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Weld ED, McGowan I, Anton P, Fuchs EJ, Ho K, Carballo-Dieguez A, Rohan LC, Giguere R, Brand R, Edick S, Bakshi RP, Parsons T, Manohar M, Seigel A, Engstrom J, Elliott J, Jacobson C, Bagia C, Wang L, Al-khouja A, Hartman DJ, Bumpus NN, Spiegel HML, Marzinke MA, Hendrix CW. Tenofovir Douche as HIV Preexposure Prophylaxis for Receptive Anal Intercourse: Safety, Acceptability, Pharmacokinetics, and Pharmacodynamics (DREAM 01). J Infect Dis 2024; 229:1131-1140. [PMID: 38019657 PMCID: PMC11011183 DOI: 10.1093/infdis/jiad535] [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: 09/02/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Despite highly effective HIV preexposure prophylaxis (PrEP) options, no options provide on-demand, nonsystemic, behaviorally congruent PrEP that many desire. A tenofovir-medicated rectal douche before receptive anal intercourse may provide this option. METHODS Three tenofovir rectal douches-220 mg iso-osmolar product A, 660 mg iso-osmolar product B, and 660 mg hypo-osmolar product C-were studied in 21 HIV-negative men who have sex with men. We sampled blood and colorectal tissue to assess safety, acceptability, pharmacokinetics, and pharmacodynamics. RESULTS The douches had high acceptability without toxicity. Median plasma tenofovir peak concentrations for all products were several-fold below trough concentrations associated with oral tenofovir disoproxil fumarate (TDF). Median colon tissue mucosal mononuclear cell (MMC) tenofovir-diphosphate concentrations exceeded target concentrations from 1 hour through 3 to 7 days after dosing. For 6-7 days after a single product C dose, MMC tenofovir-diphosphate exceeded concentrations expected with steady-state oral TDF 300 mg on-demand 2-1-1 dosing. Compared to predrug baseline, HIV replication after ex vivo colon tissue HIV challenge demonstrated a concentration-response relationship with 1.9 log10 maximal effect. CONCLUSIONS All 3 tenofovir douches achieved tissue tenofovir-diphosphate concentrations and colorectal antiviral effect exceeding oral TDF and with lower systemic tenofovir. Tenofovir douches may provide a single-dose, on-demand, behaviorally congruent PrEP option, and warrant continued development. Clinical Trials Registration . NCT02750540.
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Affiliation(s)
- Ethel D Weld
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian McGowan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | - Peter Anton
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Lisa C Rohan
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Columbia University and NewYork State Psychiatric Institute, New York, New York, USA
| | - Rhonda Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Stacey Edick
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rahul P Bakshi
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa Parsons
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Madhuri Manohar
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron Seigel
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Jared Engstrom
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Elliott
- Division of Gastroenterology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Cindy Jacobson
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Christina Bagia
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Lin Wang
- Magee Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Amer Al-khouja
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Namandje N Bumpus
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans M L Spiegel
- Kelly Government Solutions, Contractor to Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Mark A Marzinke
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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MacCarthy S, Mendoza-Graf A, Wagner Z, L Barreras J, Kim A, Giguere R, Carballo-Dieguez A, Linnemayr S. The acceptability and feasibility of a pilot study examining the impact of a mobile technology-based intervention informed by behavioral economics to improve HIV knowledge and testing frequency among Latinx sexual minority men and transgender women. BMC Public Health 2021; 21:341. [PMID: 33579242 PMCID: PMC7880516 DOI: 10.1186/s12889-021-10335-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/24/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background We developed a novel intervention that uses behavioral economics incentives and mobile-health text messages to increase HIV knowledge and testing frequency among Latinx sexual minority men and Latinx transgender women. Here we provide a theoretically-grounded assessment regarding the intervention’s acceptability and feasibility. Methods We conducted 30-min exit interviews with a stratified sample of participants (n = 26 Latinx sexual minority men, 15 Latinx transgender women), supplemented with insights from study staff (n = 6). All interviews were recorded, transcribed, and translated for a content analysis using Dedoose. Cohen’s Kappa was 89.4% across coded excerpts. We evaluated acceptability based on how participants cognitively and emotionally reacted to the intervention and whether they considered it to be appropriate. We measured feasibility based on resource, scientific and process assessments (e.g., functionality of text messaging service, feedback on study recruitment procedures and surveys). Results Regarding acceptability, most participants clearly understood the intervention as a program to receive information about HIV prevention methods through text messages. Participants who did not complete the intervention shared they did not fully understand what it entailed at their initial enrollment, and thought it was a one-time engagement and not an ongoing program. Though some participants with a higher level of education felt the information was simplistic, most appreciated moving beyond a narrow focus on HIV to include general information on sexually transmitted infections; drug use and impaired sexual decision-making; and differential risks associated with sexual positions and practices. Latinx