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Ratnayake A, Gomes G, Kissinger PJ. HIV Screening Among Young Black Men Who Have Sex with Women in New Orleans, LA. AIDS Behav 2024:10.1007/s10461-024-04354-7. [PMID: 38713280 DOI: 10.1007/s10461-024-04354-7] [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] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
There are significant disparities in HIV acquisition, with Black individuals facing disproportionately more new diagnoses. Per Centers for Disease Control and Prevention (CDC), all people aged 13-64 should be tested at least once in their lifetime, and men at increased risk (e.g., those who have male sexual contact, multiple partners, have partners with multiple partners, or share drug injection equipment) should be tested annually. The study included young Black men who have sex with women (MSW), aged 15-26, and who live in New Orleans, LA. Survey data was used to elicit the frequency and factors associated with three self-reported outcomes: (1) history of ever HIV testing, (2) HIV screening in the last year among those who were recommended per CDC, and (3) HIV positivity. Of the 1321 men included, 694/1321 men (52.5%) reported ever having been HIV tested. There were 708/1321 (54.2%) men who met the recommendation for annual screening and 321/708 (45.3%) of these eligible men reported being tested in the previous year. Of those ever tested, 44/694 (6.3%) self-reported testing positive. In logistic regression analysis, older age (OR: 1.27, p < 0.001), prior STI testing (OR: 6.45, p < 0.001), and prior incarceration (OR:1.70, p = 0.006) were positively associated with having ever received an HIV test, and ever having a male partner (OR: 3.63, p = 0.014) was associated with HIV positivity. Initiatives to improve HIV testing rates among young Black men who have sex with women are needed to reduce the burden of HIV and help the End the Epidemic initiative.
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Affiliation(s)
- Aneeka Ratnayake
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2004, New Orleans, LA, 70112, USA
| | - Gérard Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2004, New Orleans, LA, 70112, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2004, New Orleans, LA, 70112, USA.
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Pearlman RL, Van Gerwen OT, Aaron KJ, Kissinger PJ, Muzny CA. Challenges in Male Partner Referral Among Trichomonas vaginalis -Infected Women. Sex Transm Dis 2024; 51:e8-e10. [PMID: 38180841 DOI: 10.1097/olq.0000000000001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
ABSTRACT This study assessed feasibility of male partner referral by Trichomonas vaginalis -infected women. Of 93 women approached, only 20 enrolled. Only 1 male partner contacted the study but was unable to be reached for scheduling. Other public health interventions are necessary to engaged T. vaginalis -infected women and their male partners in care.
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Affiliation(s)
| | - Olivia T Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Kristal J Aaron
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
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Justman J, Skalland T, Moore A, Amos CI, Marzinke MA, Zangeneh SZ, Kelley CF, Singer R, Mayer S, Hirsch-Moverman Y, Doblecki-Lewis S, Metzger D, Barranco E, Ho K, Marques ETA, Powers-Fletcher M, Kissinger PJ, Farley JE, Knowlton C, Sobieszczyk ME, Swaminathan S, Reed D, Tapsoba JDD, Emel L, Bell I, Yuhas K, Schrumpf L, Mkumba L, Davis J, Lucas J, Piwowar-Manning E, Ahmed S. Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. Emerg Infect Dis 2024; 30:245-254. [PMID: 38270128 PMCID: PMC10826749 DOI: 10.3201/eid3002.230863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
During January-August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons >2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.
