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Kenu E, Barradas DT, Bandoh DA, Frimpong JA, Noora CL, Bekoe FA. Community-Based Surveillance and Geographic Information System‒Linked Contact Tracing in COVID-19 Case Identification, Ghana, March‒June 2020. Emerg Infect Dis 2022; 28:S114-S120. [PMID: 36502391 DOI: 10.3201/eid2813.221068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In response to the COVID-19 pandemic, Ghana implemented various mitigation strategies. We describe use of geographic information system (GIS)‒linked contact tracing and increased community-based surveillance (CBS) to help control spread of COVID-19 in Ghana. GIS-linked contact tracing was conducted during March 31-June 16, 2020, in 43 urban districts across 6 regions, and 1-time reverse transcription PCR testing of all persons within a 2-km radius of a confirmed case was performed. CBS was intensified in 6 rural districts during the same period. We extracted and analyzed data from Surveillance Outbreak Response Management and Analysis System and CBS registers. A total of 3,202 COVID-19 cases reported through GIS-linked contact tracing were associated with a 4-fold increase in the weekly number of reported SARS-CoV-2 infected cases. CBS identified 5.1% (8/157) of confirmed cases in 6 districts assessed. Adaptation of new methods, such as GIS-linked contact tracing and intensified CBS, improved COVID-19 case detection in Ghana.
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Haas AD, Radin E, Birhanu S, Low AJ, Saito S, Sachathep K, Balachandra S, Manjengwa J, Duong YT, Jonnalagadda S, Payne D, Bello G, Hakim AJ, Smart T, Ahmed N, Cuervo-Rojas J, Auld A, Patel H, Parekh B, Williams DB, Barradas DT, Mugurungi O, Mulenga LB, Voetsch AC, Justman JE. Prevalence of and factors associated with late diagnosis of HIV in Malawi, Zambia, and Zimbabwe: Results from population-based nationally representative surveys. PLOS Glob Public Health 2022; 2:e0000080. [PMID: 36962254 PMCID: PMC10021857 DOI: 10.1371/journal.pgph.0000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Late diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners. METHODS We estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner. RESULTS Of 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL. CONCLUSIONS LD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.
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Affiliation(s)
- Andreas D Haas
- ICAP, Columbia University, New York, New York, United States of America
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elizabeth Radin
- ICAP, Columbia University, New York, New York, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea J Low
- ICAP, Columbia University, New York, New York, United States of America
| | - Suzue Saito
- ICAP, Columbia University, New York, New York, United States of America
| | | | | | - Julius Manjengwa
- ICAP, Columbia University, New York, New York, United States of America
| | - Yen T Duong
- ICAP, Columbia University, New York, New York, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - George Bello
- Government of Malawi, Ministry of Health, Lilongwe, Malawi
| | - Avi J Hakim
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Theo Smart
- ICAP, Columbia University, New York, New York, United States of America
| | - Nahima Ahmed
- ICAP, Columbia University, New York, New York, United States of America
| | - Juliana Cuervo-Rojas
- ICAP, Columbia University, New York, New York, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Hetal Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel B Williams
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Owen Mugurungi
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica E Justman
- ICAP, Columbia University, New York, New York, United States of America
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Boyd MA, Fwoloshi S, Minchella PA, Simpungwe J, Siansalama T, Barradas DT, Shah M, Mulenga L, Agolory S. A national HIV clinical mentorship program: Enabling Zambia to accelerate control of the HIV epidemic. PLOS Glob Public Health 2022; 2:e0000074. [PMID: 36962250 PMCID: PMC10021441 DOI: 10.1371/journal.pgph.0000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022]
Abstract
Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018-September 2018 and the post-mentorship period was July 2019-September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P <0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p <0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.
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Affiliation(s)
- Mary Adetinuke Boyd
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sombo Fwoloshi
- Ministry of Health, Lusaka, Government of the Republic of Zambia
| | - Peter A Minchella
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James Simpungwe
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Terence Siansalama
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle T Barradas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Minesh Shah
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lloyd Mulenga
- Ministry of Health, Lusaka, Government of the Republic of Zambia
| | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Farahani M, Radin E, Saito S, Sachathep KK, Hladik W, Voetsch AC, Auld AF, Balachandra S, Tippett Barr BA, Low A, Smart TF, Musuka G, Jonnalagadda S, Hakim AJ, Wadonda-Kabondo NW, Jahn A, Mugurungi O, Williams DB, Barradas DT, Payne D, Parekh B, Patel H, Wiesner L, Hoos D, Justman JE. Population Viral Load, Viremia, and Recent HIV-1 Infections: Findings From Population-Based HIV Impact Assessments (PHIAs) in Zimbabwe, Malawi, and Zambia. J Acquir Immune Defic Syndr 2021; 87:S81-S88. [PMID: 33560041 PMCID: PMC10998157 DOI: 10.1097/qai.0000000000002637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV population viral load (PVL) can reflect antiretroviral therapy program effectiveness and transmission potential in a community. Using nationally representative data from household surveys conducted in Zimbabwe, Malawi, and Zambia in 2015-16, we examined the association between various VL measures and the probability of at least one recent HIV-1 infection in the community. METHODS We used limiting-antigen avidity enzyme immunoassay, viral load suppression (VLS) (HIV RNA <1000 copies/mL), and antiretrovirals in the blood to identify recent HIV-1 cases. RESULTS Among 1510 enumeration areas (EAs) across the 3 surveys, 52,036 adults aged 15-59 years resided in 1363 (90.3%) EAs with at least one HIV-positive adult consenting to interview and blood draw and whose VL was tested. Mean HIV prevalence across these EAs was 13.1% [95% confidence intervals (CI) 12.7 to 13.5]. Mean VLS prevalence across these EAs was 58.7% (95% CI: 57.3 to 60.0). In multivariable analysis, PVL was associated with a recent HIV-1 case in that EA (adjusted odds ratio: 1.4, 95% CI: 1.2 to 1.6, P = 0.001). VLS prevalence was inversely correlated with recent infections (adjusted odds ratio: 0.3, 95% CI: 0.1 to 0.6, P = 0.004). The 90-90-90 indicators, namely, the prevalence of HIV diagnosis, antiretroviral therapy coverage, and VLS at the EA level, were inversely correlated with HIV recency at the EA level. CONCLUSIONS We found a strong association between PVL and VLS prevalence and recent HIV-1 infection at the EA level across 3 southern African countries with generalized HIV epidemics. These results suggest that population-based measures of VLS in communities may serve as a proxy for epidemic control.
