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Williams C, Skrip LA, Adams AS, Vermund SH. Examining County-Level Associations between Federally Qualified Health Centers and Sexually Transmitted Infections: A Political Ecology of Health Framework. Healthcare (Basel) 2024; 12:295. [PMID: 38338180 PMCID: PMC10855137 DOI: 10.3390/healthcare12030295] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
Federally Qualified Health Centers (FQHCs) are the largest providers of healthcare for sexually transmitted infections (STIs) in medically underserved communities in the United States (US). Through the Affordable Care Act (ACA), FQHCs have grown in number, but the impact of this growth on STIs is poorly understood. This ecological study seeks to quantify the association between FQHCs and STI prevalence in all US counties. Variables were described utilizing medians and interquartile ranges, and distributions were compared using Kruskal-Wallis tests. Median rates of chlamydia in counties with high, low, and no FQHCs were 370.3, 422.6, and 242.1 cases per 100,000 population, respectively. Gonorrhea rates were 101.9, 119.7, and 49.9 cases per 100,000 population, respectively. Multivariable linear regression models, adjusted for structural and place-based characteristics (i.e., Medicaid expansion, social vulnerability, metropolitan status, and region), were used to examine county-level associations between FQHCs and STIs. Compared to counties with no FQHCs, counties with a high number of FQHCs had chlamydia rates that were an average of 68.6 per 100,000 population higher (β = 68.6, 95% CI: 45.0, 92.3) and gonorrhea rates that were an average of 25.2 per 100,000 population higher (β = 25.2, 95% CI: 13.2, 37.2). When controlled for salient factors associated with STI risks, greater FQHC availability was associated with greater diagnosis and treatment of STIs. These findings provide empirical support for the utility of a political ecology of health framework and the critical role of FQHCs in confronting the STI epidemic in the US.
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Affiliation(s)
- Christopher Williams
- School of Natural and Social Sciences, State University of New York at Purchase College, Purchase, NY 10577, USA
| | - Laura A. Skrip
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia 1000-10, Liberia;
- Quantitative-Data for Decision-Making Lab, Monrovia 1000-10, Liberia
| | | | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT 06510, USA;
- School of Medicine, Yale University, New Haven, CT 06510, USA
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Williams C, Gray KL, Skrip LA, Whitfield DL. Editorial: Addressing the sexually transmitted infections epidemic in the United States: a sociomedical perspective. Front Public Health 2023; 11:1320080. [PMID: 38026387 PMCID: PMC10663358 DOI: 10.3389/fpubh.2023.1320080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Christopher Williams
- Department of Natural and Social Sciences, State University of New York at Purchase College, Purchase, NY, United States
| | - Keith L. Gray
- Ministry of Health, Monrovia, Liberia
- School of Public Health, University of Liberia, Monrovia, Liberia
| | - Laura A. Skrip
- School of Public Health, University of Liberia, Monrovia, Liberia
- Quantitative-Data for Decision Making Lab, University of Liberia, Monrovia, Liberia
| | - Darren L. Whitfield
- School of Social Work, University of Maryland Baltimore, Baltimore, MD, United States
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Noori N, Skrip LA, Oron AP, McCarthy KA, Proctor JL, Chabot-Couture G, Althouse BM, Phelan KPQ, Trehan I. Potential Impacts of Mass Nutritional Supplementation on Measles Dynamics: A Simulation Study. Am J Trop Med Hyg 2022; 107:863-872. [PMID: 36096407 DOI: 10.4269/ajtmh.21-1083] [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] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/10/2022] [Indexed: 11/07/2022] Open
Abstract
The bidirectional interaction between undernutrition and infection can be devastating to child health. Nutritional deficiencies impair immunity and increase susceptibility to infection. Simultaneously, infections compound undernutrition by increasing metabolic demand and impairing nutrient absorption. Treatment of acute malnutrition (wasting) can reverse some of its deleterious effects and reduce susceptibility to infectious diseases. Nutrition-specific approaches may be packaged with other interventions, including immunization, to support overall child health. To understand how mass nutritional supplementation, treatment of wasting, and vaccination affect the dynamics of a vaccine-preventable infection, we developed a population-level, compartmental model of measles transmission stratified by age and nutrition status. We simulated a range of scenarios to assess the potential reductions in measles infection and mortality associated with targeted therapeutic feeding for children who are wasted and with a mass supplementation intervention. Nutrition interventions were assumed to increase engagement with the health sector, leading to increased vaccination rates. We found that the combination of wasting treatment and mass supplementation coverage followed by an increase in vaccination coverage of nonwasted children from a baseline of 75% to 85%, leads to 34% to 57% and 65% to 77% reduction in measles infection and mortality and 56% to 60% reduction in overall mortality among wasted children, compared with the wasting treatment alone. Our work highlights the synergistic benefits that may be achieved by leveraging mass nutritional supplementation as a touch point with the health system to increase rates of vaccination and improve child survival beyond what would be expected from the additive benefits of each intervention.
