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Affiliation(s)
- Deanna Kerrigan
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Clare Barrington
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Wendy Davis
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - S Wilson Beckham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Noya Galai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Davis TME, Davis W. The relationship between glycated haemoglobin and blood glucose-lowering treatment trajectories in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Obes Metab 2024; 26:283-292. [PMID: 37795655 DOI: 10.1111/dom.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
AIMS To examine the relationships between glycaemia and treatment complexity over 6 years in well-characterized community-based people with type 2 diabetes. MATERIALS AND METHODS Fremantle Diabetes Study Phase II participants who had type 2 diabetes with glycated haemoglobin (HbA1c) and blood glucose-lowering therapy (BGLT) data over 6 years were included. Group-based multi-trajectory modelling identified combined HbA1c/BGLT trajectory subgroups for diabetes durations of ≤1.0 year (Group 1; n = 160), >1.0 to 10.0 years (Group 2; n = 382;) and >10.0 years (Group 3; n = 357). Multinomial regression was used to identify baseline associates of subgroup membership. RESULTS The optimum numbers of trajectory subgroups were three in Group 1 (low, medium, high) and four in Groups 2 and 3 (low, low/high medium, high). Each low trajectory subgroup maintained a mean HbA1c concentration of <53 mmol/mol (<7.0%) on lifestyle measures, or monotherapy (Group 3). All five medium subgroups had stable HbA1c trajectories at <58 mmol/mol (<7.5%) but required increasing oral BGLT, or insulin (Group 3, high medium). The Group 1 high subgroup showed a falling then increasing HbA1c with steady progression to insulin. The high subgroups in Groups 2 and 3 showed stable HbA1c profiles at means of approximately 64 mmol/mol (8.0%) and 86 mmol/L (10.0%), respectively, on insulin. Non-Anglo Celt ethnicity, central obesity and hypertriglyceridaemia were strongly associated with Group 1 high subgroup membership. Younger age at diagnosis and central obesity were independent associates of the most adverse HbA1c trajectories in Groups 2 and 3. CONCLUSIONS These data demonstrate diabetes duration-dependent heterogeneity in glycaemic and treatment profiles and related clinical and laboratory variables, which have implications for management.
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Affiliation(s)
- Timothy M E Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
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Wang Y, Karver TS, Berg CJ, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Galai N, Kerrigan D. Substance Use and Depression Impede ART Adherence Among Female Sex Workers Living with HIV in the Dominican Republic. AIDS Behav 2023; 27:2079-2088. [PMID: 36477652 PMCID: PMC10225324 DOI: 10.1007/s10461-022-03940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
Female sex workers (FSW) have worse HIV outcomes in part due to lower anti-retroviral therapy (ART) adherence. Substance use and depression are important barriers to ART adherence, yet few studies have assessed these relationships among FSW in longitudinal studies. Cross-Lagged Panel Models and autoregressive mediation analyses assessed substance use (illicit drug use and alcohol use disorders) in relation to ART non-adherence and the mediation role of depressive symptoms among 240 FSW living with HIV in the Dominican Republic. In annual visits (T1, T2, T3), the majority (70%, 66%, and 53%) reported at-risk drinking and 15%, 13% and 9% used illicit drug during the past 6 months. Most FSW (70%, 62% and 46%) had mild-to-severe depression. Illicit drug use predicted later ART non-adherence. This relationship was not mediated via depressive symptoms. Integrated substance use and HIV care interventions are needed to promote ART adherence and viral suppression among FSW.
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Affiliation(s)
- Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Lobo G, Rivers L, Reeves D, Shah S, Quinet R, Davis W, Zakem J, Keshavamurthy C, Hayat S, Harris T, You Z, Zhang X. High fat diet in lupus: gender differences in skin lesion, nephritis, and autoimmunity in MRL/lpr mice. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00529-3] [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: 01/28/2023]
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Kerrigan D, Mantsios A, Karver TS, Davis W, Taggart T, Calabrese SK, Mathews A, Robinson S, Ruffin R, Feaster-Bethea G, Quinteros-Grady L, Galvis C, Reyes R, Martinez Chio G, Tesfahun M, Lane A, Peeks S, Henderson KM, Harris KM. Context and Considerations for the Development of Community-Informed Health Communication Messaging to Support Equitable Uptake of COVID-19 Vaccines Among Communities of Color in Washington, DC. J Racial Ethn Health Disparities 2023; 10:395-409. [PMID: 35118609 PMCID: PMC8812353 DOI: 10.1007/s40615-022-01231-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/26/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Communities of color have been disproportionately impacted by COVID-19. We explored barriers and facilitators to COVID-19 vaccine uptake among African American, Latinx, and African immigrant communities in Washington, DC. METHODS A total of 76 individuals participated in qualitative interviews and focus groups, and 208 individuals from communities of color participated in an online crowdsourcing contest. RESULTS Findings documented a lack of sufficient, accurate information about COVID-19 vaccines and questions about the science. African American and African immigrant participants spoke about the deeply rooted historical underpinnings to their community's vaccine hesitancy, citing the prior and ongoing mistreatment of people of color by the medical community. Latinx and African immigrant participants highlighted how limited accessibility played an important role in the slow uptake of COVID-19 vaccines in their communities. Connectedness and solidarity were found to be key assets that can be drawn upon through community-driven responses to address social-structural challenges to COVID-19 related vaccine uptake. CONCLUSIONS The historic and ongoing socio-economic context and realities of communities of color must be understood and respected to inform community-based health communication messaging to support vaccine equity for COVID-19 and other infectious diseases.
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Affiliation(s)
- Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | | | - Tahilin Sanchez Karver
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Tamara Taggart
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC USA
| | | | | | - Regretta Ruffin
- Leadership Council for Healthy Communities, Washington, DC USA
| | | | | | | | - Rosa Reyes
- Latin American Youth Center, Washington, DC USA
| | | | | | | | - Shanna Peeks
- Black Coalition Against COVID, Washington, DC USA
| | - Kimberly M. Henderson
- DC Department of Health (DC Health), Communications and Community Relations, Washington, DC USA
| | - Kimberly M. Harris
- DC Department of Health (DC Health), Health Care Access Bureau (HCAB), Washington, DC USA
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Mundy E, Shim A, Lockie R, Newman D, Smith M, Davis W. Does coincidence anticipation timing improve in police officers after a 4-week video intervention? J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.114] [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: 11/17/2022]
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Beckham SW, Mantsios A, Galai N, Likindikoki S, Mbwambo J, Davis W, Kerrigan D. Acceptability of multiple modalities of pre-exposure prophylaxis (PrEP) among female sex workers in Tanzania: a mixed-methods study. BMJ Open 2022; 12:e058611. [PMID: 35977762 PMCID: PMC9389123 DOI: 10.1136/bmjopen-2021-058611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Modalities of pre-exposure prophylaxis (PrEP) for HIV prevention offer options to women at high risk including female sex workers (FSW). This study aimed to explore FSW's acceptability and preferences for oral pills, long-acting (LA) injectable and vaginal ring PrEP. DESIGN Sequential, explanatory, mixed methods. SETTING Iringa, Tanzania. PARTICIPANTS FSW aged above 18 were recruited from sex work venues using time-location sampling (n=496); HIV-uninfected (n=293) were included in this analysis. Subsequently, survey participants were recruited for in-depth interviews (n=10) and two focus group discussions (n=20). PRIMARY OUTCOME MEASURES (1) Acceptability of PrEP (Do you personally think it would be worth it to you to take ART if it could prevent HIV?: yes/no) and (2) preference for LA injectable versus oral pills (If you personally were going to take ART to prevent HIV infection, would you prefer to take it in the form of a daily pill or an injection once every 3 months? Injection/pill). RESULTS Participants were (92%) unaware of PrEP but 58% thought it would be worth it to personally take PrEP. Acceptability of PrEP was significantly associated with higher social cohesion (aOR 2.12; 95% CI 1.29 to 3.50) and STI symptoms in the past 6 months (aOR 2.52; 95% CI 1.38 to 4.62). Most (88%) preferred LA vs oral PrEP. Qualitative findings revealed generally positive reactions to all types of PrEP, and they were viewed as a welcome backup to condoms. Participants had concerns about pills (burden of daily use, stigma from clients), and the vaginal ring (fear of client noticing and becoming suspicious, fear of infertility) and overall preferred LA-PrEP (less frequent use, easy to hide, belief in higher efficacy). CONCLUSIONS Offering multiple formulations of PrEP within the context of community-driven HIV prevention interventions among FSW may facilitate increased uptake and adherence. LA injectable PrEP may be a particularly preferred formulation among FSW. TRIAL REGISTRATION NUMBER NCT02281578.
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Affiliation(s)
- S Wilson Beckham
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Noya Galai
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samuel Likindikoki
- Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Jessie Mbwambo
- Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Wendy Davis
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Pun TB, Phillips CL, Marshall NS, Comas M, Hoyos CM, D’Rozario AL, Bartlett DJ, Davis W, Hu W, Naismith SL, Cain S, Postnova S, Grunstein RR, Gordon CJ. The Effect of Light Therapy on Electroencephalographic Sleep in Sleep and Circadian Rhythm Disorders: A Scoping Review. Clocks Sleep 2022; 4:358-373. [PMID: 35997384 PMCID: PMC9397048 DOI: 10.3390/clockssleep4030030] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 01/27/2023] Open
Abstract
Light therapy is used to treat sleep and circadian rhythm disorders, yet there are limited studies on whether light therapy impacts electroencephalographic (EEG) activity during sleep. Therefore, we aimed to provide an overview of research studies that examined the effects of light therapy on sleep macro- and micro-architecture in populations with sleep and circadian rhythm disorders. We searched for randomized controlled trials that used light therapy and included EEG sleep measures using MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials databases. Five articles met the inclusion criteria of patients with either insomnia or delayed sleep−wake phase disorder (DSWPD). These trials reported sleep macro-architecture outcomes using EEG or polysomnography. Three insomnia trials showed no effect of the timing or intensity of light therapy on total sleep time, wake after sleep onset, sleep efficiency and sleep stage duration compared to controls. Only one insomnia trial reported significantly higher sleep efficiency after evening light therapy (>4000 lx between 21:00−23:00 h) compared with afternoon light therapy (>4000 lx between 15:00−17:00 h). In the only DSWPD trial, six multiple sleep latency tests were conducted across the day (09:00 and 19:00 h) and bright light (2500 lx) significantly lengthened sleep latency in the morning (09:00 and 11:00 h) compared to control light (300 lx). None of the five trials reported any sleep micro-architecture measures. Overall, there was limited research about the effect of light therapy on EEG sleep measures, and studies were confined to patients with insomnia and DSWPD only. More research is needed to better understand whether lighting interventions in clinical populations affect sleep macro- and micro-architecture and objective sleep timing and quality.
