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Kajese Mawokomatanda TT, Singh S, Valverde EE. HIV Care Outcomes Among Non-US-Born Persons with Diagnosed HIV Infection, 2019. J Immigr Minor Health 2024; 26:443-452. [PMID: 37921941 PMCID: PMC11298239 DOI: 10.1007/s10903-023-01568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/05/2023]
Abstract
Despite the improvements in HIV care outcomes in the United States (US), non-US-born persons continue to be disproportionately affected by HIV. We analyzed National HIV Surveillance System (NHSS) data on HIV diagnoses, stage 3 (AIDS) at diagnosis, linkage to medical care, and viral suppression for non-US-born persons by region of birth (RoB) reported to the (NHSS) in 2020 to determine care outcomes among this population. Overall, a larger proportion of non-US-born persons received a late-stage diagnosis [stage 3 (AIDS)] classification. Among all non-US-born persons, African-born males, Asian-born females, and persons aged 55 + years had the highest proportions of late-stage diagnosis. Despite a late-stage of diagnosis, a higher proportion of non-US-born persons were linked to medical care and were virally suppressed compared to US-born persons. HIV care outcomes varied by RoB and selected characteristics. Knowing the RoB of non-US-born persons is necessary to identify culturally sensitive approaches for prevention planning and increasing testing activities to ultimately increase early diagnosis in this population.
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Affiliation(s)
- Tebitha T Kajese Mawokomatanda
- Exposure Investigation Section (EIS), Office of Community Health and Hazard Assessment (OCHHA), Agency of Toxic Substance and Disease Registry (ATSDR), Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA, 30341, USA.
| | - Sonia Singh
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Eduardo E Valverde
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30329, USA
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Yang X, Li L, Zhang N, Hao L, Zhu X, Yu H, Wang G, Kang D. Analysis on epidemiological characters and HIV care continuum of HIV-infected students: a retrospective cohort study in Shandong province, China. BMC Infect Dis 2023; 23:496. [PMID: 37501181 PMCID: PMC10373422 DOI: 10.1186/s12879-023-08476-6] [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: 03/24/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUD The proportion of HIV-infected students in China showed an increasing trend. This study aimed to identify the epidemiological characteristics and the HIV care continuum for HIV-infected students in Shandong Province, China. METHODS Case report and follow-up data of HIV-infected students were obtained from the National HIV/AIDS comprehensive response information management system. Logistic regression analyses were used to analyze the associating factors of HIV-infected students accepting CD4 + T cells (CD4) test and antiviral therapy (ART) in 30 days, and ArcGIS software was used for the spatial anlysis. RESULTS From 2017 to 2019, 403 HIV-infected students were reported in Shandong Province. The majority of them were male (99.5%) and transmitted through homosexual sexual activity(92.1%). Most of them lived in Jinan city and Qingdao city. 68.5% (276 cases) accepted CD4 test in 30 days, and 48.6% (196 cases) started ART in 30 days. The heterosexual transmitted cases (AOR = 0.458, 95%CI: 0.210-0.998), patients accepting HIV care in western area (AOR = 0.266,95%CI: 0.147-0.481) were less likely to test CD4 within 30 days; patients aged 23-25 (AOR = 2.316, 95%CI: 1.009-5.316) and patients who had tested CD4 within 30 days (AOR = 4.377; 95%CI: 2.572-7.447) prefered to receive ART within 30 days; patients accepted HIV care in central area (AOR = 0.407; 95%CI: 0.251-0.657) and western area (AOR = 0.508; 95%CI: 0.261-0.989) and patients diagnosed by voluntary blood donation (AOR = 0.352; 95%CI: 0.144-0.864) were less willing to receive ART in 30 days. CONCLUSIONS The HIV care continuum of HIV-infected students in Shandong Province still needed strenghthing. More health education and case management should be done for cases transmitted through heterosexual behavior, accepted HIV care in central and western area, and diagnosed by voluntary blood donation.