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Ratnayake A, Gomes G, Kissinger PJ. Syphilis Screening Among Young Black Men Who Have Sex With Women in New Orleans, LA. Sex Transm Dis 2024; 51:85-89. [PMID: 37963340 PMCID: PMC10841706 DOI: 10.1097/olq.0000000000001900] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND Current US syphilis screening focuses on men who have sex with men (MSM), because of the increased risk of infection in their sexual networks, and on pregnant people, because of complications associated with congenital syphilis. However, screening for men who have sex with women (MSW) who are at increased risk of syphilis is also recommended. Factors associated with syphilis testing and positivity were assessed among young, Black MSW. METHODS Data from the Check It study-a seek, test, and treat study for chlamydia in New Orleans, LA, among Black MSW aged 15 to 26 years-were used. Survey data were used to elicit self-reported syphilis testing, self-reported testing results, and sociodemographic and behavioral factors associated with these 2 outcomes. RESULTS Per the Centers for Disease Control and Prevention, all men in the study were recommended for syphilis screening because of their age, race, and geographic location. Of the 1458 men included, 272 (18.7%) reported ever having been syphilis tested, 267 men reported their results, and 23 (8.6%) reported testing positive. In logistic regression, older age (odds ratio [OR], 1.21 per year older; P < 0.001), prior Chlamydia trachomatis , Neisseria gonorrhoeae , and/or HIV testing (OR, 50.32; P < 0.001), and younger age at sexual debut (0.90 per year older, P = 0.005) were significantly associated with prior syphilis testing. In addition, testing positive for C. trachomatis and/or N. gonorrhoeae during the study was significantly associated with a history of syphilis positivity (OR, 3.08; P = 0.031). CONCLUSIONS Although syphilis testing was associated with factors that might increase the risk of acquisition, only 19% of individuals meeting Centers for Disease Control and Prevention testing recommendations had ever been screened.
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Affiliation(s)
- Aneeka Ratnayake
- From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Frechtling D, Chopra S, Ratnayake A, Kissinger PJ. The Association Between Human Immunodeficiency Virus and Bacterial Vaginosis and Metronidazole Treatment Failure for Trichomonas vaginalis. Sex Transm Dis 2024; 51:61-64. [PMID: 37921835 DOI: 10.1097/olq.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Trichomonas vaginalis (TV) is a common sexually transmitted infection. High rates of repeated infections have been observed, particularly among women living with human immunodeficiency virus (HIV). Trichomonas vaginalis frequently cooccurs with bacterial vaginosis (BV). The purpose of this study was to determine if coinfections with TV, BV, and HIV could lead to differential treatment failure outcomes. METHODS Data were pooled from 2 prior randomized control trials comparing 2 g oral single-dose versus 500-mg twice daily oral 7-day dose metronidazole for the treatment of TV in HIV infected and HIV uninfected women. Trichomonas vaginalis rates 1-month postcompletion of treatment were compared by arm, HIV and BV status after removing those who had sexual reexposure, and/or did not complete their treatment. RESULTS Data for 795 subjects were included in the study, of which 76 (9.6%) experienced treatment failure. In the final multivariable model, which included treatment dose, HIV status, and BV status, odds of treatment failure infection in the 7-day dose group were lower than the odds in the single dose group (odds ratio, 040; 95% confidence interval, 0.23-0.68). Treatment failure was lower in the multidose arm compared with single dose for both HIV-infected (4.0% vs 10.3%; P = 0.0568) and HIV-uninfected (7.3% vs 15.4%; P = 0.0037). Neither HIV nor BV was associated with higher treatment failure. CONCLUSIONS Human immunodeficiency virus infection and BV status did not significantly alter the rate of repeat infection for either single dose or 7-day dose metronidazole. Among all women, 7-day metronidazole lowered the odds of treatment failure.