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Affiliation(s)
| | | | | | | | - Wolfgang Hladik
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Andrew C Voetsch
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Andrew F Auld
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Malawi
| | - Shirish Balachandra
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Côte d'Ivoire
| | - Beth A Tippett Barr
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Zimbabwe
| | - Andrea Low
- ICAP at Columbia University, New York, NY
| | | | | | - Sasi Jonnalagadda
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Avi J Hakim
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | | | | | | | - Daniel B Williams
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Danielle T Barradas
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Zambia and
| | - Danielle Payne
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Malawi
| | - Bharat Parekh
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Hetal Patel
- Division of Global HIV&TB, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Lubbe Wiesner
- Pharmacology Research Laboratory, University of Cape Town, Cape Town, South Africa; and
| | - David Hoos
- ICAP at Columbia University, New York, NY
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West CA, Chang GC, W Currie D, Bray R, Kinchen S, Behel S, McCullough-Sanden R, Low A, Bissek A, Shang JD, Ndongmo CB, Dokubo EK, Balachandra S, Lobognon LR, Dube L, Nuwagaba-Biribonwoha H, Li M, Pasipamire M, Getaneh Y, Lulseged S, Eshetu F, Kingwara L, Zielinski-Gutierrez E, Tlhomola M, Ramphalla P, Kalua T, F Auld A, B Williams D, Remera E, Rwibasira GN, Mugisha V, Malamba SS, Mushi J, Jalloh MF, Mgomella GS, Kirungi WL, Biraro S, C Awor A, Barradas DT, Mugurungi O, H Rogers J, Bronson M, M Bodika S, Ajiboye A, Gaffga N, Moore C, Patel HK, C Voetsch A. Unawareness of HIV Infection Among Men Aged 15-59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015-2019. J Acquir Immune Defic Syndr 2021; 87:S97-S106. [PMID: 34166316 PMCID: PMC8711576 DOI: 10.1097/qai.0000000000002708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.
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Affiliation(s)
| | - Gregory C Chang
- Division of Global HIV and TB, Center for Global Health, CDC
- ASPPH/PHI/CDC HIV Surveillance Fellowship
| | - Dustin W Currie
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | - Steve Kinchen
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Stephanie Behel
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Rachel McCullough-Sanden
- ASPPH/PHI/CDC HIV Surveillance Fellowship
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Andrea Low
- ICAP at Columbia University, New York, NY
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | - Judith D Shang
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | - Clement B Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
- Division of Global HIV and TB, Center for Global Health, CDC Zambia
| | - Emily K Dokubo
- Division of Global HIV and TB, Center for Global Health, CDC Cameroon
| | | | - Legre R Lobognon
- Division of Global HIV and TB, Center for Global Health, CDC Cote d'Ivoire
| | - Lenhle Dube
- National AIDS Program/Ministry of Health, Eswatini
| | | | - Michelle Li
- Division of Global HIV and TB, Center for Global Health, CDC Eswatini
| | | | | | | | - Frehywot Eshetu
- Division of Global HIV and TB, Center for Global Health, CDC Ethiopia
| | - Leonard Kingwara
- National AIDS and STI Control Programme, Ministry of Health, Kenya
| | | | | | - Puleng Ramphalla
- Division of Global HIV and TB, Center for Global Health, CDC Lesotho
| | | | - Andrew F Auld
- Division of Global HIV and TB, Center for Global Health, CDC Malawi
| | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC Namibia
| | | | | | - Veronicah Mugisha
- ICAP at Columbia University, Rwanda
- ICAP at Columbia University, Tanzania
| | - Samuel S Malamba
- Division of Global HIV and TB, Center for Global Health, CDC Rwanda
| | - Jeremiah Mushi
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania
| | - Mohamed F Jalloh
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | - George S Mgomella
- Division of Global HIV and TB, Center for Global Health, CDC Tanzania
| | | | | | - Anna C Awor
- Division of Global HIV and TB, Center for Global Health, CDC Uganda
| | | | | | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC Zimbabwe
| | - Megan Bronson
- Division of Global HIV and TB, Center for Global Health, CDC
| | | | | | - Nicholas Gaffga
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Carole Moore
- Division of Global HIV and TB, Center for Global Health, CDC
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, CDC
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Hines JZ, Fwoloshi S, Kampamba D, Barradas DT, Banda D, Zulu JE, Wolkon A, Yingst S, Boyd MA, Siwingwa M, Chirwa L, Kapina M, Sinyange N, Mukonka V, Malama K, Mulenga LB, Agolory S. SARS-CoV-2 Prevalence among Outpatients during Community Transmission, Zambia, July 2020. Emerg Infect Dis 2021; 27:2166-2168. [PMID: 34287124 PMCID: PMC8314838 DOI: 10.3201/eid2708.210502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
During the July 2020 first wave of severe acute respiratory syndrome coronavirus 2 in Zambia, PCR-measured prevalence was 13.4% among outpatients at health facilities, an absolute difference of 5.7% compared with prevalence among community members. This finding suggests that facility testing might be an effective strategy during high community transmission.