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Affiliation(s)
- Teha B. Pun
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Craig L. Phillips
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Nathaniel S. Marshall
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Maria Comas
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Camilla M. Hoyos
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Angela L. D’Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Delwyn J. Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Wendy Davis
- School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Wenye Hu
- School of Architecture, Design and Planning, The University of Sydney, Sydney, NSW 2008, Australia
| | - Sharon L. Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW 2050, Australia
| | - Sean Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
| | - Svetlana Postnova
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- School of Physics, Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ron R. Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Sleep and Severe Mental Illness Clinic, CPC-RPA Clinic, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Christopher J. Gordon
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
- Correspondence: ; Tel.: +61-2-9351-0586
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Bachmann KF, Regli A, Mändul M, Davis W, Reintam Blaser A. Impact of intraabdominal hypertension on kidney failure in critically ill patients: A post-hoc database analysis. J Crit Care 2022; 71:154078. [PMID: 35738182 DOI: 10.1016/j.jcrc.2022.154078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess whether intraabdominal hypertension (IAH) may influence kidney failure as well as mortality. METHODS This post-hoc analysis of two databases (IROI and iSOFA study) tested the independent association between IAH and kidney failure. Mortality was assessed using four prespecified groups (IAH present, kidney failure present, IAH and kidney failure present and no IAH or kidney failure present). RESULTS Of 825 critically ill patients, 302 (36.6%) developed kidney failure and 192 (23.7%) died during the first 90 days. Only 'Cumulative days with IAH grade II or more' was significantly associated with kidney failure (OR 1.29 (1.08-1.55), p = 0.003) while 'cumulative days with IAH grade I or more' (p = 0.135) or highest daily IAP (p = 0.062) was not. IAH combined with kidney failure was independently associated with 90-day mortality (OR 2.20 (1.20-4.05), p = 0.011), which was confirmed for higher grades of IAH (grade II or more) alone (OR 2.14 (1.07-4.30), p = 0.032) and combined with kidney failure (OR 3.25 (1.72-6.12), p < 0.001). CONCLUSIONS This study suggest that duration as well as higher grades of IAH are associated with kidney failure and may increase mortality.
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Affiliation(s)
- Kaspar F Bachmann
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia; Medical School, The University of Notre Dame, Fremantle, WA, Australia
| | - Merli Mändul
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia; Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Wendy Davis
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Annika Reintam Blaser
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
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Wang Y, Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Davis W, Galai N, Kerrigan D. Structural and Psychosocial Impacts of the COVID-19 Pandemic on HIV Care and Treatment Outcomes Among Female Sex Workers in the Dominican Republic. J Acquir Immune Defic Syndr 2022; 89:481-488. [PMID: 34974474 PMCID: PMC9058160 DOI: 10.1097/qai.0000000000002901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV. METHODS We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes. RESULTS Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges. CONCLUSIONS FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.
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Affiliation(s)
- Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tahilin Sanchez Karver
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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13
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Greenberg AE, Celentano DD, Metzger DS, Magnus M, Blank MB, Davis W, Brooks D, Dominque T, Page KR, Limaye RJ, Collman RG, Chaisson RE, Zea MC, Beyrer C. The Mid-Atlantic Centers for AIDS Research Consortium: Promoting HIV Science Through Regional Collaboration. AIDS Res Hum Retroviruses 2022; 38:181-187. [PMID: 34465217 PMCID: PMC8968835 DOI: 10.1089/aid.2021.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Centers for AIDS Research (CFAR) program was established by the National Institutes of Health in 1988 to catalyze and support high-impact HIV research and to develop the next generation of HIV investigators at academic institutions throughout the United States. In 2014, the Penn CFAR, the Johns Hopkins University CFAR and the District of Columbia CFAR developed a partnership-the Mid-Atlantic CFAR Consortium (MACC)-to promote cross-CFAR scientific collaboration, mentoring, and communication and to address the regional HIV epidemic. Over the past 6 years, the creation of the MACC has resulted in a rich web of interconnectivity, which has fostered scientific collaboration through working groups on the black men who have sex with men (MSM) and Latinx regional HIV epidemics, joint peer-reviewed publications, and successful collaborative grant applications on topics ranging from HIV prevention in young MSM, transgender women, implementation science, and clinical epidemiology; supported developmental activities through the MACC Scholars program, cross-CFAR mentoring, joint symposia, cross-CFAR seminar participation, and keynote speakers; and promoted strategic communication through advisory committees, best practices consultations, and the social and behavioral science research network. The MACC has been highly impactful by promoting HIV science through regional collaboration, supporting a diverse network of scholars across three cities and focusing on the epidemic in underrepresented and marginalized communities. Lessons learned from this consortium may have implications for scientific research centers beyond the field of HIV.
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Affiliation(s)
- Alan E. Greenberg
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA.,Address correspondence to: Alan E. Greenberg, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, 5th floor, Washington, DC 20052, USA
| | - David D. Celentano
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - David S. Metzger
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Manya Magnus
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA
| | - Michael B. Blank
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Davis
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Durryle Brooks
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Tiffany Dominque
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen R. Page
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Rupali J. Limaye
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Ronald G. Collman
- Penn Center for AIDS Research and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard E. Chaisson
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Cecilia Zea
- District of Columbia Center for AIDS Research and George Washington University, Washington, District of Columbia, USA
| | - Chris Beyrer
- Johns Hopkins University Center for AIDS Research and Johns Hopkins University, Baltimore, Maryland, USA
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14
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Mantsios A, Muraleetharan O, Donastorg Y, Perez M, Gomez H, Shembilu C, Beckham SW, Karver TS, Davis W, Likindikoki S, Mbwambo J, Barrington C, Kerrigan D. "She is the one who knows": A qualitative exploration of oral and injectable PrEP as part of a community empowerment approach to HIV prevention among female sex workers in the Dominican Republic and Tanzania. PLOS Glob Public Health 2022; 2:e0000981. [PMID: 36712835 PMCID: PMC9880901 DOI: 10.1371/journal.pgph.0000981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite documented interest among female sex workers (FSW), uptake of oral pre-exposure prophylaxis (PrEP) for HIV prevention has been low. Recent trials and regulatory approval of long-acting injectable (LAI) PrEP offer new hope for the potential of this biomedical intervention. We examined FSW's PrEP-related interest and preferences regarding both oral and LAI PrEP situating these dynamics within their specific social and occupational realities. We conducted this work using qualitative methods across two distinct contexts by conducting 40 in-depth interviews with FSW in Tanzania and the Dominican Republic. Textual data was coded using iterative thematic content analysis. Analytic summaries were developed and reviewed to identify recurring themes. We systematically organized themes within each country and then compared across settings. Women in both settings expressed strong interest in PrEP seeing it as an important option to protect themselves in their work. Most participants preferred LAI PrEP due to expectations of reduced stigma and concerns about daily pill adherence and side effects. Occupational factors such as alcohol use, overnight dates with clients, and fear of violence from clients were identified as barriers to daily oral PrEP. LAI PrEP was seen as having the potential to reduce stress related to oral PrEP. Women who preferred pills discussed fear of needles, skepticism about the injections, and others relayed that taking a daily pill would not be challenging for them. There was a pre-dominant sentiment that women know best whether they are better suited for oral or LAI PrEP. Participants stressed the importance of FSW understanding both options to ensure informed decision-making around PrEP and described community-led peer education as key to delivering trusted information. Community empowerment approaches led by FSW which address structural and psychosocial constraints and promote safe work environments may facilitate equitable access and uptake of PrEP among FSW across settings.
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Affiliation(s)
- Andrea Mantsios
- Public Health Innovation & Action, New York, New York, United States of America
- * E-mail:
| | - Ohvia Muraleetharan
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Yeycy Donastorg
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Department of Health Policy, Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Catherine Shembilu
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States of America
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Deanna Kerrigan
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States of America
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15
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Xiang AS, Szwarcbard N, Gasevic D, Earnest A, Pease A, Andrikopoulos S, Wischer N, Davis W, Zoungas S. Trends in glycaemic control and drug use in males and females with type 2 diabetes: Results of the Australian National Diabetes Audit from 2013 to 2019. Diabetes Obes Metab 2021; 23:2603-2613. [PMID: 34338406 DOI: 10.1111/dom.14506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022]
Abstract
AIM To investigate temporal changes in glycaemic control and the use of antihyperglycaemic therapies in females and males with type 2 diabetes from 2013 to 2019. METHODS Data from adult patients with type 2 diabetes (n = 11 930; 44.9% females, mean [SD] age of 62.9 [12.9] years) were analysed from the 2013 to 2019 biennial cross-sectional Australian National Diabetes Audit. RESULTS Mean HbA1c remained similar throughout the years examined and between the sexes (7.8%-8.3%, 62-67 mmol/mol; P > .05). The number of antihyperglycaemic agents used by both sexes increased from 2013 to 2019 (P < .001), with more agents used by males (P = .014). From 2013 to 2019, there were increasing proportions of both sexes using dipeptidyl peptidase-4 inhibitors (females: 11.7%-25.7%, P = .045; males: 11.6%-29.5%, P = .036) and glucagon-like peptide-1 receptor agonists (females: 5.9%-15.3%; males: 4.9%-11.1%; P = .043 for both). Sodium-glucose co-transporter-2 inhibitors were not available in 2013; however, their use increased substantially from 2015 to 2019 in both females (4.9%-26.3%, P = .013) and males (4.7%-32.2%, P = .019). CONCLUSIONS From 2013 to 2019, mean HbA1c levels remained unchanged despite a concurrent increase in the number of antihyperglycaemic medications used. Overall, there was a trend towards preferencing newer agents with some differences in treatment regimens relating to sex and renal function.