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Affiliation(s)
- Navideh Noori
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Laura A Skrip
- School of Public Health, University of Liberia, Monrovia, Liberia
| | - Assaf P Oron
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Kevin A McCarthy
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Josh L Proctor
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Guillaume Chabot-Couture
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Benjamin M Althouse
- Information School, University of Washington, Seattle, Washington.,Department of Biology, New Mexico State University, Las Cruces, New Mexico
| | - Kevin P Q Phelan
- The Alliance for International Medical Action (ALIMA), Paris, France
| | - Indi Trehan
- Department of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington
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Sinnatwah JD, Kenneh H, Coker AA, Harmon-Gray WM, Zankah J, Day L, Hubbell E, Murphy MJ, Izzo M, Kong D, Sylwester P, Long Q, Bertozzi E, Skrip LA. Participatory Design and Process Testing to Optimize Utility, Usability, and Acceptability of a Mobile Game for Promoting Evidence-Driven Public Health Decision-Making in Resource-Constrained Settings. Front Digit Health 2022; 3:788557. [PMID: 35059686 PMCID: PMC8763845 DOI: 10.3389/fdgth.2021.788557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Innovative game-based training methods that leverage the ubiquity of cellphones and familiarity with phone-based interfaces have the potential to transform the training of public health practitioners in low-income countries such as Liberia. This article describes the design, development, and testing of a prototype of the Figure It Out mobile game. The prototype game uses a disease outbreak scenario to promote evidence-based decision-making in determining the causative agent and prescribing intervention measures to minimize epidemiological and logistical burdens in resource-limited settings. An initial prototype of the game developed by the US team was playtested and evaluated by focus groups with 20 University of Liberia Masters of Public Health (UL MPH) students. Results demonstrate that the learning objectives—improving search skills for identifying scientific evidence and considering evidence before decision-making during a public health emergency—were considered relevant and important in a setting that has repeatedly and recently experienced severe threats to public health. However, some of the game mechanics that were thought to enhance engagement such as trial-and-error and choose-your-own-path gameplay, were perceived by the target audience as distracting or too time-consuming, particularly in the context of a realistic emergency scenario. Gameplay metrics that mimicked real-world situations around lives lost, money spent, and time constraints during public health outbreaks were identified as relatable and necessary considerations. Our findings reflect cultural differences between the game development team and end users that have emphasized the need for end users to have an integral part of the design team; this formative evaluation has critically informed next steps in the iterative development process. Our multidisciplinary, cross-cultural and cross-national design team will be guided by Liberia-based public health students and faculty, as well as community members who represent our end user population in terms of experience and needs. These stakeholders will make key decisions regarding game objectives and mechanics, to be vetted and implemented by game design experts, epidemiologists, and software developers.
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Affiliation(s)
- James Douglas Sinnatwah
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Hajah Kenneh
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Alvan A. Coker
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Wahdae-Mai Harmon-Gray
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
- Ministry of Health, Monrovia, Liberia
| | - Joelyn Zankah
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
| | - Liam Day
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Emma Hubbell
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Michael J. Murphy
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
| | - Mandy Izzo
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - David Kong
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Peter Sylwester
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Qinghua Long
- Institute for Disease Modeling, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Elena Bertozzi
- Department of Game Design and Development, Quinnipiac University, Hamden, CT, United States
- *Correspondence: Elena Bertozzi
| | - Laura A. Skrip
- School of Public Health, College of Health Sciences, University of Liberia, Monrovia, Liberia
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Gray KL, Kiazolu M, Jones J, Konstantinova A, Zawolo JSW, Gray WMH, Walker NF, Garbo JT, Caldwell S, Odo M, Bhadelia N, DeMarco J, Skrip LA. Liberia adherence and loss-to-follow-up in HIV and AIDS care and treatment: A retrospective cohort of adolescents and adults from 2016-2019. PLOS Glob Public Health 2022; 2:e0000198. [PMID: 36962289 PMCID: PMC10021315 DOI: 10.1371/journal.pgph.0000198] [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: 08/13/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
Antiretroviral therapy (ART) is a lifesaving intervention for people living with HIV infection, reducing morbidity and mortality; it is likewise essential to reducing transmission. The "Treat all" strategy recommended by the World Health Organization has dramatically increased ART eligibility and improved access. However, retaining patients on ART has been a major challenge for many national programs in low- and middle-income settings, despite actionable local policies and ambitious targets. To estimate retention of patients along the HIV care cascade in Liberia, and identify factors associated with loss-to-follow-up (LTFU), death, and suboptimal treatment adherence, we conducted a nationwide retrospective cohort study utilizing facility and patient-level records. Patients aged ≥15 years, from 28 facilities who were first registered in HIV care from January 2016 -December 2017 were included. We used Cox proportional hazard models to explore associations between demographic and clinical factors and the outcomes of LTFU and death, and a multinomial logistic regression model to investigate factors associated with suboptimal treatment adherence. Among the 4185 records assessed, 27.4% (n = 1145) were males and the median age of the cohort was 37 (IQR: 30-45) years. At 24 months of follow-up, 41.8% (n = 1751) of patients were LTFU, 6.6% (n = 278) died, 0.5% (n = 21) stopped treatment, 3% (n = 127) transferred to another facility and 47.9% (n = 2008) were retained in care and treatment. The incidence of LTFU was 46.0 (95% CI: 40.8-51.6) per 100 person-years. Relative to patients at WHO clinical stage I at first treatment visit, patients at WHO clinical stage III [adjusted hazard ratio (aHR) 1.59, 95%CI: 1.21-2.09; p <0.001] or IV (aHR 2.41, 95%CI: 1.51-3.84; p <0.001) had increased risk of LTFU; whereas at registration, age category 35-44 (aHR 0.65, 95%CI: 0.44-0.98, p = 0.038) and 45 years and older (aHR 0.60, 95%CI: 0.39-0.93, p = 0.021) had a decreased risk. For death, patients assessed with WHO clinical stage II (aHR 2.35, 95%CI: 1.53-3.61, p<0.001), III (aHR 2.55, 95%CI: 1.75-3.71, p<0.001), and IV (aHR 4.21, 95%CI: 2.57-6.89, p<0.001) had an increased risk, while non-pregnant females (aHR 0.68, 95%CI: 0.51-0.92, p = 0.011) and pregnant females (aHR 0.42, 95%CI: 0.20-0.90, p = 0.026) had a decreased risk when compared to males. Suboptimal adherence was strongly associated with the experience of drug side effects-average adherence [adjusted odds ratio (aOR) 1.45, 95% CI: 1.06-1.99, p = 0.02) and poor adherence (aOR 1.75, 95%CI: 1.11-2.76, p = 0.016), and attending rural facility decreased the odds of average adherence (aOR 0.01, 95%CI: 0.01-0.03, p<0.001) and poor adherence (aOR 0.001, 95%CI: 0.0004-0.003, p<0.001). Loss-to-follow-up and poor adherence remain major challenges to achieving viral suppression targets in Liberia. Over two-fifths of patients engaged with the national HIV program are being lost to follow-up within 2 years of beginning care and treatment. WHO clinical stage III and IV were associated with LTFU while WHO clinical stage II, III and IV were associated with death. Suboptimal adherence was further associated with experience of drug side effects. Active support and close monitoring of patients who have signs of clinical progression and/or drug side effects could improve patient outcomes.