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Mulenga LB, Hines JZ, Fwoloshi S, Chirwa L, Siwingwa M, Yingst S, Wolkon A, Barradas DT, Favaloro J, Zulu JE, Banda D, Nikoi KI, Kampamba D, Banda N, Chilopa B, Hanunka B, Stevens TL, Shibemba A, Mwale C, Sivile S, Zyambo KD, Makupe A, Kapina M, Mweemba A, Sinyange N, Kapata N, Zulu PM, Chanda D, Mupeta F, Chilufya C, Mukonka V, Agolory S, Malama K. Prevalence of SARS-CoV-2 in six districts in Zambia in July, 2020: a cross-sectional cluster sample survey. Lancet Glob Health 2021; 9:e773-e781. [PMID: 33711262 PMCID: PMC8382844 DOI: 10.1016/s2214-109x(21)00053-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. METHODS Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. FINDINGS Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. INTERPRETATION The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Lloyd B Mulenga
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; Vanderbilt Medical University, Nashville, TN, USA; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Jonas Z Hines
- Centers for Disease Control and Prevention, Lusaka, Zambia.
| | - Sombo Fwoloshi
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | | | | | - Samuel Yingst
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Adam Wolkon
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | - James E Zulu
- Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia National Public Health Institute, Lusaka, Zambia
| | - Dabwitso Banda
- Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | - Brave Hanunka
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Aaron Shibemba
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Consity Mwale
- Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia; Lusaka Provincial Health Office, Lusaka, Zambia
| | - Suilanji Sivile
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Khozya D Zyambo
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Alex Makupe
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Muzala Kapina
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Aggrey Mweemba
- Zambia Ministry of Health, Lusaka, Zambia; University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Nyambe Sinyange
- Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia National Public Health Institute, Lusaka, Zambia
| | - Nathan Kapata
- Zambia National Public Health Institute, Lusaka, Zambia; Pan-African Network for Rapid Research, Response, Relief and Preparedness for Infectious Diseases Epidemics, Amsterdam, Netherlands
| | - Paul M Zulu
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Duncan Chanda
- University Teaching Hospital, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | - Francis Mupeta
- University Teaching Hospital, Lusaka, Zambia; Levy Mwanawasa Medical University, Lusaka, Zambia; School of Medicine, University of Zambia, Lusaka, Zambia
| | | | | | - Simon Agolory
- Centers for Disease Control and Prevention, Lusaka, Zambia
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Low A, Teasdale C, Brown K, Barradas DT, Mugurungi O, Sachathep K, Nuwagaba-Biribonwoha H, Birhanu S, Banda A, Frederix K, Payne D, Radin E, Wiesner L, Ginindza C, Philip N, Musuka G, Sithole S, Patel H, Maile L, Abrams EJ, Arpadi S. Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data. Clin Infect Dis 2021; 73:594-604. [PMID: 33912973 PMCID: PMC8366830 DOI: 10.1093/cid/ciab031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/18/2020] [Indexed: 01/04/2023] Open
Abstract
Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.
