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Palich R, Rodger AJ, Nicholls EJ, Wright T, Samba P, Chu IYH, Burns FM, Weatherburn P, Trevelion R, McCabe L, Witzel TC. Experiences with health care services and HIV testing after sexual assault in cisgender gay, bisexual and other men who have sex with men and transgender people. HIV Med 2024. [PMID: 38433523 DOI: 10.1111/hiv.13629] [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: 03/23/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This qualitative sub-study aimed to explore how cisgender gay, bisexual, and other men who have sex with men (cis-GBMSM) and transgender people who reported non-consensual sex (NCS) accessed health care services, what barriers they faced, and how this experience influenced subsequent HIV testing. METHODS SELPHI is an online randomized controlled trial evaluating both acceptability and efficiency of HIV-self testing among cis-GBMSM and transgender people. Semi-structured interviews were conducted, audio-recorded, transcribed, and analysed through a framework analysis, as a qualitative sub-study. We identified narratives of NCS from interviews and investigated experiences of cis-GBMSM and transgender people accessing health care services following sexual assault. RESULTS Of 95 participants, 15 (16%) spontaneously reported NCS. Participants reported a broad range of NCS, including partner's coercive behaviours, non-consensual removal of condoms, and rapes. All feared HIV transmission, leading them to test for HIV, underlining a marked lack of awareness of post-exposure prophylaxis (PEP). Most had negative experiences in communicating with reception staff in sexual health clinics following these incidents. A lack of confidentiality and empathy was described in these situations of psychological distress. Clinic visits were primarily focused on testing for HIV and sexually transmitted infection, and generally no specific psychological support was offered. Getting a negative HIV result was a key step in regaining control for people who experienced NCS. CONCLUSIONS Sexual health care providers should take care to more fully address the issue of NCS with cis-GBMSM and transgender people when it arises. Recognizing and managing the emotional impact of NCS on affected patients would prevent negative experiences and increase confidence in care.
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Affiliation(s)
- Romain Palich
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Alison J Rodger
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Emily Jay Nicholls
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Talen Wright
- University College London, Division of Psychiatry, London, UK
| | | | - Isaac Yen-Hao Chu
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | - Fiona M Burns
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
| | - Peter Weatherburn
- London School of Hygiene and Tropical Medicine, Department of Public Health, Environments and Society, London, UK
| | | | - Leanne McCabe
- University College London, MRC Clinical Trials Unit, London, UK
| | - T Charles Witzel
- University College London, Institute for Global Health, Royal Free Hospital, NHS, London, UK
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Flower B, Nguyen Thi Ngoc P, McCabe L, Le Ngoc C, Vo Thi T, Thi Kim HV, Dang Trong T, Rahman M, Thwaites G, Walker AS, Hung LM, Vinh Chau NV, Cooke GS, Day JN. Rise in alanine aminotransferase after HCV treatment is a highly sensitive screen for treatment failure. Clin Liver Dis (Hoboken) 2023; 21:138-142. [PMID: 37274950 PMCID: PMC10237684 DOI: 10.1097/cld.0000000000000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Nucleic acid testing to confirm sustained virological response (SVR) after HCV therapy is technical, often expensive, and frequently unavailable where disease prevalence is highest. Alternative surrogate biomarkers merit evaluation. In a short-treatment trial in Vietnam (SEARCH-1; n = 52) we analysed how changes in alanine transaminase (ΔALT) and aspartate transaminase (ΔAST), from end of treatment (EOT) to EOT + 12 weeks, related to SVR, defined as HCV RNA < lower limit of quantification 12 weeks after EOT. In a separate UK trial (STOPHCV1; n = 202), we then tested the hypothesis that any elevation in ALT or AST between EOT and EOT12 is a sensitive screen for treatment failure. In SEARCH-1, among 48 individuals with data, 13 failed to achieve SVR. Median ΔALT and ΔAST were negative in cured patients but elevated when treatment failed [median ΔALT (IQR): -2 IU/L (-6, +2)] versus +17 IU/L (+7.5, +38) (p< 0.001). Amongst treatment failures, 12/13 had increase in ALT and 13/13 had increase in AST after EOT, compared with 12/35 in those cured. In STOPHCV1, 196/202 patients had evaluable data, of which 57 did not achieve SVR. A rise in ALT after EOT was 100% sensitive (95% C.I. [93.7 - 100%]) and 51% specific (42.4 - 59.7%) for detecting treatment failure. ΔAST >0 IU/L was 98.1% (89.9 - 99.9%) sensitive and 35.8% (27.3 - 45.1%) specific. A rise in ALT or AST after HCV therapy is a highly sensitive screen for treatment failure in mild liver disease. This finding could reduce costs and complexity of managing HCV.
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Affiliation(s)
- Barnaby Flower
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Department of Infectious Disease, Imperial College London, London, UK
| | - Phuong Nguyen Thi Ngoc
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Leanne McCabe
- MRC Clinical Trials Unit at UCL, University College London, London, UK
| | - Chau Le Ngoc
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Thu Vo Thi
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Hang Vu Thi Kim
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Thuan Dang Trong
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Motiur Rahman
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Guy Thwaites
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Ann Sarah Walker
- MRC Clinical Trials Unit at UCL, University College London, London, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Le Manh Hung
- Department of Hepatology, Hospital for Tropical Diseases, Ho Chi Minh City
| | | | - Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jeremy N. Day
- Department of CNS Infection, HIV and Viral Hepatitis, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
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Dunn D, McCabe L, White E, Delpech V, Kirwan PD, Khawam J, Croxford S, Ward D, Brodnicki E, Rodger A, McCormack S. Electronic health records to capture primary outcome measures: two case studies in HIV prevention research. Trials 2023; 24:244. [PMID: 36997941 PMCID: PMC10063429 DOI: 10.1186/s13063-023-07264-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND There is increasing interest in the use of electronic health records (EHRs) to improve the efficiency and cost-effectiveness of clinical trials, including the capture of outcome measures. MAIN TEXT We describe our experience of using EHRs to capture the primary outcome measure - HIV infection or the diagnosis of HIV infection - in two randomised HIV prevention trials conducted in the UK. PROUD was a clinic-based trial evaluating pre-exposure prophylaxis (PrEP), and SELPHI was an internet-based trial evaluating HIV self-testing kits. The EHR was the national database of HIV diagnoses in the UK, curated by the UK Health Security Agency (UKHSA). In PROUD, linkage to the UKHSA database was performed at the end of the trial and identified five primary outcomes in addition to the 30 outcomes diagnosed by the participating clinics. Linkage also produced an additional 345 person-years follow-up, an increase of 27% over clinic-based follow-up. In SELPHI, new HIV diagnoses were primarily identified via UKHSA linkage, complemented by participant self-report through internet surveys. Rates of survey completion were low, and only 14 of the 33 new diagnoses recorded in the UKHSA database were also self-reported. Thus UKHSA linkage was essential for capturing HIV diagnoses and the successful conduct of the trial. CONCLUSIONS Our experience of using the UKHSA database of HIV diagnoses as a source of primary outcomes in two randomised trials in the field of HIV prevention was highly favourable and encourages the use of a similar approach in future trials in this disease area.
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Affiliation(s)
- David Dunn
- MRC Clinical Trials Unit at UCL, London, UK.
- Institute for Global Health, University College London, London, UK.
| | | | | | | | | | | | | | | | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
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Sy A, McCabe L, Hudson E, Ansari AM, Pedergnana V, Lin SK, Santana S, Fiorino M, Ala A, Stone B, Smith M, Nelson M, Barclay ST, McPherson S, Ryder SD, Collier J, Barnes E, Walker AS, Pett SL, Cooke G. Utility of a buccal swab point-of-care test for the IFNL4 genotype in the era of direct acting antivirals for hepatitis C virus. PLoS One 2023; 18:e0280551. [PMID: 36689413 PMCID: PMC9870125 DOI: 10.1371/journal.pone.0280551] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The CC genotype of the IFNL4 gene is known to be associated with increased Hepatitis C (HCV) cure rates with interferon-based therapy and may contribute to cure with direct acting antivirals. The Genedrive® IFNL4 is a CE marked Point of Care (PoC) molecular diagnostic test, designed for in vitro diagnostic use to provide rapid, real-time detection of IFNL4 genotype status for SNP rs12979860. METHODS 120 Participants were consented to a substudy comparing IFNL4 genotyping results from a buccal swab analysed on the Genedrive® platform with results generated using the Affymetix UK Biobank array considered to be the gold standard. RESULTS Buccal swabs were taken from 120 participants for PoC IFNL4 testing and a whole blood sample for genetic sequencing. Whole blood genotyping vs. buccal swab PoC testing identified 40 (33%), 65 (54%), and 15 (13%) had CC, CT and TT IFNL4 genotype respectively. The Buccal swab PoC identified 38 (32%) CC, 64 (53%) CT and 18 (15%) TT IFNL4 genotype respectively. The sensitivity and specificity of the buccal swab test to detect CC vs non-CC was 90% (95% CI 76-97%) and 98% (95% CI 91-100%) respectively. CONCLUSIONS The buccal swab test was better at correctly identifying non-CC genotypes than CC genotypes. The high specificity of the Genedrive® assay prevents CT/TT genotypes being mistaken for CC, and could avoid patients being identified as potentially 'good responders' to interferon-based therapy.