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Affiliation(s)
- Xingguang Yang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Lianzheng Hao
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Haiying Yu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
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Elmileik E, Turnbull I. Impact of HIV/AIDS on African-born Women Living in the United States: a Systematic Review. J Racial Ethn Health Disparities 2023; 10:680-707. [PMID: 35132608 DOI: 10.1007/s40615-022-01256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is paucity of surveillance data about African-born women (ABW) living with HIV/AIDS in the USA. Out of the 50 US states, only Washington state and Minnesota report HIV surveillance data about African-born people, and Minnesota is the only state that reports data about ABW, specifically. In Minnesota, ABW have the largest prevalence rate of HIV/AIDS among all women. In Washington state, foreign-born Black people have the highest incidence of HIV behind white people and foreign-born Hispanic people. This study aims to better understand the impact HIV/AIDS on ABW. METHODS This systematic review is based on articles available on three databases (PubMed, Embase, and Cochrane Library). Databases were searched for articles that included quantitative and/or qualitative findings about the impact of HIV/AIDS on ABW in the USA. RESULTS Several themes were identified including disproportionate impact of HIV/AIDS on ABW, barriers to care, low sexual health knowledge, HIV-related stigma, and limited HIV testing. Based on 2013 data, the incidence of HIV among ABW was 12 times higher than the incidence among women in the general US population. In 2008-2014, ABW had the smallest decline in HIV diagnosis rate when compared to US-born men and women, African-born men, and Caribbean-born men and women. Barriers that ABW face when trying to access care include, language barriers, fear of deportation and difficulty navigating the US healthcare system. CONCLUSION ABW living in the USA are uniquely impacted by HIV/AIDS. Lasting negative health consequences can be mitigated by improving HIV surveillance and investing in further studies about this population.
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Affiliation(s)
- Eiman Elmileik
- Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Ivy Turnbull
- AIDS Alliance for Women, Infants, Children, Youth & Families, Washington, D.C., WA, USA
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Kerani RP, Lugg A, Berzins B, Gaye O, Lipira LE, Bundy C, Kwakwa H, Holmes KK, Golden MR. Post-migration HIV acquisition among african immigrants in the U.S. J Immigr Minor Health 2022; 24:1459-1468. [PMID: 35415766 PMCID: PMC9554041 DOI: 10.1007/s10903-022-01356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND African immigrants in the U.S. are more likely to have a late HIV diagnosis than U.S.-born people, potentially leading to onward transmission. We sought to determine the proportion of African-born people living with HIV (APLWH) who (1) had tested HIV negative prior to diagnosis, and (2) likely acquired HIV in the U.S. METHODS We interviewed APLWH from 2014 to 2017 and estimated the proportion with post-migration HIV acquisition based on clinical data, HIV testing history, immigration date, and behavioral data. RESULTS Of 179 participants, 113 (63%) were women. Less than half (44%) reported a negative HIV test prior to diagnosis. Among 142 (79%) participants with sufficient data to evaluate post-migration HIV acquisition, we estimate that 29% acquired HIV post-migration. Most APLWH acquire HIV prior to immigration. DISCUSSION Approximately one-quarter of APLWH acquire HIV post-migration and HIV testing is infrequent, highlighting the need for prevention efforts for African immigrants in the U.S.
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Affiliation(s)
- Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, WA, United States.
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States.
- Department of Epidemiology, University of Washington, Seattle, WA, United States.