transgender women in particular appreciated receiving information about Pre-Exposure Prophylaxis. While participants didn’t fully understand the exact chances of winning a prize in the quiz component, most enjoyed the quizzes and chance of winning a prize. Participants appreciated that the intervention required a minimal time investment. Participants shared that the intervention was generally culturally appropriate. Regarding feasibility, most participants reported the text message platform worked well though inactive participants consistently said technical difficulties led to their disengagement. Staff shared that clients had varying reactions to being approached while being tested for HIV, with some unwilling to enroll and others being very open and curious about the program. Both staff and participants relayed concerns regarding the length of the recruitment process and study surveys. Conclusions Our theoretically-grounded assessment shows the intervention is both acceptable and feasible. Trial registration The trial was registered on May 5, 2017 with the ClinicalTrials.gov registry [NCT03144336]. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10335-5.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA.
| | | | - Zachary Wagner
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
| | - Joanna L Barreras
- Bienestar Human Services, Inc., 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.,School of Social Work, California State University, Long Beach, CA, USA
| | - Alice Kim
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
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Carballo-Dieguez A, Giguere R, Lentz C, Dolezal C, Fuchs EJ, Hendrix CW. Rectal Douching Practices Associated with Anal Intercourse: Implications for the Development of a Behaviorally Congruent HIV-Prevention Rectal Microbicide Douche. AIDS Behav 2019; 23:1484-1493. [PMID: 30415431 DOI: 10.1007/s10461-018-2336-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tenofovir administration via rectal douching results in higher rectal-mucosa drug concentration than oral administration. Many who engage in receptive anal intercourse (RAI) use cleansing rectal douches. To inform development of a behaviorally-congruent tenofovir douche, 4751 individuals ≥ 18 years-old, born male, from all US states/territories, who engaged in anal intercourse responded to an online survey. Of those who reported RAI in the prior 3 months, 80% douched beforehand, 82% within 1 h, mean 2.9 consecutive applications; 27% douched afterwards, 83% within 1 h, mean 1.7 consecutive applications. Among multidose users, 78% applied doses within 2 min, and 76% retained liquid < 1 min. Most used tap water (89%) in an enema bottle (50%) or rubber bulb (43%), and douched for cleanliness (97%), to avoid smelling bad (65%), and to enhance pleasure (24%). 98% reported high likelihood of using an HIV-prevention douche. An ideal product will protect within a user's typical number of applications, within 1 h, and be dissolvable in tap water.
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Affiliation(s)
- Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, MD, USA
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Linnemayr S, MacCarthy S, Kim A, Giguere R, Carballo-Dieguez A, Barreras JL. Behavioral economics-based incentives supported by mobile technology on HIV knowledge and testing frequency among Latino/a men who have sex with men and transgender women: Protocol for a randomized pilot study to test intervention feasibility and acceptability. Trials 2018; 19:540. [PMID: 30290851 PMCID: PMC6173939 DOI: 10.1186/s13063-018-2867-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 01/05/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mobile Technology and Incentives (MOTIVES) is a randomized pilot study of a mobile technology-based and behavioral economics-supported HIV prevention intervention. Behavioral economics (BE) uses financial incentives in a way that departs from the traditional focus on large monetary payments. Instead, BE suggests that relatively small “nudges” can effectively initiate and sustain behavior change. This pilot study examines the feasibility and acceptability of an HIV prevention intervention that uses text messages in combination with BE incentives to improve retention of HIV prevention information and increase frequency of HIV testing among Latino/a men who have sex with men (MSM) and transgender women (TGW). The pilot will also estimate mission-critical design parameters with point and confidence interval estimates of the intervention to inform a future, fully powered effectiveness study. Methods The project will be conducted in collaboration with Bienestar Human Services, Inc. (Bienestar), a non-profit community-based service organization. The intervention is being tested in a small, randomized controlled trial to pilot the intervention’s feasibility and acceptability among 200 Latino/a MSM and TGW from Bienestar’s HIV testing sites. Information on feasibility will include recruitment, refusal, and retention rates as well as message sending success rates; acceptability will include perceived appropriateness based on responses to the intervention. Participants will be randomized into either the “information only” control group (e.g. receiving text messages with HIV prevention information) or the “information plus” intervention group (e.g. additionally receiving quiz questions that provide the possibility of winning prizes). Participants will be followed for 12 months from enrollment. In addition to using data abstracted from Bienestar’s routine data collection mechanisms, we will also collect survey data (blinded outcome assessment) from participants at 0, 6, and 12 months to provide an initial assessment of whether incentives affect their level of HIV knowledge and testing frequency. Discussion If shown to be acceptable, feasible, and resource-efficient, MOTIVES will provide an innovative way to communicate the latest HIV prevention information and support trimestral HIV screening among Latino/a MSM and TGW. Trial registration ClinicalTrials.gov, NCT03144336. Registered on 5 May 2017.