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Affiliation(s)
- Aminata Sy
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Leanne McCabe
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Emma Hudson
- Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - Azim M. Ansari
- Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | | | - Shang-Kuan Lin
- Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - S. Santana
- Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
| | - Marzia Fiorino
- Mortimer Market Centre, Central and NorthWest London NHS Foundation Trust, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Aftab Ala
- Clinical and Experimental Medicine, University of Surrey, Guilford, United Kingdom
| | - Ben Stone
- Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - M. Smith
- Hepatology, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Mark Nelson
- HIV Medicine, Chelsea & Westminster NHS Trust, London, United Kingdom
| | | | - Stuart McPherson
- Hepatology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen D. Ryder
- Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jane Collier
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Oxford, United Kingdom
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ann Sarah Walker
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Sarah L. Pett
- MRC Clinical Trials Unit, University College London, London, United Kingdom
- Mortimer Market Centre, Central and NorthWest London NHS Foundation Trust, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- NIHR Biomedical Research Centre, Imperial College NHS Trust, London, United Kingdom
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Rodger AJ, McCabe L, Phillips AN, Lampe FC, Burns F, Ward D, Delpech V, Weatherburn P, Witzel TC, Pebody R, Kirwan P, Gabriel M, Khawam J, Brady M, Fenton KA, Trevelion R, Collaco-Moraes Y, McCormack S, Dunn D. Free HIV self-test for identification and linkage to care of previously undetected HIV infection in men who have sex with men in England and Wales (SELPHI): an open-label, internet-based, randomised controlled trial. Lancet HIV 2022; 9:e838-e847. [PMID: 36460023 DOI: 10.1016/s2352-3018(22)00266-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND High levels of HIV testing in men who have sex with men remain key to reducing the incidence of HIV. We aimed to assess whether the offer of a single, free HIV self-testing kit led to increased HIV diagnoses with linkage to care. METHODS SELPHI was an internet-based, open-label, randomised controlled trial that recruited participants via sexual and social networking sites. Eligibility criteria included being a man or trans woman (although trans women are reported separately); being resident in England or Wales, UK; being aged 16 years or older; having had anal intercourse with a man; not having a positive HIV diagnosis; and being willing to provide name, email address, date of birth, and consent to link to national HIV databases. Participants were randomly allocated (3:2) by computer-generated number sequence to receive a free HIV self-test kit (BT group) or to not receive this free kit (nBT group). Online surveys collected data at baseline, 2 weeks after enrolment (BT group only), 3 months after enrolment, and at the end of the study. The primary outcome was confirmed (linked to care) new HIV diagnosis within 3 months of enrolment, analysed by intention to treat. Those assessing the primary outcome were masked to allocation. This study is registered with the ISRCTN Clinical Trials Register, number ISRCTN20312003. FINDINGS 10 111 participants (6049 in BT group and 4062 in nBT group) enrolled between Feb 16, 2017, and March 1, 2018. The median age of participants was 33 years (IQR 26-44 years); 9000 (89%) participants were White; 8118 (80%) participants were born in the UK; 81 (1%) participants were transgender men; 4706 (47%) participants were university educated; 1537 (15%) participants had never been tested for HIV; and 389 (4%) participants were taking pre-exposure prophylaxis. At enrolment, 7282 (72%) participants reported condomless anal sex with at least one male partner in the previous 3 months. In the BT group, of the 4511 participants for whom HIV testing information was available, 4263 (95%) reported having used the free HIV self-test kit within 3 months.Within 3 months of enrolment there were 19 confirmed new HIV diagnoses (0·31%) in 6049 participants in the BT group and 15 (0·37%) of 4062 in the nBT group (p=0·64). INTERPRETATION The offer of a single, free HIV self-test did not lead to increased rates of new HIV diagnoses, which could reflect decreasing HIV incidence rates in the UK. Nonetheless, the offer of a free HIV self-testing kit resulted in high HIV testing rates, indicating that self-testing is an attractive testing option for a large group of men who have sex with men. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Alison J Rodger
- Institute for Global Health, University College London, London, UK.
| | - Leanne McCabe
- UK MRC Clinical Trials Unit, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Denise Ward
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - Valerie Delpech
- National Infection Service, UK Health Security Agency, London, UK
| | - Peter Weatherburn
- Department of Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - T Charles Witzel
- Institute for Global Health, University College London, London, UK
| | | | - Peter Kirwan
- National Infection Service, UK Health Security Agency, London, UK
| | - Michelle Gabriel
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - Jameel Khawam
- National Infection Service, UK Health Security Agency, London, UK
| | - Michael Brady
- Department of Sexual Health and HIV, King's College Hospital, London, UK
| | | | | | | | - Sheena McCormack
- UK MRC Clinical Trials Unit, University College London, London, UK
| | - David Dunn
- UK MRC Clinical Trials Unit, University College London, London, UK
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White IR, Choodari-Oskooei B, Sydes MR, Kahan BC, McCabe L, Turkova A, Esmail H, Gibb DM, Ford D. Combining factorial and multi-arm multi-stage platform designs to evaluate multiple interventions efficiently. Clin Trials 2022; 19:432-441. [PMID: 35579066 PMCID: PMC9373200 DOI: 10.1177/17407745221093577] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Factorial-MAMS design platform designs have many advantages, but the practical advantages and disadvantages of combining the two designs have not been explored. METHODS We propose practical methods for a combined design within the platform trial paradigm where some interventions are not expected to interact and could be given together. RESULTS We describe the combined design and suggest diagrams that can be used to represent it. Many properties are common both to standard factorial designs, including the need to consider interactions between interventions and the impact of intervention efficacy on power of other comparisons, and to standard multi-arm multi-stage designs, including the need to pre-specify procedures for starting and stopping intervention comparisons. We also identify some specific features of the factorial-MAMS design: timing of interim and final analyses should be determined by calendar time or total observed events; some non-factorial modifications may be useful; eligibility criteria should be broad enough to include any patient eligible for any part of the randomisation; stratified randomisation may conveniently be performed sequentially; and analysis requires special care to use only concurrent controls. CONCLUSION A combined factorial-MAMS design can combine the efficiencies of factorial trials and multi-arm multi-stage platform trials. It allows us to address multiple research questions under one protocol and to test multiple new treatment options, which is particularly important when facing a new emergent infection such as COVID-19.
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Nicholls EJ, Samba P, McCabe L, Gafos M, Philips AN, Trevelion R, Rodger AJ, Burns FM, Weatherburn P, Witzel TC. Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self-Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing. BMC Public Health 2022; 22:809. [PMID: 35459233 PMCID: PMC9034480 DOI: 10.1186/s12889-022-13189-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background HIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations. Methods Twenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework. Results The gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of ‘whiteness’ on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options. Conclusions HIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services. Trial Registration SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003).
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Affiliation(s)
- Emily Jay Nicholls
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK. .,Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
| | - Phil Samba
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - Andrew N Philips
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Roy Trevelion
- HIV I-Base, 107 The Maltings, 169 Tower Bridge Road, London, SE1 3LJ, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Peter Weatherburn
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK
| | - T Charles Witzel
- Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK.,Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
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9
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Cooke GS, Pett S, McCabe L, Jones C, Gilson R, Verma S, Ryder SD, Collier JD, Barclay ST, Ala A, Bhagani S, Nelson M, Ch'Ng C, Stone B, Wiselka M, Forton D, McPherson S, Halford R, Nguyen D, Smith D, Ansari A, Dennis E, Hudson F, Barnes EJ, Walker AS. Strategic treatment optimization for HCV (STOPHCV1): a randomised controlled trial of ultrashort duration therapy for chronic hepatitis C. Wellcome Open Res 2021; 6:93. [PMID: 34405118 PMCID: PMC8361811 DOI: 10.12688/wellcomeopenres.16594.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The World Health Organization (WHO) has identified the need for a better understanding of which patients with hepatitis C virus (HCV) can be cured with ultrashort course HCV therapy. Methods: A total of 202 individuals with chronic HCV were randomised to fixed-duration shortened therapy (8 weeks) vs variable-duration ultrashort strategies (VUS1/2). Participants not cured following first-line treatment were retreated with 12 weeks' sofosbuvir/ledipasvir/ribavirin. The primary outcome was sustained virological response 12 weeks (SVR12) after first-line treatment and retreatment. Participants were factorially randomised to receive ribavirin with first-line treatment. Results: All evaluable participants achieved SVR12 overall (197/197, 100% [95% CI 98-100]) demonstrating non-inferiority between fixed-duration and variable-duration strategies (difference 0% [95% CI -3.8%, +3.7%], 4% pre-specified non-inferiority margin). First-line SVR12 was 91% [86%-97%] (92/101) for fixed-duration vs 48% [39%-57%] (47/98) for variable-duration, but was significantly higher for VUS2 (72% [56%-87%] (23/32)) than VUS1 (36% [25%-48%] (24/66)). Overall, first-line SVR12 was 72% [65%-78%] (70/101) without ribavirin and 68% [61%-76%] (69/98) with ribavirin (p=0.48). At treatment failure, the emergence of viral resistance was lower with ribavirin (12% [2%-30%] (3/26)) than without (38% [21%-58%] (11/29), p=0.01). Conclusions: Unsuccessful first-line short-course therapy did not compromise retreatment with sofosbuvir/ledipasvir/ribavirin (100% SVR12). SVR12 rates were significantly increased when ultrashort treatment varied between 4-7 weeks rather than 4-6 weeks. Ribavirin significantly reduced resistance emergence in those failing first-line therapy. ISRCTN Registration: 37915093 (11/04/2016).