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Affiliation(s)
- Angie S Xiang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Naomi Szwarcbard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Pease
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Sof Andrikopoulos
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Australian Diabetes Society, Sydney, New South Wales, Australia
| | - Natalie Wischer
- National Association of Diabetes Centres, Sydney, New South Wales, Australia
| | - Wendy Davis
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
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16
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Kerrigan D, Karver TS, Barrington C, Davis W, Donastorg Y, Perez M, Gomez H, Mbwambo J, Likindikoki S, Shembilu C, Mantsios A, Beckham SW, Galai N, Chan KS. Correction to: Development of the Experiences of Sex Work Stigma Scale Using Item Response Theory: Implications for Research on the Social Determinants of HIV. AIDS Behav 2021; 25:189. [PMID: 34018120 PMCID: PMC8541982 DOI: 10.1007/s10461-021-03298-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
A correction to this paper has been published: https://doi.org/10.1007/s10461-021-03298-6
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17
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Rodriguez-Diaz CE, Davis W, Ellis MV, Cameron MS, Donastorg Y, Bowleg L, Greenberg A, Kerrigan D. Disrupting the Systems: Opportunities to Enhance Methodological Approaches to Address Socio-Structural Determinants of HIV and End the Epidemic Through Effective Community Engagement. AIDS Behav 2021; 25:225-231. [PMID: 34618266 PMCID: PMC8494756 DOI: 10.1007/s10461-021-03475-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/12/2022]
Abstract
A world without HIV is only possible by addressing the socio-structural determinants of health. Our understanding of socio-structural determinants is constantly changing, and parallel changes must occur with the methodologies used to explain the drivers of the HIV epidemic. We argue for the need to engage communities in the planning, implementation, and dissemination of research on the socio-structural determinants of HIV. Community engagement should cross-cut various types of research including rigorous measurement development of socio-structural determinants and novel analytic techniques to model their role in the trajectory of the epidemic and the impact of interventions. Considering the role of place, we recommend collaboration between scientists and communities in the interpretation of results from studies that map HIV-related behaviors and movement. As we collectively delve into historically oppressive systems with colonial antecedents, we must be ready to challenge these systems and replace them with collaborative models. The success of research-driven HIV policy and programming will best be evaluated with methodologies derived from the insights of the very individuals that these policies and programs aim to serve.
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Affiliation(s)
- Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA.
- DC Center for AIDS Research, Washington, USA.
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA
- DC Center for AIDS Research, Washington, USA
| | | | | | - Yeycy Donastorg
- Instituto Dermatológico y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Lisa Bowleg
- DC Center for AIDS Research, Washington, USA
- Department of Psychology and Brain Sciences, George Washington University, Washington, USA
| | - Alan Greenberg
- DC Center for AIDS Research, Washington, USA
- Department of Epidemiology, George Washington University-Milken Institute School of Public Health, Washington, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA
- DC Center for AIDS Research, Washington, USA
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18
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Foster VA, Harrison JM, Williams CR, Asiodu IV, Ayala S, Getrouw-Moore J, Davis NK, Davis W, Mahdi IK, Nedhari A, Niles PM, Peprah S, Perritt JB, McLemore MR, Mask Jackson F. Reimagining Perinatal Mental Health: An Expansive Vision For Structural Change. Health Aff (Millwood) 2021; 40:1592-1596. [PMID: 34606355 DOI: 10.1377/hlthaff.2021.00805] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall well-being of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate well-being in the perinatal period.
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Affiliation(s)
- Vu-An Foster
- Vu-An Foster is the executive director of Life After 2 Losses, in Montclair, New Jersey
| | - Jessica M Harrison
- Jessica M. Harrison is a doctoral candidate in the Department of Social and Behavioral Sciences, University of California San Francisco (UCSF), in San Francisco, California
| | - Caitlin R Williams
- Caitlin R. Williams is a doctoral candidate in the Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
| | - Ifeyinwa V Asiodu
- Ifeyinwa V. Asiodu is an assistant professor in the Department of Family Health Care Nursing, UCSF
| | - Sequoia Ayala
- Sequoia Ayala is the director of operations for Move to End Violence, in Atlanta, Georgia
| | - Jasmine Getrouw-Moore
- Jasmine Getrouw-Moore is a PhD candidate at the University of North Carolina at Greensboro, in Greensboro, North Carolina. She was the executive director of the Office for Diversity, Equity & Inclusion, Guilford County Schools, in Greensboro, North Carolina, at the time this work was performed
| | - Nastassia K Davis
- Nastassia K. Davis is the executive director of the Perinatal Health Equity Foundation, in Montclair, New Jersey
| | - Wendy Davis
- Wendy Davis is the executive director of Postpartum Support International, in Portland, Oregon
| | - Inas K Mahdi
- Inas K. Mahdi is a doctoral student in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Aza Nedhari
- Aza Nedhari is the executive director of Mamatoto Village, in Baltimore, Maryland
| | - P Mimi Niles
- P. Mimi Niles is an assistant professor and faculty fellow at the Rory Meyers College of Nursing, New York University, in New York, New York
| | - Sayida Peprah
- Sayida Peprah is the executive director of Diversity Uplifts, Inc., in Rancho Cucamonga, California
| | - Jamila B Perritt
- Jamila B. Perritt is the president and CEO of Physicians for Reproductive Health, in Washington, D.C
| | - Monica R McLemore
- Monica R. McLemore is an associate professor in the Department of Family Health Care Nursing, UCSF
| | - Fleda Mask Jackson
- Fleda Mask Jackson is the president and CEO of MAJAICA, LLC, in Atlanta, Georgia
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Griffen A, McIntyre L, Belsito JZ, Burkhard J, Davis W, Kimmel M, Stuebe A, Clark C, Meltzer-Brody S. Perinatal Mental Health Care In The United States: An Overview Of Policies And Programs. Health Aff (Millwood) 2021; 40:1543-1550. [PMID: 34606347 DOI: 10.1377/hlthaff.2021.00796] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the United States, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers. Although awareness of and action on perinatal mental health is increasing, significant gaps remain. Screening and treatment are widely recommended but unevenly implemented, and policies and funding do not adequately support the mental health of childbearing people. As a result, treatable perinatal mental health conditions can have long-term, multigenerational negative consequences. This article provides an overview of the perinatal mental health landscape in the United States by identifying serious gaps in screening, education, and treatment; describing recent federal and state policy efforts; highlighting successful models of care; and offering recommendations for robust and integrated perinatal mental health care.
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Affiliation(s)
- Adrienne Griffen
- Adrienne Griffen is the executive director of the Maternal Mental Health Leadership Alliance in Arlington, Virginia
| | - Lynne McIntyre
- Lynne McIntyre is the chief mental health officer at Mammha and a coordinator for Postpartum Support International, in Barcelona, Spain
| | - Jamie Zahlaway Belsito
- Jamie Zahlaway Belsito is the policy director at the Maternal Mental Health Leadership Alliance in Topsfield, Massachusetts
| | - Joy Burkhard
- Joy Burkhard is the executive director of 2020 Mom, in Los Angeles, California
| | - Wendy Davis
- Wendy Davis is the executive director of Postpartum Support International, in Portland, Oregon
| | - Mary Kimmel
- Mary Kimmel is an assistant professor in the Department of Psychiatry, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
| | - Alison Stuebe
- Alison Stuebe is a professor in the Department of Maternal-Child Health and the Department of Obstetrics and Gynecology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Crystal Clark
- Crystal Clark is an associate professor in the Department of Psychiatry and Behavioral Sciences and the Department of Obstetrics and Gynecology, Northwestern University, in Chicago, Illinois
| | - Samantha Meltzer-Brody
- Samantha Meltzer-Brody is the department chair in the Department of Psychiatry, University of North Carolina at Chapel Hill
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Oliver J, Pawlukiewicz A, Geringer M, Davis W, Nassery D, April M, Streitz M, Hyams J. 319 Inter-rater Agreement and Reliability of the HEART Score History Sub-Section. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.333] [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: 10/20/2022]
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21
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Kerrigan D, Karver TS, Barrington C, Donastorg Y, Perez M, Gomez H, Mbwambo J, Likindikoki S, Davis W, Wilson Beckham S, Mantsios A, Galai N, Sibinga E. Mindfulness, Mental Health and HIV Outcomes Among Female Sex Workers in the Dominican Republic and Tanzania. AIDS Behav 2021; 25:2941-2950. [PMID: 33511496 DOI: 10.1007/s10461-021-03168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
We examined the relationship between mindfulness, mental health and HIV outcomes among female sex workers (FSW) from the Dominican Republic (DR) (n = 201) and Tanzania (n = 208) using cross-sectional survey and biologic data. We employed stratified multivariate linear and logistic regression. Depression was associated with lower odds of ART adherence in the DR (AOR 0.25, 95% CI: 0.08-0.78) and of viral suppression in Tanzania (AOR 0.49, 95% CI: 0.24-0.97). In both countries, mindfulness was associated with lower odds of moderate to severe depression (AOR 0.82, 95% CI: 0.76-0.88 for the DR; AOR 0.85, 95% CI: 0.77-0.95 for Tanzania). In the DR, mindfulness was associated with lower odds of anxiety (AOR 0.83, 95% CI: 0.77-0.89), lower HIV stigma (β = - 0.28 per unit change, 95% CI: - 0.37 to - 0.19) and greater odds of viral suppression (AOR 1.09, 95% CI: 1.02-1.15). Findings demonstrate the potential of tailored mindfulness interventions to improve mental health and HIV outcomes among FSW.
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22
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Mantsios A, Murray M, Karver TS, Davis W, Margolis D, Kumar P, Swindells S, Bredeek UF, Deltoro MG, García RR, Antela A, Garris C, Shaefer M, Gomis SC, Bernáldez MP, Kerrigan D. "I feel empowered": women's perspectives on and experiences with long-acting injectable antiretroviral therapy in the USA and Spain. Cult Health Sex 2021; 23:1066-1078. [PMID: 32436478 DOI: 10.1080/13691058.2020.1752397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Long-acting injectable antiretroviral therapy has been shown to be non-inferior to daily oral antiretroviral therapy in clinical trials and may soon become part of clinical care. While most trial participants to date have been men, approximately one quarter of ongoing Phase 3 trial participants are women offering an important opportunity to understand how long-acting antiretroviral therapy is perceived and experienced by women. We conducted in-depth interviews with 80 people living with HIV participating in Phase 2 and 3 clinical trials of long-acting antiretroviral therapy in the USA and Spain. Fifteen percent (12/80) of trial participants interviewed were women. Interviews were audio-recorded, transcribed and coded using content analysis, focused on gender-specific themes. Women shared many of the positive perceptions expressed by men but also had unique perspectives, including finding that long-acting antiretroviral therapy addressed the challenge of remembering pills amidst busy day-to-day realities including multiple roles and responsibilities, is less time consuming and creates less stress compared to oral antiretroviral therapy, and is emotionally freeing and empowering. The gendered nature of women's lives shaped why and how they were satisfied with long-acting antiretroviral therapy. Findings can inform interventions and support systems to facilitate uptake of and adherence to long-acting antiretroviral therapy in women.