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Affiliation(s)
- Andrea Low
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Chloe Teasdale
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Owen Mugurungi
- Ministry of Health and Child Welfare, AIDS and TB Programme, Harare, Zimbabwe
| | - Karam Sachathep
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Sehin Birhanu
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Koen Frederix
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Elizabeth Radin
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Neena Philip
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA
| | - Godfrey Musuka
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Sakhile Sithole
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Hetal Patel
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Stephen Arpadi
- ICAP at Columbia, Mailman School of Public Health, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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9
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Fwoloshi S, Hines JZ, Barradas DT, Yingst S, Siwingwa M, Chirwa L, Zulu JE, Banda D, Wolkon A, Nikoi KI, Chirwa B, Kampamba D, Shibemba A, Sivile S, Zyambo KD, Chanda D, Mupeta F, Kapina M, Sinyange N, Kapata N, Zulu PM, Makupe A, Mweemba A, Mbewe N, Ziko L, Mukonka V, Mulenga LB, Malama K, Agolory S. Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Healthcare Workers-Zambia, July 2020. Clin Infect Dis 2021; 73:e1321-e1328. [PMID: 33784382 PMCID: PMC8083617 DOI: 10.1093/cid/ciab273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) in Zambia have become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). However, SARS-CoV-2 prevalence among HCWs is not known in Zambia. METHODS We conducted a cross-sectional SARS-CoV-2 prevalence survey among Zambian HCWs in 20 health facilities in 6 districts in July 2020. Participants were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) and for SARS-CoV-2 antibodies using enzyme-linked immunosorbent assay (ELISA). Prevalence estimates and 95% confidence intervals (CIs), adjusted for health facility clustering, were calculated for each test separately, and a combined measure for those who had PCR and ELISA was performed. RESULTS In total, 660 HCWs participated in the study, with 450 (68.2%) providing a nasopharyngeal swab for PCR and 575 (87.1%) providing a blood specimen for ELISA. Sixty-six percent of participants were females, and median age was 31.5 years (interquartile range, 26.2-39.8). The overall prevalence of the combined measure was 9.3% (95% CI, 3.8%-14.7%). PCR-positive prevalence of SARS-CoV-2 was 6.6% (95% CI, 2.0%-11.1%), and ELISA-positive prevalence was 2.2% (95% CI, .5%-3.9%). CONCLUSIONS SARS-CoV-2 prevalence among HCWs was similar to a population-based estimate (10.6%) during a period of community transmission in Zambia. Public health measures such as establishing COVID-19 treatment centers before the first cases, screening for COVID-19 symptoms among patients who access health facilities, infection prevention and control trainings, and targeted distribution of personal protective equipment based on exposure risk might have prevented increased SARS-CoV-2 transmission among Zambian HCWs.
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Affiliation(s)
- Sombo Fwoloshi
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Jonas Z Hines
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Danielle T Barradas
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Samuel Yingst
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Mpanji Siwingwa
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Lameck Chirwa
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - James E Zulu
- Zambia Field Epidemiology Training Program, Lusaka, Zambia.,Zambia National Public Health Institute, Lusaka, Zambia
| | - Dabwitso Banda
- Zambia Field Epidemiology Training Program, Lusaka, Zambia.,Zambia National Public Health Institute, Lusaka, Zambia
| | - Adam Wolkon
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Kotey I Nikoi
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Bob Chirwa
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Davies Kampamba
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Aaron Shibemba
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Suilanji Sivile
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Khozya D Zyambo
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Duncan Chanda
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Francis Mupeta
- Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Muzala Kapina
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Nyambe Sinyange
- Zambia Field Epidemiology Training Program, Lusaka, Zambia.,Zambia National Public Health Institute, Lusaka, Zambia
| | - Nathan Kapata
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Paul M Zulu
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Alex Makupe
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | - Aggrey Mweemba
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia
| | | | | | | | - Lloyd B Mulenga
- Zambia Ministry of Health, Lusaka, Zambia.,Department of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia.,Levy Mwanawasa Medical University, Lusaka, Zambia.,University of Zambia, School of Medicine, Lusaka, Zambia.,Vanderbilt Institute for Global Health, Vanderbilt Medical University, Nashville, Tennessee, USA
| | | | - Simon Agolory
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Lusaka, Zambia
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10
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Gilbert LK, Strine TW, Szucs LE, Crawford TN, Parks SE, Barradas DT, Njai R, Ko JY. Racial and Ethnic Differences in Parental Attitudes and Concerns About School Reopening During the COVID-19 Pandemic - United States, July 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1848-1852. [PMID: 33301437 PMCID: PMC7737683 DOI: 10.15585/mmwr.mm6949a2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In light of the disproportionate risk of hospitalization and death attributable to coronavirus disease 2019 (COVID-19) among racial and ethnic minority groups, parental attitudes and concerns regarding school reopening were assessed by race and ethnicity using data from three online CARAVAN omnibus surveys conducted during July 8-12, 2020, by ENGINE Insights.* Survey participants included 858 parents who had children and adolescents in kindergarten through grade 12 (school-aged children) living in their household. Overall, 56.5% of parents strongly or somewhat agreed that school should reopen this fall, with some differences by race/ethnicity: compared with 62.3% of non-Hispanic White (White) parents, 46.0% of non-Hispanic Black or African American (Black) parents (p = 0.007) and 50.2% of Hispanic parents (p = 0.014) agreed that school should reopen this fall. Fewer White parents (62.5%) than Hispanic (79.5%, p = 0.026) and non-Hispanic parents of other racial/ethnic groups (66.9%, p = 0.041) were supportive of a mask mandate for students and staff members. Understanding parental attitudes and concerns is critical to informing communication and messaging around COVID-19 mitigation. Families' concerns also highlight the need for flexible education plans and equitable resource provision so that youth education is not compromised.
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11
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Haas AD, Radin E, Hakim AJ, Jahn A, Philip NM, Jonnalagadda S, Saito S, Low A, Patel H, Schwitters AM, Rogers JH, Frederix K, Kim E, Bello G, Williams DB, Parekh B, Sachathep K, Barradas DT, Kalua T, Birhanu S, Musuka G, Mugurungi O, Tippett Barr BA, Sleeman K, Mulenga LB, Thin K, Ao TT, Brown K, Voetsch AC, Justman JE. Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys. J Int AIDS Soc 2020; 23:e25631. [PMID: 33225559 PMCID: PMC7680921 DOI: 10.1002/jia2.25631] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months. METHODS We analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household surveys. Data collection included structured interviews, home-based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load <1000 copies/mL), nonsuppressed viral load (NVL; viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL) and rates of switching to second-line ART (protease inhibitors present) among PLHIV aged 15 to 59 years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self-report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART. RESULTS We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts <200 cells/µL, but few (0.31% per year) switched to second-line ART. CONCLUSIONS Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor- or integrase inhibitor-based regimens may further reduce NVL prevalence.