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Affiliation(s)
- Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
- NIHR Biomedical Research Centre, Imperial College NHS Trust, London, W2 1NY, UK
| | - Sarah Pett
- MRC Clinical Trials Unit, University College London Medical School, London, UK
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Institute of Global Health, University College London Medical School, London, UK
| | - Leanne McCabe
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Chris Jones
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
- NIHR Biomedical Research Centre, Imperial College NHS Trust, London, W2 1NY, UK
| | - Richard Gilson
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Institute of Global Health, University College London Medical School, London, UK
| | - Sumita Verma
- Hepatology, Brighton and Sussex Medical School, Brighton, UK
| | - Stephen D. Ryder
- Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Aftab Ala
- Clinical and Experimental Medicine, University of Surrey, Guilford, UK
| | - Sanjay Bhagani
- Infectious Diseases, Royal Free Hampstead NHS Trust Hospital, London, UK
| | - Mark Nelson
- HIV Medicine, Chelsea & Westminster NHS Trust, London, UK
| | | | - Ben Stone
- Infectious Diseases, Sheffield Teaching Hospitals Nhs Foundation Trust, Sheffield, UK
| | - Martin Wiselka
- Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel Forton
- Hepatology, St George's Hospital, London, London, UK
| | - Stuart McPherson
- Heaptology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | | | - Dung Nguyen
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - David Smith
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - Azim Ansari
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - Emily Dennis
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Fleur Hudson
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Eleanor J. Barnes
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Ann Sarah Walker
- MRC Clinical Trials Unit, University College London Medical School, London, UK
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10
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Flower B, McCabe L, Le Ngoc C, Le Manh H, Le Thanh P, Dang Trong T, Vo Thi T, Vu Thi Kim H, Nguyen Tat T, Phan Thi Hong D, Nguyen Thi Chau A, Dinh Thi T, Tran Thi Tuyet N, Tarning J, Kingsley C, Kestelyn E, Pett SL, Thwaites G, Nguyen Van VC, Smith D, Barnes E, Ansari MA, Turner H, Rahman M, Walker AS, Day J, Cooke GS. High Cure Rates for Hepatitis C Virus Genotype 6 in Advanced Liver Fibrosis With 12 Weeks Sofosbuvir and Daclatasvir: The Vietnam SEARCH Study. Open Forum Infect Dis 2021; 8:ofab267. [PMID: 34337093 PMCID: PMC8320300 DOI: 10.1093/ofid/ofab267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Genotype 6 is the most genetically diverse lineage of hepatitis C virus, and it predominates in Vietnam. It can be treated with sofosbuvir with daclatasvir (SOF/DCV), the least expensive treatment combination globally. In regional guidelines, longer treatment durations of SOF/DCV (24 weeks) are recommended for cirrhotic individuals, compared with other pangenotypic regimens (12 weeks), based on sparse data. Early on-treatment virological response may offer means of reducing length and cost of therapy in patients with liver fibrosis. METHODS In this prospective trial in Vietnam, genotype 6-infected adults with advanced liver fibrosis or compensated cirrhosis were treated with SOF/DCV. Day 14 viral load was used to guide duration of therapy: participants with viral load <500 IU/mL at day 14 were treated with 12 weeks of SOF/DCV and those ≥500 IU/mL received 24 weeks. Primary endpoint was sustained virological response (SVR). RESULTS Of 41 individuals with advanced fibrosis or compensated cirrhosis who commenced treatment, 51% had genotype 6a and 34% had 6e. The remainder had 6h, 6k, 6l, or 6o. One hundred percent had viral load <500 IU/mL by day 14, meaning that all received 12 weeks of SOF/DCV. One hundred percent achieved SVR12 despite a high frequency of putative NS5A inhibitor resistance-associated substitutions at baseline. CONCLUSIONS Prescribing 12 weeks of SOF/DCV results in excellent cure rates in this population. These data support the removal of costly genotyping in countries where genotype 3 prevalence is <5%, in keeping with World Health Organization guidelines. NS5A resistance-associated mutations in isolation do not affect efficacy of SOF/DCV therapy. Wider evaluation of response-guided therapy is warranted.
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Affiliation(s)
- Barnaby Flower
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Leanne McCabe
- MRC Clinical Trials Unit at UCL, University College London, United Kingdom
| | - Chau Le Ngoc
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Hung Le Manh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Thu Vo Thi
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Hang Vu Thi Kim
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Thanh Nguyen Tat
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Dao Phan Thi Hong
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - An Nguyen Thi Chau
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Tan Dinh Thi
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Nga Tran Thi Tuyet
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Cherry Kingsley
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Sarah L Pett
- MRC Clinical Trials Unit at UCL, University College London, United Kingdom
| | - Guy Thwaites
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | | | | | | | | | - Hugo Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, United Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Ann Sarah Walker
- Department of Infectious Disease, Imperial College London, United Kingdom
| | - Jeremy Day
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, United Kingdom
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11
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Wright T, Nicholls EJ, Rodger AJ, Burns FM, Weatherburn P, Pebody R, McCabe L, Wolton A, Gafos M, Witzel TC. Accessing and utilising gender-affirming healthcare in England and Wales: trans and non-binary people's accounts of navigating gender identity clinics. BMC Health Serv Res 2021; 21:609. [PMID: 34182985 PMCID: PMC8240290 DOI: 10.1186/s12913-021-06661-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transgender, or trans, people experience a number of barriers to accessing gender-affirming healthcare and have a range of barriers and facilitators to primary care and specialist services, commonly citing discrimination and cisgenderism playing a central role in shaping accessibility. The pathway through primary care to specialist services is a particularly precarious time for trans people, and misinformation and poorly applied protocols can have a detrimental impact on wellbeing. METHOD We recruited trans participants from an HIV Self-Testing Public Health Intervention (SELPHI) trial to interviews which explored contemporary gender-affirming service experiences, with an aim to examine the path from primary care services through to specialist gender services, in the UK. RESULTS A narrative synthesis of vignettes and thematic analysis of in-depth qualitative interviews were conducted with twenty trans individuals. We summarise positive and negative accounts of care under three broad categories: Experiences with primary care physicians, referrals to gender identity clinics (GICs), and experiences at GICs. CONCLUSIONS We discuss implications of this research in terms of how to improve best practice for trans people attempting to access gender-affirming healthcare in the UK. Here we highlight the importance of GP's access to knowledge around pathways and protocols and clinical practice which treats trans patients holistically.
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Affiliation(s)
- Talen Wright
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.
| | - Emily Jay Nicholls
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
| | | | - Leanne McCabe
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London , UK
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12
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Cooke GS, Pett S, McCabe L, Jones C, Gilson R, Verma S, Ryder SD, Collier JD, Barclay ST, Ala A, Bhagani S, Nelson M, Ch'Ng C, Stone B, Wiselka M, Forton D, McPherson S, Halford R, Nguyen D, Smith D, Ansari A, Dennis E, Hudson F, Barnes EJ, Walker AS. Strategic treatment optimization for HCV (STOPHCV1): a randomised controlled trial of ultrashort duration therapy for chronic hepatitis C. Wellcome Open Res 2021; 6:93. [PMID: 34405118 PMCID: PMC8361811 DOI: 10.12688/wellcomeopenres.16594.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 04/05/2024] Open
Abstract
Background: The world health organization (WHO) has identified the need for a better understanding of which patients with hepatitis C virus (HCV) can be cured with ultrashort course HCV therapy. Methods: A total of 202 individuals with chronic HCV were randomised to fixed-duration shortened therapy (8 weeks) vs variable-duration ultrashort strategies (VUS1/2). Participants not cured following first-line treatment were retreated with 12 weeks' sofosbuvir/ledipasvir/ribavirin. The primary outcome was sustained virological response 12 weeks (SVR12) after first-line treatment and retreatment. Participants were factorially randomised to receive ribavirin with first-line treatment. Results: All evaluable participants achieved SVR12 overall (197/197, 100% [95% CI 98-100]) demonstrating non-inferiority between fixed-duration and variable-duration strategies (difference 0% [95% CI -3.8%, +3.7%], 4% pre-specified non-inferiority margin). First-line SVR12 was 91% [86%-97%] (92/101) for fixed-duration vs 48% [39%-57%] (47/98) for variable-duration, but was significantly higher for VUS2 (72% [56%-87%] (23/32)) than VUS1 (36% [25%-48%] (24/66)). Overall, first-line SVR12 was 72% [65%-78%] (70/101) without ribavirin and 68% [61%-76%] (69/98) with ribavirin (p=0.48). At treatment failure, the emergence of viral resistance was lower with ribavirin (12% [2%-30%] (3/26)) than without (38% [21%-58%] (11/29), p=0.01). Conclusions: Unsuccessful first-line short-course therapy did not compromise retreatment with sofosbuvir/ledipasvir/ribavirin (100% SVR12). SVR12 rates were significantly increased when ultrashort treatment varied between 4-7 weeks rather than 4-6 weeks. Ribavirin significantly reduced resistance emergence in those failing first-line therapy. ISRCTN Registration: 37915093 (11/04/2016).
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Affiliation(s)
- Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
- NIHR Biomedical Research Centre, Imperial College NHS Trust, London, W2 1NY, UK
| | - Sarah Pett
- MRC Clinical Trials Unit, University College London Medical School, London, UK
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Institute of Global Health, University College London Medical School, London, UK
| | - Leanne McCabe
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Chris Jones
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
- NIHR Biomedical Research Centre, Imperial College NHS Trust, London, W2 1NY, UK
| | - Richard Gilson
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Institute of Global Health, University College London Medical School, London, UK
| | - Sumita Verma
- Hepatology, Brighton and Sussex Medical School, Brighton, UK
| | - Stephen D. Ryder
- Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Aftab Ala
- Clinical and Experimental Medicine, University of Surrey, Guilford, UK
| | - Sanjay Bhagani
- Infectious Diseases, Royal Free Hampstead NHS Trust Hospital, London, UK
| | - Mark Nelson
- HIV Medicine, Chelsea & Westminster NHS Trust, London, UK
| | | | - Ben Stone
- Infectious Diseases, Sheffield Teaching Hospitals Nhs Foundation Trust, Sheffield, UK
| | - Martin Wiselka
- Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel Forton
- Hepatology, St George's Hospital, London, London, UK
| | - Stuart McPherson
- Heaptology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, UK
| | | | - Dung Nguyen
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - David Smith
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - Azim Ansari
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
| | - Emily Dennis
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Fleur Hudson
- MRC Clinical Trials Unit, University College London Medical School, London, UK
| | - Eleanor J. Barnes
- Peter Medawar Buildling for Pathogen Research, Oxford, UK
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Ann Sarah Walker
- MRC Clinical Trials Unit, University College London Medical School, London, UK
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13
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Witzel TC, Wright T, McCabe L, Gabriel MM, Wolton A, Gafos M, Ward D, Lampe FC, Phillips AN, Trevelion R, Collaco-Moraes Y, Harbottle J, Speakman A, Bonell C, Dunn DD, McCormack S, Burns FM, Weatherburn P, Rodger AJ. Impact and acceptability of HIV self-testing for trans men and trans women: A mixed-methods subgroup analysis of the SELPHI randomised controlled trial and process evaluation in England and Wales. EClinicalMedicine 2021; 32:100700. [PMID: 33681732 PMCID: PMC7910695 DOI: 10.1016/j.eclinm.2020.100700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Globally, trans people are disproportionately affected by HIV, but research on strategies to increase testing are limited. SELPHI is a randomised-controlled-trial (RCT) of 10,135 cis men, trans men, and trans women reporting lifetime anal intercourse with male partners (cis or trans), evaluating whether the offer of free HIV self-testing (HIVST) increases diagnosis. This subgroup analysis from the SELPHI RCT aims to describe key HIVST outcomes and HIVST acceptability for trans people. METHODS SELPHI recruited using social networking and trans focused social media. Participants were randomised 60/40 to baseline HIVST (Biosure™) (BT) vs no baseline HIVST (nBT); and at 3-months (if completed the survey and reported recent CAI) 50/50 to 3-monthly HIVST (RT) vs no repeat HIVST (nRT). Outcomes were self-reported through online surveys. We conducted a qualitative study of semi-structured peer-led participant interviews (n = 20) exploring HIVST motivations and experiences. These were analysed using a framework approach. FINDINGS SELPHI recruited and randomised 118 trans men and trans women (94 trans men, 24 trans women), of whom 20 (16 trans men, 4 trans women) underwent the second randomisation. Median age at baseline was 29 (IQR: 22, 37), 79% were white, 79% were UK born, 37% had degree level education, and 31% had never tested for HIV. 62% (n = 59) of trans men completed the 3-month survey, but survey completion by trans women in nBT was too low (1/11) for randomised comparison. In trans men HIV testing uptake by 3 months was significantly higher in BT (95% 36/38) vs nBT (29%, 6/21) (RR=3.32 (1.68, 6.55) p<0.001). Trans people randomised to RT reported 3 times higher rate of HIV testing compared to nRT during the two-year follow-up (IRR 3.66 (1.86, 8.01) p<0.0001). STI testing frequency (mean number of tests during each 13 week period/ 2-year follow-up) was not significantly different across interventions: RT (0.03) and nRT (0.01) (IRR=1.86 95%CI; 0.77, 5.15; p = 0.15). Social harms were rare. Acceptability was very high in BT: 97% (38/39) found instructions easy to understand, 97% (37/38) found the HIVST simple to use and 100% (39/39) reported good overall experience. In interviews, reported HIVST benefits included increased autonomy, privacy, convenience and avoidance of health care providers perceived to be discriminatory and services that increased dysphoria. Minor lancet and test processing issues were reported. INTERPRETATION HIVST significantly increased testing uptake and frequency in trans men and trans people overall, although recruitment and retention of trans women was low. HIVST acceptability was high and indicates easy access to this novel technology may increase HIV testing access for this key population.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
- Corresponding author.
