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Zhang Y, Song Y, Weng Z, Yang J, Avery L, Dieckhaus KD, Lai RY, Gao X, Zhang Y. A point-of-care microfluidic biosensing system for rapid and ultrasensitive nucleic acid detection from clinical samples. Lab Chip 2023; 23:3862-3873. [PMID: 37539483 DOI: 10.1039/d3lc00372h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Rapid and ultrasensitive point-of-care RNA detection plays a critical role in the diagnosis and management of various infectious diseases. The gold-standard detection method of reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is ultrasensitive and accurate yet limited by the lengthy turnaround time (1-2 days). On the other hand, an antigen test offers rapid at-home detection (typically ~15 min) but suffers from low sensitivity and high false-negative rates. An ideal point-of-care diagnostic device would combine the merits of PCR-level sensitivity and rapid sample-to-result workflow comparable to antigen testing. However, the existing detection platforms typically possess superior sensitivity or rapid sample-to-result time, but not both. This paper reports a point-of-care microfluidic device that offers ultrasensitive yet rapid detection of viral RNA from clinical samples. The device consists of a microfluidic chip for precisely manipulating small volumes of samples, a miniaturized heater for viral lysis and ribonuclease inactivation, a Cas13a-electrochemical sensor for target preamplification-free and ultrasensitive RNA detection, and a smartphone-compatible potentiostat for data acquisition. As demonstrations, the devices achieve the detection of heat-inactivated SARS-CoV-2 samples with a limit of detection down to 10 aM within 25 minutes, which is comparable to the sensitivity of RT-PCR and rapidness of an antigen test. The platform also successfully distinguishes all nine positive unprocessed clinical SARS-CoV-2 nasopharyngeal swab samples from four negative samples within 25 minutes of sample-to-result time. Together, this device provides a point-of-care solution that can be deployed in diverse settings beyond laboratory environments for rapid and accurate detection of RNA from clinical samples. The device can potentially be expandable to detect other viral targets, such as human immunodeficiency virus self-testing and Zika virus, where rapid and ultrasensitive point-of-care detection is required.
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Affiliation(s)
- Yuxuan Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Yang Song
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Zhengyan Weng
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Jie Yang
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA
| | - Lori Avery
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT 06030, USA
| | - Kevin D Dieckhaus
- Division of Infectious Diseases, Department of Medicine, UConn Health, Farmington, CT 06030, USA
| | - Rebecca Y Lai
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Xue Gao
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA
- Department of Bioengineering, Rice University, Houston, TX 77005, USA
- Department of Chemistry, Rice University, Houston, TX 77005, USA
| | - Yi Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.
- Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
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Yang J, Song Y, Deng X, Vanegas JA, You Z, Zhang Y, Weng Z, Avery L, Dieckhaus KD, Peddi A, Gao Y, Zhang Y, Gao X. Engineered LwaCas13a with enhanced collateral activity for nucleic acid detection. Nat Chem Biol 2023; 19:45-54. [PMID: 36138140 DOI: 10.1038/s41589-022-01135-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/08/2022] [Indexed: 12/31/2022]
Abstract
Clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 13 (Cas13) has been rapidly developed for nucleic-acid-based diagnostics by using its characteristic collateral activity. Despite the recent progress in optimizing the Cas13 system for the detection of nucleic acids, engineering Cas13 protein with enhanced collateral activity has been challenging, mostly because of its complex structural dynamics. Here we successfully employed a novel strategy to engineer the Leptotrichia wadei (Lwa)Cas13a by inserting different RNA-binding domains into a unique active-site-proximal loop within its higher eukaryotes and prokaryotes nucleotide-binding domain. Two LwaCas13a variants showed enhanced collateral activity and improved sensitivity over the wild type in various buffer conditions. By combining with an electrochemical method, our variants detected the SARS-CoV-2 genome at attomolar concentrations from both inactive viral and unextracted clinical samples, without target preamplification. Our engineered LwaCas13a enzymes with enhanced collateral activity are ready to be integrated into other Cas13a-based platforms for ultrasensitive detection of nucleic acids.