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Affiliation(s)
- Andreas D Haas
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Elizabeth Radin
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Avi J Hakim
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | | | - Neena M Philip
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Suzue Saito
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrea Low
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Hetal Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Amee M Schwitters
- Division of Global HIV and TB, Center for Global Health, CDC Lesotho, Maseru, Lesotho
| | - John H Rogers
- Division of Global HIV and TB, Center for Global Health, CDC Zimbabwe, Harare, Zimbabwe
| | - Koen Frederix
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Evelyn Kim
- Division of Global HIV and TB, Center for Global Health, CDC Malawi, Lilongwe, Malawi
| | | | - Daniel B Williams
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Bharat Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Karampreet Sachathep
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Danielle T Barradas
- Division of Global HIV and TB, Center for Global Health, CDC Zambia, Lusaka, Zambia
| | | | - Sehin Birhanu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Godfrey Musuka
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Beth A Tippett Barr
- Division of Global HIV and TB, Center for Global Health, CDC Zimbabwe, Harare, Zimbabwe
| | - Katrina Sleeman
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | | | - Kyaw Thin
- Research Coordination Unit, Ministry of Health, Maseru, Lesotho
| | - Trong T Ao
- Division of Global HIV and TB, Center for Global Health, CDC Eswatini, Mbabane, Swaziland
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Andrew C Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, GA, USA
| | - Jessica E Justman
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
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12
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Chipimo PJ, Barradas DT, Kayeyi N, Zulu PM, Muzala K, Mazaba ML, Hamoonga R, Musonda K, Monze M, Kapata N, Sinyange N, Simwaba D, Kapaya F, Mulenga L, Chanda D, Malambo W, Ngosa W, Hines J, Yingst S, Agolory S, Mukonka V. First 100 Persons with COVID-19 - Zambia, March 18-April 28, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1547-1548. [PMID: 33090982 PMCID: PMC7583505 DOI: 10.15585/mmwr.mm6942a5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Boyd MA, Shah M, Barradas DT, Herce M, Mulenga LB, Lumpa M, Ishimbulo S, Saadani A, Mumba M, Essiet-Gibson I, Tally L, Minchella P, Kancheya N, Mwila A, Zyambo K, Chungu C, Chanda S, Mbewe W, Zulu I, Siansalama T, Mweebo K, Nkwemu K, Simpungwe J, Medley A, Sikazwe I, Mwale C, Agolory S, Ellerbrock T. Increase in Antiretroviral Therapy Enrollment Among Persons with HIV Infection During the Lusaka HIV Treatment Surge - Lusaka Province, Zambia, January 2018-June 2019. MMWR Morb Mortal Wkly Rep 2020; 69:1039-1043. [PMID: 32759917 PMCID: PMC7454894 DOI: 10.15585/mmwr.mm6931a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Within Zambia, a landlocked country in southern-central Africa, the highest prevalence of human immunodeficiency virus (HIV) infection is in Lusaka Province (population 3.2 million), where approximately 340,000 persons are estimated to be infected (1). The 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA) estimated the adult HIV prevalence in Lusaka Province to be 15.7%, with a 62.7% viral load suppression rate (HIV-1 RNA <1,000 copies/mL) (2). ZAMPHIA results highlighted remaining treatment gaps in Zambia overall and by subpopulation. In January 2018, Zambia launched the Lusaka Province HIV Treatment Surge (Surge project) to increase enrollment of persons with HIV infection onto antiretroviral therapy (ART). The Zambia Ministry of Health (MoH), CDC, and partners analyzed the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) Monitoring and Evaluation Reporting data set to assess the effectiveness of the first 18 months of the Surge project (January 2018-June 2019). During this period, approximately 100,000 persons with positive test results for HIV began ART. These new ART clients were more likely to be persons aged 15-24 years. In addition, the number of persons with documented viral load suppression doubled from 66,109 to 134,046. Lessons learned from the Surge project, including collaborative leadership, efforts to improve facility-level performance, and innovative strategies to disseminate successful practices, could increase HIV treatment rates in other high-prevalence settings.