| | - Talen Wright
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Michelle M. Gabriel
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Aedan Wolton
- 56T, Chelsea and Westminster NHS Hospital Foundation Trust, 56 Dean Street, London W1D 4PR, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Denise Ward
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Fiona C. Lampe
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Andrew N. Phillips
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Roy Trevelion
- HIV i-base, 107 The Maltings, 169 Tower Bridge Road, London SE1 3LJ, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Justin Harbottle
- SH:24, 35a Westminster Bridge Road, South Bank, London SE1 7JB, United Kingdom
| | - Andrew Speakman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - David D. Dunn
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, London WC1V 6LJ, United Kingdom
| | - Fiona M. Burns
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Alison J. Rodger
- Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
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14
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Rodger AJ, Dunn D, McCabe L, Weatherburn P, Lampe FC, Witzel TC, Burns F, Ward D, Pebody R, Trevelion R, Brady M, Kirwan PD, Khawam J, Delpech VC, Gabriel M, Collaco-Moraes Y, Phillips AN, McCormack S. Sexual risk and HIV testing disconnect in men who have sex with men (MSM) recruited to an online HIV self-testing trial. HIV Med 2020; 21:588-598. [PMID: 32776431 DOI: 10.1111/hiv.12919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/02/2019] [Revised: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We report the frequency of previous HIV testing at baseline in men who have sex with men (MSM) who enrolled in an HIV self-testing (HIVST) randomized controlled trial [an HIV self-testing public health intervention (SELPHI)]. METHODS Criteria for enrolment were age ≥ 16 years, being a man (including trans men) who ever had anal intercourse (AI) with a man, not being known to be HIV positive and having consented to national HIV database linkage. Using online survey baseline data (2017-2018), we assessed associations with never having tested for HIV and not testing in the previous 6 months, among men who reported at least two recent condomless AI (CAI) partners. RESULTS A total of 10 111 men were randomized; the median age was 33 years [interquartile range (IQR) 26-44 years], 89% were white, 20% were born outside the UK, 0.8% were trans men, 47% were degree educated, and 8% and 4% had ever used and were currently using pre-exposure prophylaxis (PrEP), respectively. In the previous 3 months, 89% reported AI and 72% reported CAI with at least one male partner. Overall, 17%, 33%, 54%, and 72% had tested for HIV in the last 3 months, 6 months, 12 months and 2 years, respectively; 13% had tested more than 2 years ago and 15% had never tested. Among 3972 men reporting at least two recent CAI partners, only 22% had tested in the previous 3 months. Region of residence and education level were independently associated with recent HIV testing. Among current PrEP users, 15% had not tested in the previous 6 months. CONCLUSIONS Most men in SELPHI, particularly those reporting at least two CAI partners and current PrEP users, were not testing in line with current UK recommendations. The results of the trial will inform whether online promotion of HIVST addresses ongoing testing barriers.
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Affiliation(s)
- A J Rodger
- Institute for Global Health, University College London, London, UK
| | - D Dunn
- MRC Clinical Trials Unit at UCL, London, UK
| | - L McCabe
- MRC Clinical Trials Unit at UCL, London, UK
| | - P Weatherburn
- London School of Hygiene & Tropical Medicine, London, UK
| | - F C Lampe
- Institute for Global Health, University College London, London, UK
| | - T C Witzel
- London School of Hygiene & Tropical Medicine, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - D Ward
- MRC Clinical Trials Unit at UCL, London, UK
| | | | | | - M Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - P D Kirwan
- National Infection Service, Public Health England, London, UK
| | - J Khawam
- National Infection Service, Public Health England, London, UK
| | - V C Delpech
- National Infection Service, Public Health England, London, UK
| | - M Gabriel
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - A N Phillips
- Institute for Global Health, University College London, London, UK
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McCabe L, White IR, Chau NVV, Barnes E, Pett SL, Cooke GS, Walker AS. The design and statistical aspects of VIETNARMS: a strategic post-licensing trial of multiple oral direct-acting antiviral hepatitis C treatment strategies in Vietnam. Trials 2020; 21:413. [PMID: 32423467 PMCID: PMC7236096 DOI: 10.1186/s13063-020-04350-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Eliminating hepatitis C is hampered by the costs of direct-acting antiviral treatment and the need to treat hard-to-reach populations. Access could be widened by shortening or simplifying treatment, but limited research means it is unclear which approaches could achieve sufficiently high cure rates to be acceptable. We present the statistical aspects of a multi-arm trial designed to test multiple strategies simultaneously and a monitoring mechanism to detect and stop individual randomly assigned groups with unacceptably low cure rates quickly. METHODS The VIETNARMS trial will factorially randomly assign patients to two drug regimens, three treatment-shortening strategies or control, and adjunctive ribavirin or no adjunctive ribavirin with shortening strategies (14 randomly assigned groups). We will use Bayesian monitoring at interim analyses to detect and stop recruitment into unsuccessful strategies, defined by more than 0.95 posterior probability that the true cure rate is less than 90% for the individual randomly assigned group (non-comparative). Final comparisons will be non-inferiority for regimens (margin 5%) and strategies (margin 10%) and superiority for adjunctive ribavirin. Here, we tested the operating characteristics of the stopping guideline for individual randomly assigned groups, planned interim analysis timings and explored power at the final analysis. RESULTS A beta (4.5, 0.5) prior for the true cure rate produces less than 0.05 probability of incorrectly stopping an individual randomly assigned group with a true cure rate of more than 90%. Groups with very low cure rates (<60%) are very likely (>0.9 probability) to stop after about 25% of patients are recruited. Groups with moderately low cure rates (80%) are likely to stop (0.7 probability) before overall recruitment finishes. Interim analyses 7, 10, 13 and 18 months after recruitment commences provide good probabilities of stopping inferior individual randomly assigned groups. For an overall true cure rate of 95%, power is more than 90% to confirm non-inferiority in the regimen and strategy comparisons, regardless of the control cure rate, and to detect a 5% absolute difference in the ribavirin comparison. CONCLUSIONS The operating characteristics of the stopping guideline are appropriate, and interim analyses can be timed to detect individual randomly assigned groups that are highly likely to have suboptimal performance at various stages. Therefore, our design is suitable for evaluating treatment-shortening or -simplifying strategies. TRIAL REGISTRATION ISRCTN registry: ISRCTN61522291. Registered on 4 October 2019.
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Affiliation(s)
- Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | - Ian R. White
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | | | - Sarah L. Pett
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
| | | | - A. Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, 90 High Holborn, WC1V 6LJ London, UK
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Witzel TC, Weatherburn P, Bourne A, Rodger AJ, Bonell C, Gafos M, Trevelion R, Speakman A, Lampe F, Ward D, Dunn DT, Gabriel MM, McCabe L, Harbottle J, Collaco Moraes Y, Michie S, Phillips AN, McCormack S, Burns FM. Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales. Int J Environ Res Public Health 2020; 17:ijerph17020466. [PMID: 31936798 PMCID: PMC7014239 DOI: 10.3390/ijerph17020466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/02/2022]
Abstract
SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
- Correspondence:
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne 3086, Australia;
| | - Alison J. Rodger
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.W.); (C.B.)
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1h 9SH, UK;
| | | | - Andrew Speakman
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Fiona Lampe
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - David T. Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Michelle M. Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | | | - Yolanda Collaco Moraes
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Susan Michie
- Centre for Behaviour Change, University College London, London WC1N 3AZ, UK;
| | - Andrew N. Phillips
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK; (D.W.); (D.T.D.); (M.M.G.); (L.M.); (Y.C.M.); (S.M.)
| | - Fiona M. Burns
- Institute for Global Health, University College London, London NW3 2PF, UK; (A.J.R.); (A.S.); (F.L.); (A.N.P.); (F.M.B.)