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Affiliation(s)
- Andrea Mantsios
- Department of Sociology, American University, Washington, DC, USA
| | - Miranda Murray
- Department of Sociology, American University, Washington, DC, USA
| | - Tahilin S Karver
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, USA
| | - David Margolis
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | - Princy Kumar
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Miguel García Deltoro
- Infectious Disease Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario, Santiago de Compostela, Compostela, Spain
| | - Cindy Garris
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | - Mark Shaefer
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | | | | | - Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, USA
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Beckham SW, Stockton M, Galai N, Davis W, Mwambo J, Likindikoki S, Kerrigan D. Family planning use and correlates among female sex workers in a community empowerment HIV prevention intervention in Iringa, Tanzania: a case for tailored programming. BMC Public Health 2021; 21:1377. [PMID: 34247614 PMCID: PMC8274018 DOI: 10.1186/s12889-021-11426-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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 06/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Female sex workers in sub-Saharan Africa face high unmet need for family planning and higher risk for unintended pregnancy. Community empowerment HIV prevention approaches have the potential to increase family planning uptake and present an opportunity to integrate HIV, reproductive health, and contraception. This article describes family planning use and pregnancy among female sex workers in Iringa, Tanzania and evaluates whether engagement in a community empowerment HIV prevention program is associated with contraceptive use. METHODS This study consists of secondary analysis from a two-community randomized controlled trial following a longitudinal cohort over 18 months. We implemented a year-long community empowerment intervention consisting of 1) a community-led drop-in-center; 2) venue-based peer education, condom distribution, and HIV testing; 3) peer service navigation; 4) sensitivity trainings for providers and police; and 5) text messages to promote engagement. Additionally, monthly seminars were held at the drop-in-center, one of which focused on family planning. Modified Poisson regression models were used to estimate the association between program exposure and family planning use in the intervention arm. (Trials Registration NCT02281578, Nov 2, 2014.) RESULTS: Among the 339 participants with follow-up data on family planning, 60% reported current family planning use; 6% reported dual use of modern contraception and condoms; over 90% had living children; and 85% sought antenatal care at their most recent pregnancy. Among the 185 participants in the intervention arm, the adjusted relative risk (aRR) of family planning use among female sex workers who reported ever attending the Shikamana drop-in-center and among female sex workers who reported attending a family planning-related workshop was respectively 26% (aRR 1.26 [95% Confidence Interval (CI): 1.02-1.56]) and 36% (aRR 1.36 [95%CI: 1.13-1.64) higher than among those who had not attended. CONCLUSION There is a clear need for family planning among this population. General program exposure and exposure to a family planning workshop were associated with higher family planning use, which suggests that community empowerment models have potential to increase family planning uptake for this vulnerable group.
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Affiliation(s)
- S. Wilson Beckham
- grid.21107.350000 0001 2171 9311Johns Hopkins School of Public Health; Department of Health, Behavior and Society, 624 N Broadway HH 757, Baltimore, MD 21205 USA
| | - Melissa Stockton
- grid.10698.360000000122483208Gillings School of Global Public Health, Department of Epidemiology, 135 Dauer Dr., University of North Carolina—Chapel Hill, Chapel Hill, NC 27599 USA
| | - Noya Galai
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Wendy Davis
- grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205 USA
| | - Jessie Mwambo
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- grid.21107.350000 0001 2171 9311Johns Hopkins School of Public Health; Department of Health, Behavior and Society, 624 N Broadway HH 757, Baltimore, MD 21205 USA
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24
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Hendrickson ZM, Leddy AM, Galai N, Beckham SW, Davis W, Mbwambo JK, Likindikoki S, Kerrigan DL. Mobility for sex work and recent experiences of gender-based violence among female sex workers in Iringa, Tanzania: A longitudinal analysis. PLoS One 2021; 16:e0252728. [PMID: 34081739 PMCID: PMC8174717 DOI: 10.1371/journal.pone.0252728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
Female sex workers are highly mobile, which may influence their risk of experiencing physical and sexual violence. However, there remains a paucity of research, particularly longitudinal, from Sub-Saharan Africa exploring mobility and gender-based violence among female sex workers. To address this gap, this study examined the longitudinal relationship between work-related mobility and recent experience of physical or sexual gender-based violence from a client or partner among female sex workers in Iringa, Tanzania. A secondary data analysis was conducted using baseline and 18-month follow-up data from Project Shikamana, a community empowerment-based combination HIV prevention intervention. Responses from 387 female sex workers aged 18 years and older participating in both baseline and follow-up were analyzed. Unadjusted and adjusted Poisson regression models with robust variance estimations, accounting for clustering of female sex workers' responses over time, were fit. Final models adjusted for socio-demographic characteristics and aspects of participants' living situations and work environments. Recent physical or sexual violence from a client or partner was common (baseline: 40%; follow-up: 29%). Twenty-six percent of female sex workers at baseline, and 11% at follow-up, had recently traveled outside of Iringa for sex work. In the final adjusted longitudinal model, female sex workers recently mobile for sex work had a 25% increased risk of any recent experience of physical or sexual gender-based violence when compared with their non-mobile counterparts (adjusted incidence rate ratio: 1.25; 95% CI: 1.03-1.53; p<0.05). Interventions must identify ways-such as mobile support services, linkages and referrals to health and other social services while traveling, or the use of mobile or digital technology-to address mobile female sex workers' unique needs while traveling. Future quantitative and qualitative research is needed to understand the context of female sex workers' mobility and how and why mobility influences risk environments and experiences of gender-based violence.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Anna M. Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Jessie K. Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna L. Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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25
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Arnell TL, York C, Nadeau A, Donnelly ML, Till L, Zargari P, Davis W, Finley C, Delaney T, Carney J. The Role of the Dental Community in Oropharyngeal Cancer Prevention Through HPV Vaccine Advocacy. J Cancer Educ 2021; 36:299-304. [PMID: 31728921 DOI: 10.1007/s13187-019-01628-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 05/05/2023]
Abstract
As rates of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) continue to rise, the dental community's role in primary prevention efforts related to HPV vaccination will become increasingly important. The aim of this study was to assess knowledge, beliefs, practices, and perceived barriers regarding HPV and HPV vaccine advocacy within the dental community. A sample of 266 dentists and dental hygienists completed an online survey, and responses were then analyzed using frequencies of responses, t tests, chi-square tests, and Spearman's correlations. Ninety percent of providers believe it is important to play an "active role" in their patients' general medical care, yet only 50% believe it is their responsibility to recommend the HPV vaccine. Only 50% feel knowledgeable enough to recommend the vaccine. 78.6% of providers rarely discuss HPV vaccination with their age-appropriate patients, and 82% rarely recommend the vaccine. The two most strongly agreed-upon barriers were "parent concerns about the safety or efficacy of the vaccine" (71.6%) and "parent opposition to HPV vaccination for philosophical or religious reasons" (72.6%). Dentists were more knowledgeable about HPV vaccination and more likely to recommend the vaccine than hygienists. Higher levels of HPV-related knowledge correlated positively with beliefs and practices that support HPV vaccine advocacy. We have identified multiple opportunities for intervention aimed at increasing vaccine advocacy among oral health providers. These include clarification of role from dental professional organizations, alleviation of concerns related to perceived parental objection to the vaccine, and educational interventions targeting knowledge deficits among oral health providers.
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Affiliation(s)
- Thomas Luke Arnell
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Collin York
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Alexis Nadeau
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Maeve Lauren Donnelly
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Laura Till
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Pedram Zargari
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Wendy Davis
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Christine Finley
- Vermont Department of Health, 108 Cherry St, Burlington, VT, 05402, USA
| | - Thomas Delaney
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Jan Carney
- Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
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Mantsios A, Murray M, Karver TS, Davis W, Galai N, Kumar P, Swindells S, Bredeek UF, García RR, Antela A, Gomis SC, Bernáldez MP, Czarnogorski M, Hudson K, Walters N, Kerrigan D. Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials. BMC Health Serv Res 2021; 21:255. [PMID: 33743684 PMCID: PMC7980753 DOI: 10.1186/s12913-021-06214-9] [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: 10/05/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background Long-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings. Methods This analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings. Results Barriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance. Conclusions Results suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06214-9.
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Affiliation(s)
| | | | | | - Wendy Davis
- George Washington University, Washington, DC, USA
| | - Noya Galai
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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27
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Beckham SW, S Karver T, Mantsios A, Shembilu C, Donastorg Y, Perez M, Gomez H, Barrington C, Mwampashi A, Davis W, Likindikoki S, Mbwambo JK, Kerrigan D. Acceptability and perceptions of HIV oral self-testing across settings: A comparative qualitative study among Dominican and Tanzanian female sex workers. Glob Public Health 2021; 17:870-884. [PMID: 33736565 DOI: 10.1080/17441692.2021.1901129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Rapid oral HIV self-tests (HIVST) have potential to increase the proportion of people who know their HIV status, especially among stigmatised populations. This study was embedded in two cohorts of female sex workers (FSW) in the Dominican Republic (DR) and Tanzania. Qualitative interviews with 40 FSW were conducted to explore perceived acceptability of HIVST. Interviews were analysed using inductive and deductive thematic coding. Emergent themes were organised by socio-ecological framework levels. FSW in both settings responded positively to the ease of use of HIVST but questioned test accuracy due to the use of saliva rather than blood. FSW in the DR had a more cautious response, while women in Tanzania had favourable perceptions expressing eagerness to use it. At the individual level, themes shaping participants' interest included autonomy, HIV risk perception, and emotional well-being for those with reactive test results, and self-efficacy. At the interpersonal level, privacy, confidentiality, sex work and HIV stigma and social support were salient. Structural level themes focused on health systems including linkages to HIV treatment, provider roles, and access (cost, travel, distribution). Understanding FSW's perceptions and acceptability of HIVST is essential to its integration into health systems and programmes using a community-driven approach.