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Affiliation(s)
- Jie Yang
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX, USA
| | - Yang Song
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT, USA
| | - Xiangyu Deng
- Department of Biosciences, Rice University, Houston, TX, USA
| | - Jeffrey A Vanegas
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX, USA
| | - Zheng You
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX, USA
| | - Yuxuan Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT, USA
| | - Zhengyan Weng
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT, USA
| | - Lori Avery
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT, USA
| | - Kevin D Dieckhaus
- Division of Infectious Diseases, Department of Medicine, UConn Health, Farmington, CT, USA
| | - Advaith Peddi
- Department of Biosciences, Rice University, Houston, TX, USA
| | - Yang Gao
- Department of Biosciences, Rice University, Houston, TX, USA.
| | - Yi Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, USA. .,Polymer Program, Institute of Materials Science, University of Connecticut, Storrs, CT, USA.
| | - Xue Gao
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX, USA. .,Department of Bioengineering, Rice University, Houston, TX, USA. .,Department of Chemistry, Rice University, Houston, TX, USA.
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3
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Sung A, Zhang TP, Huang W, Tang W, Alexander M, Forastiere L, Kumar N, Hall BJ, Ransome Y, Dieckhaus KD, Wu D, Tucker JD, Yang F. Development of a Psychometric Tool to Measure Community Solidarity Among Sexual Minorities: Evidence From a Pay-it-Forward Randomized Controlled Trial. Sex Transm Dis 2022; 49:628-634. [PMID: 35675708 PMCID: PMC9378620 DOI: 10.1097/olq.0000000000001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community solidarity is increasingly important in public health. However, few studies have examined solidarity in relation to health outcomes. The purpose of this study was to develop a psychometric tool to measure solidarity among Chinese men who have sex with men (MSM) and assess whether community solidarity relates to differences in sexually transmitted infection testing. METHODS We used data from the pay-it-forward randomized controlled trial of 301 men from Beijing and Guangzhou, China. Men who have sex with men were randomized into pay-it-forward (participants receive free gonorrhea/chlamydia testing as gifts and choose to donate toward subsequent MSM's tests), pay-what you-want, and standard payment arms. After testing decision, participants completed a cross-sectional questionnaire to assess community solidarity. Factor analysis was conducted to identify dimensions of solidarity. The solidarity factors were compared across study arms and assessed against gonorrhea/chlamydia test uptake in multivariable logistic regression. RESULTS Two hundred eighty-eight participants responded to the survey. We identified 3 latent community solidarity factors: engagement, social network support, and sense of belonging. Several items related to belonging were significantly greater among participants in the pay-it-forward scenario compared with those assigned to other scenarios. Higher sense of belonging was associated with higher odds of gonorrhea and chlamydia test uptake. CONCLUSIONS Community solidarity among MSM in China can be characterized by 3 factors: engagement, social network support, and sense of belonging. Sense of belonging was higher in the pay-it-forward intervention arm and may be associated with the uptake of gonorrhea/chlamydia test. Future studies are warranted to confirm the psychometric structure of community solidarity and further investigate behavioral mechanisms of pay it forward.