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Witzel TC, Bourne A, Burns FM, Rodger AJ, McCabe L, Gabriel MM, Gafos M, Ward D, Collaco-Moraes Y, Dunn DT, Speakman A, Bonell C, Pebody R, Lampe FC, Harbottle J, Phillips AN, McCormack S, Weatherburn P. HIV self-testing intervention experiences and kit usability: results from a qualitative study among men who have sex with men in the SELPHI (Self-Testing Public Health Intervention) randomized controlled trial in England and Wales. HIV Med 2019; 21:189-197. [PMID: 31821698 PMCID: PMC7065141 DOI: 10.1111/hiv.12818] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 06/04/2019] [Revised: 08/21/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
Objectives SELPHI (HIV Self‐Testing Public Health Intervention) is the largest randomized controlled trial (RCT) of HIV self‐testing (HIVST) in a high‐income setting to date, and has recruited 10 000 men who have sex with men (cis‐ and transgender) and transgender women who have sex with men. This qualitative substudy aimed to explore how those utilizing self‐tests experience HIVST and the implications for further intervention development and scale‐up. This is the first qualitative study in Europe investigating experiences of HIVST among intervention users, and the first globally examining the experience of using blood‐based HIVST. Methods Thirty‐seven cisgender MSM SELPHI participants from across England and Wales were purposively recruited to the substudy, in which semi‐structured interviews were used to explore testing history, HIVST experiences and intervention preferences. Interviews were audio‐recorded, transcribed and analysed through a framework analysis. Results Men accessed the intervention because HIVST reduced barriers related to convenience, stigma and privacy concerns. Emotional responses had direct links to acceptability. Supportive intervention components increased engagement with testing and addressed supportive concerns. HIVST facilitated more frequent testing, with the potential to reduce sexually transmitted infection (STI) screening frequency. Substudy participants with an HIV‐positive result (n = 2) linked to care promptly and reported very high acceptability. Minor adverse outcomes (n = 2; relationship discord and fainting) did not reduce acceptability. Ease of use difficulties were with the lancet and the test processing stage. Conclusions Intervention components shaped acceptability, particularly in relation to overcoming a perceived lack of support. The intervention was broadly acceptable and usable; participants expressed an unexpected degree of enthusiasm for HIVST, including those with HIV‐positive results and individuals with minor adverse outcomes.
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Affiliation(s)
- T C Witzel
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - F M Burns
- Institute for Global Health, University College London, London, UK
| | - A J Rodger
- Institute for Global Health, University College London, London, UK
| | - L McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - M M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - M Gafos
- Medical Research Council Clinical Trials Unit, University College London, London, UK.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Y Collaco-Moraes
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - D T Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - A Speakman
- Institute for Global Health, University College London, London, UK
| | - C Bonell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - F C Lampe
- Institute for Global Health, University College London, London, UK
| | | | - A N Phillips
- Institute for Global Health, University College London, London, UK
| | - S McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - P Weatherburn
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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18
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Witzel TC, Gabriel MM, McCabe L, Weatherburn P, Gafos M, Speakman A, Pebody R, Burns FM, Bonell C, Lampe FC, Dunn DT, Ward D, Harbottle J, Phillips AN, McCormack S, Rodger AJ. Pilot phase of an internet-based RCT of HIVST targeting MSM and transgender people in England and Wales: advertising strategies and acceptability of the intervention. BMC Infect Dis 2019; 19:699. [PMID: 31391003 PMCID: PMC6686516 DOI: 10.1186/s12879-019-4247-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SELPHI study (An HIV Self-Testing Public Health Intervention) is an online randomised controlled trial (RCT) of HIV self-testing (HIVST). The aim of this study was to assess the feasibility of recruiting UK men who have sex with men (cis and trans) and trans women who have sex with men to the SELPHI pilot, and the acceptability of the HIVST intervention used among those randomised to receive a kit. METHODS A mixed-methods approach to assessing trial feasibility and intervention acceptability was taken, using quantitative data from advertising sources and RCT surveys alongside qualitative data from a nested sub-study. RESULTS Online recruitment and intervention delivery was feasible. The recruitment strategy led to the registration of 1370 participants of whom 76% (1035) successfully enrolled and were randomised 60/40 to baseline testing vs no baseline testing. Advertising platforms performed variably. Reported HIVST kit use increased from 83% at two weeks to 96% at three months. Acceptability was very high across all quantitative measures. Participants described the instructions as easy to use, and the testing process as simple. The support structures in SELPHI were felt to be adequate. Described emotional responses to HIVST varied. CONCLUSIONS Recruiting to a modest sized HIVST pilot RCT is feasible, and the recruitment, intervention and HIVST kit were acceptable. Research on support needs of individuals with reactive results is warranted.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | | | - Peter Weatherburn
- Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Fiona M Burns
- Institute for Global Health, UCL, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Chris Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Alison J Rodger
- Institute for Global Health, UCL, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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19
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Jackson LH, Price AN, Hutter J, Ho A, Roberts TA, Slator PJ, Clough JR, Deprez M, McCabe L, Malik SJ, Chappell L, Rutherford MA, Hajnal JV. Respiration resolved imaging with continuous stable state 2D acquisition using linear frequency SWEEP. Magn Reson Med 2019; 82:1631-1645. [PMID: 31183892 PMCID: PMC6682494 DOI: 10.1002/mrm.27834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/21/2018] [Revised: 04/04/2019] [Accepted: 05/09/2019] [Indexed: 01/31/2023]
Abstract
Purpose To investigate the potential of continuous radiofrequency (RF) shifting (SWEEP) as a technique for creating densely sampled data while maintaining a stable signal state for dynamic imaging. Methods We present a method where a continuous stable state of magnetization is swept smoothly across the anatomy of interest, creating an efficient approach to dense multiple 2D slice imaging. This is achieved by introducing a linear frequency offset to successive RF pulses shifting the excited slice by a fraction of the slice thickness with each successive repeat times (TR). Simulations and in vivo imaging were performed to assess how this affects the measured signal. Free breathing, respiration resolved 4D volumes in fetal/placental imaging is explored as potential application of this method. Results The SWEEP method maintained a stable signal state over a full acquisition reducing artifacts from unstable magnetization. Simulations demonstrated that the effects of SWEEP on slice profiles was of the same order as that produced by physiological motion observed with conventional methods. Respiration resolved 4D data acquired with this method shows reduced respiration artifacts and resilience to non‐rigid and non‐cyclic motion. Conclusions The SWEEP method is presented as a technique for improved acquisition efficiency of densely sampled short‐TR 2D sequences. Using conventional slice excitation the number of RF pulses required to enter a true steady state is excessively high when using short‐TR 2D acquisitions, SWEEP circumvents this limitation by creating a stable signal state that is preserved between slices.
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Affiliation(s)
- L H Jackson
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - A N Price
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - J Hutter
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - A Ho
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - T A Roberts
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - P J Slator
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - J R Clough
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - M Deprez
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - L McCabe
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - S J Malik
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - L Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - M A Rutherford
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | - J V Hajnal
- Biomedical Engineering, School of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
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Gabriel MM, Dunn DT, Speakman A, McCabe L, Ward D, Witzel TC, Harbottle J, Collins S, Gafos M, Burns FM, Lampe FC, Weatherburn P, Phillips A, McCormack S, Rodger AJ. Protocol, rationale and design of SELPHI: a randomised controlled trial assessing whether offering free HIV self-testing kits via the internet increases the rate of HIV diagnosis. BMC Infect Dis 2018; 18:531. [PMID: 30352556 PMCID: PMC6199717 DOI: 10.1186/s12879-018-3433-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among men who have sex with men (MSM) in the UK, an estimated 28% have never tested for HIV and only 27% of those at higher risk test at least every 6 months. HIV self-testing (HIVST), where the person takes their own blood/saliva sample and processes it themselves, offers the opportunity to remove many structural and social barriers to testing. Although several randomised controlled trials are assessing the impact of providing HIVST on rates of HIV testing, none are addressing whether this results in increased rates of HIV diagnoses that link to clinical care. Linking to care is the critical outcome because it is the only way to access antiretroviral treatment (ART). We describe here the design of a large, internet-based randomised controlled trial of HIVST, called SELPHI, which aims to inform this key question. METHODS/DESIGN The SELPHI study, which is ongoing is promoted via social networking website and app advertising, and aims to enroll HIV negative men, trans men and trans women, aged over 16 years, who are living in England and Wales. Apart from the physical delivery of the test kits, all trial processes, including recruitment, take place online. In a two-stage randomisation, participants are first randomised (3:2) to receive a free baseline HIVST or no free baseline HIVST. At 3 months, participants allocated to receive a baseline HIVST (and meeting further eligibility criteria) are subsequently randomised (1:1) to receive the offer of regular (every 3 months) free HIVST, with testing reminders, versus no such offer. The primary outcome from both randomisations is a laboratory-confirmed HIV diagnosis, ascertained via linkage to a national HIV surveillance database. DISCUSSION SELPHI will provide the first reliable evidence on whether offering free HIVST via the internet increases rates of confirmed HIV diagnoses and linkage to clinical care. The two randomisations reflect the dual objectives of detecting prevalent infections (possibly long-standing) and the more rapid diagnosis of incident HIV infections. It is anticipated that the results of SELPHI will inform future access to HIV self-testing provision in the UK. TRIAL REGISTRATION DOI 10.1186/ISRCTN20312003 registered 24/10/2016.
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Affiliation(s)
- Michelle M. Gabriel
- MRC Clinical Trials Unit at UCL, London, UK
- Trial Sponsor – University College London via MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 90 High Holborn, 2nd Floor, London, WC1V 6LJ UK
| | | | - Andrew Speakman
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | | | | | - T. Charles Witzel
- Department of Social and Environmental Health Research, Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | | | - Fiona C. Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | - Peter Weatherburn
- Department of Social and Environmental Health Research, Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
| | | | - Alison J. Rodger
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, UCL, London, UK
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Siika A, McCabe L, Bwakura-Dangarembizi M, Kityo C, Mallewa J, Berkley J, Maitland K, Griffiths A, Baleeta K, Mudzingwa S, Abach J, Nathoo K, Thomason MJ, Prendergast AJ, Walker AS, Gibb DM. Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial. Clin Infect Dis 2018; 66:S140-S146. [PMID: 29514235 PMCID: PMC5850547 DOI: 10.1093/cid/cix1142] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/16/2022] Open
Abstract
Background Severely immunocompromised human immunodeficiency virus (HIV)-infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts <100 cells/µL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identified using Cox regression with backwards elimination (exit P > .1). Results Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%-6% mortality. Conclusions Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. Clinical Trials Registration ISRCTN43622374.