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Affiliation(s)
- Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
| | - Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA.
| | - Alice Kim
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Alex Carballo-Dieguez
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Health and Sexuality, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, USA
| | - Joanna L Barreras
- Bienestar Human Services, Inc., 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA
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Abstract
The purpose of this study was to understand high-risk young adults' use of the rapid human immunodeficiency virus (HIV) self-test. The highest rate of new HIV infections occurs in people between 15 and 24 years. Improving identification of young people infected with HIV is a critical public health priority. The first rapid HIV self-testing kit was approved in the US in 2012. Despite the product's promise, its use by untrained young adults is not well-understood. We conducted a mixed methods study using surveys, a think-aloud protocol, observations, and in-depth interviews. A systematic checklist was developed to assess participants' use of the test. A total of 21 racial and/or ethnic minority young adults aged 18-24 participated in this study. Analysis of our interview data was guided by the theory of reasoned action (TRA). Participants completed the initial procedures of the test with a mean time of 8:36 min (range of 2:04'-16:33'). On a 14-point checklist, participants had a mean score of 10.8 (SD 2.26, range 3-14). In the qualitative analysis of the participants' interviews, guided by the theoretical constructs of the TRA, the following themes emerged: "Did I use it correctly?", "Can I trust the results?" (attitude); "How will my partner react?!", "What will people think?" (subjective norm); "Quick, easy and blood free," and "Avoids the hassle of dealing with the healthcare system" (behavioral intention). This study provided evidence of the usefulness of the test perceived by young adults, especially in light of their concerns about lack of privacy in medical settings. Since many participants did not follow all of the instructions while using the test, it is not evident that young adults can correctly use the HIV self-test. Development of instructions manuals that are understandable and guide proper use of medical devices is a great need, especially in the context of home testing technology.
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Affiliation(s)
- Rebecca Schnall
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA.
| | - Rita Marie John
- Columbia University, School of Nursing, 617 W. 168th Street, New York, NY, 10032, USA
| | - Alex Carballo-Dieguez
- Columbia University Medical Center, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, Unit 15, 1051 Riverside Drive, New York, NY, 10032, USA
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Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27:522-37. [PMID: 26595265 PMCID: PMC4868035 DOI: 10.1521/aeap.2015.27.6.522] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM.