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Affiliation(s)
- Anne Sung
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tiange P. Zhang
- University of North Carolina, Project-China, Guangzhou, China
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Wenting Huang
- University of North Carolina, Project-China, Guangzhou, China
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Weiming Tang
- University of North Carolina, Project-China, Guangzhou, China
- University of North Carolina, School of Medicine, Chapel Hill, USA
| | - Marcus Alexander
- Human Nature Laboratory, Department of Sociology, Yale University, New Haven, CT, USA
| | - Laura Forastiere
- Human Nature Laboratory, Department of Sociology, Yale University, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Navin Kumar
- Human Nature Laboratory, Department of Sociology, Yale University, New Haven, CT, USA
| | - Brian J. Hall
- Center for Global Health Equity, New York University (Shanghai), Shanghai, China
- School of Global Public Health, New York University, NY, USA
| | | | | | - Dan Wu
- University of North Carolina, Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joseph D. Tucker
- University of North Carolina, Project-China, Guangzhou, China
- University of North Carolina, School of Medicine, Chapel Hill, USA
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fan Yang
- University of North Carolina, Project-China, Guangzhou, China
- Institute of Population Research, Peking University, Beijing, China
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Li H, Yang J, Wu G, Weng Z, Song Y, Zhang Y, Vanegas JA, Avery L, Gao Z, Sun H, Chen Y, Dieckhaus KD, Gao X, Zhang Y. Amplification‐Free Detection of SARS‐CoV‐2 and Respiratory Syncytial Virus Using CRISPR Cas13a and Graphene Field‐Effect Transistors. Angew Chem Int Ed Engl 2022. [PMCID: PMC9350237 DOI: 10.1002/anie.202209501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Huijie Li
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Jie Yang
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
| | - Guangfu Wu
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Zhengyan Weng
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yang Song
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yuxuan Zhang
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Jeffrey A. Vanegas
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
| | - Lori Avery
- Department of Pathology and Laboratory Medicine UConn Health Farmington CT 06030 USA
| | - Zan Gao
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - He Sun
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yupeng Chen
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
| | - Kevin D. Dieckhaus
- Division of Infectious Diseases Department of Medicine UConn Health Farmington CT 06030 USA
| | - Xue Gao
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
- Department of Bioengineering Rice University Houston TX 77005 USA
- Department of Chemistry Rice University Houston TX 77005 USA
| | - Yi Zhang
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
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5
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Li H, Yang J, Wu G, Weng Z, Song Y, Zhang Y, Vanegas JA, Avery L, Gao Z, Sun H, Chen Y, Dieckhaus KD, Gao X, Zhang Y. Amplification‐Free Detection of SARS‐CoV‐2 and Respiratory Syncytial Virus Using CRISPR Cas13a and Graphene Field‐Effect Transistors. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202209501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Huijie Li
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Jie Yang
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
| | - Guangfu Wu
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Zhengyan Weng
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yang Song
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yuxuan Zhang
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Jeffrey A. Vanegas
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
| | - Lori Avery
- Department of Pathology and Laboratory Medicine UConn Health Farmington CT 06030 USA
| | - Zan Gao
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - He Sun
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
| | - Yupeng Chen
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
| | - Kevin D. Dieckhaus
- Division of Infectious Diseases Department of Medicine UConn Health Farmington CT 06030 USA
| | - Xue Gao
- Department of Chemical and Biomolecular Engineering Rice University Houston TX 77005 USA
- Department of Bioengineering Rice University Houston TX 77005 USA
- Department of Chemistry Rice University Houston TX 77005 USA
| | - Yi Zhang
- Department of Biomedical Engineering University of Connecticut Storrs CT 06269 USA
- Institute of Materials Science University of Connecticut Storrs CT 06269 USA
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6
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Li H, Yang J, Wu G, Weng Z, Song Y, Zhang Y, Vanegas JA, Avery L, Gao Z, Sun H, Chen Y, Dieckhaus KD, Gao X, Zhang Y. Amplification-Free Detection of SARS-CoV-2 and Respiratory Syncytial Virus Using CRISPR Cas13a and Graphene Field-Effect Transistors. Angew Chem Int Ed Engl 2022; 61:e202203826. [PMID: 35559592 PMCID: PMC9347639 DOI: 10.1002/anie.202203826] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 12/26/2022]
Abstract
The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR‐associated (Cas) systems have recently received notable attention for their applications in nucleic acid detection. Despite many attempts, the majority of current CRISPR‐based biosensors in infectious respiratory disease diagnostic applications still require target preamplifications. This study reports a new biosensor for amplification‐free nucleic acid detection via harnessing the trans‐cleavage mechanism of Cas13a and ultrasensitive graphene field‐effect transistors (gFETs). CRISPR Cas13a‐gFET achieves the detection of SARS‐CoV‐2 and respiratory syncytial virus (RSV) genome down to 1 attomolar without target preamplifications. Additionally, we validate the detection performance using clinical SARS‐CoV‐2 samples, including those with low viral loads (Ct value >30). Overall, these findings establish our CRISPR Cas13a‐gFET among the most sensitive amplification‐free nucleic acid diagnostic platforms to date.