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Affiliation(s)
- Keith L Gray
- Health Services, Ministry of Health, Monrovia, Liberia
| | | | - Janjay Jones
- Health Services, Ministry of Health, Monrovia, Liberia
| | | | - Jethro S W Zawolo
- College of Health Sciences, University of Liberia, Monrovia, Liberia
| | | | - Naomi F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Julia T Garbo
- Health Services, Ministry of Health, Monrovia, Liberia
| | | | | | - Nahid Bhadelia
- Boston University, Massachusetts, United States of America
| | - Jean DeMarco
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Laura A Skrip
- College of Health Sciences, University of Liberia, Monrovia, Liberia
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Skrip LA, Fallah MP, Bedson J, Hébert-Dufresne L, Althouse BM. Coordinated support for local action: Modeling strategies to facilitate behavior adoption in urban-poor communities of Liberia for sustained COVID-19 suppression. Epidemics 2021; 37:100529. [PMID: 34871942 PMCID: PMC8641945 DOI: 10.1016/j.epidem.2021.100529] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 09/23/2021] [Accepted: 11/12/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Long-term suppression of SARS-CoV-2 transmission will involve strategies that recognize the heterogeneous capacity of communities to undertake public health recommendations. We highlight the epidemiological impact of barriers to adoption and the potential role of community-led coordination of support for cases and high-risk contacts in urban slums. METHODS A compartmental model representing transmission of SARS-CoV-2 in urban poor versus less socioeconomically vulnerable subpopulations was developed for Montserrado County, Liberia. Adoption of home-isolation behavior was assumed to be related to the proportion of each subpopulation residing in housing units with multiple rooms and with access to sanitation, water, and food. We evaluated the potential impact of increasing the maximum attainable proportion of adoption among urban poor following the scheduled lifting of the state of emergency. RESULTS Without intervention, the model estimated higher overall infection burden but fewer severe cases among urban poor versus the less socioeconomically vulnerable population. With self-isolation by mildly symptomatic individuals, median reductions in cumulative infections, severe cases, and maximum daily incidence were 7.6% (IQR: 2.2%-20.9%), 7.0% (2.0%-18.5%), and 9.9% (2.5%-31.4%), respectively, in the urban poor subpopulation and 16.8% (5.5%-29.3%), 15.0% (5.0%-26.4%), and 28.1% (9.3%-47.8%) in the less socioeconomically vulnerable population. An increase in the maximum attainable percentage of behavior adoption by the urban slum subpopulation was associated with median reductions of 19.2% (10.1%-34.0%), 21.1% (13.3%-34.2%), and 26.0% (11.5%-48.9%) relative to the status quo scenario. CONCLUSIONS Post-lockdown recommendations that prioritize home-isolation by confirmed cases are limited by resource constraints. Investing in community-based initiatives that coordinate support for self-identified cases and their contacts could more effectively suppress COVID-19 in settings with socioeconomic vulnerabilities.
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Affiliation(s)
- Laura A Skrip
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Laurent Hébert-Dufresne
- Vermont Complex Systems Center, University of Vermont, Burlington, VT, USA; Department of Computer Science, University of Vermont, Burlington, VT, USA
| | - Benjamin M Althouse
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA; University of Washington, Seattle, WA, USA; New Mexico State University, Las Cruces, NM, USA.