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Affiliation(s)
- Sam Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Tahilin S Karver
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Catherine Shembilu
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- Instituto Dominicano de Dermatologia y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ardi Mwampashi
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie K Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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28
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Fields T, Patterson M, Bremova-Ertl T, Belcher G, Billington I, Churchill GC, Davis W, Evans W, Flint S, Galione A, Granzer U, Greenfield J, Karl R, Kay R, Lewi D, Mathieson T, Meyer T, Pangonis D, Platt FM, Tsang L, Verburg C, Factor M, Strupp M. A master protocol to investigate a novel therapy acetyl-L-leucine for three ultra-rare neurodegenerative diseases: Niemann-Pick type C, the GM2 gangliosidoses, and ataxia telangiectasia. Trials 2021; 22:84. [PMID: 33482890 PMCID: PMC7821839 DOI: 10.1186/s13063-020-05009-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/27/2020] [Accepted: 12/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The lack of approved treatments for the majority of rare diseases is reflective of the unique challenges of orphan drug development. Novel methodologies, including new functionally relevant endpoints, are needed to render the development process more feasible and appropriate for these rare populations and thereby expedite the approval of promising treatments to address patients' high unmet medical need. Here, we describe the development of an innovative master protocol and primary outcome assessment to investigate the modified amino acid N-acetyl-L-leucine (Sponsor Code: IB1001) in three separate, multinational, phase II trials for three ultra-rare, autosomal-recessive, neurodegenerative disorders: Niemann-Pick disease type C (NPC), GM2 gangliosidoses (Tay-Sachs and Sandhoff disease; "GM2"), and ataxia telangiectasia (A-T). METHODS/DESIGN The innovative IB1001 master protocol and novel CI-CS primary endpoints were developed through a close collaboration between the Industry Sponsor, Key Opinion Leaders, representatives of the Patient Communities, and National Regulatory Authorities. As a result, the open-label, rater-blinded study design is considerate of the practical limitations of recruitment and retention of subjects in these ultra-orphan populations. The novel primary endpoint, the Clinical Impression of Change in Severity© (CI-CS), accommodates the heterogenous clinical presentation of NPC, GM2, and A-T: at screening, the principal investigator appoints for each patient a primary anchor test (either the 8-m walk test (8MWT) or 9-hole peg test of the dominant hand (9HPT-D)) based on his/her unique clinical symptoms. The anchor tests are videoed in a standardized manner at each visit to capture all aspects related to the patient's functional performance. The CI-CS assessment is ultimately performed by independent, blinded raters who compare videos of the primary anchor test from three periods: baseline, the end of treatment, and the end of a post-treatment washout. Blinded to the time point of each video, the raters make an objective comparison scored on a 7-point Likert scale of the change in the severity of the patient's neurological signs and symptoms from video A to video B. To investigate both the symptomatic and disease-modifying effects of treatment, N-acetyl-L-leucine is assessed during two treatment sequences: a 6-week parent study and 1-year extension phase. DISCUSSION The novel CI-CS assessment, developed through a collaboration of all stakeholders, is advantageous in that it better ensures the primary endpoint is functionally relevant for each patient, is able to capture small but meaningful clinical changes critical to the patients' quality of life (fine-motor skills; gait), and blinds the primary outcome assessment. The results of these three trials will inform whether N-acetyl-L-leucine is an effective treatment for NPC, GM2, and A-T and can also serve as a new therapeutic paradigm for the development of future treatments for other orphan diseases. TRIAL REGISTRATION The three trials (IB1001-201 for Niemann-Pick disease type C (NPC), IB1001-202 for GM2 gangliosidoses (Tay-Sachs and Sandhoff), IB1001-203 for ataxia telangiectasia (A-T)) have been registered at www.clinicaltrials.gov (NCT03759639; NCT03759665; NCT03759678), www.clinicaltrialsregister.eu (EudraCT: 2018-004331-71; 2018-004406-25; 2018-004407-39), and https://www.germanctr.de (DR KS-ID: DRKS00016567; DRKS00017539; DRKS00020511).
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Affiliation(s)
- T. Fields
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Patterson
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - T. Bremova-Ertl
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - G. Belcher
- PV Consultancy, 113 St Georges Square Mews, London, SW1V 3RZ UK
| | - I. Billington
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - G. C. Churchill
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - W. Davis
- Ataxia-Telangiectasia Society, Rothamsted Experimental Station West Common, Harpenden, AL5 2JQ UK
| | - W. Evans
- Niemann-Pick UK, Vermont House, Concord, Washington, Tyne and Wear NE37 2SQ UK
- Primary Care Stratified Medicine (PRISM) Division of Primary Care, University of Nottingham, Nottingham, UK
| | - S. Flint
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - A. Galione
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - U. Granzer
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, D-81379 Munich, Germany
| | | | - R. Karl
- Cure Tay-Sachs Foundation, 2409 E. Luke Avenue, Phoenix, AZ 85016 USA
| | - R. Kay
- RK Statistics, Brook House, Mesne Lane, Bakewell, DE45 1AL UK
| | - D. Lewi
- The Cure & Action for Tay-Sachs Foundation, 94 Milborough Crescent, Lee, London, SE12 0RW UK
| | - T. Mathieson
- International Niemann-Pick Disease Alliance, Vermont House, Concord, Washington, Tyne and Wear NE37 2SQ UK
| | - T. Meyer
- Granzer Regulatory Consulting & Services, Kistlerhofstr. 172C, D-81379 Munich, Germany
| | - D. Pangonis
- National Tay-Sachs and Allied Disease Foundation, 2001 Beacon Street, Suite 204, Boston, MA 02135 USA
| | - F. M. Platt
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT UK
| | - L. Tsang
- Arnold & Porter Kaye Scholer LLP, 25 Old Broad Street, London, EC2N 1HQ UK
| | - C. Verburg
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Factor
- IntraBio Ltd, Begbroke Science Park, Begbroke Hill, Woodstock Road, Oxford, OX5 1PF UK
| | - M. Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, University Hospital, Ludwig Maximilians University, Munich, Germany
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Mantsios A, Murray M, Karver TS, Davis W, Margolis D, Kumar P, Swindells S, Bredeek UF, García Del Toro M, Garcia Gasalla M, Rubio García R, Antela A, Hudson K, Griffith S, Kerrigan D. Efficacy and Freedom: Patient Experiences with the Transition from Daily Oral to Long-Acting Injectable Antiretroviral Therapy to Treat HIV in the Context of Phase 3 Trials. AIDS Behav 2020; 24:3473-3481. [PMID: 32410051 DOI: 10.1007/s10461-020-02918-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Long-acting injectable antiretroviral therapy (LA ART) may be an alternative for people living with HIV (PLHIV) with adherence challenges or who prefer not to take pills. Using in-depth interviews, this study sought to understand the experiences of PLHIV (n = 53) participating in Phase 3 LA ART trials in the United States and Spain. The most salient consideration when contemplating LA ART was its clinical efficacy; many participants reported wanting to ensure that it worked as well as daily oral ART, including with less frequent dosing (every 8 versus 4 weeks). While injection side effects were often reported, most participants felt that regimen benefits outweighed such drawbacks. Participants described the main benefit of LA ART as the "freedom" it afforded both logistically and psychosocially, including through reduced HIV stigma. Findings highlight the importance of patient-provider communication related to weighing potential benefits and side effects and the continued need to address HIV stigma.
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Affiliation(s)
| | | | | | | | | | | | - Susan Swindells
- University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - U Fritz Bredeek
- Metropolis Medical San Francisco, San Francisco, CA, 94109, USA
| | | | | | | | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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30
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Grant-McAuley W, Fogel JM, Galai N, Clarke W, Breaud A, Marzinke MA, Mbwambo J, Likindikoki S, Aboud S, Donastorg Y, Perez M, Barrington C, Davis W, Kerrigan D, Eshleman SH. Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic. PLoS One 2020; 15:e0240890. [PMID: 33119663 PMCID: PMC7595323 DOI: 10.1371/journal.pone.0240890] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/05/2020] [Indexed: 02/04/2023] Open
Abstract
Objective Female sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania. Methods Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters. Results Among 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013). Conclusions In this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.
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Affiliation(s)
- Wendy Grant-McAuley
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessica M. Fogel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - William Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mark A. Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Martha Perez
- Unidad de Investigacion de Vacunas, Instituto Dermatologico y Cirugia de la Piel, Santo Domingo, Dominican Republic
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Wendy Davis
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, District of Columbia, United States of America
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Wallace-Brodeur R, Li R, Davis W, Humiston S, Albertin C, Szilagyi PG, Rand CM. A quality improvement collaborative to increase human papillomavirus vaccination rates in local health department clinics. Prev Med 2020; 139:106235. [PMID: 32800972 DOI: 10.1016/j.ypmed.2020.106235] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Human papillomavirus (HPV) vaccination rates are well below the Healthy People 2020 goal of 80%. Vaccinating in settings other than primary care, such as local health departments (LHDs), may help achieve higher HPV immunization rates. We tested the effect of a quality improvement (QI) collaborative to reduce missed opportunities (MOs) for HPV vaccine in LHDs. Between 2016 and 2019, we conducted four consecutive cohorts of a virtual QI collaborative at 24 LHDs across multiple states. Participants were trained on topics including how to provide an effective recommendation for HPV vaccine, strategies to reduce MOs, and motivational interviewing. Throughout the 6-month project implementation, LHDs tested strategies to reduce MOs through Plan-Do-Study-Act cycles, performed chart reviews to identify and characterize MOs, and received feedback reports to assess progress on MOs. HPV vaccination rates were assessed pre- and post-intervention. LHDs reduced MOs for HPV vaccine in all four cohorts with aggregated data showing a 25.3 percentage point reduction in MOs. Modified Poisson regression analysis found a 44% reduction in the relative risk of missing the opportunity for an HPV vaccine at a visit (RR = 0.56, 0.46-0.68, p < .001). This project shows that strategies effective in reducing MO for HPV vaccine in primary care settings are also effective in LHD settings. Training LHD staff on these strategies may help the U.S. approach national goals for HPV vaccine coverage.
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Affiliation(s)
- Rachel Wallace-Brodeur
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America.
| | - Rui Li
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochetester, NY, United States of America
| | - Wendy Davis
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America
| | - Sharon Humiston
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT, United States of America; Universtiy of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Christina Albertin
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Peter G Szilagyi
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochetester, NY, United States of America
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Rand CM, Concannon C, Wallace-Brodeur R, Davis W, Albertin CS, Humiston SG, Szilagyi PG. Identifying Strategies to Reduce Missed Opportunities for HPV Vaccination in Primary Care: A Qualitative Study of Positive Deviants. Clin Pediatr (Phila) 2020; 59:1058-1068. [PMID: 32597722 DOI: 10.1177/0009922820930357] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to assess the contextual factors, practice strategies, and sustainability of interventions implemented during a national quality improvement (QI) project to raise human papillomavirus (HPV) vaccination rates. We conducted semistructured interviews with positive deviant practices that successfully reduced missed opportunities by ≥20% for HPV vaccination in the prior year. We assessed leadership support, motivators, interventions used, and sustainability. Key themes related to QI teams included strong leadership support, multidisciplinary teams, having a practice champion, and a collaborative environment. Themes related to the interventions included using a presumptive bundled recommendation for all appropriate vaccines at age 11, previsit planning, and reminders for preventive visits, which were sustainable for most practices 1-year postintervention. Both internal practice-level factors (multidisciplinary teams, collaboration, and previsit planning) and organizational factors (institutional support and health system-level reminders for preventive visits) were key to a successful QI intervention to improve HPV vaccination.
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Affiliation(s)
- Cynthia M Rand
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Wendy Davis
- University of Vermont Medical Center, Burlington, VT, USA
| | | | | | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, CA, USA
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Sharif I, Yarash T, Masood F, Clifford RM, Davis W, Davis TME. Complementary and alternative medicine beliefs in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Res Clin Pract 2020; 166:108311. [PMID: 32673699 DOI: 10.1016/j.diabres.2020.108311] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/23/2020] [Accepted: 07/06/2020] [Indexed: 01/02/2023]
Abstract
Complementary medicine (CM) treatment beliefs of people with type 2 diabetes were assessed using a validated three-domain questionnaire. Belief in holistic health, but not natural treatments or participation in treatment, was independently associated with CM use (P = 0.003). Strong holistic health beliefs could identify present/future CM use, with potential management implications.
