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Maier M, Beste LA, Lowy E, Hauser RG, Van Epps P, Yakovchenko V, Rogal S, Chartier M, Ross D. Veteran's Health Administration HIV Care Continuum: 2019 vs 2022. Open Forum Infect Dis 2024; 11:ofae382. [PMID: 39086463 PMCID: PMC11288371 DOI: 10.1093/ofid/ofae382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
Background The diagnosis-based Human Immunodeficiency Virus (HIV) Care Continuum offers a well-established framework for measuring HIV care quality. It is used by the government agencies, community organizations, and health care institutions to "guide the nation's response to HIV" and assesses HIV care from the time of HIV diagnosis through viral suppression. Our objective is to present the Veteran Health Administration's (VHA) HIV Care Continuum, assess postpandemic versus prepandemic performance, and compare VHA performance to Centers for Disease Control and Prevention-published data. Methods We conducted a nationwide retrospective cohort analysis examining the care continuum for people with HIV (PWH) in VHA care in 2019 versus 2022. Measurements included linkage to care, receipt of care, retention in care, and viral suppression. We used multivariable logistic regression of virological suppression to identify factors associated with viral suppression. Results In VHA in 2019, 83% of individuals newly diagnosed with HIV were linked to care, 84% of PWH received care, 76% were retained in care, and viral suppression was 76% among those with HIV and 93% of those with viral load (VL) results. In 2022, 74% were linked to care, 79% received care, 67% were retained in care, and viral suppression was 70% among those with HIV and 94% of those with a VL result. Conclusions VHA has achieved >90% viral suppression among those with a VL result. Among all PWH, viral suppression decreased an absolute 5.2% between 2019 and 2022. VHA's performance on the HIV Care Continuum exceeds the national HIV Care Continuum reported by the Centers for Disease Control and Prevention.
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Affiliation(s)
- Marissa Maier
- Oregon Health & Science University, Division of Infectious Diseases, Department of Medicine; VA Portland Health Care System, Portland, Oregon, USA
| | - Lauren A Beste
- University of Washington, Department of Medicine, VA Puget Sound Health Care System, Seattle, Washington USA
| | - Elliott Lowy
- VA Puget Sound Health Care System, Seattle, Washington USA
| | - Ronald G Hauser
- Yale University School of Medicine, Department of Laboratory Medicine, VA Connecticut Healthcare System, New Haven, Connecticut USA
| | - Puja Van Epps
- Case Western Reserve University School of Medicine, Division of Infectious Diseases, VA North East Ohio Health Care System, Cleveland, Ohio USA
| | - Vera Yakovchenko
- VA Pittsburgh Health Care System, Pittsburgh Pennsylvania, USA; Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shari Rogal
- VA Pittsburgh Health Care System, Pittsburgh Pennsylvania, USA; Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maggie Chartier
- Office of Specialty Care Services, Department of Veterans Affairs, Washington DC, Washington, USA
| | - David Ross
- HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services, Department of Veterans Affairs, Washington DC, Washington, USA
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Rudolph JE, Calkins KL, Zhang X, Zhou Y, Xu X, Wentz EL, Joshu CE, Lau B. Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001-2015. AIDS Care 2024:1-13. [PMID: 39078934 DOI: 10.1080/09540121.2024.2383901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid - an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001-2015, aged 18-64, living in 14 US states. We estimated the monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001-2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.
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Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Keri L Calkins
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Mathematica, Ann Arbor, MI, USA
| | - Xueer Zhang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yiyi Zhou
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xiaoqiang Xu
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eryka L Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Corinne E Joshu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Rudolph JE, Calkins KL, Zhang X, Zhou Y, Xu X, Wentz EL, Joshu CE, Lau B. Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001-2015. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.13.24307278. [PMID: 38798374 PMCID: PMC11118595 DOI: 10.1101/2024.05.13.24307278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid - an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001-2015, aged 18-64, living in 14 US states. We estimated monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001-2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.