- Center for AIDS and STD, Harborview Medical Center, 325 9th Ave, Box 359932, 98104, Seattle, WA, United States.
| | - Amanda Lugg
- African Services Committee, New York, NY, United States
| | - Baiba Berzins
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
| | - Oumar Gaye
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - Lauren E Lipira
- Department of Health Services, University of Washington, Seattle, WA , United States
- Oregon Health Authority and the Regional Research Institute, Portland State University, Portland, OR, United States
| | - Camille Bundy
- Division of Infectious Diseases, Northwestern University, Evanston, IL, United States
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Helena Kwakwa
- Philadelphia Department of Public Health, Philadelphia, PA, United States
| | - King K Holmes
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA, United States
- HIV/STD Program, Public Health - Seattle and King County, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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Ramírez-Ortiz D, Seitchick J, Polpitiya M, Algarin AB, Sheehan DM, Fennie K, Cyrus E, Trepka MJ. Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review. ETHNICITY & HEALTH 2022; 27:1859-1899. [PMID: 34647837 PMCID: PMC9008069 DOI: 10.1080/13557858.2021.1990217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors. DESIGN We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020. RESULTS A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship. CONCLUSION These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
| | - Jessica Seitchick
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Medhani Polpitiya
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Angel B. Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL
| | | | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
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Shelton BA, Sawinski D, MacLennan PA, Lee W, Wyatt C, Nadkarni G, Fatima H, Mehta S, Crane HM, Porrett P, Julian B, Moore RD, Christopoulos K, Jacobson JM, Muller E, Eron JJ, Saag M, Peter I, Locke JE. Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study. EClinicalMedicine 2022; 53:101653. [PMID: 36159042 PMCID: PMC9489495 DOI: 10.1016/j.eclinm.2022.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Abstract
Background Women represent a meaningful proportion of new HIV diagnoses, with Black women comprising 58% of new diagnoses among women. As HIV infection also increases risk of chronic kidney disease (CKD), understanding CKD risk among women with HIV (WWH), particularly Black women, is critical. Methods In this longitudinal cohort study of people with HIV (PWH) enrolled in CFAR Network of Integrated Clinical Systems (CNICS), a multicentre study comprised of eight academic medical centres across the United States from Jan 01, 1996 and Nov 01, 2019, adult PWH were excluded if they had ≤2 serum creatinine measurements, developed CKD prior to enrollment, or identified as intersex or transgendered, leaving a final cohort of 33,998 PWH. The outcome was CKD development, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1·73 m2 calculated using the CKD-EPI equation, for ≥90 days with no intervening higher values. Findings Adjusting for demographic and clinical characteristics, WWH were 61% more likely to develop CKD than men (adjusted hazard ratio [aHR]: 1·61, 95% CI: 1·46-1·78, p<0·001). This difference persisted after further adjustment for APOL1 risk variants (aHR female sex: 1·92, 95% CI: 1·63-2·26, p<0·001) and substance abuse (aHR female sex: 1·70, 95% CI: 1·54-1·87, p<0·001). Interpretation WWH experienced increased risk of CKD. Given disparities in care among patients with end-stage kidney disease, efforts to engage WWH in nephrology care to improve chronic disease management are critical. Funding US National Institutes of Health.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
| | | | - Paul A. MacLennan
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Wonjun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Girish Nadkarni
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Huma Fatima
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Shikha Mehta
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Heidi M. Crane
- University of Washington School of Medicine, United States
| | - Paige Porrett
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Bruce Julian
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | | | | | | | - Elmi Muller
- Stellenbosch University, Medicine and Health Sciences, South Africa
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill School of Medicine, United States
| | - Michael Saag
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Heersink School of Medicine, United States
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Erly S, Roberts DA, Kerani R, Kim HN, Harrington R, Dhanireddy S, Patel R. Assessing HIV Care Outcomes Among African-Born People Living with HIV in Seattle: An Analysis of the University of Washington Electronic Medical Record. J Immigr Minor Health 2021; 23:1136-1144. [PMID: 33206277 PMCID: PMC8274475 DOI: 10.1007/s10903-020-01121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 01/10/2023]
Abstract
To examine the relationship between African birth and HIV outcomes and comorbidities among individuals accessing care at the University of Washington. Patients who received a diagnosis of HIV at the University of Washington from 1995 to 2018 were identified. African-born patients were defined as those with recorded birthplace or primary language belonging to an African country. This cohort was compared to all non-African-born patients for initial CD4 count < 200 cells/mL, time from diagnosis to viral suppression, and prevalence of comorbid conditions. We identified 357 African-born and 3710 non-African-born patients. Over the time period, African-born patients were more likely to present with initial CD4 counts < 200 cells/mL (31% vs 19%, p < 0.01), but had shorter time to viral suppression (HR 1.31, [95% CI: 1.14-1.56]). African-born patients had higher rates of hepatitis B and tuberculosis (12% vs. 7% p < 0.01 and 13% vs. 3% p < 0.01). African-born patients living in the Seattle area have better HIV outcomes, but low initial CD4 counts suggest that they are presenting to care late. Increased efforts to engage this population in HIV, hepatitis B, and tuberculosis screening are warranted.