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Gray KL, Walker NF, Martineau F, Bhadelia N, Harmon-Gray WM, Skrip LA, DeMarco J, Konwloh P, Dunbar N. Interruption of tuberculosis detection and care during the Ebola virus disease epidemic (2014-2015) in Liberia: time-series analyses for 2013-2017. Int J Infect Dis 2021; 112:13-20. [PMID: 34433096 DOI: 10.1016/j.ijid.2021.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Interrupted time-series analyses, using 5 years of routinely collected health information system data, were conducted to estimate the magnitude of impact of the 2014-2015 Ebola virus disease (EVD) epidemic and determine trends in tuberculosis (TB) care services in Liberia. METHODS A segmented linear regression model was used to generate estimates and predictions for trends for three TB service indicators before, during, and after EVD, from January 2013 to December 2017. RESULTS It was found that the number of presumptive TB cases declined significantly at the start of the EVD outbreak, with an estimated loss of 3222 cases (95% confidence interval (CI) -5691 to -752; P = 0.014). There was also an estimated loss of 709 cases per quarter post-EVD (95% CI -1346 to -71; P = 0.032). However, over the post-EVD period, quarterly increases were observed in the proportion of smear-positive to presumptive cases (1.45%, 95% CI 0.38% to 2.5%; P = 0.011) and the proportion of treatment success to TB cases evaluated (3.3%, 95% CI 0.82% to 5.79%; P = 0.013). CONCLUSIONS These findings suggest that the EVD outbreak (2014-2015) negatively affected TB care services. Rigorous quantitative analyses can be used to assess the magnitude of interruption and advocate for preparedness in settings with limited healthcare capacity.
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Affiliation(s)
| | | | | | | | | | | | - Jean DeMarco
- University of North Carolina, Chapel Hill, North Carolina, USA
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Skrip LA, Selvaraj P, Hagedorn B, Ouédraogo AL, Noori N, Orcutt A, Mistry D, Bedson J, Hébert-Dufresne L, Scarpino SV, Althouse BM. Seeding COVID-19 across Sub-Saharan Africa: An Analysis of Reported Importation Events across 49 Countries. Am J Trop Med Hyg 2021; 104:1694-1702. [PMID: 33684067 PMCID: PMC8103462 DOI: 10.4269/ajtmh.20-1502] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
The first case of COVID-19 in sub-Saharan Africa (SSA) was reported by Nigeria on February 27, 2020. Whereas case counts in the entire region remain considerably less than those being reported by individual countries in Europe, Asia, and the Americas, variation in preparedness and response capacity as well as in data availability has raised concerns about undetected transmission events in the SSA region. To capture epidemiological details related to early transmission events into and within countries, a line list was developed from publicly available data on institutional websites, situation reports, press releases, and social media accounts. The availability of indicators-gender, age, travel history, date of arrival in country, reporting date of confirmation, and how detected-for each imported case was assessed. We evaluated the relationship between the time to first reported importation and the Global Health Security Index (GHSI) overall score; 13,201 confirmed cases of COVID-19 were reported by 48 countries in SSA during the 54 days following the first known introduction to the region. Of the 2,516 cases for which travel history information was publicly available, 1,129 (44.9%) were considered importation events. Imported cases tended to be male (65.0%), with a median age of 41.0 years (range: 6 weeks-88 years; IQR: 31-54 years). A country's time to report its first importation was not related to the GHSI overall score, after controlling for air traffic. Countries in SSA generally reported with less publicly available detail over time and tended to have greater information on imported than local cases.
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Affiliation(s)
- Laura A. Skrip
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Prashanth Selvaraj
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Brittany Hagedorn
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Andre Lin Ouédraogo
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Navideh Noori
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Amanda Orcutt
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Dina Mistry
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Jamie Bedson
- Consultant to the Bill & Melinda Gates Foundation, Seattle, Washington
| | - Laurent Hébert-Dufresne
- Department of Computer Science, Vermont Complex Systems Center, University of Vermont, Burlington, Vermont;,Department of Computer Science, University of Vermont, Burlington, Vermont
| | - Samuel V. Scarpino
- Network Science Institute, Northeastern University, Boston, Massachusetts;,Department of Marine and Environmental Sciences, Northeastern University, Boston, Massachusetts;,Department of Physics, Northeastern University, Boston, Massachusetts;,Department of Health Sciences, Northeastern University, Boston, Massachusetts;,ISI Foundation, Turin, Italy
| | - Benjamin M. Althouse
- Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington;,University of Washington, Seattle, Washington;,New Mexico State University, Las Cruces, New Mexico,Address correspondence to Benjamin M. Althouse, Institute for Disease Modeling, Global Health Division Bill & Melinda Gates Foundation, 500 5th Ave. N, Seattle, WA 98109. E-mail:
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Skrip LA, Dermauw V, Dorny P, Ganaba R, Millogo A, Tarnagda Z, Carabin H. Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa. PLoS Negl Trop Dis 2021; 15:e0009234. [PMID: 33755677 PMCID: PMC8018642 DOI: 10.1371/journal.pntd.0009234] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/02/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
Background The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso. Methodology/Principal findings Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces. Conclusions/Significance Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis. It is important to consider context-specific behaviors and transmission pathways when designing scalable and sustainable intervention strategies for neglected tropical diseases (NTDs). To reduce the morbidity and mortality associated with cysticercosis, suites of interventions have been recommended but are inconsistently implemented due to cost and feasibility-related constraints. This study investigated the potential of a cooking intervention to interrupt transmission via undercooked pork in marketplaces of Burkina Faso. The sensitivity of Taenia solium parasite to temperatures attainable via improved cooking strategies provides a low-cost, human-centered approach to prevent consumption of infected pork meals. By accounting for differential behavior and the relative role of this transmission route across three provinces, we show how the potential of cysticercosis elimination (as a public health problem) varies across behavior-focused interventions. Further investigation into intervention strategies against human and pig cysticercosis warrants data-driven analyses that account for local variation in transmission behaviors.