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Brown K, Williams DB, Kinchen S, Saito S, Radin E, Patel H, Low A, Delgado S, Mugurungi O, Musuka G, Tippett Barr BA, Nwankwo-Igomu EA, Ruangtragool L, Hakim AJ, Kalua T, Nyirenda R, Chipungu G, Auld A, Kim E, Payne D, Wadonda-Kabondo N, West C, Brennan E, Deutsch B, Worku A, Jonnalagadda S, Mulenga LB, Dzekedzeke K, Barradas DT, Cai H, Gupta S, Kamocha S, Riggs MA, Sachathep K, Kirungi W, Musinguzi J, Opio A, Biraro S, Bancroft E, Galbraith J, Kiyingi H, Farahani M, Hladik W, Nyangoma E, Ginindza C, Masangane Z, Mhlanga F, Mnisi Z, Munyaradzi P, Zwane A, Burke S, Kayigamba FB, Nuwagaba-Biribonwoha H, Sahabo R, Ao TT, Draghi C, Ryan C, Philip NM, Mosha F, Mulokozi A, Ntigiti P, Ramadhani AA, Somi GR, Makafu C, Mugisha V, Zelothe J, Lavilla K, Lowrance DW, Mdodo R, Gummerson E, Stupp P, Thin K, Frederix K, Davia S, Schwitters AM, McCracken SD, Duong YT, Hoos D, Parekh B, Justman JE, Voetsch AC. Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15-24 Years - Seven African Countries, 2015-2017. MMWR Morb Mortal Wkly Rep 2018; 67:29-32. [PMID: 29329280 PMCID: PMC5769792 DOI: 10.15585/mmwr.mm6701a6] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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15
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Lindblade KA, Nyenswah T, Keita S, Diallo B, Kateh F, Amoah A, Nagbe TK, Raghunathan P, Neatherlin JC, Kinzer M, Pillai SK, Attfield KR, Hajjeh R, Dweh E, Painter J, Barradas DT, Williams SG, Blackley DJ, Kirking HL, Patel MR, Dea M, Massoudi MS, Barskey AE, Zarecki SLM, Fomba M, Grube S, Belcher L, Broyles LN, Maxwell TN, Hagan JE, Yeoman K, Westercamp M, Mott J, Mahoney F, Slutsker L, DeCock KM, Marston B, Dahl B. Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014-2015. Emerg Infect Dis 2016; 22:1653-5. [PMID: 27268508 PMCID: PMC4994349 DOI: 10.3201/eid2209.160416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.
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Lindblade KA, Nyenswah T, Keita S, Diallo B, Kateh F, Amoah A, Nagbe TK, Raghunathan P, Neatherlin JC, Kinzer M, Pillai SK, Attfield KR, Hajjeh R, Dweh E, Painter J, Barradas DT, Williams SG, Blackley DJ, Kirking HL, Patel MR, Dea M, Massoudi MS, Barskey AE, Zarecki SLM, Fomba M, Grube S, Belcher L, Broyles LN, Maxwell TN, Hagan JE, Yeoman K, Westercamp M, Mott J, Mahoney F, Slutsker L, DeCock KM, Marston B, Dahl B. Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014–2015. Emerg Infect Dis 2016. [DOI: 10.3201/eid2209.16.0416] [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: 11/19/2022] Open
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Lindblade KA, Kateh F, Nagbe TK, Neatherlin JC, Pillai SK, Attfield KR, Dweh E, Barradas DT, Williams SG, Blackley DJ, Kirking HL, Patel MR, Dea M, Massoudi MS, Wannemuehler K, Barskey AE, Zarecki SLM, Fomba M, Grube S, Belcher L, Broyles LN, Maxwell TN, Hagan JE, Yeoman K, Westercamp M, Forrester J, Mott J, Mahoney F, Slutsker L, DeCock KM, Nyenswah T. Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014. Emerg Infect Dis 2016; 21:1800-7. [PMID: 26402477 PMCID: PMC4593457 DOI: 10.3201/eid2110.150912] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival.
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Barradas DT, Dietz PM, Pearl M, England LJ, Callaghan WM, Kharrazi M. Validation of obstetric estimate using early ultrasound: 2007 California birth certificates. Paediatr Perinat Epidemiol 2014; 28:3-10. [PMID: 24117928 PMCID: PMC4741369 DOI: 10.1111/ppe.12083] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obstetric estimate (OE) of gestational age, recently added to the standard US birth certificate, has not been validated. Using early ultrasound-based gestational age (prior to 20 weeks gestation) as the criterion standard, we estimated the prevalence of preterm delivery and the sensitivity and positive predictive value (PPV) of gestational age estimates based on OE. METHODS We analyzed 165 148 singleton livebirth records (38% of California livebirths during the study period) with linked early ultrasound information from a statewide California prenatal screening programme. OE of gestational age estimates was obtained from birth certificates. RESULTS Prevalence of preterm delivery (<37 weeks gestation) was higher based on early ultrasound (8.1%) compared with preterm delivery based on OE (7.1%). Sensitivity for preterm birth when using OE for gestational age was 74.9% (95% confidence interval [CI] [74.1, 75.6]), and PPV was 85.1% (95% CI [84.4, 85.7]). Incongruence, defined as a ≥ 14-day difference between early-ultrasound-derived gestational age and OE, was 3.4%. CONCLUSIONS OE reported on the birth certificate may underestimate the prevalence of preterm delivery, particularly among women of non-Hispanic non-white race and ethnicity and women with lower educational attainment, public insurance at time of delivery, and missing prepregnancy BMI. Additional validation studies in other samples of births are needed.