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Affiliation(s)
- Dan Frechtling
- From the John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Shubam Chopra
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Aneeka Ratnayake
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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Muzny CA, Kissinger PJ. Where Do Tinidazole and Secnidazole Fit in With the Treatment of Trichomoniasis? Sex Transm Dis 2023; 50:e17-e21. [PMID: 37432997 DOI: 10.1097/olq.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Christina A Muzny
- From the Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA
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Ratnayake A, Campbell MB, Gomes G, Kissinger PJ. Are Prior Sexual Risk Behaviors Associated With Adherence to COVID-19 Preventative Behaviors Among Young Black Men? Sex Transm Dis 2023; 50:687-691. [PMID: 37432988 PMCID: PMC10528327 DOI: 10.1097/olq.0000000000001851] [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] [Indexed: 07/13/2023]
Abstract
BACKGROUND Behavioral clustering is a phenomenon in which several risk or protective behaviors co-occur in an individual. We sought to determine if prior sexual risk behaviors among young Black men who have sex with women could predict subsequent nonadherence to COVID-19 prevention behaviors. METHODS Young Black men who have sex with women aged 15 to 24 years previously enrolled in a community-based Chlamydia trachomatis (Ct) screening program were enrolled in a substudy between May and June 2020 and asked about adherence to 4 COVID-19 recommended nonpharmaceutical prevention behaviors (handwashing, mask wearing, social distancing, and following stay at home orders). Data from the original study were used to elicit the follow prepandemic behaviors including having multiple sex partners, inconsistent condom use, prior sexually transmitted infection testing behaviors, and substance use. Wilcoxon rank sum tests were used to assess the association between historic risk behaviors and COVID-19 behavior score. RESULTS There were 109 men included in the analysis, with a mean (SD) age of 20.5 (2.0) years. Inconsistent condom use, multiple sex partners, and prior HIV/sexually transmitted infection testing status were not associated with fewer COVID-19 preventive behaviors, but men who used any nonprescription drugs ( P = 0.001) or marijuana only ( P = 0.028) had a lower median COVID-19 preventative score compared with those who did not engage in those activities. CONCLUSIONS Although none of the sexual risk behavior variables were associated, self-reported nonprescription drug and marijuana use were both significant predictors of lower adherence to COVID-19 preventative behaviors among young Black men. Young men who use drugs may need additional support to promote COVID-19 preventative behavior uptake.
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Affiliation(s)
- Aneeka Ratnayake
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - Mary Beth Campbell
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - Gérard Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
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Kissinger PJ, Green J, Latimer J, Schmidt N, Ratnayake A, Madkour AS, Clum G, Wingood GM, DiClemente RJ, Johnson C. Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial. Sex Transm Dis 2023; 50:329-335. [PMID: 36806151 DOI: 10.1097/olq.0000000000001784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. METHODS Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. RESULTS Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. CONCLUSION AND RELEVANCE The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.
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Affiliation(s)
| | | | | | | | | | - Aubrey Spriggs Madkour
- Social, Behavioral, and Population Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA
| | - Gretchen Clum
- Social, Behavioral, and Population Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA
| | | | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, New York University, School of Global Public Health, New York, NY
| | - Carolyn Johnson
- Social, Behavioral, and Population Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA
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Jones AT, Moreno-Walton L, Sossamon SD, Tahmeena F, Tran T, Briones C, Stevens R, Isaacson K, He H, Rhodes S, Percak J, Kissinger PJ. Delays in fibrosis staging reduce the likelihood of achieving hepatitis C treatment and cure. Infect Dis (Lond) 2023; 55:309-315. [PMID: 36853886 PMCID: PMC10284034 DOI: 10.1080/23744235.2023.2178670] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Updated 2021 hepatitis C virus (HCV) treatment guidelines no longer recommend fibrosis staging for treatment-naïve patients without cirrhosis; however, numerous US state Medicaid plans continue to restrict initiation of HCV therapy by fibrosis stage. The study objective was to determine whether delays from HCV diagnosis to fibrosis staging impact the likelihood of initiating/completing HCV treatment and achieving sustained virologic response (SVR). METHODS A retrospective cohort study was performed among patients diagnosed with chronic HCV by an urban US emergency department who subsequently underwent fibrosis staging. Time elapsed from HCV diagnosis to hepatic fibrosis staging was evaluated on the likelihood of treatment initiation, treatment completion and SVR. RESULTS Among fibrosis staging modalities, hepatic ultrasounds occurred more quickly following HCV diagnosis (3.5 months, IQR = 12.4 months), compared to FibroSure (8.5 months, IQR = 20.4 months) and FibroScan (9.9 months, IQR = 18.0 months) (p<.001). Each six-month delay in fibrosis staging decreased the likelihood of initiating treatment by 5% (adjusted relative risk (aRR)=0.95; 95% confidence interval (CI)=0.91-0.998; p=.04) and the likelihood of SVR by 7% (aRR = 0.93; 95% CI = 0.87-0.995; p=.04) after adjusting for insurance, race/ethnicity and history of HIV testing. CONCLUSIONS Delays in hepatitis fibrosis staging were significantly associated with decreased likelihood of HCV treatment initiation and SVR.