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Affiliation(s)
| | - Veronique Dermauw
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Pierre Dorny
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Athanase Millogo
- Department of Medicine, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Zékiba Tarnagda
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo Dioulasso, Burkina Faso
| | - Hélène Carabin
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, St-Hyacinthe, Québec, Canada
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche en Santé Publique (CReSP), Montréal, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique, St-Hyacinthe, Québec, Canada
- * E-mail:
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Skrip LA, Bedson J, Abramowitz S, Jalloh MB, Bah S, Jalloh MF, Langle-Chimal OD, Cheney N, Hébert-Dufresne L, Althouse BM. Unmet needs and behaviour during the Ebola response in Sierra Leone: a retrospective, mixed-methods analysis of community feedback from the Social Mobilization Action Consortium. Lancet Planet Health 2020; 4:e74-e85. [PMID: 32112750 PMCID: PMC8180180 DOI: 10.1016/s2542-5196(20)30008-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND The west African Ebola epidemic (2014-15) necessitated behaviour change in settings with prevalent and pre-existing unmet needs as well as extensive mechanisms for local community action. We aimed to assess spatial and temporal trends in community-reported needs and associations with behaviour change, community engagement, and the overall outbreak situation in Sierra Leone. METHODS We did a retrospective, mixed-methods study. Post-hoc analyses of data from 12 096 mobiliser visits as part of the Social Mobilization Action Consortium were used to describe the evolution of satisfied and unsatisfied needs (basic, security, autonomy, respect, and social support) between Nov 12, 2014, and Dec 18, 2015, and across 14 districts. Via Bayesian hierarchical regression modelling, we investigated associations between needs categories and behaviours (numbers of individuals referred to treatment within 24 h of symptom onset or deaths responded to with safe and dignified burials) and the role of community engagement programme status (initial vs follow-up visit) in the association between satisfied versus unsatisfied needs and behaviours. FINDINGS In general, significant associations were observed between unsatisfied needs categories and both prompt referrals to treatment and safe burials. Most notably, communities expressing unsatisfied capacity needs reported fewer safe burials (relative risk [RR] 0·86, 95% credible interval [CrI] 0·82-0·91) and fewer prompt referrals to treatment (RR 0·76, 0·70-0·83) than did those without unsatisfied capacity needs. The exception was expression of unsatisfied basic needs, which was associated with significantly fewer prompt referrals only (RR 0·86, 95% CrI 0·79-0·93). Compared with triggering visits by community mobilisers, follow-up visits were associated with higher numbers of prompt referrals (RR 1·40, 95% CrI 1·30-1·50) and safe burials (RR 1·08, 1·02-1·14). INTERPRETATION Community-based development of locally feasible, locally owned action plans, with the support of community mobilisers, has potential to address unmet needs for more sustained behaviour change in outbreak settings. FUNDING Bill & Melinda Gates, Bill & Melinda Gates Foundation, and National Institutes of Health.
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Affiliation(s)
- Laura A Skrip
- Institute for Disease Modeling, Bellevue, Seattle, WA, USA
| | - Jamie Bedson
- Restless Development Sierra Leone, Freetown, Sierra Leone; Consultant to the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | | | - Saiku Bah
- Restless Development Sierra Leone, Freetown, Sierra Leone
| | | | - Ollin Demian Langle-Chimal
- Vermont Complex Systems Center, Department of Computer Science, University of Vermont, Burlington, VT, USA
| | - Nicholas Cheney
- Vermont Complex Systems Center, Department of Computer Science, University of Vermont, Burlington, VT, USA
| | - Laurent Hébert-Dufresne
- Vermont Complex Systems Center, Department of Computer Science, University of Vermont, Burlington, VT, USA; Département de Physique, de Génie Physique, et d'Optique, Université Laval, Québec City, QC, Canada
| | - Benjamin M Althouse
- Institute for Disease Modeling, Bellevue, Seattle, WA, USA; Information School, University of Washington, Seattle, WA, USA; Department of Biology, New Mexico State University, Las Cruces, NM, USA.
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11
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Parpia AS, Skrip LA, Nsoesie EO, Ngwa MC, Abah Abah AS, Galvani AP, Ndeffo-Mbah ML. Spatio-temporal dynamics of measles outbreaks in Cameroon. Ann Epidemiol 2019; 42:64-72.e3. [PMID: 31902625 DOI: 10.1016/j.annepidem.2019.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE In 2012, Cameroon experienced a large measles outbreak of over 14,000 cases. To determine the spatio-temporal dynamics of measles transmission in Cameroon, we analyzed weekly case data collected by the Ministry of Health. METHODS We compared several multivariate time-series models of population movement to characterize the spatial spread of measles in Cameroon. Using the best model, we evaluated the contribution of population mobility to disease transmission at increasing geographic resolutions: region, department, and health district. RESULTS Our spatio-temporal analysis showed that the power law model, which accounts for long-distance population movement, best represents the spatial spread of measles in Cameroon. Population movement between health districts within departments contributed to 7.6% (range: 0.4%-13.4%) of cases at the district level, whereas movement between departments within regions contributed to 16.0% (range: 1.3%-23.2%) of cases. Long-distance movement between regions contributed to 16.7% (range: 0.1%-59.0%) of cases at the region level, 20.1% (range: 7.1%-30.0%) at the department level, and 29.7% (range: 15.3%-47.6%) at the health district level. CONCLUSIONS Population long-distance mobility is an important driver of measles dynamics in Cameroon. These findings demonstrate the need to improve our understanding of the roles of population mobility and local heterogeneity of vaccination coverage in the spread and control of measles in Cameroon.