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Affiliation(s)
- Danielle T. Barradas
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Patricia M. Dietz
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Lucinda J. England
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - William M. Callaghan
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Martin Kharrazi
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA
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Kroelinger CD, Kasehagen L, Barradas DT, 'Ali Z. Building leadership skills and promoting workforce development: evaluation data collected from public health professionals in the field of maternal and child health. Matern Child Health J 2013; 16 Suppl 2:370-5. [PMID: 22923283 DOI: 10.1007/s10995-012-1098-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Professional development, including training and leadership skill building, is important for maternal and child health (MCH) epidemiologists. Current workforce development and training opportunities vary, but lack an emphasis on linking leadership competencies with MCH epidemiology. This paper describes efforts at the annual MCH Epidemiology Conference (the "Conference") to promote leadership activities and workforce development, and recommendations to enhance professional development. An evaluation of attendee opinions on Conference workforce development activities was conducted during the 2009 and 2010 Conferences (70 and 66 % response rates, respectively). Frequencies and percentages were calculated overall and by attendee profession. Qualitative responses to questions regarding workforce and professional development were classified by theme in 2009, and a categorical question was developed for the 2010 evaluation. A combined 38 % of Conference attendees in 2009 and 2010 were MCH epidemiologists and 62 % were other MCH professionals. Attendees recommended more support and access to training, mentoring, and resources including job opportunities. Continuing education (41 %), special knowledge and skills-building training (51 %), and development of online resources for training (57 %) were highly recommended by attendees. Career (47 %) and leadership (49 %) mentoring by senior-level professionals in the field were also highly recommended. Promotion of leadership can be achieved by integrating the concept of leadership into the Conference itself; by publishing and disseminating MCH epidemiologic research in scientific, program, and policy settings; and by communicating the importance of epidemiologic findings to stakeholders and other non-scientific audiences.
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Affiliation(s)
- Charlan D Kroelinger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA.
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Ness M, Barradas DT, Irving J, Manning SE. Correlates of overweight and obesity among American Indian/Alaska Native and Non-Hispanic White children and adolescents: National Survey of Children's Health, 2007. Matern Child Health J 2012; 16 Suppl 2:268-77. [PMID: 23229132 PMCID: PMC4538947 DOI: 10.1007/s10995-012-1191-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 12/25/2022]
Abstract
Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children's Health, behavioral (child's sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child's bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child's age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10-17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5-2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1-3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3-5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.
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Affiliation(s)
- Maria Ness
- Oregon Public Health Division, Office of Family Health, 800 NE Oregon Street, Suite 825, Portland, OR 97232, USA
| | - Danielle T. Barradas
- Division of Reproductive Health, Centers for Disease Control, and Prevention, Atlanta, GA, USA
| | - Jennifer Irving
- Great Plains Tribal Chairmen’s Health Board, Northern Plains, Tribal Epidemiology Center, Rapid City, SD, USA
| | - Susan E. Manning
- Career Epidemiology Field Officer Program, Centers for Disease, Control and Prevention, Atlanta, GA, USA
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Barradas DT, Barfield WD, Wright V, D'Angelo D, Manning SE, Schieve LA. Assessment of assisted reproductive technology use questions: Pregnancy Risk Assessment Monitoring System Survey, 2004. Public Health Rep 2012; 127:516-23. [PMID: 22942469 PMCID: PMC3407851 DOI: 10.1177/003335491212700507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Women who conceive with the assistance of fertility treatments are at increased risk for multiple-gestation pregnancies and accompanying adverse pregnancy outcomes. The Pregnancy Risk Assessment Monitoring System (PRAMS) can be used to assess outcomes associated with fertility treatments, but a previous study suggested that PRAMS questions about fertility treatments overestimated use of assisted reproductive technology (ART) by 2.6 times. These PRAMS ART questions were revised in 2004. We compared prevalence estimates based on revised questions with counts from the National ART Surveillance System (NASS), the standard for describing ART prevalence. METHODS We compared weighted PRAMS prevalence estimates of births conceived by using ART with corresponding counts from NASS for three states (Florida, Maryland, and Utah) for 2004. We also compared these data by age, parity, plurality, and infant birthweight. RESULTS Estimated ART births determined from PRAMS totaled 3,672 (95% confidence interval 2,210, 5,134), compared with 2,939 ART births reported to NASS. PRAMS estimates and NASS counts differed by maternal age (p=0.02) and parity (p<0.01). For example, PRAMS responses from women aged ≥ 40 years overestimated ART use by 70% (27.9% vs. 16.5%, p<0.01). CONCLUSIONS Revised PRAMS questions better estimate numbers of ART births than earlier PRAMS questions. PRAMS data are useful to describe behaviors and outcomes associated with ART use.
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Affiliation(s)
- Danielle T Barradas
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, GA 30341, USA.
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Barradas DT, Kroelinger CD, Kogan MD. Medical home access among American Indian and Alaska Native children in 7 states: National Survey of Children's Health. Matern Child Health J 2012; 16 Suppl 1:S6-13. [PMID: 22466686 PMCID: PMC4741308 DOI: 10.1007/s10995-012-0990-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 10/28/2022]
Abstract
To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children's Health data. Analyses included 1-17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child's age, household education and income, and state) and health-related [child's insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4-50.8) than NHW children (58.3, 95 % CI = 56.2-60.4). Child's age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3-5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1-0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.
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Affiliation(s)
- Danielle T Barradas
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-22, Atlanta, GA 30341, USA.