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Affiliation(s)
| | - Leanne McCabe
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Jane Mallewa
- Department/College of Medicine and Malawi-Liverpool–Wellcome Trust Clinical Research Programme, Blantyre
| | - Jay Berkley
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi
| | - Kath Maitland
- Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi
| | - Anna Griffiths
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | | | | | - James Abach
- Joint Clinical Research Centre, Gulu, Uganda
| | - Kusum Nathoo
- University of Zimbabwe Clinical Research Centre, Harare
| | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | | | - Ann Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, United Kingdom
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Edelman N, de Visser R, Mercer C, McCabe L, Cassell J. P14.04 Which psychosocial factors are associated with poor sexual health outcomes in women of reproductive age? a systematic review of probability surveys. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McCabe L, Kehoe B. DI-016 Development of a quick reference guide for syringe driver drug compatibilities. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
We have previously shown that the foetal guinea-pig hypothalamic-pituitary-adrenal (HPA) axis is activated near the time of parturition and that this is associated with changes in limbic glucocorticoid receptors (GR) and mineralocorticoid receptors. In the present study, we hypothesized that the foetal hypothalamic paraventricular nucleus (PVN) and pituitary contribute significantly to foetal HPA drive but that these areas remain sensitive to negative feedback by circulating glucocorticoids in late gestation. However, we observed decreased corticotrophin-releasing hormone mRNA expression in the PVN and decreased pro-opiomelanocortin (POMC) mRNA levels in the anterior pituitary with advanced gestational age. The reduction in POMC mRNA expression was likely the result of negative feedback via circulating glucocorticoids because GR mRNA was unchanged during development in the foetal pituitary. Furthermore, we found that maternally administered glucocorticoids significantly decreased foetal pituitary POMC mRNA expression in a dose-dependent manner at gestational day (gd) 62 with male foetuses being more sensitive to these effects. These findings show that the foetal HPA axis remains highly sensitive to glucocorticoid feedback even as plasma adrenocorticotropic hormone and cortisol levels are elevated at the end of gestation.
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Affiliation(s)
- D Owen
- Department of Physiology, Facult of Medicine, University of Toronto, Medical Sciences Building, Toronto, Ontario, Canada
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26
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Liu B, McGrath J, McCabe L, Baumann M. Response of Murine Osteoblasts and Porous Hydroxyapatite Scaffolds to Two-Step, Slow Freezing and Vitrification Processes. ACTA ACUST UNITED AC 2002. [DOI: 10.1089/15383440260073275] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- B.L. Liu
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - J. McGrath
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan
| | - L. McCabe
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - M. Baumann
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, Michigan
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27
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Cameron NE, Tuck Z, McCabe L, Cotter MA. Effect of the hydroxyl radical scavenger, dimethylthiourea, on peripheral nerve tissue perfusion, conduction velocity and nociception in experimental diabetes. Diabetologia 2001; 44:1161-9. [PMID: 11596672 DOI: 10.1007/s001250100626] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS/HYPOTHESIS Increased oxidative stress has been linked to diabetic neurovascular complications, which are reduced by antioxidants. Our aim was to assess the contribution of hydroxyl radicals to early neuropathic changes by examining the effects of treatment with the specific scavenger, dimethylthiourea, on nerve function and neural tissue blood flow in diabetic rats. METHODS Diabetes was induced by streptozotocin. Measurements comprised sciatic nerve motor and saphenous nerve sensory conduction velocity. Responses to noxious mechanical and thermal stimuli were estimated by Randall-Sellito and Hargreaves tests respectively. Sciatic nerve and superior cervical ganglion blood flow were measured by hydrogen clearance microelectrode polarography. RESULTS Eight weeks of diabetes reduced motor and sensory conduction velocity by 19.9% and 15.7% respectively, and these were completely corrected by 2 weeks of dimethylthiourea treatment. The ED50 for motor conduction was 9 mg kg(-1) x day(-1). Mechanical and thermal nociceptive sensitivities were 18.9% and 25.0% increased by diabetes, respectively, indicating hyperalgesia which was 70% reduced by dimethylthiourea. Sciatic endoneurial and superior cervical ganglion blood flows were 51.2% and 52.4% reduced by diabetes and there was an approximately 80% improvement with treatment. CONCLUSION/INTERPRETATION Hydroxyl radicals seem to make a major contribution to neuropathy and vasculopathy in diabetic rats. Treatment with the hydroxyl scavenger, dimethylthiourea, was highly effective. The data suggest that the development of potent hydroxyl radical scavengers suitable for use in man could markedly enhance the potential therapeutic value of an antioxidant approach to the treatment of diabetic neuropathy and vascular disease.
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Affiliation(s)
- N E Cameron
- Department of Biomedical Sciences, Institute of Medical Sciences, University of Aberdeen, Scotland, UK.
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28
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McCabe L, Marash D, Li A, Matthews SG. Repeated antenatal glucocorticoid treatment decreases hypothalamic corticotropin releasing hormone mRNA but not corticosteroid receptor mRNA expression in the fetal guinea-pig brain. J Neuroendocrinol 2001; 13:425-31. [PMID: 11328452 DOI: 10.1046/j.1365-2826.2001.00649.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 10% of pregnant women are treated with synthetic glucocorticoids in late gestation, to promote fetal lung maturation. The effectiveness of this treatment has led to the use of repeated dose regimens, with little knowledge of the impact on neuroendocrine development. Animal studies have recently shown that repeated fetal glucocorticoid exposure can lead to permanent changes in hypothalamic-pituitary-adrenal (HPA) function in offspring. In this study, we hypothesized that such treatment modifies corticotropin releasing hormone (CRH), glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) systems in the developing limbic system and hypothalamus. Pregnant guinea-pigs were treated with dexamethasone, betamethasone or vehicle on days 40,41,50,51,60 and 61 of gestation (birth = 68 days). On day 62, guinea-pigs were killed and the fetuses rapidly removed. Glucocorticoid treatment resulted in a dose-dependent reduction in plasma cortisol concentrations in both male and female fetuses. There was also a significant reduction in CRH mRNA expression in the hypothalamic paraventricular nucleus. In contrast, exposure to glucocorticoid increased MR mRNA expression in the hippocampus (CA1/2 and CA3) and dentate gyrus of female fetuses. There was a small but significant increase in GR mRNA expression in limbic structures in male fetuses following treatment with 1 mg/kg dexamethasone. However, there was no significant effect of glucocorticoid exposure on hippocampal GR mRNA expression in female fetuses, or hypothalamic GR mRNA in either males or females. In conclusion, repeated maternal glucocorticoid treatment inhibits fetal HPA function. The fact that CRH mRNA levels were reduced indicates that synthetic glucocorticoids enter the fetal brain. By contrast, fetal glucocorticoid exposure does not downregulate GR mRNA, and increases MR mRNA expression. The latter likely reflects removal of circulating endogenous ligand (cortisol). These alterations may form the basis for permanently modified HPA activity in later life.
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Affiliation(s)
- L McCabe
- Department of Physiology, Faculty of Medicine, University of Toronto, Ontario, Canada
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29
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Buchanan J, McCabe L, Fitzsimons D. Using research to improve infection control practice. Prof Nurse 2001; 16:1091-4. [PMID: 12029908] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Research into nurses' knowledge of infection control provided the basis for a hospital training programme. A combined approach by occupational health and infection control specialists developed an appropriate needs-based programme.
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30
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Aslam F, McCabe L, Frenkel B, van Wijnen AJ, Stein GS, Lian JB, Stein JL. AP-1 and vitamin D receptor (VDR) signaling pathways converge at the rat osteocalcin VDR element: requirement for the internal activating protein-1 site for vitamin D-mediated trans-activation. Endocrinology 1999; 140:63-70. [PMID: 9886808 DOI: 10.1210/endo.140.1.6429] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Responsiveness of genes to steroid hormones is a complex process involving synergistic and/or antagonistic interactions between specific receptors and other nonreceptor transcription factors. Thus, DNA recognition elements for steroid hormone receptors are often located among binding sites for other trans-acting factors. The hormonal form of vitamin D, 1,25-dihydroxyvitamin D3, stimulates transcription of the tissue-specific osteocalcin (OC) gene in osteoblastic cells. The rat OC vitamin D response element contains an internal acitvating protein-1 (AP-1) site. Here, we report for the first time that this AP-1 site is critical for the transcriptional enhancement of rat osteocalcin gene expression mediated by vitamin D. Precise mutations were introduced either in the steroid half-elements or in the internal AP-1 sequences. One mutation within the internal AP-1 site retained vitamin D receptor/retinoid X receptor binding equivalent to that of the wild-type sequence, but resulted in complete loss of vitamin D inducibility of the OC promoter. These results suggest a functional interaction between the hormone receptor and nuclear oncoproteins at the rat OC vitamin D response element. This cooperation of activities may have important consequences in physiological regulation of osteocalcin transcription during osteoblast differentiation and bone tissue development in vivo.