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Affiliation(s)
- Alyssa S Parpia
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | | | - Elaine O Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Moise C Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, MD
| | - Aristide S Abah Abah
- Department of Epidemiological Surveillance, Ministry of Health, Yaoundé, Cameroon
| | - Alison P Galvani
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Martial L Ndeffo-Mbah
- Department of Veterinary and Integrative Biosciences, Texas A&M College of Veterinary Medicine and Biomedical Sciences, College Station, TX; Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, TX.
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Affiliation(s)
- Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia 1000-10, Liberia; Harvard T H Chan School of Public Health, Boston, MA, USA; National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia.
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13
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Ndeffo-Mbah ML, Vigliotti VS, Skrip LA, Dolan K, Galvani AP. Dynamic Models of Infectious Disease Transmission in Prisons and the General Population. Epidemiol Rev 2018; 40:40-57. [PMID: 29566137 DOI: 10.1093/epirev/mxx014] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
Incarcerated populations experience elevated burdens of infectious diseases, which are exacerbated by limited access to prevention measures. Dynamic models are used to assess the spread and control of diseases within correctional facilities and repercussions on the general population. Our systematic review of dynamic models of infectious diseases within correctional settings identified 34 studies published between 1996 and 2017. Of these, 23 focused on disease dynamics and intervention in prison without accounting for subsequent spread to the community. The main diseases modeled in these studies were human immunodeficiency virus (HIV; n = 14, 41%), tuberculosis (TB; n = 10, 29%), and hepatitis C virus (HCV; n = 7, 21%). Models were fitted to epidemiologic data in 14 studies; uncertainty and sensitivity analyses were conducted in 8, and validation of model projection against empirical data was done in 1 study. According to the models, prison-based screening and treatment may be highly effective strategies for reducing the burden of HIV, TB, HCV, and other sexually transmissible infections among prisoners and the general community. Decreasing incarceration rates were projected to reduce HIV and HCV infections among people who inject drugs and TB infections among all prisoners. Limitations of the modeling studies and opportunities for using dynamic models to develop quantitative evidence for informing prison infection control measures are discussed.
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Affiliation(s)
- Martial L Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology and Microbial Disease, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Vivian S Vigliotti
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology and Microbial Disease, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology and Microbial Disease, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology and Microbial Disease, Yale School of Public Health, Yale University, New Haven, Connecticut
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Ondeck NT, Fu MC, Skrip LA, McLynn RP, Cui JJ, Basques BA, Albert TJ, Grauer JN. Missing data treatments matter: an analysis of multiple imputation for anterior cervical discectomy and fusion procedures. Spine J 2018; 18:2009-2017. [PMID: 29649614 DOI: 10.1016/j.spinee.2018.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The presence of missing data is a limitation of large datasets, including the National Surgical Quality Improvement Program (NSQIP). In addressing this issue, most studies use complete case analysis, which excludes cases with missing data, thus potentially introducing selection bias. Multiple imputation, a statistically rigorous approach that approximates missing data and preserves sample size, may be an improvement over complete case analysis. PURPOSE The present study aims to evaluate the impact of using multiple imputation in comparison with complete case analysis for assessing the associations between preoperative laboratory values and adverse outcomes following anterior cervical discectomy and fusion (ACDF) procedures. STUDY DESIGN/SETTING This is a retrospective review of prospectively collected data. PATIENT SAMPLE Patients undergoing one-level ACDF were identified in NSQIP 2012-2015. OUTCOME MEASURES Perioperative adverse outcome variables assessed included the occurrence of any adverse event, severe adverse events, and hospital readmission. METHODS Missing preoperative albumin and hematocrit values were handled using complete case analysis and multiple imputation. These preoperative laboratory levels were then tested for associations with 30-day postoperative outcomes using logistic regression. RESULTS A total of 11,999 patients were included. Of this cohort, 63.5% of patients had missing preoperative albumin and 9.9% had missing preoperative hematocrit. When using complete case analysis, only 4,311 patients were studied. The removed patients were significantly younger, healthier, of a common body mass index, and male. Logistic regression analysis failed to identify either preoperative hypoalbuminemia or preoperative anemia as significantly associated with adverse outcomes. When employing multiple imputation, all 11,999 patients were included. Preoperative hypoalbuminemia was significantly associated with the occurrence of any adverse event and severe adverse events. Preoperative anemia was significantly associated with the occurrence of any adverse event, severe adverse events, and hospital readmission. CONCLUSIONS Multiple imputation is a rigorous statistical procedure that is being increasingly used to address missing values in large datasets. Using this technique for ACDF avoided the loss of cases that may have affected the representativeness and power of the study and led to different results than complete case analysis. Multiple imputation should be considered for future spine studies.
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Affiliation(s)
- Nathaniel T Ondeck
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Ryan P McLynn
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA
| | - Jonathan J Cui
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W, Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Todd J Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT 06510, USA.
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Affiliation(s)
- Mosoka P Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia; Harvard TH Chan School of Public Health, Boston, MA, USA; National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, 1000 Monrovia 10, Liberia.
| | - Laura A Skrip
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Jonathan Enders
- National Public Health Institute of Liberia, Monrovia, Liberia
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16
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Fallah MP, Skrip LA, Dahn BT, Nyenswah TG, Flumo H, Glayweon M, Lorseh TL, Kaler SG, Higgs ES, Galvani AP. Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. Lancet Glob Health 2018; 4:e678-9. [PMID: 27633422 DOI: 10.1016/s2214-109x(16)30147-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mosoka P Fallah
- Ministry of Health, Monrovia, Liberia; A M Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia; US National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | | | | | - Hilary Flumo
- US National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia
| | | | | | - Stephen G Kaler
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth S Higgs
- National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Alison P Galvani
- A M Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA.