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Affiliation(s)
- Negar Aliabadi
- Division of General Medicine, Columbia University, New York, New York
| | | | - Suzanne Bakken
- Division of General Medicine, Columbia University, New York, New York
| | - Marlene Rojas
- Division of General Medicine, Columbia University, New York, New York
| | | | - Monique Carry
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jocelyn Patterson Mosley
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Gelaude
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Schnall
- Division of General Medicine, Columbia University, New York, New York
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Leyva F, Fuchs EJ, Bakshi R, Carballo-Dieguez A, Ventuneac A, Yue C, Caffo B, Du Y, Torbenson M, Li L, Mullin G, Lee L, Rohan L, Anton PA, Hendrix CW. Simultaneous Evaluation of Safety, Acceptability, Pericoital Kinetics, and Ex Vivo Pharmacodynamics Comparing Four Rectal Microbicide Vehicle Candidates. AIDS Res Hum Retroviruses 2015; 31:1089-97. [PMID: 26066390 DOI: 10.1089/aid.2015.0086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Preexposure prophylaxis (PrEP) of HIV infection with tenofovir-containing regimens is effective, but plagued by poor adherence in some studies. Options for safe, effective, and acceptable PrEP products, especially for men and women at risk of HIV via receptive anal intercourse (RAI), are needed. We performed a randomized, partially blinded, first-in-human evaluation of four candidate rectal microbicide vehicles-aqueous gel, aqueous fluid, lipid gel, and lipid fluid-to select a prototype for further clinical development. Eight seronegative participants received three doses of each product with each dose separated by at least 2 weeks: one dose was given alone without simulated RAI in clinic, another dose was followed by simulated RAI in clinic, and another dose was self-administered at home in the context of RAI with a partner. Assessments included safety, acceptability, colon histology, ex vivo HIV infectivity of colon tissue explants, and colonic luminal distribution of vehicle and HIV surrogates. Adverse events were all mild and mainly sigmoidoscopy associated. There were minor differences in colon distribution of products and little effect of RAI. Vehicle distribution covered 95% (±7% standard deviation) of the distribution of an HIV surrogate in the colonic lumen. The lipid fluid vehicle increased HIV colon tissue infectability 5-fold [log10 p24 0.68 (95% confidence interval 0.08, 1.28)] and aqueous gel provided 6-fold protection [log10 p24 0.80 (95% confidence interval 0.20, 1.41)] compared to no product baseline. Colon permeability of lipid vehicles was more than 10-fold greater than aqueous vehicles. All products received similar acceptability ratings, though trends favored the gel products. Intensive simultaneous assessment of safety and toxicity, luminal and tissue distribution, ex vivo HIV infectivity, and product acceptability in relevant sexual contexts provided clear differentiation among candidate gels very early in product development. We selected the aqueous gel for further development as a rectal microbicide vehicle.
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Affiliation(s)
- Francisco Leyva
- Department of Medicine (Clinical Pharmacology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward J. Fuchs
- Department of Medicine (Clinical Pharmacology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rahul Bakshi
- Department of Medicine (Clinical Pharmacology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alex Carballo-Dieguez
- Department of Medicine (Gastroenterology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana Ventuneac
- Department of Medicine (Gastroenterology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Yue
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Caffo
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yong Du
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Liye Li
- Department of Medicine (Clinical Pharmacology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald Mullin
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Linda Lee
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York
| | - Lisa Rohan
- Magee Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peter A. Anton
- UCLA Center for HIV Prevention Research, UCLA AIDS Institute, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Schnall R, Higgins T, Brown W, Carballo-Dieguez A, Bakken S. Trust, Perceived Risk, Perceived Ease of Use and Perceived Usefulness as Factors Related to mHealth Technology Use. Stud Health Technol Inform 2015; 216:467-471. [PMID: 26262094 PMCID: PMC5588863] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mobile technology use is nearly ubiquitous which affords the opportunity for using these technologies for modifying health related behaviors. At the same time, use of mobile health (mHealth) technology raises privacy and security concerns of consumers. The goal of this analysis was to understand the perceived ease of use, usefulness, risk and trust that contribute to behavioral intention to use a mobile application for meeting the healthcare needs of persons living with HIV (PLWH). To understand these issues, we conducted focus group sessions with 50 persons living with HIV and 30 HIV healthcare providers. We used the e-commerce acceptance model to analyze our focus group data. Findings from the study demonstrated the need for mHealth to be perceived as useful, easy to use, with little perceived risk accompanied by a measure of trust in the creators of the technology. Findings from this work can inform future work on patients and providers' perceptions of risk, trust, ease of use and usefulness of mHealth technology.