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Affiliation(s)
- Huijie Li
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Jie Yang
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA
| | - Guangfu Wu
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Zhengyan Weng
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Yang Song
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Yuxuan Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Jeffrey A Vanegas
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA
| | - Lori Avery
- Department of Pathology and Laboratory Medicine, UConn Health, Farmington, CT 06030, USA
| | - Zan Gao
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - He Sun
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
| | - Yupeng Chen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Kevin D Dieckhaus
- Division of Infectious Diseases, Department of Medicine, UConn Health, Farmington, CT 06030, USA
| | - Xue Gao
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, USA.,Department of Bioengineering, Rice University, Houston, TX 77005, USA.,Department of Chemistry, Rice University, Houston, TX 77005, USA
| | - Yi Zhang
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.,Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA
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7
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Li H, Yang J, Wu G, Weng Z, Song Y, Zhang Y, Vanegas JA, Avery L, Gao Z, Sun H, Chen Y, Dieckhaus KD, Gao X, Zhang Y. Amplification‐Free Detection of SARS‐CoV‐2 and Respiratory Syncytial Virus Using CRISPR Cas13a and Graphene Field‐Effect Transistors. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202203826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Huijie Li
- University of Connecticut Biomedical Engineering 97 N Eagleville Rd Unit 3137 06269-7012 Storrs Mansfield UNITED STATES
| | - Jie Yang
- Rice University Chemical and Biomolecular Engineering UNITED STATES
| | - Guangfu Wu
- University of Connecticut Biomedical Engineering UNITED STATES
| | - Zhengyan Weng
- University of Connecticut Biomedical Engineering UNITED STATES
| | - Yang Song
- University of Connecticut Biomedical Engineering UNITED STATES
| | - Yuxuan Zhang
- University of Connecticut Biomedical Engineering UNITED STATES
| | | | - Lori Avery
- University of Connecticut Health Center: UConn Health Pathology and Laboratory Medicine UNITED STATES
| | - Zan Gao
- University of Connecticut Biomedical Engineering UNITED STATES
| | - He Sun
- University of Connecticut Biomedical Engineering 97 N Eagleville Rd Unit 3137 06269-7012 Storrs Mansfield UNITED STATES
| | - Yupeng Chen
- University of Connecticut Biomedical Engineering UNITED STATES
| | - Kevin D. Dieckhaus
- University of Connecticut Health Center: UConn Health Medicine UNITED STATES
| | - Xue Gao
- Rice University Chemical and Biomolecular Engineering UNITED STATES
| | - Yi Zhang
- University of Connecticut 97 N Eagleville Rd Unit 3137 06269 Storrs UNITED STATES
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8
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Dieckhaus KD, Ha TH, Schensul SL, Sarna A. Modeling HIV Transmission from Sexually Active Alcohol-Consuming Men in ART Programs to Seronegative Wives. J Int Assoc Provid AIDS Care 2020; 19:2325958220952287. [PMID: 32851898 PMCID: PMC7457687 DOI: 10.1177/2325958220952287] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The rollout of antiviral therapy in Low and Middle Income Countries (LMICs) has reduced HIV transmission rates at the potential risk of resistant HIV transmission. We sought to predict the risk of wild type and antiviral resistance transmissions in these settings. METHODS A predictive model utilizing viral load, ART adherence, genital ulcer disease, condom use, and sexual event histories was developed to predict risks of HIV transmission to wives of 233 HIV+ men in 4 antiretroviral treatment centers in Maharashtra, India. RESULTS ARV Therapy predicted a 5.71-fold reduction in transmissions compared to a model of using condoms alone, with 79.9%, of remaining transmissions resulting in primary ART-resistance. CONCLUSIONS ART programs reduce transmission of HIV to susceptible partners at a substantial increased risk for transmission of resistant virus. Enhanced vigilance in monitoring adherence, use of barrier protections, and viral load may reduce risks of resistant HIV transmissions in LMIC settings.