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Affiliation(s)
- F Aslam
- Department of Cell Biology, University of Massachusetts Medical Center, Worcester 01655, USA
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31
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McCabe L. The new body of AIDS: Crixivan bellies, legs, and humps. Newsline People AIDS Coalit N Y 1998:37-9. [PMID: 11367490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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32
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Zhang YH, Guo W, Wagner RL, Huang BL, McCabe L, Vilain E, Burris TP, Anyane-Yeboa K, Burghes AH, Chitayat D, Chudley AE, Genel M, Gertner JM, Klingensmith GJ, Levine SN, Nakamoto J, New MI, Pagon RA, Pappas JG, Quigley CA, Rosenthal IM, Baxter JD, Fletterick RJ, McCabe ER. DAX1 mutations map to putative structural domains in a deduced three-dimensional model. Am J Hum Genet 1998; 62:855-64. [PMID: 9529340 PMCID: PMC1377022 DOI: 10.1086/301782] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The DAX1 protein is an orphan nuclear hormone receptor based on sequence similarity in the putative ligand-binding domain (LBD). DAX1 mutations result in X-linked adrenal hypoplasia congenita (AHC). Our objective was to identify DAX1 mutations in a series of families, to determine the types of mutations resulting in AHC and to locate single-amino-acid changes in a DAX1 structural model. The 14 new mutations identified among our 17 families with AHC brought the total number of families with AHC to 48 and the number of reported mutations to 42; 1 family showed gonadal mosaicism. These mutations included 23 frameshift, 12 nonsense, and six missense mutations and one single-codon deletion. We mapped the seven single-amino-acid changes to a homology model constructed by use of the three-dimensional crystal structures of the thyroid-hormone receptor and retinoid X receptor alpha. All single-amino-acid changes mapped to the C-terminal half of the DAX1 protein, in the conserved hydrophobic core of the putative LBD, and none affected residues expected to interact directly with a ligand. We conclude that most genetic alterations in DAX1 are frameshift or nonsense mutations and speculate that the codon deletion and missense mutations give insight into the structure and function of DAX1.
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Affiliation(s)
- Y H Zhang
- Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA
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33
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Tuller S, McCabe L, Cronenwett L, Hastings D, Shaheen AM, Daley-Faulkner C, Wheeler K. Patient, visitor, and nurse evaluations of visitation for adult postanesthesia care unit patients. J Perianesth Nurs 1997; 12:402-12. [PMID: 9464029 DOI: 10.1016/s1089-9472(97)90003-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although PACU visitation for children is sometimes encouraged, most families of adult postoperative patients continue to be excluded from PACUs in this country. At an academic medical center, an open visitation policy for adult postoperative patients was evaluated by eliciting patient, visitor, and nurse evaluations of visitation for adult patients from 181 families. Commonly cited reasons for restricting PACU visitation were not identified as problems by the vast majority of respondents. Even when some aspect of a PACU visit was disturbing, patients and families expressed a desire for visitation. The results of this evaluation of a change in practice led to permanent implementation of an open visitation policy in this PACU.
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Affiliation(s)
- S Tuller
- Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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34
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McCabe L. Taking responsibility for our own health. Sidahora 1997:20-2. [PMID: 11364825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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35
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Abstract
Associations among dust exposure, smoking habits, and demographic factors and longitudinal changes of lung function were assessed among male steel workers. Cohort descriptive data analysis was conducted in 541 steel workers who had performed spirometry at least twice between 1982 and 1991 (mean follow-up, 6.1 years). The annual change (slope) in FVC, FEV1, FEV1/FVC%, and in body weight was determined by simple linear regression. The Pearson correlation coefficient between weight change and spirometry changes was calculated. Comparisons were also done in 75 pairs of steel workers matched by age, height, initial FEV1, and smoking status, but whose FEV1 declines differed by > or = 60 mL/yr. The FEV1 and FVC declined an average of 44 and 50 mL/yr, respectively, for the cohort as a whole. The FEV1 and FVC declined 52 and 54 mL/yr for current smokers, 43 and 53 mL/yr for ex-smokers, and 36 and 43 mL/yr for nonsmokers, respectively. Increasing weight was highly correlated with accelerated decline in lung function (p<0.0001). In the matched pairs, mean slopes for FVC, FEV1, and FEV1/FVC ratio were -96 mL/yr, -95 mL/yr, and -0.40%/yr for the rapid decliners; and +5 mL/yr, +10 mL/yr, and +0.10%/yr for their partners (p<0.0001). Matched pair comparisons showed that the rapid decliners averaged a 4.313 kg weight gain, while their partners gained 1.044 kg during the follow-up period. The slope of weight gain was 0.708 kg/yr for rapid decliners and 0.191 kg/yr for comparison workers (p<0.0036). Weight gain, in addition to aging and cigarette smoking, was found to be associated with the longitudinal rate of decline in FVC, FEV1, and FEV1/FVC ratio.
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Affiliation(s)
- M L Wang
- Section of Pulmonary and Critical Care Medicine, West Virginia University School of Medicine, Morgantown 26506-9166, USA
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36
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McCabe L. Efficacy of a targeted genetic screening program for adolescents. Am J Hum Genet 1996; 59:762-3. [PMID: 8808589 PMCID: PMC1914795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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37
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Wang ML, McCabe L, Hankinson JL, Shamssain MH, Gunel E, Lapp NL, Banks DE. Longitudinal and cross-sectional analyses of lung function in steelworkers. Am J Respir Crit Care Med 1996; 153:1907-13. [PMID: 8665054 DOI: 10.1164/ajrccm.153.6.8665054] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We evaluated associations between dust exposure, demographic factors, and lung function by longitudinal and cross-sectional analyses in 475 steelworkers who participated in at least three spirometry tests over 5 yr between 1982 and 1991. Baseline and follow-up spirometry and changes between baseline and final follow-up assessment attributable to age, height, weight, weight gain, smoking status, pack-years, and years worked in dusty areas were examined using stepwise multiple linear regression techniques. Smoking, aging, being overweight, excessive weight gain, and dust exposure were related to a lower level and a steeper slope of decline of pulmonary function. Cigarette smoking was also an important risk factor. Dust exposure was related to the level of lung function, with a stronger effect at baseline than at follow-up. Estimated loss at baseline of FEV1, FVC, and FEV1/FVC% was 9.3, 6.4 ml, and 0.1 % per year of employment in a dusty area, respectively, whereas the association between dust exposure and longitudinal decline of lung function was weak. However, a strong relationship between weight gain and longitudinal decline of FEV1 and FVC was found. Estimated decreases in FEV1 and FVC attributable to weight gain were 4.7 and 6.3 ml per lb/yr, respectively. This work suggests that weight gain is an important determinant for longitudinal lung function decline. This large impact of weight gain in the decline of lung function in a middle-age and relatively overweight working population has not been previously reported. Additional work needs to be undertaken to show the strength of this relationship in other populations.
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Affiliation(s)
- M L Wang
- Section of Pulmonary and Critical Care Medicine, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9166, USA
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38
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Banks DE, Wang ML, McCabe L, Billie M, Hankinson J. Improvement in lung function measurements using a flow spirometer that emphasizes computer assessment of test quality. J Occup Environ Med 1996; 38:279-83. [PMID: 8882100 DOI: 10.1097/00043764-199603000-00013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We compared retrospective measurements of lung function from 101 steel workers using a commercially available spirometer to prospective lung function measurements performed, on average, 1.3 years later, with a newly developed spirometer. This spirometer was designed and developed to incorporate technology that provides immediate feedback on the quantitative and qualitative aspects of each forced expiratory effort. Of the 101 workers, 82 who had spirometry performed with each spirometer had at least two acceptable curves, and 51 workers tested with each spirometer had curves that met all American Thoracic Society (ATS) criteria for spirometry. No group showed the anticipated decline in forced expiratory volume in 1 second (FEV1) over time. The results showed an increased number of curves meeting ATS acceptability and reproducibility criteria, and a statistically significant increase in the FVC in all groups, and an increase in the FEV1 in the group encompassing all workers. Use of technology that strengthens the interaction between the spirometry technician, the data available to the technician on the computer, and the participant appears to represent true underlying lung function more accurately. Such an approach to the collection of lung function data should be considered by those evaluating spirometers for implementation in the workplace or pulmonary function laboratory as well as by those planning future spirometer development.
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Affiliation(s)
- D E Banks
- Section of Pulmonary and Critical Care Medicine, West Virginia University School of Medicine, Morgantown 26506-9166, USA
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39
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Lian JB, Stein GS, Stein JL, Van Wijnen A, McCabe L, Banerjee C, Hoffmann H. The osteocalcin gene promoter provides a molecular blueprint for regulatory mechanisms controlling bone tissue formation: role of transcription factors involved in development. Connect Tissue Res 1996; 35:15-21. [PMID: 9084639 DOI: 10.3109/03008209609029170] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Characterization of regulatory sequences and their cognate binding factors in the bone-specific osteocalcin (OC) gene promoter has provided insight into mechanisms that control expression of the gene under diverse biological conditions. We present evidence for AP-1 motifs and two multipartite conserved regulatory sequences, the OC Box I (nt-99 to-76) and a site designated OC Box II (nt-136 to-130) in contributing to developmental and tissue-specific expression of osteocalcin. OC Box I is characterized by a homeodomain binding site and OC Box II is a recognition sequence for AML-1 (also called PEBP2 alpha), a runt homology-related DNA binding protein. Functional activity of the elements was established in osseous and non-osseous cell lines and is in part related to the binding of osteoblast-specific complexes which enhance OC transcription. The contribution of several elements and binding of multiple classes of transcription factors to independent elements in both these domains serve to illustrate the complexity of control required for tissue-specific OC expression.
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Affiliation(s)
- J B Lian
- University of Massachusetts Medical Center, Department of Cell Biology, Worcester 01655, USA
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40
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Breen EC, Ignotz RA, McCabe L, Stein JL, Stein GS, Lian JB. TGF beta alters growth and differentiation related gene expression in proliferating osteoblasts in vitro, preventing development of the mature bone phenotype. J Cell Physiol 1994; 160:323-35. [PMID: 8040190 DOI: 10.1002/jcp.1041600214] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study examines the mechanism by which TGF-beta 1, an important mediator of cell growth and differentiation, blocks the differentiation of normal rat diploid fetal osteoblasts in vitro. We have established that the inability for pre-osteoblasts to differentiate is associated with changes in the expression of cell growth, matrix forming, and bone related genes. These include histone, jun B, c-fos, collagen, fibronectin, osteocalcin, alkaline phosphatase, and osteopontin. Morphologically, the TGF-beta 1-treated osteoblasts exhibit an elongated, spread shape as opposed to the characteristic cuboidal appearance during the early stages of growth. This is followed by a decrease in the number of bone nodules formed and the amount of calcium deposition. These effects on differentiation can occur without dramatic changes in cell growth if TGF-beta 1 is given for a short time early in the proliferative phase. However, continuous exposure to TGF-beta 1 leads to a bifunctional growth response from a negative effect during the proliferative phase to a positive growth effect during the later matrix maturation and mineralization phases of the osteoblast developmental sequence. Extracellular matrix genes, fibronectin, osteopontin and alpha 1(I) collagen, are altered in their expression pattern which may provide an aberrant matrix environment for mineralization and osteoblast maturation and potentiate the TGF-beta 1 response throughout the course of osteoblast differentiation. The initiation of a TGF-beta 1 effect on cell growth and differentiation is restricted to the proliferative phase of the culture before the cells express the mature osteoblastic phenotype. Second passage cells that are accelerated to differentiate by the addition of dexamethasone or by seeding cultures at a high density are refractory to TGF-beta 1. These in vitro results indicate that TGF-beta 1 exerts irreversible effects at a specific stage of osteoblast phenotype development resulting in a potent inhibition of osteoblast differentiation at concentrations from 0.1 ng/ml.