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Affiliation(s)
- Steven Erly
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | - D Allen Roberts
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Roxanne Kerani
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - H Nina Kim
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Robert Harrington
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Shireesha Dhanireddy
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Rena Patel
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
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Nace A, Johnson G, Eastwood E. Comparison of HIV Viral Suppression Between a Sample of Foreign-Born and U.S.-Born Women of Color in the United States. J Immigr Minor Health 2021; 23:1129-1135. [PMID: 33974177 DOI: 10.1007/s10903-021-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
We investigate the association between nativity status (U.S.- vs foreignborn) and viral suppression among women of color (WOC) with HIV (HIV +) and whether this association was modified by education and housing. METHODS Data were from 549 HIV + WOC, who participated in the Health Resources and Services Administration-funded WOC Initiative 2009-2013. We used generalized estimating equation models to quantify the association between the respondents' nativity status and viral suppression. RESULTS After adjusting for covariates, foreign-born WOC were 2.2 times (95% confidence interval: 1.25, 3.85) more likely to achieve viral suppression than U.S.-born WOC. This association was not modified by education or housing status. CONCLUSIONS Despite facing barriers to care, foreign-born WOC were more likely to achieve viral suppression than U.S.-born WOC. Programs aiming to end the HIV epidemic and reduce HIV disparities in the U.S. should consider these findings as they provide a more nuanced understanding of HIV + WOC.
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Affiliation(s)
- Amanda Nace
- CUNY Graduate School of Public Health and Health Policy, Health Policy and Management, 55 W 125 th Street, 5 th Fl. NY, New York, 10027, USA.
| | - Glen Johnson
- CUNY Graduate School of Public Health and Health Policy, Health Policy and Management, 55 W 125 th Street, 5 th Fl. NY, New York, 10027, USA
| | - Elizabeth Eastwood
- CUNY Graduate School of Public Health and Health Policy, Health Policy and Management, 55 W 125 th Street, 5 th Fl. NY, New York, 10027, USA
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Kerani RP, Satcher Johnson A, Buskin SE, Rao D, Golden MR, Hu X, Hall HI. The Epidemiology of HIV Among People Born Outside the United States, 2010-2017. Public Health Rep 2020; 135:611-620. [PMID: 32805191 DOI: 10.1177/0033354920942623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although some studies have reported a higher incidence of HIV infection among non-US-born people than among US-born people, national data on this topic are scarce. We compared the epidemiology of HIV infection between US-born and non-US-born residents of the United States and examined the characteristics of non-US-born people with diagnosed HIV infection by region of birth (ROB). METHODS We used a cross-sectional study design to produce national, population-based data describing HIV infection among US-born and non-US-born people. We analyzed National HIV Surveillance System data for people with HIV infection diagnosed during 2010-2017 and reported to the Centers for Disease Control and Prevention (CDC). We compared data on demographic characteristics, transmission risk category, and stage 3 infection (AIDS) classification within 3 months of HIV diagnosis, by nativity and ROB. RESULTS During 2010-2017, 328 317 children and adult US residents were diagnosed with HIV infection and were reported to CDC: 214 973 (65.5%) were US-born, 50 301 (15.3%) were non-US-born, and 63 043 (19.2%) were missing data on country of birth. After adjusting for missing country of birth, 266 147 (81.1%) people were US-born and 62 170 (18.9%) were non-US-born. This group accounted for 15 928 of 65 645 (24.2%) HIV diagnoses among girls and women and 46 242 of 262 672 (17.6%) HIV diagnoses among boys and men. A larger percentage of non-US-born people than US-born people had stage 3 infection (AIDS) at HIV diagnosis (31.2% vs 23.9%). Among non-US-born people with HIV diagnoses, 19 876 (39.5%) resided in the South. CONCLUSIONS Characterizing non-US-born people with HIV infection is essential for developing effective HIV interventions, particularly in areas with large immigrant populations.