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Affiliation(s)
| | - Tracy Higgins
- Columbia University School of Nursing, New York, NY, USA
| | - William Brown
- Columbia University Department of Biomedical Informatics, New York, NY, USA
| | - Alex Carballo-Dieguez
- HIV center, Division of Gender, Sexuality and Health NYS Psychiatric Institute and Columbia University, New York, NY, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Martinez O, Wu E, Spadafino J, Sandfort T, Shultz AZ, Rios JL, Ovejero H, Rhodes SD, Moya E, Baray SC, Dodge B, Carballo-Dieguez A. Sexual Health, Alcohol Use, Childhood Sexual Abuse, and Mental Health Outcomes Among Spanish-speaking Latino MSM in the Northeastern United States. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5272b.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar Martinez
- HIV Center for Clinical and Behavioral Studies at Columbia University, Division of Gender, Sexuality, and Health, New York, NY, United States
| | - Elwin Wu
- Columbia University, New York, NY, United States
| | | | | | - Andrew Z Shultz
- HIV Center for Clinical and Behavioral Studies at Columbia University, Division of Gender, Sexuality, and Health, New York, NY, United States
| | - Javier Lopez Rios
- HIV Center for Clinical and Behavioral Studies at Columbia University, Division of Gender, Sexuality, and Health, New York, NY, United States
| | - Hugo Ovejero
- Latino Commission on AIDS, New York, NY, United States
| | - Scott D Rhodes
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Eva Moya
- University of Texas, El Paso, TX, United States
| | | | - Brian Dodge
- Indiana University Bloomington, Bloomington, IN, United States
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10
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Martinez O, Wu E, Shultz AZ, Capote J, López Rios J, Sandfort T, Manusov J, Ovejero H, Carballo-Dieguez A, Chavez Baray S, Moya E, López Matos J, DelaCruz JJ, Remien RH, Rhodes SD. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res 2014; 16:e113. [PMID: 24763130 PMCID: PMC4019772 DOI: 10.2196/jmir.3311] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 11/13/2022] Open
Abstract
Background Online social networking use has increased rapidly among African American and Latino men who have sex with men (MSM), making it important to understand how these technologies can be used to reach, retain, and maintain individuals in care and promote health wellness. In particular, the Internet is increasingly recognized as a platform for health communication and education. However, little is known about how primarily Spanish-speaking populations use and engage with each other through social media platforms. Objective We aimed to recruit eligible couples for a study to adapt “Connect ‘n Unite” (an HIV prevention intervention initially created for black gay couples) for Spanish-speaking Latino gay couples living in New York City. Methods In order to successfully design and implement an effective social media recruitment campaign to reach Spanish-speaking Latino gay couples for our ongoing “Latinos en Pareja” study, our community stakeholders and research team used McGuire’s communication/persuasion matrix. The matrix guided our research, specifically each marketing “channel”, targeted “message”, and target population or “receiver”. We developed a social media recruitment protocol and trained our research staff and stakeholders to conduct social media recruitment. Results As a result, in just 1 month, we recruited all of our subjects (N=14 couples, that is, N=28 participants) and reached more than 35,658 participants through different channels. One of the major successes of our social media recruitment campaign was to build a strong stakeholder base that became involved early on in all aspects of the research process—from pilot study writing and development to recruitment and retention. In addition, the variety of “messages” used across different social media platforms (including Facebook, the “Latinos en Pareja” study website, Craigslist, and various smartphone applications such as Grindr, SCRUFF, and Jack’d) helped recruit Latino gay couples. We also relied on a wide range of community-based organizations across New York City to promote the study and build in the social media components. Conclusions Our findings highlight the importance of incorporating communication technologies into the recruitment and engagement of participants in HIV interventions. Particularly, the success of our social media recruitment strategy with Spanish-speaking Latino MSM shows that this population is not particularly “hard to reach”, as it is often characterized within public health literature.
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Affiliation(s)
- Omar Martinez
- Columbia University, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, United States.