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Skrip LA, Fallah MP, Gaffney SG, Yaari R, Yamin D, Huppert A, Bawo L, Nyenswah T, Galvani AP. Characterizing risk of Ebola transmission based on frequency and type of case-contact exposures. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160301. [PMID: 28396472 PMCID: PMC5394639 DOI: 10.1098/rstb.2016.0301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Accepted: 01/14/2017] [Indexed: 11/12/2022] Open
Abstract
During the initial months of the 2013-2016 Ebola epidemic, rapid geographical dissemination and intense transmission challenged response efforts across West Africa. Contextual behaviours associated with increased risk of exposure included travel to high-transmission settings, caring for sick and preparing the deceased for traditional funerals. Although such behaviours are widespread in West Africa, high-transmission pockets were observed. Superspreading and clustering are typical phenomena in infectious disease outbreaks, as a relatively small number of transmission chains are often responsible for the majority of events. Determining the characteristics of contacts at greatest risk of developing disease and of cases with greatest transmission potential could therefore help curb propagation of infection. Our analysis of contact tracing data from Montserrado County, Liberia, suggested that the probability of transmission was 4.5 times higher for individuals who were reported as having contact with multiple cases. The probability of individuals developing disease was not significantly associated with age or sex of their source case but was higher when they were in the same household as the infectious case. Surveillance efforts for rapidly identifying symptomatic individuals and effectively messaged campaigns encouraging household members to bring the sick to designated treatment centres without administration of home care could mitigate transmission.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Mosoka P Fallah
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
- National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, JFK Hospital, Tubman Blvd, Monrovia, Liberia
| | - Stephen G Gaffney
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Rami Yaari
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Huppert
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
- Department of Epidemiology and Preventive Medicine, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luke Bawo
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
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Fallah MP, Skrip LA, Raftery P, Kullie M, Borbor W, Laney AS, Blackley DJ, Christie A, Dokubo EK, Lo TQ, Coulter S, Baller A, Vonhm BT, Bemah P, Lomax S, Yeiah A, Wapoe-Sackie Y, Mann J, Clement P, Davies-Wayne G, Hamblion E, Wolfe C, Williams D, Gasasira A, Kateh F, Nyenswah TG, Galvani AP. Bolstering Community Cooperation in Ebola Resurgence Protocols: Combining Field Blood Draw and Point-of-Care Diagnosis. PLoS Med 2017; 14:e1002227. [PMID: 28118353 PMCID: PMC5261562 DOI: 10.1371/journal.pmed.1002227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment.
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Affiliation(s)
- Mosoka P. Fallah
- Ministry of Health, Monrovia, Liberia
- Community-Based Initiative, United Nations Development Programme, Ministry of Health, Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
- National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia
| | - Laura A. Skrip
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | | | | | - A. Scott Laney
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | | | | | | | - Terrence Q. Lo
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Stewart Coulter
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | | | | | | | | | | | | | - Jennifer Mann
- Centers for Disease Control and Prevention, Monrovia, Liberia
| | | | | | | | | | | | | | | | | | - Alison P. Galvani
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
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Affiliation(s)
- Laura A. Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
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Durham DP, Ndeffo-Mbah ML, Skrip LA, Jones FK, Bauch CT, Galvani AP. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. Proc Natl Acad Sci U S A 2016; 113:5107-12. [PMID: 27091978 PMCID: PMC4983834 DOI: 10.1073/pnas.1515528113] [Citation(s) in RCA: 40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.
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Affiliation(s)
- David P Durham
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511;
| | - Martial L Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Forrest K Jones
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
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Fallah M, Dahn B, Nyenswah TG, Massaquoi M, Skrip LA, Yamin D, Mbah MN, Joe N, Freeman S, Harris T, Benson Z, Galvani AP. Interrupting Ebola Transmission in Liberia Through Community-Based Initiatives. Ann Intern Med 2016; 164:367-9. [PMID: 26746879 DOI: 10.7326/m15-1464] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
BACKGROUND Poverty has been implicated as a challenge in the control of the current Ebola outbreak in West Africa. Although disparities between affected countries have been appreciated, disparities within West African countries have not been investigated as drivers of Ebola transmission. To quantify the role that poverty plays in the transmission of Ebola, we analyzed heterogeneity of Ebola incidence and transmission factors among over 300 communities, categorized by socioeconomic status (SES), within Montserrado County, Liberia. METHODOLOGY/PRINCIPAL FINDINGS We evaluated 4,437 Ebola cases reported between February 28, 2014 and December 1, 2014 for Montserrado County to determine SES-stratified temporal trends and drivers of Ebola transmission. A dataset including dates of symptom onset, hospitalization, and death, and specified community of residence was used to stratify cases into high, middle and low SES. Additionally, information about 9,129 contacts was provided for a subset of 1,585 traced individuals. To evaluate transmission within and across socioeconomic subpopulations, as well as over the trajectory of the outbreak, we analyzed these data with a time-dependent stochastic model. Cases in the most impoverished communities reported three more contacts on average than cases in high SES communities (p<0.001). Our transmission model shows that infected individuals from middle and low SES communities were associated with 1.5 (95% CI: 1.4-1.6) and 3.5 (95% CI: 3.1-3.9) times as many secondary cases as those from high SES communities, respectively. Furthermore, most of the spread of Ebola across Montserrado County originated from areas of lower SES. CONCLUSIONS/SIGNIFICANCE Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions. Thus, Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding was dedicated to development projects that meet basic needs.