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Affiliation(s)
- Austin T. Jones
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Lisa Moreno-Walton
- Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sierra D. Sossamon
- Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Fnu Tahmeena
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Torrence Tran
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Christopher Briones
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | | | | | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Stacey Rhodes
- Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jeffrey Percak
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Campbell MB, Ratnayake A, Gomes G, Stoecker C, Kissinger PJ. Effectiveness of Incentivized Peer Referral to Increase Enrollment in a Community-Based Chlamydia Screening and Treatment Study Among Young Black Men. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01595-5. [PMID: 37095285 PMCID: PMC10124922 DOI: 10.1007/s40615-023-01595-5] [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: 09/09/2022] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Young Black men are under-represented in sexual health services and research, a condition likely magnified during COVID-19 shutdowns due to disruption of STI screening and treatment services. We examined the effect of incentivized peer referral (IPR) increasing peer referral among young Black men in a community-based chlamydia screening program. METHODS Young Black men in New Orleans, LA, age 15-26 years enrolled in a chlamydia screening program between 3/2018 and 5/2021 were included. Enrollees were provided with recruitment materials to distribute to peers. Starting July 28, 2020, enrollees were also offered a $5 incentive for each peer enrolled. Enrollment was compared before and after the incentivize peer referral program (IPR) was implemented using multiple time series analysis (MTSA). RESULTS The percentage of men referred by a peer was higher during IPR compared to pre-IPR (45.7% vs. 19.7%, p < 0.001). After the COVID-19 shutdown was lifted, there were 2.007 more recruitments per week (p = 0.044, 95% CI (0.0515, 3.964)) for IPR, compared to pre-IPR. Overall, there was a trending increase in recruitments in the IPR era relative to the pre-IPR era (0.0174 recruitments/week, p = 0.285, 95% CI (- 0.0146, 0.0493)) with less recruitment decay during IPR compared to pre-IPR. CONCLUSIONS IPR may be an effective means of engaging young Black men in community-based STI research and prevention programs, particularly when clinic access is limited. CLINICAL TRIALS REGISTRY SITE AND NUMBER Clinicaltrials.gov identifier NCT03098329.
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Affiliation(s)
- Mary Beth Campbell
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Aneeka Ratnayake
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Gérard Gomes
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Charles Stoecker
- Health Policy and Management Department, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Patricia J Kissinger
- Epidemiology Department, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA.
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Lederer AM, Foster AM, Schmidt N, Gomes GR, Scott G, Watson S, Kissinger PJ. A framework for using real-time evaluative interview feedback for health promotion program and evaluation improvement: The Check It case study. Eval Program Plann 2023; 97:102216. [PMID: 36682139 DOI: 10.1016/j.evalprogplan.2022.102216] [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] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/07/2021] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Formative evaluation is a crucial strategy for health promotion program improvement. Early and ongoing formative evaluation can make a major impact on program outcomes; however, there are few frameworks that provide actual guidance on how programmatic or research teams can systematically perform this kind of important work. In this article we describe the use of an iterative real-time interview feedback framework we developed for Check It, a community-wide chlamydia screening and treatment program for young African American men in New Orleans, Louisiana. The framework considers the diverse and needed perspectives of multiple stakeholders, including participants, interviewers, transcribers, program staff, and lead researchers and/or administrators. Interviews were conducted with N = 15 Check It participants utilizing this approach. Employing the framework led to critical insights that resulted in several vital programmatic and evaluation improvements. Lessons learned, including strengths and challenges of utilizing the framework, are also shared so that this model can be replicated or adapted by program planning and evaluation professionals for other kinds of programs.
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Affiliation(s)
- Alyssa M Lederer
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Suite 116, Bloomington, IN 47405, USA.