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Affiliation(s)
- Kevin D. Dieckhaus
- University of Connecticut Division of Infectious Diseases,
Farmington, CT, USA
| | - Toan H. Ha
- University of Pittsburgh Graduate School of Public Health,
Pittsburgh, PA, USA
| | - Stephen L. Schensul
- University of Connecticut Department of Community Medicine and
Healthcare, Farmington, CT, USA
| | - Avina Sarna
- Population Council, India Habitat Centre, New Delhi, India
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9
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Dieckhaus KD, Kyebambe PS. Human Brucellosis in Rural Uganda: Clinical Manifestations, Diagnosis, and Comorbidities at Kabale Regional Referral Hospital, Kabale, Uganda. Open Forum Infect Dis 2017; 4:ofx237. [PMID: 29255733 PMCID: PMC5726460 DOI: 10.1093/ofid/ofx237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/06/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
Background Brucellosis is a zoonotic infection transmitted to humans through direct contact with infected animals, their products, or excreta such as urine or dung. Brucellosis is associated with significant morbidity in Southwestern Uganda, where cattle and goat rearing are a major economic industry. As in many settings in sub-Saharan Africa, diagnosis and management of brucellosis remain a challenge due to the presence of comorbidities and limitations in resources for diagnostic testing and therapy. Methods A chart review was conducted to characterize the clinical manifestations, diagnosis, comorbidities, and management of 101 patients treated for brucellosis at the Kabale Regional Referral Hospital from September 2002 to May 2010. Results Patients presented with substantial comorbidities. The most common manifestation of illness was osteoarticular, but disease manifestations were quite varied. A high rate of focal illness in this cohort (77%) was observed. Conclusions Clinicians in this setting should be cognizant of the varied presentations, comorbidities, and treatment options for this disease.
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Affiliation(s)
- Kevin D Dieckhaus
- Department of Medicine, University of Connecticut School of Medicine, Farmington
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10
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Song ES, Musinguzi P, Dieckhaus KD. Factors affecting patient presentation at a national dermatology referral clinic in Kampala, Uganda. Int J Dermatol 2016; 56:291-295. [PMID: 27813140 DOI: 10.1111/ijd.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 03/28/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study sought to gain a better understanding of the patient population in Kampala and was further designed to elucidate barriers that may delay individuals from receiving proper dermatologic care. METHODS The study took place at the dermatovenereology clinic of a tertiary care hospital in Kampala. New adult patients were surveyed in July and August of 2013. The primary dependent variable was time from reported onset of symptoms to presentation to the clinic. Participant demographic characteristics, medical and treatment history, and perception of illness as measured by the dermatology life quality index (DLQI) were assessed. RESULTS A total of 232 subjects participated in the study. The most common skin diseases were allergic (20.3%), infectious (15.1%), follicular (7.8%), and papulosquamous (7.8%) disorders. Greater home distance from the clinic correlated with later presentation times (r = 0.259, P < 0.001). DLQI score was not correlated with presentation time. HIV+ individuals presented earlier (mean 5 vs. 11 months, P = 0.043) and had higher DLQI scores (mean 12.6 vs. 9.3, P = 0.006) than HIV- individuals. The majority of participants (72.5%) had contact with at least one other healthcare worker (HCW) for management of their dermatologic symptoms; 65.8% reported that these previous treatments were ineffective. CONCLUSIONS Efforts to educate HCWs should be focused on districts outside of Kampala and highlight recognition and proper treatment of allergic diseases. HCWs should aggressively treat skin problems in HIV+ individuals. HCWs practicing in Kampala without formal dermatological training should refer patients with skin disease to the clinic, as patients may receive care that is more appropriate.