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Affiliation(s)
- Roxanne P Kerani
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Anna Satcher Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Buskin
- 7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- 7284 Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew R Golden
- 7284 Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA.,7285 HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, USA.,7284 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Xiaohong Hu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - H Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Dawit R, Sheehan DM, Gbadamosi SO, Fennie KP, Li T, Curatolo D, Maddox LM, Spencer EC, Trepka MJ. Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015-2017. AIDS Care 2020; 33:131-135. [PMID: 32460517 DOI: 10.1080/09540121.2020.1771264] [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: 01/20/2023]
Abstract
The study objective was to classify women with newly diagnosed HIV into patterns of retention in care (≥2 HIV care visits ≥3 months apart) and viral suppression over time and identify factors associated with class membership. Florida HIV/AIDS surveillance data were used to conduct Latent Class Analysis to classify women into patterns, and multinomial regression was used to compare the prevalence of class membership by demographic and clinical factors. Four classes were selected based on model fit parameters: (Class 1) consistently retained and suppressed (>90% probability of being retained and suppressed), (Class 2) not consistently retained or suppressed (≤10% probability of being retained and suppressed), (Class 3) increasingly retained and suppressed, and (Class 4) decreasingly retained and suppressed. The proportion of women in each class was 48.6%, 24.9%, 14.3%, and 12.2%, respectively. Women aged 25-34 compared to 35-49 years old, injection drug use mode of exposure, US born, and not linked to care three months post-diagnosis had a lower prevalence of belonging to the consistently retained and suppressed class. Findings may be useful in tailoring and targeting interventions to increase the prevalence of women who are consistently retained in care and virally suppressed.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | | | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Danielle Curatolo
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,Research Center in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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11
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Demeke HB, Luo Q, Beer L, Weiser J. Antiretroviral prescription, retention in care and viral suppression by place of birth among adults with diagnosed HIV in the United States-2015-2017, medical monitoring project. AIDS Care 2020; 33:86-91. [PMID: 32156156 DOI: 10.1080/09540121.2020.1738007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
HIV clinical outcomes have not been fully assessed by place of birth at the national level. We analyzed the Medical Monitoring Project data, an annual cross-sectional survey designed to produce nationally representative estimates on adults with diagnosed HIV in the United States, collected during 2015-2017 (n = 7617). We compared sociodemographic, behavioral, and clinical outcomes by place of birth using Rao-Scott chi-square tests (P < .05). Overall, 13.6% of adults with diagnosed HIV were non-US-born. During the past 12 months, a higher percentage of non-US-born than US-born adults, respectively, were prescribed ART (89.4% vs. 84.1%), retained in care (87.1% vs. 80.0%), virally suppressed at the last test (77.2% vs. 70.9%), and had sustained viral suppression (70.9% vs. 63.3%). A lower percentage of non-US-born adults reported binge drinking (13.0% vs. 16.1%), using non-injection drugs (15.3% vs. 31.7%), and suffering from depression (15.9% vs. 23.3%) or anxiety (10.0% vs. 20.2%). A significantly higher percentage of non-US-born adults had Ryan White HIV/AIDS Program (RWHAP) coverage (54.4% vs. 43.1%) and attended a RWHAP-funded health care facility (73.9% vs. 66.6%). Factors contributing to better HIV clinical outcomes among non-US-born persons may include access to RWHAP coverage, lower levels of substance use, and better mental health.