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Affiliation(s)
- Mosoka P. Fallah
- Community-Based Initiative, Ministry of Health, Monrovia, Liberia
- National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Laura A. Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Shai Gertler
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Dan Yamin
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Alison P. Galvani
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
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Durham DP, Skrip LA, Bruce RD, Vilarinho S, Elbasha EH, Galvani AP, Townsend JP. The Impact of Enhanced Screening and Treatment on Hepatitis C in the United States. Clin Infect Dis 2015; 62:298-304. [PMID: 26628566 DOI: 10.1093/cid/civ894] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/03/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The effectiveness of interferon-free direct-acting antivirals (DAA) in treating chronic hepatitis C virus (HCV) is limited by low screening and treatment rates, particularly among people who inject drugs (PWIDs). METHODS To evaluate the levels of screening and treatment with interferon-free DAAs that are required to control HCV incidence and HCV-associated morbidity and mortality, we developed a transmission model, stratified by age and by injection drug use, and calibrated it to epidemiological data in the United States from 1992 to 2014. We quantified the impact of administration of DAAs at current and at enhanced screening and treatment rates, focusing on outcomes of HCV incidence, prevalence, compensated and decompensated cirrhosis, hepatocellular carcinoma, liver transplants, and mortality from 2015 to 2040. RESULTS Increasing annual treatment of patients 4-fold-from the approximately 100 000 treated historically to 400 000-is predicted to prevent 526 084 (95% confidence interval, 466 615-593 347) cases of cirrhosis and 256 315 (201 589-316 114) HCV-associated deaths. By simultaneously increasing treatment capacity and increasing the number of HCV infections diagnosed, total HCV prevalence could fall to as low as 305 599 (222 955-422 110) infections by 2040. Complete elimination of HCV transmission in the United States through treatment with DAAs would require nearly universal screening of PWIDs, with an annual treatment rate of at least 30%. CONCLUSIONS Interferon-free DAAs are projected to achieve marked reductions in HCV-associated morbidity and mortality. Aggressive expansion in HCV screening and treatment, particularly among PWIDs, would be required to eliminate HCV in the United States.
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Affiliation(s)
- David P Durham
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Robert Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center.,Department of Medicine
| | - Silvia Vilarinho
- Departments of Genetics and Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health.,Program in Computational Biology and Bioinformatics, Yale University
| | - Jeffrey P Townsend
- Program in Computational Biology and Bioinformatics, Yale University.,Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Affiliation(s)
- Mosoka Fallah
- Ministry of Health and Social Welfare, 1000 Monrovia 10, Liberia; University of Liberia, Monrovia, Liberia.
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | | | - Alison P Galvani
- University of Liberia, Monrovia, Liberia; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
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25
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Yamin D, Gertler S, Ndeffo-Mbah ML, Skrip LA, Fallah M, Nyenswah TG, Altice FL, Galvani AP. Effect of Ebola progression on transmission and control in Liberia. Ann Intern Med 2015; 162:11-7. [PMID: 25347321 PMCID: PMC4402942 DOI: 10.7326/m14-2255] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Ebola outbreak that is sweeping across West Africa is the largest, most volatile, and deadliest Ebola epidemic ever recorded. Liberia is the most profoundly affected country, with more than 3500 infections and 2000 deaths recorded in the past 3 months. OBJECTIVE To evaluate the contribution of disease progression and case fatality on transmission and to examine the potential for targeted interventions to eliminate the disease. DESIGN Stochastic transmission model that integrates epidemiologic and clinical data on incidence and case fatality, daily viral load among survivors and nonsurvivors evaluated on the basis of the 2000-2001 outbreak in Uganda, and primary data on contacts of patients with Ebola in Liberia. SETTING Montserrado County, Liberia, July to September 2014. MEASUREMENTS Ebola incidence and case-fatality records from 2014 Liberian Ministry of Health and Social Welfare. RESULTS The average number of secondary infections generated throughout the entire infectious period of a single infected case, R, was estimated as 1.73 (95% CI, 1.66 to 1.83). There was substantial stratification between survivors (RSurvivors), for whom the estimate was 0.66 (CI, 0.10 to 1.69), and nonsurvivors (RNonsurvivors), for whom the estimate was 2.36 (CI, 1.72 to 2.80). The nonsurvivors had the highest risk for transmitting the virus later in the course of disease progression. Consequently, the isolation of 75% of infected individuals in critical condition within 4 days from symptom onset has a high chance of eliminating the disease. LIMITATION Projections are based on the initial dynamics of the epidemic, which may change as the outbreak and interventions evolve. CONCLUSION These results underscore the importance of isolating the most severely ill patients with Ebola within the first few days of their symptomatic phase. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Dan Yamin
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Shai Gertler
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Martial L. Ndeffo-Mbah
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Laura A. Skrip
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Mosoka Fallah
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Tolbert G. Nyenswah
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Frederick L. Altice
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Alison P. Galvani
- From Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, and Ministry of Health and Social Welfare, Monrovia, Liberia
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