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Affiliation(s)
- Eunice S Song
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Patrick Musinguzi
- National Referral Skin and STD Unit of Mulago Hospital, Kampala, Uganda
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11
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Anthony P, Feinn R, Brenner B, Dieckhaus KD, Chirch LM. The Addition of High-Risk HPV Testing to Anal Cytology Increases the Identification of Anal Dysplasia in HIV-Infected Patients. Conn Med 2015; 79:389-394. [PMID: 26411174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Anal dysplasia (AD) is prevalent in HIV-infected patients. Screening for AD is recommended for high-risk groups, including HIV-infected patients. We evaluated screening algorithms for AD using cytology, high-risk human papillomavirus (HRH) testing, or both. METHODS HIV-infected patients were offered AD screening by both anal cytology and PCR-based detection of HRH. Patients with abnormal cytology (AC) or HRH genotypes were referred to the same oncologic surgeon for high-resolution anoscopy (HRA). RESULTS Ninety patients underwent screening (84% men who have sex with men). Forty-four patients (52.6%) had abnormal screens (31.5% AC, 46% HRH). Twenty-six patients with AC and/or positive HRH had HRA. AC and nadir CD4+ cell count of < 200 cells/mm3 were predictors of abnormal histology on HRA by univariate analysis (OR 4.5 and 2.5, respectively). Using a log-linear model, we estimated that for every 49 cases with two normal screening tests, one case of AD would be missed. Conclusions: Universal screening for AD in an HIV+ population yielded a high percentage of abnormal findings. Addition of HRH to cytology screening increased positive screens by 24%. Larger studies are needed to determine the ideal screening method.
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Chirch LM, Cataline PR, Dieckhaus KD, Grant-Kels JM. Proactive infectious disease approach to dermatologic patients who are taking tumor necrosis factor-alfa antagonists: Part II. Screening for patients on tumor necrosis factor-alfa antagonists. J Am Acad Dermatol 2014; 71:11.e1-7; quiz 18-20. [PMID: 24947699 DOI: 10.1016/j.jaad.2014.01.879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 12/16/2022]
Abstract
Tumor necrosis factor-alfa levels are linked to disease severity in patients with inflammatory conditions, such as psoriasis. Inhibitors of this cytokine are commonly used with significant success in the treatment of such inflammatory disorders. Their use, however, can be plagued by infectious complications. An awareness of potential infections associated with these therapies is critical in order to maximize preventive efforts both before and during therapy. This review provides a guide for dermatologists caring for patients in need of this type of biologic therapy to preemptively address the infectious risks. Part II of this continuing medical education article reviews recommended screening methods for patients undergoing evaluations for tumor necrosis factor inhibitor therapy for psoriasis or other dermatologic diseases, and discusses possible prophylactic strategies to use, including the appropriate use of immunizations.