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Affiliation(s)
- E C Breen
- University of Massachusetts Medical Center, Worcester 01655
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41
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Kockx M, McCabe L, Stein JL, Lian JB, Stein GS. Influence of DNA replication inhibition on expression of cell growth and tissue-specific genes in osteoblasts and osteosarcoma cells. J Cell Biochem 1994; 54:47-55. [PMID: 8126086 DOI: 10.1002/jcb.240540106] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interrelationships between proliferation and expression of cell growth as well as bone cell-related genes were examined from two standpoints. First, the consequence of downregulating proliferation by DNA synthesis inhibition on expression of a cell cycle-regulated histone gene and genes associated with development of the bone cell phenotype (type I collagen, alkaline phosphatase, osteopontin, and osteocalcin) was investigated. Second, the requirement for stringent growth control to support functional relationships between expression of proliferation and differentiation-related genes was explored. Parameters of cell growth and osteoblast-related gene expression in primary cultures of normal diploid osteoblasts, that initially express proliferation-dependent genes and subsequently postproliferative genes associated with mature bone cell phenotypic properties, were compared to those operative in ROS 17/2.8 osteosarcoma cells that concomitantly express cell growth and mature osteoblast phenotypic genes. Our findings indicate that in both normal diploid osteoblasts and osteosarcoma cells, expression of the cell cycle regulated histone genes is tightly coupled with DNA synthesis and controlled predominantly at a posttranscriptional level. Inhibition of proliferation by blocking DNA synthesis with hydroxyurea upregulates a subset of developmentally expressed genes that postproliferatively support progressive establishment of mature osteoblast phenotypic properties (e.g., alkaline phosphatase, type 1 collagen, and osteopontin). However, the osteocalcin gene, which is expressed during the final stage of osteoblast differentiation when extracellular matrix mineralization occurs, is not upregulated. Variations in the extent to which inhibition of proliferation in normal diploid osteoblasts and in ROS 17/2.8 osteosarcoma cells selectively affects transcription and cellular levels of mRNA transcripts from bone cell-related genes (e.g., osteocalcin) may reflect modifications in proliferation/differentiation interrelationships when stringent growth control is abrogated.
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Affiliation(s)
- M Kockx
- University of Massachusetts Medical Center, Worcester 01655
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42
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McCabe L, Griffin LD, Kinzer A, Chandler M, Beckwith JB, McCabe ER. Overo lethal white foal syndrome: equine model of aganglionic megacolon (Hirschsprung disease). Am J Med Genet 1990; 36:336-40. [PMID: 2363434 DOI: 10.1002/ajmg.1320360319] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The lethal white foal syndrome (LWFS) is a congenital abnormality of overo spotted horses which is a model for human aganglionic megacolon or Hirschsprung disease. Foals with LWFS have an all white, or nearly all white, coat. They also present clinically with an intestinal obstruction that proves fatal within the first few days of life. The LWFS involves both melanocytes and intestinal ganglion cells, and appears to result from a genetic defect involving neural crest cells. This report describes pathologic studies of two recent cases of LWFS. Two different hypothetical models of inheritance of LWFS are presented and discussed.
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Affiliation(s)
- L McCabe
- Institute for Molecular Genetics, Baylor College of Medicine, Houston, TX 77030
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Abstract
Treatment for phenylketonuria (PKU) involves using low phenylalanine-free or phenylalanine-free formulas and supplementation with sufficient phenylalanine for normal growth and development. Eighteen infants with phenylketonuria who received breast milk as their primary phenylalanine source were compared with ten other infants with PKU who received their phenylalanine primarily from infant formulas. There were no significant differences between breast-fed and formula-fed infants for serum phenylalanine, serum tyrosine, length, weight, head circumference, haematocrit, haemoglobin, serum iron, total iron binding capacity, percentage iron saturation, ferritin, plasma zinc and total calorie intake. Breast-fed infants did show lower mean corpuscular volume at 3 months and 6 months of age. Breast-fed infants had lower phenylalanine intake at 2, 4, 5 and 6 months of age. Breast-fed infants at 1, 2, 3, 4, 5 and 6 months of age had lower protein intake. Breast feeding may be continued in the newly diagnosed phenylketonuric infant without any apparent adverse nutritional consequences.
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Affiliation(s)
- L McCabe
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver
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44
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Affiliation(s)
- A M Nord
- Department of Pediatrics, University of Colorado School of Medicine, Denver 80262
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45
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McCabe ER, Nord AM, Ernest A, McCabe L. Evaluation of a phenylalanine-free product for treatment of phenylketonuria. Am J Dis Child 1987; 141:1327-9. [PMID: 3318396 DOI: 10.1001/archpedi.1987.04460120093043] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ten children with classic phenylketonuria (PKU) participated in a controlled study of a phenylalanine-free formula recently released in the United States (PKU-2). Control data were obtained in the clinic while the children were receiving their baseline formula. The children were given the study formula and returned to the clinic for follow-up after they had been receiving the new formula for 4, 8, and 12 months. Serum phenylalanine and tyrosine concentrations, other hematologic measurements, urine analysis, growth, electroencephalogram, and physical findings remained similar to baseline values throughout the study. Nutrient intakes were comparable with the exception of a decrease in several micronutrients relative to baseline levels. We found that PKU-2 is appropriate for children with PKU who are over 3 years of age and may prove beneficial for the overweight child with PKU.
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Affiliation(s)
- E R McCabe
- Department of Pediatrics, University of Colorado, School of Medicine, Denver
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Chung KF, Osborne ML, Corrales RJ, Evans TW, McCabe L, Frick OL, Nadel JA, Gold WM. Histamine release and circulating cells after antigen inhalation in allergic dogs. J Appl Physiol (1985) 1987; 62:253-8. [PMID: 2435696 DOI: 10.1152/jappl.1987.62.1.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Histamine can be recovered from the blood of ragweed-sensitized dogs after aerosol antigen challenge, although its source is unknown. Neutrophils and eosinophils have been recovered from bronchoalveolar lavage fluid (BALF) obtained under identical conditions. We investigated the time course of changes in histamine levels in plasma and BALF taken from ragweed-sensitized dogs after aerosol challenge. Changes in the numbers of circulating neutrophils, eosinophils, lymphocytes, monocytes, and platelets were also studied. After 3 min, total pulmonary resistance (RL) was maximally increased and systolic blood pressure was maximally decreased. Histamine levels in plasma and BALF were increased and circulating eosinophils and neutrophils were decreased. After 15 min, platelet numbers were reduced. By 90 min, changes in RL, blood pressure, plasma and BALF histamine concentrations, and circulating neutrophils and eosinophils had returned to base-line values, but platelet numbers remained significantly decreased. Sham challenge caused no significant changes in any of these variables. Intravenous administration of histamine in doses large enough to attain plasma levels comparable with those achieved after aerosol antigen challenge resulted in no concomitant rise in BALF histamine levels. We conclude that antigen challenge in sensitized dogs causes increases in BALF and plasma histamine levels and is associated with a reduction in circulating neutrophils, eosinophils, and platelets. It is likely that antigen causes airway mast cells to release mediators that move down a concentration gradient from the airways to the pulmonary circulation.
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Abstract
We have reviewed our experience with supplemental breast-feeding of the infant with PKU. Our results indicate no harmful nutritional effects of breast-feeding the child with PKU, in comparison with the traditional approach using formula or cow's milk for supplementation. In addition, breast-feeding may provide a source of emotional support for the mother during this difficult period of initial diagnosis and management. It is hoped that this may improve the family's adjustment to this chronic illness. Our work with breast-feeding led us to a consideration of trace-metal nutriture in children treated with these synthetic and semi-synthetic formulas. The results of these investigations suggest that there is a biochemically significant decrease in the bioavailability of zinc when these artificial formulas are used. While no clinical trace-metal deficiency has been described in treated PKU patients, we suggest that these nutritional deficits may relate to subtle abnormalities exhibited by these patients.
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McCabe ER, McCabe L, Mosher GA, Allen RJ, Berman JL. Newborn screening for phenylketonuria: predictive validity as a function of age. Pediatrics 1983; 72:390-8. [PMID: 6889045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Data from questionnaires were assembled for 109 infants with phenylketonuria (PKU) and 114 control infants to assess the predictive validity of newborn screening for PKU as a function of age. Patients with PKU had values of less than 4 mg/dL in cord blood and in samples from days 1, 2, and 4 through 7. The proportion of patients with PKU expected to fall below screening cutoffs of 2, 4, and 6 mg/dL was predicted for each age range. Using a cutoff of 4 mg/dL, approximately one third of patients with PKU would be missed by a sample taken from the neonate in the first 12 hours of life, and nearly 10% would be missed with a sample from the second 12 hours of life. This study shows that not all patients with PKU will be detected by newborn screening, and that the phenomenon of early nursery discharges must be considered in developing appropriate screening strategies.
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Tabaczynski R, McCabe L, Cole D, Bradow R. General discussion: session I. Bull N Y Acad Med 1980; 56:812-816. [PMID: 19313006 PMCID: PMC1808363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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