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Affiliation(s)
- Jacqueline E. Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Keri L. Calkins
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
- Mathematica, Ann Arbor, MI
| | - Xueer Zhang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Yiyi Zhou
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Xiaoqiang Xu
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Eryka L. Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Corinne E. Joshu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Kim GS, Baek S, Kim N, Shim MS, Lee S, Lee Y, Park CG, Kim L. Network visualization to interpret which healthcare services are central to people living with HIV. J Adv Nurs 2024. [PMID: 38444110 DOI: 10.1111/jan.16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/05/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024]
Abstract
AIM To employ network analysis to identify the central healthcare service needs of people living with HIV (PLWH) for integrated care. DESIGN Cross-sectional survey. METHODS A list of healthcare services was identified through literature reviews, expert workshops and validity evaluations by PLWH. A total of 243 PLWH participated at five hospitals and self-reported their need for healthcare services on a four-point Likert scale. Centrality of healthcare service needs was analysed using network analysis. RESULTS The mean score for 20 healthcare service needs was 3.53 out of 4. The highest scoring need, "Precaution for interaction between antiretroviral therapy and other drugs," received a rating of 3.73 but had a centrality of only 0.31. The most central node in the network of healthcare service needs, "Information and coping with opportunistic infections," had a strength centrality of 1.63 and showed significant relationships with "non-HIV-related medical services (e.g., health check-ups)" and "Regular dental services." The correlation stability coefficient, which quantifies the stability of centrality, was 0.44 with an acceptable value. CONCLUSIONS The most central need was information on opportunistic infections that had connections with many nodes in network analysis. By interpreting the relationships between needs, healthcare providers can design interventions with an integrative perspective. IMPLICATIONS FOR PATIENT CARE Network visualization provides dynamic relationships between needs that are unknown from the score scale by presenting them graphically and qualitatively. IMPACT Using network analysis to interpret need assessment offers an integrated nursing perspective. Coping with opportunistic infection is central to connecting the chain of healthcare. This study highlights the multifaceted understanding of patients' needs that nurses gain when they conduct network analysis. REPORTING METHOD We adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Seoyoung Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - SangA Lee
- Manning College of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts, USA
| | - YoungJin Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Chang Gi Park
- Department of Population Nursing Science, College of Nursing, University of Illinois, Chicago, Illinois, USA
| | - Layoung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
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Satre DD, Sarovar V, Leyden WA, Leibowitz AS, Lam JO, Hojilla JC, Davy-Mendez T, Hare CB, Silverberg MJ. Age group differences in substance use, social support, and physical and mental health concerns among people living with HIV two years after receiving primary care-based alcohol treatment. Aging Ment Health 2023; 27:1011-1019. [PMID: 35765902 PMCID: PMC9797622 DOI: 10.1080/13607863.2022.2084504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Objectives: People living with HIV (PWH) have seen reduction in HIV-associated morbidity and increase in near-normal life expectancy, yet unhealthy alcohol use poses substantial risks to older as well as younger adults. Further research regarding age-associated physical and mental health concerns among PWH who drink alcohol is needed to inform services, given the expanding age range of patients in care.Methods: We compared age group differences (18-34, 35-44, 45-54, ≥55 years old) in two-year patient-reported outcomes and HIV viral control among PWH enrolled in a primary care-based behavioral alcohol intervention trial; with 90% follow up from baseline.Results: Of 553 PWH, 50 (9%) were 18-34, 85 (15%) were 35-44, 197 (36%) were 45-54, and 221 (40%) were ≥55 years old. Most were men (97%) and White (64%). At two years, PWH ≥55 reported less substance use in the prior 30 days, fewer social contacts, and more pain; younger PWH had lower antiretroviral therapy (ART) adherence. In adjusted analyses, PWH ages 18-34 had higher odds of unhealthy alcohol use, tobacco, cannabis, or other substances compared to those ≥55; with higher odds of anxiety among PWH 35-44 compared with those ≥55; and physical quality of life was worse among those ≥55 compared with younger groups.Conclusions: While older PWH report less substance use than younger PWH and have better ART adherence post-treatment, they are more likely to experience limited social support and worse physical quality of life. Findings can inform interventions to address varying needs of PWH across the lifespan.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Wendy A. Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Jennifer O. Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - J. Carlo Hojilla
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Charles B. Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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Newman DR, Matthias J, Rahman MM, Brantley A, Peterman TA. Repeat Syphilis Among HIV-Infected Men in Florida and Louisiana 2000-2018: Implications for Screening Recommendations. AIDS Patient Care STDS 2021; 35:435-440. [PMID: 34739335 DOI: 10.1089/apc.2021.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. We evaluated rates of reinfection to see if frequent rescreening might lead to earlier treatment and prevent infections. All syphilis records of all stages for males and females aged 15-70 years from the Florida and Louisiana Departments of Health surveillance databases 2000-2018 were evaluated. The first episode of syphilis during this period was considered the initial diagnosis for each person. Demographics of cases and repeaters (individuals reported with two or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ males. During 2000-2018, 124,827 syphilis cases were reported from 107,405 individuals: 73,811 (68.7%) males; 33,594 (31.3%) females. There were 12,545 individuals (repeaters) with two or more syphilis diagnoses (n = 17,422 cases; range, 2-10). From 2010 to 2018, repeaters accounted for steadily increasing percentage of all syphilis reported: 2010 (11%), 2013 (16%), 2015 (20%), and 2018 (26%). Among HIV+ male cases the percentage from repeaters also increased: 2010 (28%), 2013 (35%), 2015 (42%), and 2018 (50%). In 2018, 19% of all cases (n = 2455) were from HIV+ males who had a previous syphilis diagnosis. Among HIV+ males diagnosed with syphilis in 2015, 34% had a repeat syphilis diagnosis within 3 years. Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time. However, some subgroups could possibly benefit from more frequent screening. Males living with HIV who had a prior syphilis diagnosis were at very high risk of repeat infection.