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Affiliation(s)
- Lisa M Chirch
- Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut
| | - Philip R Cataline
- Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut
| | - Kevin D Dieckhaus
- Department of Medicine, Division of Infectious Diseases, University of Connecticut Health Center, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Chirch LM, Cataline PR, Dieckhaus KD, Grant-Kels JM. Proactive infectious disease approach to dermatologic patients who are taking tumor necrosis factor–alfa antagonists. J Am Acad Dermatol 2014; 71:1.e1-8; quiz 1.e8-9, 10. [DOI: 10.1016/j.jaad.2014.01.875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/22/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
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Abstract
Treatment of HIV infection with highly active antiretroviral therapy (HAART) requires high levels of adherence in order to obtain maximum benefit and minimize the development of antiviral resistance. Many patients in community clinical settings have imperfect adherence that may lead to poor clinical outcomes. The Connecticut HIV Medication Project (CHaMP) is a multidisciplinary program designed to evaluate patients receiving antiviral therapy. Based on results of a multifaceted assessment, a variety of targeted interventions and follow-up are offered. A retrospective analysis was performed on patients who were referred to the program over a 35-month period from March 2002 through January 2005. Two hundred forty-nine patients who were referred for adherence services had baseline and follow-up data available for analysis. Participants who maintained an unchanged antiretroviral regimen experienced a significant increase in self-reported adherence (89.1% to 96.9%, p < 0.001) and likelihood of reporting more than 95% adherence (36.6% to 73.1%, p < 0.001) by 7-day recall. Improvements in plasma HIV viremia (3.10 +/- 1.21 log copies to 2.78 +/- 0.98, p < 0.01) were also demonstrated. Limitations to this study included the unusually high level of baseline adherence, the large fraction of patients (28.6%) who were lost to follow-up, and follow-up that was limited to one time point at 12-16 weeks such that attrition of the intervention effect could not be assessed. The CHaMP experience demonstrates that the development of a multifaceted clinical program can have significant impact on medication adherence and viral burden in HIV infection.
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Affiliation(s)
- Kevin D Dieckhaus
- Division of Infectious Diseases , University of Connecticut Health Center, Farmington, Connecticut 06030-3212, USA.
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Abstract
BACKGROUND Few rigorously designed studies have documented the efficacy of interventions to improve medication adherence among patients prescribed highly active antiretroviral. Data are needed to justify the use of limited resources for these programs. METHODS A 2-arm, randomized, controlled trial evaluated the efficacy of a community-based, home-visit intervention to improve medication adherence. Participants were 171 HIV-infected adults prescribed a minimum of 3 antiretroviral agents. The majority had a past or current history of substance abuse. Subjects were randomly assigned to receive home visits for 1 year or usual care. Medication adherence was assessed with Medication Event Monitoring stem caps at 3-month intervals from randomization through 3 months after the conclusion of the intervention. RESULTS A larger proportion of subjects in the intervention group demonstrated adherence greater than 90% compared with the control group at each time point after baseline. The difference over time was statistically significant (Extended Mantel-Haenszel test: 5.80, P = 0.02). A statistically significant intervention effect on HIV-RNA level or CD4 cell count was not seen, but there was a statistically significant association between greater than 90% adherence and an undetectable HIV-RNA over time (P < 0.03). CONCLUSION Home visits from a nurse and a community worker were associated with medication adherence greater than 90% among a cohort of socially vulnerable people living with HIV/AIDS in northeastern United States.
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Affiliation(s)
- Ann B Williams
- Yale University School of Nursing, New Haven, CT 06536, USA.
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Bova CA, Fennie KP, Knafl GJ, Dieckhaus KD, Watrous E, Williams AB. Use of electronic monitoring devices to measure antiretroviral adherence: practical considerations. AIDS Behav 2005; 9:103-10. [PMID: 15812617 DOI: 10.1007/s10461-005-1685-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Revised: 06/17/2004] [Accepted: 06/29/2004] [Indexed: 10/25/2022]
Abstract
The purpose of this paper is to describe electronic monitoring device (EMD) (e.g., MEMS caps) use among HIV-infected adults enrolled in a randomized clinical trial and to make explicit some of the benefits and caveats of using electronic monitoring device technology. This is a descriptive, exploratory study of EMD use among 128 HIV-infected adults treated with at least three antiretroviral agents. Thirty-six percent of the sample admitted that they did not use the EMD consistently. Forty-one percent of the subjects reported taking out more than one dose at a time and 26% reported opening the EMD but not taking the medication. Special subject-related issues accounted for only a small percentage of all reported problems with EMD use (e.g., transient housing, incarceration, substance abuse relapse and drug treatment). Results of this study suggest that EMDs may underestimate antiretroviral adherence among HIV-infected adults. Recommendations for improving EMD data quality are presented.
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Affiliation(s)
- Carol A Bova
- Graduate School of Nursing and Division of Infectious Diseases, University of Massachusetts, Worcester, Massachusetts 01655, USA.