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11
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McGowan I, Hoesley C, Cranston RD, Andrew P, Janocko L, Dai JY, Carballo-Dieguez A, Ayudhya RKN, Piper J, Hladik F, Mayer K. A phase 1 randomized, double blind, placebo controlled rectal safety and acceptability study of tenofovir 1% gel (MTN-007). PLoS One 2013; 8:e60147. [PMID: 23573238 PMCID: PMC3616022 DOI: 10.1371/journal.pone.0060147] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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: 10/15/2012] [Accepted: 02/21/2013] [Indexed: 11/25/2022] Open
Abstract
Objective Rectal microbicides are needed to reduce the risk of HIV acquisition associated with unprotected receptive anal intercourse. The MTN-007 study was designed to assess the safety (general and mucosal), adherence, and acceptability of a new reduced glycerin formulation of tenofovir 1% gel. Methods Participants were randomized 1∶1:1∶1 to receive the reduced glycerin formulation of tenofovir 1% gel, a hydroxyethyl cellulose placebo gel, a 2% nonoxynol-9 gel, or no treatment. Each gel was administered as a single dose followed by 7 daily doses. Mucosal safety evaluation included histology, fecal calprotectin, epithelial sloughing, cytokine expression (mRNA and protein), microarrays, flow cytometry of mucosal T cell phenotype, and rectal microflora. Acceptability and adherence were determined by computer-administered questionnaires and interactive telephone response, respectively. Results Sixty-five participants (45 men and 20 women) were recruited into the study. There were no significant differences between the numbers of ≥ Grade 2 adverse events across the arms of the study. Likelihood of future product use (acceptability) was 87% (reduced glycerin formulation of tenofovir 1% gel), 93% (hydroxyethyl cellulose placebo gel), and 63% (nonoxynol-9 gel). Fecal calprotectin, rectal microflora, and epithelial sloughing did not differ by treatment arms during the study. Suggestive evidence of differences was seen in histology, mucosal gene expression, protein expression, and T cell phenotype. These changes were mostly confined to comparisons between the nonoxynol-9 gel and other study arms. Conclusions The reduced glycerin formulation of tenofovir 1% gel was safe and well tolerated rectally and should be advanced to Phase 2 development. Trial Registration ClinicalTrials.gov NCT01232803.
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Affiliation(s)
- Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
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Anic G, Auslander BA, Bell DL, Carballo-Dieguez A, Catallozzi M, Cates W, Cooper MD, Cunningham AL, Deal CD, Dwyer D, Estcourt C, Giuliano AR, Hafner LM, Herring B, Hillier SL, Kissinger P, Kreimer AR, Lu B, Marrazzo JM, Mindel A, Morrow KM, Nyitray AG, Ott MA, Patel MV, Quinn TC, Rodríguez-García M, Rompalo AM, Rosenthal SL, Sanusi A, Sawleshwarkar S, Stanberry LR, Stupiansky NW, Timms P, Tobian AA, Tolley EE, Torjesen K, Varma R, Wira CR, Zenilman JM, Zimet GD, Zuckerman AJ, Zuckerman JN. Contributors. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.01002-0] [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: 10/26/2022]
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13
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Jacobson JO, Alonso-Gonzalez M, Ramachandran D, Morales-Miranda S, Carballo-Dieguez A, Medrano J, Solano T, Rosales-Perez MD. P1-S2.65 Crack/cocaine use among MSM in Latin America: a multilevel analysis of RDS studies to identify drug use patterns and associated factors across cities. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.122] [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: 11/03/2022]
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Barreda V, Carballo-Dieguez A, Marone R, Balán I, Pando MÁ, Avila MM. PREVENCIÓN DEL VIH/SIDA EN LOS CIRCUITOS DE LEVANTE HSH: UNA ASIGNATURA PENDIENTE. Sex Salud Soc (Rio J) 2010:41-62. [PMID: 21874154 DOI: 10.1590/s1984-64872010000100003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A partir de un relevamiento de tipo etnográfico, se describen lugares de encuentro de HSH en la Ciudad de Buenos Aires y sus prácticas sexuales. El reconocimiento de tales espacios, así como las características que asumen en ellos los encuentros sexuales entre los HSH, plantean obstáculos específicos en la adopción de comportamientos preventivos y, asimismo, generan nuevos desafíos para las actividades de prevención. Se plantean las dificultades y debates conceptuales que la misma categoría presenta, y sus consecuencias en el abordaje preventivo y teórico-metodológico para las ciencias sociales. Además, se proponen nuevos interrogantes acerca de los alcances y las limitaciones del modelo preventivo del VIH/Sida para HSH.
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Affiliation(s)
- Victoria Barreda
- Universidad Nacional de Buenos Aires - Argentina Antropóloga de Equipos de Prevención VIH/Sida. Ministerio de Salud (GCBA)
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15
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Wilson PA, Valera P, Ventuneac A, Balan I, Rowe M, Carballo-Dieguez A. Race-based sexual stereotyping and sexual partnering among men who use the internet to identify other men for bareback sex. J Sex Res 2009; 46:399-413. [PMID: 19337934 PMCID: PMC2754596 DOI: 10.1080/00224490902846479] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This qualitative study used sexual scripting theory to explore sexual stereotyping and sexual partnering practices among a racially diverse sample of men who use the Internet to engage in "bareback" sex with other men. The sample included 81 (73%) HIV-negative and 30 (27%) HIV-positive men who were recruited on Web sites where men seek other men to have bareback sex. Participants completed a semi-structured interview that included topics on their racial identification, their sexual experiences tied to race, and their experiences having sex with men of different racial groups. The findings suggested that a variety of race-based sexual stereotypes were used by participants. Sexual stereotyping appeared to directly and indirectly affect the sexual partnering decisions of participants. Sexual scripts may reinforce and facilitate race-based sexual stereotyping, and this behavior may structure sexual networks.