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Barfield WD, Barradas DT, Manning SE, Kotelchuck M, Shapiro-Mendoza CK. Sickle cell disease and pregnancy outcomes: women of African descent. Am J Prev Med 2010; 38:S542-9. [PMID: 20331956 DOI: 10.1016/j.amepre.2009.12.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/16/2009] [Accepted: 12/22/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a severe hematologic condition that presents unique complications among affected pregnant women. Many studies of adverse perinatal outcomes associated with SCD are limited by small samples or fail to consider important risk factors. PURPOSE This study compared perinatal outcomes among women of African ancestry with and without SCD in a large, population-based sample. METHODS Data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System were analyzed during June-August 2009 to identify in-state deliveries to resident women of African descent. Logistic regression analyses compared perinatal outcomes for deliveries among women with and without SCD, adjusted for maternal age, education, parity, plurality, insurance status, adequacy of prenatal care, smoking during pregnancy, and infant gender. RESULTS During 1998-2006, there were 116,076 deliveries to 84,561 women; SCD prevalence was 0.6%. Adjusted odds of fetal death among deliveries to women with SCD were 2.2 times those among women without SCD (95% CI=1.2, 4.2). Compared to women without SCD, the odds of preterm delivery, low birth weight, and having babies small for gestational age (SGA) among women with SCD were 1.5 (95% CI=1.2, 1.8); 1.7 (95% CI=1.1, 2.6); and 1.3 (95% CI=1.0, 1.7), respectively. Sickle cell disease was positively associated with cesarean delivery and inductions. CONCLUSIONS Population-based linked data systems are useful for assessing risks of adverse health outcomes among women with specific medical conditions, such as SCD. Women with SCD should seek preconception care to identify and modify risk behaviors and receive counseling regarding potential adverse sequelae associated with pregnancy-related morbidity and preterm delivery.
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Affiliation(s)
- Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia 30341, USA.
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Day RS, Fulton JE, Dai S, Mihalopoulos NL, Barradas DT. Nutrient intake, physical activity, and CVD risk factors in children: Project HeartBeat! Am J Prev Med 2009; 37:S25-33. [PMID: 19524152 PMCID: PMC2729283 DOI: 10.1016/j.amepre.2009.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 10/30/2008] [Accepted: 04/14/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Associations among dietary intake, physical activity, and cardiovascular disease (CVD) risk factors are inconsistent among male and female youth, possibly from lack of adjustment for pubertal status. The purpose of this report is to describe the associations of CVD risk factors among youth, adjusted for sexual maturation. METHODS Data analyzed in 2007 from a sumsample of 556 children aged 8, 11, and 14 years in Project HeartBeat!, 1991-1993, provide cross-sectional patterns of CVD risk factors by age and gender, adjusting for sexual maturation, within dietary fat and physical activity categories. RESULTS Girls consuming moderate- to high-fat diets were significantly less physically active than those consuming low-fat diets. Boys and girls consuming high-fat diets had higher saturated fat and cholesterol intakes than children in low-fat categories. Boys had no significant differences in physical activity, blood pressure, waist circumference, or plasma cholesterol levels across fat categories. Girls' plasma cholesterol levels showed no significant differences across fat categories. Dietary intake did not differ across moderate-to-vigorous physical activity (MVPA) categories within gender. There were no differences in BMI by fat or MVPA categories for either gender. Girls' waist circumference differed significantly by fat category, and systolic blood pressure differed significantly across fat and MVPA categories. Boys' fifth-phase diastolic blood pressure was significantly different across MVPA categories. CONCLUSIONS Girls consuming atherogenic diets were significantly less physically active than those with low fat intakes, whereas boys consuming high-fat diets did not show differences in physical activity measures. With the prevalence of overweight rising among youth, the impact of atherogenic diets and sedentary lifestyles on CVD risk factors is of concern to public health professionals.
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Affiliation(s)
- R Sue Day
- Michael & Susan Dell Center for Advancement of Healthy Living, School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler, Houston, TX 77030, USA.
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Moore LV, Fulton JE, Carlson SA, Barradas DT, Kruger J. Public Support For Street-Scale Urban Design Policies To Promote Physical Activity. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353409.93362.c4] [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: 11/21/2022]
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Barradas DT, Fulton JE, Blanck HM, Huhman M. Parental influences on youth television viewing. J Pediatr 2007; 151:369-73, 373.e1-4. [PMID: 17889071 DOI: 10.1016/j.jpeds.2007.04.069] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 03/16/2007] [Accepted: 04/30/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess associations among youth television (TV) viewing and parental TV viewing, parental knowledge of the American Academy of Pediatrics (AAP) recommendations to limit children's TV viewing time to < or = 2 hours per day (knowledge), and parental limits on the frequency of children's TV viewing (rules). STUDY DESIGN Adult participants in the 2002 Styles surveys answered questions about their weekly TV viewing, knowledge, and rules. TV viewing time of children of the adult participants (520 boys and 525 girls) age 10 to 18 years was also collected. Associations between hours of child TV viewing and parental TV viewing, parental knowledge, and parental rules were quantified using linear regression techniques. RESULTS Variables included in multivariate regression models accounted for 8% to 18% of the variance in TV viewing among boys and girls. Parent TV viewing was significantly associated with TV viewing in 10- to 12-year-old and 16- to 18-year-old boys and girls. Knowledge was not associated with TV viewing in boys and girls in this sample. Rules were associated with TV viewing in boys and girls of all ages. CONCLUSIONS Our findings suggest that parental TV viewing and rules limiting their child's TV time may play an important role in children's weekly TV viewing time.
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Affiliation(s)
- Danielle T Barradas
- Program in Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA.
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Barradas DT, Thompson NJ, Fulton JE, Blanck HM, Dai S. Correlates of Intention to Lose Weight Among High School Athletes. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000274481.97713.87] [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: 11/21/2022]
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