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Rosen MI, Rigsby MO, Dieckhaus KD, Cramer JA. Effects of illicit drug use on adherence to prescribed antiretroviral medication. Am J Addict 2003; 12:455-8. [PMID: 14660159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
This exploratory analysis compared adherence to antiretroviral medication on days that illicit drugs were used and on matched abstinence days in twelve subjects who used MEMS caps during participation in a clinical trial. Adherence on drug use days was lower in seven subjects, higher in one, and the same in four. Three subjects maintained 100% adherence despite illicit substance use on studied days. Thus, in a subset of patients, the actions involved in procuring drugs and the acute effects of using them contribute to non-adherence on those specific drug use days, associated with substance abuse. (Am J Addict 2003;12:455-458)
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Affiliation(s)
- Marc I Rosen
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
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Rosen MI, Rigsby MO, Dieckhaus KD, Cramer JA. Effects of Illicit Drug Use on Adherence to Prescribed Antiretroviral Medication. Am J Addict 2003. [DOI: 10.1080/10550490390240828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rigsby MO, Rosen MI, Beauvais JE, Cramer JA, Rainey PM, O'Malley SS, Dieckhaus KD, Rounsaville BJ. Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention. J Gen Intern Med 2000; 15:841-7. [PMID: 11119180 PMCID: PMC1495713 DOI: 10.1046/j.1525-1497.2000.00127.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention. DESIGN Randomized, controlled, pilot study. SETTING Department of Veterans Affairs HIV clinic and community-based HIV clinical trials site. PARTICIPANTS Fifty-five HIV-infected subjects on stable antiretroviral therapy regimens. Subjects were predominantly male (89%) and African American (69%), and had histories of heroin or cocaine use (80%). INTERVENTIONS Four weekly sessions of either nondirective inquiries about adherence (control group, C), cue-dose training, which consisted of the use of personalized cues for remembering particular dose times, and feedback about medication taking using Medication Event Monitoring System (MEMS) pill bottle caps, which record time of bottle opening (CD group), or cue-dose training combined with cash reinforcement for correctly timed bottle opening (CD+CR). MEASUREMENTS Opening of the pill bottle within 2 hours before or after a predetermined time was measured by MEMS. RESULTS Adherence to the medication as documented by MEMS was significantly enhanced during the 4-week training period in the CD+CR group, but not in the CD group, compared with the control group. Improvement was also seen in adherence to antiretroviral drugs that were not the object of training and reinforcement. Eight weeks after training and reinforcement were discontinued, adherence in the cash-reinforced group returned to near-baseline levels. CONCLUSIONS Cue-dose training with cash reinforcement led to transient improvement in adherence to antiretroviral therapy in a population including mostly African Americans and subjects with histories of drug abuse. However, we were not able to detect any sustained improvement beyond the active training period, and questions concerning the timing and duration of such an intervention require further study. Randomized, controlled clinical studies with objective measures of adherence can be conducted in HIV-infected subjects and should be employed for further evaluation of this and other adherence interventions.
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Affiliation(s)
- M O Rigsby
- Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Conn. 06516, USA.
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Affiliation(s)
- K D Dieckhaus
- Division of Infectious Diseases, University of Connecticut Health Center, Farmington, USA
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Abstract
Patients with critical illnesses requiring aggressive medical intervention are at risk of acquiring serious nosocomial infection that may lead to increases in medical expenditures, morbidity, and mortality. Infection control in this population entails continuous surveillance for hospital-acquired infection, with investigation of outbreaks. Policies for effective antibiotic utilization, disinfection of medical devices and hospital environment, and patient isolation may limit nosocomial infection in this population. Finally, an effective infection control program should protect the health care worker from hospital-acquired infections through educational programs, routine health surveillance, vaccinations, and post-exposure care.
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Affiliation(s)
- K D Dieckhaus
- Infectious Disease Division, Hartford Hospital, Connecticut, USA
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