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Affiliation(s)
- Imrana Sharif
- University of Western Australia, School of Allied Health, Crawley, Western Australia, Australia
| | - Tatsiana Yarash
- University of Western Australia, School of Allied Health, Crawley, Western Australia, Australia
| | - Farhat Masood
- University of Western Australia, School of Allied Health, Crawley, Western Australia, Australia
| | - Rhonda M Clifford
- University of Western Australia, School of Allied Health, Crawley, Western Australia, Australia
| | - Wendy Davis
- University of Western Australia, Medical School, Crawley, Western Australia, Australia
| | - Timothy M E Davis
- University of Western Australia, Medical School, Crawley, Western Australia, Australia.
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Kerrigan D, Sanchez Karver T, Muraleetharan O, Savage V, Mbwambo J, Donastorg Y, Likindikoki S, Perez M, Gomez H, Mantsios A, Murray M, Beckham SW, Davis W, Galai N, Barrington C. "A dream come true": Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania. PLoS One 2020; 15:e0234666. [PMID: 32530939 PMCID: PMC7292359 DOI: 10.1371/journal.pone.0234666] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens. METHODS Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis. RESULTS Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be "likely" or "very likely" to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90-11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05-12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41-6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27-4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00-1.34/DR: AOR 1.07 per year; 95% CI 1.00-1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use. CONCLUSIONS We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.
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Affiliation(s)
- Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ohvia Muraleetharan
- Department of Health Policy, Yale University, New Haven, Connecticut, United States of America
| | - Virginia Savage
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Andrea Mantsios
- Public Health Innovation and Action, New York, New York, United States of America
| | | | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, United States of America
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Quinet R, Zhang X, Meng J, Shi X, Ali H, Kumar N, Hellmers L, Washington T, Davis W, Zakem J, You Z. AB0139 T FOLLICULAR HELPER CELLS MAY BE INVOLVED IN THE LUPUS DEVELOPMENT IN HIGH FAT DIET-INDUCED OBESITY MICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:System lupus erythematosus (SLE) is an autoimmune disease that is associated with skin rash and multiple organs lesion. It is known that obesity is a major factor contributing to the onset and progression of autoimmune diseases including SLE. Our previous study showed that circulating T follicular helper (Tfh) cells played an important role in autoantibody production in SLE patients. A recent study showed that Tfh cells promote B cell production of IgA antibodies, which help shape the composition of the gut microbiota and may modulate obesity.Objectives:By establishing an obesity-associated lupus mouse model, we investigated the pathophysiologic link of obesity, SLE and Tfh cells using MRL/lpr lupus prone mice.Methods:Twenty MRL/lpr mice (10 male and 10 female) were randomized equally fed with a regular diet (RD) or high fat diet (HFD, 60% calories comprised of fat). Their body weights were recorded weekly as an indicator of obesity achievement. SLE progression was monitored weekly by development of skin lesion and urine protein levels assessed by Bradford assay. Blood was collected for IgG, anti-dsDNA and anti-nuclear antibody (ANA) detection. At the endpoint of week 14, spleen was measured and weighted. Spleen, kidney, and dorsum of neck skin were collected and embedded for H&E, PAS, Masson’s staining, and immune complex staining to detect active histopathological lupus lesions and be quantified as histological skin score and kidney index. Tfh cells in spleen was identified by immunohistochemistry (IHC) staining glomerulus of kidney.Results:Obesity was achieved with a significant difference of mouse body weight between the RD and HFD groups by week 3 and continued until week 14 (p<0.05 top<0.01). Evidence of SLE development, such as skin rash on the dorsal neck and back in HFD group showed up as earlier as week 6 and occurred in 55.6% of the HFD group vs 11.1% of the RD group (p<0.05), with a higher histological score of skin in HFD group (p<0.05). Proteinuria was increased from 11 to 14 week in male HFD group with an elevated kidney index and immune-complex deposits in their glomerulus of kidney. There was an increase trend of anti-dsDNA and IgG titer in HFD group, but no difference of ANA was observed between these two groups. Splenomegaly was observed in the HFD mice (p<0.05). The Tfh cells in the spleen of HFD group were higher than RD group.Conclusion:Our results show accelerated and greater severity of lupus development in MRL/lpr mice with HFD compared to mice on RD, indicating HFD-induced obesity exacerbates lupus development in mice. Tfh cells may be involved in the relation of SLE and obesity. This model could be used to investigate the mechanism underlying the link between obesity and SLE development. Interventions to reduce body weight or target Tfh cells may improve both lupus symptoms and outcomes in genetically predisposed SLE patients.References:[1]Tedeschi S, et al. Obesity and the risk of systemic lupus erythematosus among woman in the Nurses’ Health Studies. Semi in Arth and Rheu. 2017, 47:376-383[2]Cozier YC, et al. A prospective study of obesity and risk of systemic lupus erythematosus (SLE) among Black woman. Semi in Arth and Rheu. 2019, 48:1030-1034[3]Wang G, et al. Differential oxidative modification of proteins in MRL+/+and MRL/lpr mice: Increased formation of lipid peroxidation-derived aldehyde-protein adducts may contribute to accelerated onset of autoimmune response. Free Radic Res. 2012, 46(12):1472-1481[4]Seth A, et al. Spatial and functional heterogeneity of follicular helper T cells in autoimmunity. Current Opinion in Immunology. 2019, 61:1-95.Petersen C, et al. T cell–mediated regulation of the microbiota protects against obesity. Science. 2019, 365 (6451): eaat9351Disclosure of Interests:None declared
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Davis W, Mantsios A, Karver T, Murray M, Punekar Y, Ward D, Bredeek UF, Moreno S, Merino D, Knobel H, Campis A, Kerrigan D. "It made me more confident that I have it under control": Patient and provider perspectives on moving to a two-drug ART regimen in the United States and Spain. PLoS One 2020; 15:e0232473. [PMID: 32357195 PMCID: PMC7194407 DOI: 10.1371/journal.pone.0232473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Two-drug regimens (2DR) to treat HIV infection have the potential to reduce long-term toxicity and increase therapeutic options for people living with HIV (PLHIV). Prior phase III trials, SWORD-1 and SWORD-2, as well as GEMINI-1 and GEMINI-2, have demonstrated that a dolutegravir-based 2DR is as effective as three- or four-drug regimens among virologically suppressed patients. Limited information exists, however, on patient and provider experiences with 2DR to inform roll-out and integration into routine clinical care. METHODS We conducted 39 in-depth interviews with PLHIV currently on 2DR in the context of routine care and 8 of their clinical care providers in the United States (U.S.) and Spain. Participants included 33 male and 6 female PLHIV and 8 providers. Interview topics explored perceptions of and experiences with 2DR compared to prior anti-retroviral regimens (ARVs), side effects, patient satisfaction, and clinical performance. Interviews were audio-recorded, transcribed and analyzed using thematic content analysis. RESULTS Participants viewed 2DR as a significant and positive advance, in terms of its ability to effectively treat HIV with reduced toxicity and essentially no reported side effects. Patients noted the central role providers played in the decision to switch to a 2DR regimen and, among U.S. participants, the importance of insurance coverage making this preferred option feasible. Patients and providers agreed that a 2DR regimen would be appropriate for any PLHIV regardless of whether they were treatment naïve or had significant experience with ARVs. CONCLUSIONS Participants' experiences with a 2DR regimen were positive with no participants, reporting side effects and all reporting continued viral suppression. Providers valued the reduced toxicity offered by 2DR and served as the primary gateway to a transition to 2DR for patients in both settings. This study provides a foundation for further research on the transition to 2DR regimens in other populations and contexts including low- and middle-income settings.
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Affiliation(s)
- Wendy Davis
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
- * E-mail:
| | - Andrea Mantsios
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Tahilin Karver
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Miranda Murray
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
| | - Yogesh Punekar
- ViiV Healthcare, Raleigh, North Carolina, United States of America
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, D.C., United States of America
| | - U. Fritz Bredeek
- Metropolis Medical Group, San Francisco, California, United States of America
| | | | | | | | | | - Deanna Kerrigan
- Center on Health, Risk and Society, American University, Washington, D.C., United States of America
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Leddy AM, Mantsios A, Davis W, Muraleetharan O, Shembilu C, Mwampashi A, Beckham S, Galai N, Likindikoki S, Mbwambo J, Kerrigan D. Essential elements of a community empowerment approach to HIV prevention among female sex workers engaged in project Shikamana in Iringa, Tanzania. Cult Health Sex 2020; 22:111-126. [PMID: 31496423 PMCID: PMC7061086 DOI: 10.1080/13691058.2019.1659999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/21/2019] [Indexed: 06/01/2023]
Abstract
Globally, female sex workers bear a disproportionate burden of HIV, with those in sub-Saharan Africa being among the most affected. Community empowerment approaches have proven successful at preventing HIV among this population. These approaches facilitate a process whereby sex workers take collective ownership over programmes to address the barriers they face in accessing their health and human rights. Limited applications of such approaches have been documented in Africa. We describe the community empowerment process among female sex workers in Iringa, Tanzania, in the context of a randomised controlled trial of a community empowerment-based model of combination HIV prevention. We conducted 24 in-depth interviews with participants from the intervention community and 12 key informant interviews with HIV care providers, police, venue managers, community advisory board members and research staff. Content analysis was employed, and salient themes were extracted. Findings reveal that the community empowerment process was facilitated by the meaningful engagement of sex workers in programme development, encouraging sex worker ownership over the programme, providing opportunities for solidarity and capacity building, and forming partnerships with key stakeholders. Through this process, sex workers mobilised their collective agency to access their health and human rights including HIV prevention, care and treatment.
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Affiliation(s)
- Anna M. Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea Mantsios
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, USA
| | - Ohvia Muraleetharan
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Catherine Shembilu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ard Mwampashi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S.W. Beckham
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deanna Kerrigan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Sociology, American University, Washington, DC, USA
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Davis TME, Davis W. Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II. BMJ Open Diabetes Res Care 2020; 8:8/1/e000983. [PMID: 32139599 PMCID: PMC7059509 DOI: 10.1136/bmjdrc-2019-000983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/22/2019] [Accepted: 02/18/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort. METHODS All hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency. RESULTS There were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001). CONCLUSIONS These data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.