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Affiliation(s)
- Hanna B Demeke
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Linda Beer
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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13
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Demeke HB, Luo Q, Luna-Gierke RE, Padilla M, Girona-Lozada G, Miranda-De León S, Weiser J, Beer L. HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015-2018, Medical Monitoring Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010171. [PMID: 31881732 PMCID: PMC6981500 DOI: 10.3390/ijerph17010171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
Relocation from one’s birthplace may affect human immunodeficiency virus (HIV) outcomes, but national estimates of HIV outcomes among Hispanics/Latinos by place of birth are limited. We analyzed Medical Monitoring Project data collected in 2015–2018 from 2564 HIV-positive Hispanic/Latino adults and compared clinical outcomes between mainland US-born (referent group), Puerto Rican (PR-born), and those born outside the United States (non-US-born). We reported weighted percentages of characteristics and used logistic regression with predicted marginal means to examine differences between groups (p < 0.05). PR-born Hispanics/Latinos were more likely to be prescribed antiretroviral therapy (ART) (94%) and retained in care (94%) than mainland-US-born (79% and 77%, respectively) and non-US-born (91% and 87%, respectively) Hispanics/Latinos. PR-born Hispanics/Latinos were more likely to have sustained viral suppression (75%) than mainland-US-born Hispanics/Latinos (57%). Non-US-born Hispanics/Latinos were more likely to be prescribed ART (91% vs. 79%), retained in care (87% vs. 77%), and have sustained viral suppression (74% vs. 57%) than mainland-US-born Hispanics/Latinos. Greater Ryan White HIV/AIDS-funded facility usage among PR-born, better mental health among non-US-born, and less drug use among PR-born and non-US-born Hispanics/Latinos may have contributed to better HIV outcomes. Expanding programs with comprehensive HIV/AIDS services, including for mental health and substance use, may reduce HIV outcome disparities among Hispanics/Latinos.
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Affiliation(s)
- Hanna B. Demeke
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-6230
| | - Qingwei Luo
- ICF Assigned to DHAP, NCHHSTP, CDC, Atlanta, GA 30329, USA
| | - Ruth E. Luna-Gierke
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mabel Padilla
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | | | | | - John Weiser
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Linda Beer
- The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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White-Means S, Gaskin DJ, Osmani AR. Intervention and Public Policy Pathways to Achieve Health Care Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142465. [PMID: 31373297 PMCID: PMC6679008 DOI: 10.3390/ijerph16142465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/30/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022]
Abstract
Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one's health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. In this paper, we summarize the approaches introduced by authors contributing to this Special Issue and how their work is captured by the National Institute of Minority Health and Health Disparities (NIMHD) framework. The paper concludes by pointing out intervention and public policy opportunities for future investigation in order to achieve health care equity.
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Affiliation(s)
- Shelley White-Means
- Department of Interprofessional Education, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
- CHEER Health Disparities Center, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Ross J, Akiyama MJ, Slawek D, Stella J, Nichols K, Bekele M, Cunningham CO, Blackstock OJ. Undocumented African Immigrants' Experiences of HIV Testing and Linkage to Care. AIDS Patient Care STDS 2019; 33:336-341. [PMID: 31194578 DOI: 10.1089/apc.2019.0036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the United States, undocumented African immigrants living with HIV enter care late, potentially leading to adverse individual and population health outcomes, yet little is known about the specific experiences of HIV diagnosis and linkage to care among this population. We conducted individual, semi-structured interviews with adults who were undocumented African immigrants living with HIV in New York City. Interviews explored perspectives regarding individual, social, institutional, and societal barriers and facilitators of HIV testing and linkage to care. Of 14 participants from 9 different African countries, 9 were women and the median age was 44 years (interquartile range: 42-50). Participants described fear of discovery by immigration authorities as a substantial barrier to HIV testing and linking to initial medical appointments. Actual and perceived structural barriers to both testing and care linkage included difficulty obtaining health insurance and a belief that undocumented immigrants are ineligible for any health services. Participants also expressed reluctance to be tested because of HIV-related stigma within the immigrant communities that they heavily relied on. After diagnosis, however, participants overwhelmingly described a positive role of health and social service providers in facilitating linkage to HIV care. Concerns about immigration status and HIV-related stigma are significant barriers to HIV testing and linkage to care among undocumented African immigrants. Multilevel efforts to reduce stigma and increase awareness of available services could enhance rates of HIV testing and care linkage in this population.