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Affiliation(s)
- Daniel R. Newman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Matthias
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Florida Department of Health, Tallahassee, Florida, USA
| | - Mohammad M. Rahman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Louisiana Department of Health-STD/HIV/Hepatitis Program, New Orleans, Louisiana, USA
| | - Antoine Brantley
- Louisiana Department of Health-STD/HIV/Hepatitis Program, New Orleans, Louisiana, USA
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Thomas A. Peterman
- Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jonas MC, Rubenstein K, Watson E, Basra S, Horberg M. A Comprehensive Coordinator Supported Hepatitis C Virus Testing and Linkage to Treatment Program at Kaiser Permanente Mid-Atlantic States. Viruses 2021; 13:v13112140. [PMID: 34834947 PMCID: PMC8619706 DOI: 10.3390/v13112140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 01/28/2023] Open
Abstract
Since 2020, the US Preventive Services Taskforce has recommended expanding hepatitis C virus (HCV) screening to include ages 18−79, in addition to baby boomers (born 1945−1965) and those at-risk for hepatitis C virus. This retrospective cohort analysis compared patients (18 years and above) tested for HCV through usual care versus a coordinator-supported program (HCV pathway) during 2015−2018 within Kaiser Permanente Mid-Atlantic States (KPMAS). In total, 131,176 patients were tested through the HCV pathway and 128,311 through usual care (non-standardized testing). Of those tested, 1.6% (HCV pathway) and 0.5% (usual care) had chronic HCV. Of those with chronic HCV, more patients tested within the HCV pathway completed hepatic transient elastography (82.6% HCV pathway vs. 45.6% usual care; p < 0.001) and a gastroenterology visit (72.2% HCV pathway vs. 46.5% usual care; p < 0.001), and had filled prescriptions for treatment (56.5% HCV pathway vs. 40.3% usual care; p < 0.001). The median time to complete each step was shorter for those tested through the HCV pathway (hepatic transient elastography (26 vs. 118 days), gastroenterology visit (63 vs. 131 days), and prescription fill (222 vs. 326 days)). More patients tested through a coordinator-supported, standardized testing pathway completed the necessary testing steps, in less time, compared to usual care. These findings may inform institutions seeking to create effective population-wide testing programs for HCV and other conditions.
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Affiliation(s)
- Mary Cabell Jonas
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson Street, Rockville, MD 20852, USA; (K.R.); (E.W.); (S.B.); (M.H.)
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, 2101 E. Jefferson Street, Rockville, MD 20852, USA
- Correspondence:
| | - Kevin Rubenstein
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson Street, Rockville, MD 20852, USA; (K.R.); (E.W.); (S.B.); (M.H.)
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, 2101 E. Jefferson Street, Rockville, MD 20852, USA
| | - Eric Watson
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson Street, Rockville, MD 20852, USA; (K.R.); (E.W.); (S.B.); (M.H.)
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, 2101 E. Jefferson Street, Rockville, MD 20852, USA
| | - Sundeep Basra
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson Street, Rockville, MD 20852, USA; (K.R.); (E.W.); (S.B.); (M.H.)
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, 2101 E. Jefferson Street, Rockville, MD 20852, USA
| | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson Street, Rockville, MD 20852, USA; (K.R.); (E.W.); (S.B.); (M.H.)
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, 2101 E. Jefferson Street, Rockville, MD 20852, USA
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Kumar RN, Masters MC, Williams J, Morrison LR, Galvin S, Krueger KM. Evaluation of Adherence to Dual-Energy X-Ray Absorptiometry Scan Ordering for Persons Living with HIV at a Tertiary Medical Center. AIDS Patient Care STDS 2021; 35:31-32. [PMID: 33571045 DOI: 10.1089/apc.2020.0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary C. Masters
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Janna Williams
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Infection Prevention, Shirley Ryan Ability Lab, Chicago, Illinois, USA
| | - Lindsay R. Morrison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shannon Galvin
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen M. Krueger
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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