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Affiliation(s)
- Timothy M E Davis
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Wendy Davis
- Medical School, University of Western Australia, Perth, Western Australia, Australia
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Manning L, Hamilton EJ, Raby E, Norman PE, Davis W, Wood F, Carville K, Baba M, Hiew J, Ryan E, Ferreira I, Gittings P, Ritter JC. Spray on skin for diabetic foot ulcers: an open label randomised controlled trial. J Foot Ankle Res 2019; 12:52. [PMID: 31788029 PMCID: PMC6858641 DOI: 10.1186/s13047-019-0362-x] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/30/2019] [Indexed: 12/24/2022] Open
Abstract
Background One Australian loses a limb every 3 h as a result of infected diabetic foot ulcers (DFU). This common condition accounts for substantial morbidity and mortality for affected individuals and heavy economic costs for the health sector and the community. There is an urgent need to test interventions that improve wound healing time, prevent amputations and recurrent ulceration in patients presenting with DFU whilst improving quality of life and reducing health care costs. Methods One hundred and fifty eligible participants will be randomised to receive an autologous skin cell suspension, also termed 'spray-on' skin (ReCell®) or standard care interventions for their DFU. The primary outcome is complete wound healing at 6 months, but participants will be followed up for a total of 12 months to enable secondary outcomes including total overall costs, ulcer free days at 12 months and quality of life to be assessed. Discussion Outpatient costs for dressings, home nursing visits and outpatient appointments are key cost drivers for DFU. If spray-on skin is effective, large cost savings to WA Health will be realised immediately through a shortened time to healing, and through a higher proportion of patients achieving complete healing. Shortened healing times may enable participants to return to work earlier. Any economic benefits are likely to be amplified across Australia and other similar demographic settings where aging populations with increased diabetes rates are considered major future challenges. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000511235. Registered on 9 April 2018.
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Affiliation(s)
- Laurens Manning
- 1Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Emma J Hamilton
- 2Endocrinology Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Edward Raby
- 1Department of Infectious Diseases, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Paul E Norman
- 3Medical School, University of Western Australia, Crawley, WA 6009 Australia.,4Department of Vascular Surgery, Fremantle Hospital, Alma Street, Fremantle, WA 6160 Australia
| | - Wendy Davis
- 3Medical School, University of Western Australia, Crawley, WA 6009 Australia
| | - Fiona Wood
- 5State Burns Unit, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Keryln Carville
- 6Silver Chain Group and School of Nursing and Midwifery, Curtin University, Bentley, WA 6102 Australia
| | - Mendel Baba
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Jonathan Hiew
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Erica Ryan
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Ivana Ferreira
- 7Podiatry Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Paul Gittings
- 8Burns Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
| | - Jens C Ritter
- 9Department of Vascular Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
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Affiliation(s)
- S. Miles
- Palm Beach Equine Clinic Wellington Florida USA
| | - W. Davis
- Palm Beach Equine Clinic Wellington Florida USA
| | - W. F. Craft
- Department of Comparative, Diagnostic, and Population Medicine College of Veterinary Medicine University of Florida Veterinary School Gainesville Florida USA
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Mantsios AR, Murray M, Karver TS, Davis W, Margolis D, Kumar P, Swindells S, Bredeek F, Deltoro MG, García RR, Antela A, Garris C, Shaefer MS, Gomis SC, Bernaldez MP, Kerrigan D. 2497. Women’s Perspectives on and Experiences with Long-acting Injectable Anti-retroviral Therapy in the United States and Spain: the Potential Role of Gender in Patient Preferences. Open Forum Infect Dis 2019. [PMCID: PMC6809882 DOI: 10.1093/ofid/ofz360.2175] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Adherence to antiretroviral therapy (ART) to treat HIV remains a critical global health challenge given its relationship with individual health outcomes and population-level transmission. Given barriers associated with oral ART adherence, and considerations of patients’ preferences, long-acting injectable (LA) ART (cabotegravir + rilpivirine) is under development and has been shown to be non-inferior to daily oral ART in Phase III trials. While most of the trial participants have been men, as LA ART gets closer to becoming available for routine clinical use, it is critical to understand how this option is perceived by women. Methods We conducted in-depth interviews with 67 individuals, 53 people living with HIV (PLHIV) and 14 healthcare providers, in 11 sites in the United States and Spain participating in Phase III LA ART trials (ATLAS, ATLAS 2-M and FLAIR). Twenty percent (10/53) of trial participants interviewed were women. Interviews explored patient and provider perspectives and experiences with LA ART, and appropriate candidates and recommendations to support use. Interviews were audio-recorded, transcribed and coded using thematic content analysis. Results Overall, several salient themes emerged regarding participant’s generally positive experiences transitioning from daily oral ART to injectable ART including: the importance of the clinical efficacy of LA ART, the ability to learn to manage injection side-effects over time, and the “freedom” reportedly afforded by LA ART logistically and psychosocially. Women interviewed shared many of the aforementioned positive perceptions of LA ART but also had some unique perspectives. Female participants discussed how LA ART was easier to integrate into their daily lives including managing their multiple roles and responsibilities, which often involved working full-time and taking care of themselves as well as their family and children. Conclusion Similar to all participants, female participants had generally positive views of LA ART. However, the gendered nature of their daily lives also led to some unique perspectives on why and how they were satisfied with LA ART that merits further exploration in future research. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | | | - Princy Kumar
- Georgetown University School of Medicine, Washington, DC
| | | | | | | | | | - Antonio Antela
- Hospital Clínico Universitario de santiago de Compostela, Spain, Coruna, Galicia, Spain
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Durmus D, Davis W. Blur perception and visual clarity in light projection systems. Opt Express 2019; 27:A216-A223. [PMID: 30876137 DOI: 10.1364/oe.27.00a216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Previous studies proposed a smart lighting system that can detect object colors and emit spectrally optimized lighting to reduce the light absorbed by surfaces. The spatial resolution of an absorption-minimization light projection system is investigated using images of various visual complexity. Participants with normal color vision and good visual acuity judged the visual clarity of low, medium, and high complexity images by using a mean opinion score (MOS) scale. Results from the visual assessments show that blur acceptability of illuminated images significantly reduces when the circle of confusion (CoC) is increased by 3%. Blur perception also changes with visual complexity.
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Elkhanany A, Takabe K, Khoury T, Omilian A, Cheng D, Katsuta E, Davis W, Yan L, Hong CC, Bandera E, Ambrosone C, Yao S. Abstract P4-06-05: PanCancer profiling reveals population difference in breast cancer immune microenvironment. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-06-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND. Breast Cancer (BC) outcome in patients (pts) of African ancestry (AA) is worse than pts of European ancestry (EA) despite accounting for socioeconomic status and access. AA have higher hormone receptor negative (HR-) and Triple Negative (TNBC) tumors, subtypes associated with stronger presence of tumor infiltrating lymphocytes (TILs). We hypothesize that BC Immune Microenvironment (IME) composition differs by ancestry, and describe IME from two independent datasets.
METHODS. Transcriptome data from the Cancer Genome Atlas (TCGA) (Group 1, Gp1) were used to estimate 22 IME cell types in BC samples by CIBERSORT. Clinical and overall survival (OS) data were accessed from XENA. Gp2 tissue samples were obtained from Women's Circle of Health study and Pathology Resource Network at Roswell Park Comprehensive Cancer Center and processed using NanoString™ PanCancer Immune Profiling panel, consisting of 770 immunity-related genes describing 24 IME cell types. Immune Dysfunction and Exclusion (TIDE) scores were derived from an algorithm by Jiang et al.
RESULTS. Gp1 consisted of 183 AA and 752 EA, with median age older in EA (54.5 vs 59). On CIBERSORT IME analysis by race, AA had higher IME infiltrates including macrophages (Mp), dendritic cells (DC) and TILs; notably T regulatory (Treg) and T Follicular Helper (Tfh) cells. The ratios of Tregs and Tfh to total TILs were also elevated. When stratified by subtypes, AAs with TNBC/Basal-like BC had higher Tregs and Tfh cells. CD8+ cells were higher in HR+ and high-grade AA pts only. CD4+/total T-cells was higher in AA across all subtypes, and predicted worse OS (HR 3.15[1.07-9.2]). Gp2 had 190 AA and 177 EA with comparable median age at diagnosis (53 versus 54) and tumor grade. By subtype, TNBC had significantly higher total TILs, CD45+, CD8+, exhausted CD8+, Treg, cytotoxic T cells, B, natural killer (NK), activated NK, DC and Mp; yet significantly lower mast cells and neutrophils (p <0.01). CD8+/Exhausted CD8+ and CD8+/Treg ratios were lower in TNBC and higher-grade tumors, and lowest in HR- grade III. Most of immune pathways were enriched in HR- tumors, with only exception being cell cycle genes being remarkably enriched in HR+ tissues (p <0.01). TIDE demonstrated high immune dysfunction in HR- and high exclusion in HR+ tumors. When compared to EA, AA had more TILs, including B, cytotoxic T-cells, exhausted CD8+, NK, activated NK and Tregs (p <0.01). Neutrophils, Mp and CD8+ were higher in EA. EA also had significantly higher ratio of immune cell types to total TILs across cytotoxic, exhausted CD8+ and Tregs, as well as persistent higher neutrophils, Mp and CD8+ ratios. CD8+/Treg ratio was higher in EA. Consistent with Gp1; CD4+/total T-cell ratio was higher in AA across all subtypes.
CONCLUSION. IME differed significantly by HR, grade and ancestry. Aggressive BC demonstrated stronger overall immune response but dysfunctional IME phenotype (higher Treg, lower granulocytes and mast cells ratios). AA had more TILs across all subtypes, but lower ratios of activator (CD8+, Cytotoxic) to suppressor TILs (Treg, exhausted CD8+), demonstrating immune tolerance and immune-desert model, exception being persistently high fraction of CD4+ ratio predicting worse OS.
Citation Format: Elkhanany A, Takabe K, Khoury T, Omilian A, Cheng D, Katsuta E, Davis W, Yan L, Hong C-C, Bandera E, Ambrosone C, Yao S. PanCancer profiling reveals population difference in breast cancer immune microenvironment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-05.