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Affiliation(s)
- Jonathan Ross
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Matthew J. Akiyama
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Deepika Slawek
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Stella
- Division of Hospital Medicine, Zuckerberg San Francisco General/University of California, San Francisco, San Francisco, California
| | - Kim Nichols
- African Services Committee, New York, New York
| | | | - Chinazo O. Cunningham
- Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Oni J. Blackstock
- New York City Department of Health and Mental Hygiene, New York, New York
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Roberts DA, Kerani R, Tsegaselassie S, Abera S, Lynes A, Scott E, Chung K, Yohannes E, Basualdo G, Stekler JD, Barnabas R, James J, Cooper-Ashford S, Patel R. Harambee!: A pilot mixed methods study of integrated residential HIV testing among African-born individuals in the Seattle area. PLoS One 2019; 14:e0216502. [PMID: 31059553 PMCID: PMC6502314 DOI: 10.1371/journal.pone.0216502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background African-born individuals in the U.S. are disproportionately affected by HIV yet have low HIV testing rates. We conducted a mixed methods study to assess the uptake and feasibility of a novel strategy for integrating HIV testing into residential health fairs among African-born individuals in Seattle, WA. Methods From April to May 2018, we held six health fairs at three apartment complexes with high numbers of African-born residents. Fairs included free point-of-care screening for glucose, cholesterol, body mass index, blood pressure, and HIV, as well as social services and health education. The health fairs were hosted in apartment complex common areas with HIV testing conducted in private rooms. Health fair participants completed a series of questionnaires to evaluate demographics, access to health services, and HIV testing history. We conducted 18 key informant interviews (KIIs) with health fair participants and community leaders to identify barriers to HIV testing among African-born individuals. Results Of the 111 adults who accessed at least one service at a health fair, 92 completed questionnaires. Fifty-five (61%) were female, 48 (52%) were born in Africa, and 55 (63%) had health insurance. Half of African-born participants accepted HIV testing; all tested negative. The most common reasons for declining testing were lack of perceived risk for HIV and knowledge of HIV status. We identified a high prevalence of non-communicable diseases (NCDs) among health fair participants; among those tested, 77% (55/71) were overweight/obese, 39% (31/79) had blood pressure > 140/90 mmHg, and 30% (22/73) had total cholesterol > 200 mg/dL. KIIs identified community stigma and misinformation as major barriers to HIV testing among African-born individuals. Conclusions Residential health fairs are a feasible method to increase HIV testing among African-born individuals in Seattle. The high prevalence of NCDs highlights the importance of integrating general preventive services within HIV testing programs in this population.
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Affiliation(s)
- D Allen Roberts
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Roxanne Kerani
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- HIV/STD Program, Public Health–Seattle and King County, Seattle, Washington, United States of America
| | | | - Seifu Abera
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Ashley Lynes
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Emily Scott
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Karen Chung
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Ermias Yohannes
- School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Guiomar Basualdo
- College of Arts and Sciences, University of Washington, Seattle, United States of America
| | - Joanne D. Stekler
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Ruanne Barnabas
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jocelyn James
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | | | - Rena Patel
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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