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Affiliation(s)
- Patrick A Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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16
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Abstract
Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.
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Affiliation(s)
- Mary Ann Chiasson
- Medical and Health Research Association of New York City, Inc., 40 Worth Street, Suite 720, New York, NY 10013, USA.
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Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, El-Bassel N, Jung TM. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS 2005; 19:807-14. [PMID: 15867495 DOI: 10.1097/01.aids.0000168975.44219.45] [Citation(s) in RCA: 187] [Impact Index Per Article: 9.8] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the efficacy of a couple-based intervention to improve medication-taking behavior in a clinic population with demonstrated adherence problems. DESIGN A randomized controlled trial (SMART Couples Study) conducted between August 2000 and January 2004. SETTING Two HIV/AIDS outpatient clinics in New York City. PARTICIPANTS Heterosexual and homosexual HIV-serodiscordant couples (n = 215) in which the HIV-seropositive partner had < 80% adherence at baseline. The sample was predominantly lower-income racial/ethnic minorities. INTERVENTION Participants were randomly assigned to a four-session couple-focused adherence intervention or usual care. The intervention consisted of education about treatment and adherence, identifying adherence barriers, developing communication and problem-solving strategies, optimizing partner support, and building confidence for optimal adherence. OUTCOME MEASURES Medication adherence at week 8 (2 weeks after the intervention) compared with baseline, assessed with a Medication Event Monitoring System cap. RESULTS Intervention participants showed higher mean medication adherence at post-intervention when compared with controls whether adherence was defined as proportion of prescribed doses taken (76% versus 60%) or doses taken within specified time parameters (58% versus 35%). Also, participants in the intervention arm were significantly more likely to achieve high levels of adherence (> 80%, > 90%, or > 95%) when compared with controls. However, in most cases, effects diminished with time, as seen at follow-up at 3 and 6 months. CONCLUSION The SMART Couples program significantly improved medication adherence over usual care, although the level of improved adherence, for many participants, was still suboptimal and the effect was attenuated over time.
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Affiliation(s)
- Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York 10032, USA.
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Carballo-Dieguez A, Remien R, Benson DA, Dolezal C, Decena CU, Blank S. Intention to notify sexual partners about potential HIV exposure among New York city STD clinics' clients. Sex Transm Dis 2002; 29:465-71. [PMID: 12172531 DOI: 10.1097/00007435-200208000-00006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Partner notification legislation has recently been implemented in New York State. GOAL The goal of the study was to assess willingness of individuals seeking HIV testing to (1) give counselors contact information about partners, if infected, and (2) contact partners on their own. STUDY DESIGN Before implementation of the legislation, 1372 individuals seeking HIV testing at New York City Department of Health STD clinics completed a brief, anonymous survey. RESULTS More than 90% of heterosexually active individuals and more than 80% of men who have sex with men (MSM) could contact sex partners with whom they had had unprotected vaginal/anal sex. Were they to test HIV-positive, almost all respondents would have been willing to notify sex partners personally; 90% of heterosexually active individuals and 80% of MSM also expressed willingness to provide contact information to providers. Respondents preferred to be notified by a sex partner rather than by a provider. Patient-referred clients reported being more comfortable with the referral than provider-referred clients. CONCLUSIONS Voluntary partner notification performed by the index case-with notification by the provider should the former fail to occur-is recommended.
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Affiliation(s)
- Alex Carballo-Dieguez
- HIV Center for Clinical; Sexually Transmitted Diseases Control Program of the New York City Department of Health, New York, New York 10032, USA.
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Madera I, de Caprariis PJ, Carballo-Dieguez A, Rodriguez G, Stehney M, Dansky SF, Visconti E. Approaching "DNR" Issues with AIDS Patients. Can Fam Physician 1989; 35:749-750. [PMID: 21249019 PMCID: PMC2280845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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