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Affiliation(s)
- A Elkhanany
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - K Takabe
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - T Khoury
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - A Omilian
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - D Cheng
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - E Katsuta
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - W Davis
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - L Yan
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - C-C Hong
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - E Bandera
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - C Ambrosone
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - S Yao
- Roswell Park Comprehensive Cancer Center, Buffalo, NY; University of Florida, Gainesville, FL; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Adair S, Baus M, Bell R, Boero M, Bussy C, Cardenas F, Casey T, Castro J, Davis W, Erskine M, Farr R, Fischer A, Forbes B, Ford T, Genovese R, Gottschalk R, Hoge M, Honnas C, Hunter G, Joyce J, Kaneps A, Keegan K, Kramer J, Labens R, Lischer C, Marshall J, Oosterlinck M, Radue P, Redding R, Reed S, Rick M, Santschi E, Schoonover M, Schramme M, Schumacher J, Stephenson R, Thaler R, Nielsen JV, Wilson D. Letter to the Editor: A response to 'What is lameness and what (or who) is the gold standard to detect it?'. Equine Vet J 2018; 51:270-272. [PMID: 30570777 DOI: 10.1111/evj.13043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Adair
- University of Tennessee, Knoxville, Tennessee, USA
| | - M Baus
- Gran Prix Equine, Hawleyville, Connecticut, USA
| | - R Bell
- Park Equine Hospital, Lexington, Kentucky, USA
| | | | - C Bussy
- Clinique Vétérinaire du Grand Renaud, Saint Saturnin, France
| | - F Cardenas
- 3H Equine Hospital and Mobile Veterinary Services, New Hill, North Carolina, USA
| | - T Casey
- Fourways Equine Clinic, Johannesburg, South Africa
| | - J Castro
- Davie County Large Animal Hospital, Mocksville, North Carolina, USA
| | - W Davis
- Palm Beach Equine Clinic, Wellington, Florida, USA
| | - M Erskine
- Virginia Tech, Leesburg, Virginia, USA
| | - R Farr
- Farr and Pursey Equine Veterinary Services, Aldbury, Hertfordshire, UK
| | - A Fischer
- Chino Valley Equine Hospital, Chino Hills, California, USA
| | - B Forbes
- Singapore Turf Club, Singapore, Singapore
| | - T Ford
- Ford Veterinary Surgery Center, Clovis, California, USA
| | - R Genovese
- Cleveland Equine Clinic, Ravenna, Ohio, USA
| | - R Gottschalk
- Witbos Veterinary Clinic, Blue Hills AH, South Africa
| | - M Hoge
- Murrieta Equine, Murrieta, California, USA
| | - C Honnas
- Texas Equine Hospital, Bryan, Texas, USA
| | - G Hunter
- Ardene House Veterinary Practice, Aberdeen, UK
| | - J Joyce
- Total Equine Veterinary Associates, Leesburg, Virginia, USA
| | - A Kaneps
- Kaneps Equine Sports Medicine and Surgery, Beverly, Massachusetts, USA
| | - K Keegan
- University of Missouri, Columbia, Missouri, USA
| | - J Kramer
- University of Missouri, Columbia, Missouri, USA
| | - R Labens
- Charles Sturt University, Albury, New South Wales, Australia
| | - C Lischer
- Freie Universität Berlin, Berlin, Germany
| | | | | | - P Radue
- Damascus Equine Associates, Mount Airy, Maryland, USA
| | - R Redding
- North Carolina State University, Raleigh, North Carolina, USA
| | - S Reed
- Ohio State University, Columbus, Ohio, USA
| | - M Rick
- Alamo Pintado Equine Medical Centre, Los Olivos, California, USA
| | - E Santschi
- Kansas State University, Manhattan, Kansas, USA
| | - M Schoonover
- Oklahoma State University, Stillwater, Oklahoma, USA
| | | | | | | | - R Thaler
- Metamora Equine PC, Metamora, Michigan, USA
| | - J V Nielsen
- Ansager Veterinary Hospital, Ansager, Denmark
| | - D Wilson
- University of Missouri, Columbia, Missouri, USA
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Cairns R, Brown JA, Dawson AH, Davis W, Buckley NA. Carols by glow sticks: a retrospective analysis of Poisons Information Centre data. Med J Aust 2018; 209:505-508. [DOI: 10.5694/mja18.01032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Rose Cairns
- NSW Poisons Information Centre, The Childrenˈs Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Jared A Brown
- NSW Poisons Information Centre, The Childrenˈs Hospital at Westmead, Sydney, NSW
| | - Andrew H Dawson
- NSW Poisons Information Centre, The Childrenˈs Hospital at Westmead, Sydney, NSW
- National Poisons Register, Royal Prince Alfred Hospital, Sydney, NSW
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Berg K, Davis W, Sheon A, Newman J, Daprano J, Adebambo I, Einstadter D, Perzynski A. STRATEGIES FOR ADDRESSING DIGITAL LITERACY AND INTERNET ACCESS AS SOCIAL DETERMINANTS OF HEALTH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Berg
- Case Western Reserve University
| | - W Davis
- Ashbury Senior Computer Community Center (ASC3)
| | - A Sheon
- The Urban Health Initiative, Case Western Reserve University
| | | | - J Daprano
- MetroHealth Medical Center and Case Western Reserve University
| | - I Adebambo
- MetroHealth Medical Center and Case Western Reserve University
| | - D Einstadter
- MetroHealth Medical Center and Case Western Reserve University
| | - A Perzynski
- MetroHealth Medical Center and Case Western Reserve University
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Mantsios A, Galai N, Mbwambo J, Likindikoki S, Shembilu C, Mwampashi A, Beckham SW, Leddy A, Davis W, Sherman S, Kennedy C, Kerrigan D. Community Savings Groups, Financial Security, and HIV Risk Among Female Sex Workers in Iringa, Tanzania. AIDS Behav 2018; 22:3742-3750. [PMID: 29478147 DOI: 10.1007/s10461-018-2065-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 11/29/2022]
Abstract
This study assessed the association between community savings group participation and consistent condom use (CCU) among female sex workers (FSW) in Iringa, Tanzania. Using cross-sectional data from a survey of venue-based FSW (n = 496), logistic regression was used to examine the associations between financial indicators including community savings group participation and CCU. Over one-third (35%) of the women participated in a savings group. Multivariable regression results indicated that participating in a savings group was significantly associated with nearly two times greater odds of CCU with new clients in the last 30 days (aOR = 1.77, 95% CI 1.10-2.86). Exploratory mediation analysis indicated that the relationship between savings group participation and CCU was partially mediated by financial security, as measured by monthly income. Findings indicate that community savings groups may play an important role in reducing sexual risk behaviors of FSW and hold promise as part of comprehensive, community-led HIV prevention strategies among FSW.
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Affiliation(s)
- Andrea Mantsios
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Noya Galai
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Statistics, The University of Haifa, Haifa, Israel
| | - Jessie Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Catherine Shembilu
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ard Mwampashi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - S W Beckham
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Anna Leddy
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wendy Davis
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Sociology, American University, Washington, DC, USA
| | - Susan Sherman
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Caitlin Kennedy
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Department of Sociology, American University, Washington, DC, USA
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Page KR, Grieb SD, Nieves-Lugo K, Yamanis T, Taylor H, Martinez O, Yamasaki Y, Limaye R, Davis W, Beyrer C, Zea MC. Enhanced immigration enforcement in the USA and the transnational continuity of HIV care for Latin American immigrants in deportation proceedings. Lancet HIV 2018; 5:e597-e604. [PMID: 29997050 PMCID: PMC6211169 DOI: 10.1016/s2352-3018(18)30074-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/24/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
In our work as clinicians, researchers, and immigrant rights advocates, we have noted increased anxiety about the possibility of deportation and disruptions in care among immigrants with HIV. Before the 2016 US elections, patients rarely asked about HIV treatment in their home countries. However, since the increase in anti-immigrant rhetoric and arrests by US Immigration and Customs Enforcement, patients have voiced concerns about the availability of HIV treatment in their home countries much more frequently. Although antiretroviral therapy is available throughout Latin America, access depends on economic, social, and political circumstances. Maintaining uninterrupted continuity of care among immigrants held in detention or deported to their home countries is challenging. In this Viewpoint, we identify periods of particular vulnerability for immigrants during deportation proceedings, from initial detention to deposition in their country of origin. We discuss the effect of enhanced immigration enforcement on the health and wellbeing of HIV-infected immigrants, and on public health. Finally, we also discuss recommendations for clinicians, immigration authorities, and public health institutions in the USA and in receiving countries.
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Affiliation(s)
- Kathleen R Page
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Suzanne Dolwick Grieb
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Holly Taylor
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Rupali Limaye
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Chris Beyrer
- Bloomberg Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Albain K, Darke A, Mack P, Redman M, Cheng T, Moon J, Holland W, Borczuk A, Chay C, Morris P, Vallieres E, Kratzke R, Molina J, Kolesar J, Chen Y, Macrae R, Matsumoto S, Reid M, Zirpoli G, Davis W, Ondracek R, Bshara W, Omilian A, Gandara D, Kelly K, Santella R, Ambrosone C. OA06.01 Case-Series Study in Ever- and Never-Smoking Females and Males with NSCLC: Exposures, Tumor Factors, Biology and Survival (SWOG S0424). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.263] [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: 10/28/2022]
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Adair S, Baus M, Belknap J, Bell R, Boero M, Bussy C, Cardenas F, Casey T, Castro J, Davis W, Erskine M, Farr R, Fischer T, Forbes B, Ford T, Genovese R, Gottschalk R, Hoge M, Honnas C, Hunter G, Joyce J, Kaneps A, Keegan K, Kramer J, Lischer C, Marshall J, Oosterlinck M, Radue P, Redding R, Reed SK, Rick M, Santschi E, Schoonover M, Schramme M, Schumacher J, Stephenson R, Thaler R, Vedding Neilsen J, Wilson DA. Response to Letter to the Editor: Do we have to redefine lameness in the era of quantitative gait analysis. Equine Vet J 2018; 50:415-417. [PMID: 29633362 DOI: 10.1111/evj.12820] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Adair
- University of Tennessee, USA
| | - M Baus
- Gran Prix Equine, Connecticut, USA
| | | | - R Bell
- Park Equine Hospital, Kentucky, USA
| | | | | | - F Cardenas
- 3H Equine Hospital and Mobile Veterinary Services, North Carolina, USA
| | - T Casey
- Fourways Equine Clinic, South Africa
| | | | - W Davis
- Palm Beach Equine Clinic, Florida, USA
| | | | - R Farr
- Farr and Pursey Equine Veterinary Services, Hertfordshire, UK
| | - T Fischer
- Chino Valley Equine Hospital, California, USA
| | | | - T Ford
- Ford Veterinary Surgery Center, California, USA
| | | | | | - M Hoge
- Murrieta Equine, California, USA
| | | | - G Hunter
- Ardene House Veterinary Practice, Aberdeen, UK
| | - J Joyce
- Total Equine Veterinary Associates, Virginia, USA
| | - A Kaneps
- Kaneps Equine Sports Medicine and Surgery, Massachusetts, USA
| | | | | | | | | | | | - P Radue
- Damascus Equine Associates, Maryland, USA
| | - R Redding
- North Carolina State University, USA
| | | | - M Rick
- Alamo Pintado Equine Medical Centre, California, USA
| | | | | | | | | | | | - R Thaler
- Metamora Equine PC, Michigan, USA
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