| | - Allison M Foster
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Gérard R Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Glenis Scott
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Shannon Watson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
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Stapleton JL, Ratnayake A, Gomes G, He H, Kissinger PJ. Past incarceration and chlamydia infection among young Black men in New Orleans. Front Public Health 2023; 11:1114877. [PMID: 37064683 PMCID: PMC10103590 DOI: 10.3389/fpubh.2023.1114877] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
BackgroundYoung Black men are disproportionately and adversely affected by incarceration and sexually transmitted infections (STIs), both of which share common social and structural determinants. It is well documented that incarcerated individuals, including youth, are more likely to acquire STIs in the carceral setting compared to the general population. However, the effects of imprisonment on sexual health outcomes after imprisonment are not well-understood. The relationship between incarceration history (having ever spent time in a correctional institution such as prison, jail, or juvenile detention) and chlamydia positivity was examined in this study.MethodsA secondary analysis of the Check it Program, a Chlamydia trachomatis (Ct) community-based seek, test, and treat screening program for Black men aged 15–24 who have sex with women in New Orleans was conducted. Participants completed a computer-assisted self-administered questionnaire on relevant sexual and social histories and provided a urine specimen for a Ct urine nucleic acid amplification test. Bivariate and multivariable regressions were used to estimate the association between incarceration history and chlamydia positivity.ResultsParticipants (N = 1,907) were enrolled from May 2017 to March 2020. Of those, 351/1,816 (19.3%) reported past incarceration and 203/1,888 (10.8%) tested positive for Ct. When adjusted for age, insurance status, and condom use, having a history of incarceration was positively associated with a positive Ct test (adjusted odds ratio (95% confidence interval):1.61 (1.12, 2.31), p = 0.0095).ConclusionsInteracting with the carceral system is associated with a positive Ct test post-incarceration. Incarceration may be an important marker for Ct acquisition in young Black men who have sex with women and those with a history of incarceration should be prioritized for Ct screening after release.
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Sauter SR, Ratnayake A, Campbell MB, Kissinger PJ. Sexual Networks and STI Infection Among Young Black Men Who Have Sex With Women in a Southern U.S. City. J Adolesc Health 2023; 72:730-736. [PMID: 36599759 DOI: 10.1016/j.jadohealth.2022.11.248] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The configuration of one's sexual network has been shown to influence sexually transmitted infection (STI) acquisition in some populations. Young Black men who have sex with women (MSW) have high rates of STIs, yet little is known about their sexual networks. The purpose of this study is to describe the characteristics of sexual networks and their association with selected STI infections among young Black MSW. METHODS Black MSW aged 15-26 years who were enrolled in the New Orleans community-based screening program named Check It from March 2018 to March 2020 were tested for C. trachomatis and N. gonorrhoeae infection and asked about the nature of their sexual partnerships. Sexual partnerships with women were defined as dyadic, somewhat dense (either themselves or their partner had multiple partners), and dense (both they and their partner(s) had multiple partners). RESULTS Men (n = 1,350) reported 2,291 sex partners. The percentage of men who reported their networks were dyadic, somewhat dense, and dense was 48.7%, 27.7%, and 23.3%, respectively; 11.2% were STI-positive and 39.2% thought their partner(s) had other partners. Compared to men in dyadic relationships, those in somewhat dense network did not have increased risk of STI infection, but those in dense networks were more likely to have an STI (adjusted odds ratio = 2.06, 95% confidence interval [1.35-3.13]). DISCUSSION Young Black MSW, who had multiple partners and who thought their partner(s) had other sex partners were at highest risk for STIs. Providers should probe not only about the youth's personal risk but should probe about perceived sexual partners' risk for more targeted counseling/STI testing.
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Affiliation(s)
- Sydney R Sauter
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Aneeka Ratnayake
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Mary Beth Campbell
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
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14
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Tauhid L, Fondong M, Lovett A, Kissinger PJ, Bennani Y, Clement ME. 443. Do people living with HIV lose weight on GLP-1 agonist therapy? Open Forum Infect Dis 2022. [PMCID: PMC9752354 DOI: 10.1093/ofid/ofac492.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Anti-retroviral therapy (ART) has been associated with significant weight gain and metabolic derangements in persons with HIV (PWH), and many PWH on ART experience comorbid obesity. GLP-1 receptor agonists (GLP-1RA) are used to treat type-2 diabetes and obesity in people without HIV infection, but data on the use of these agents in PWH on ART are limited. Methods We extracted data from electronic medical records of PWH on ART receiving care at a clinic in New Orleans, LA who had been started on GLP-1RA therapy. We tracked weight (change in body weight, body mass index [BMI]) and changes in hemoglobin A1c (Hba1c) over time from initiation of GLP-1RA to April 2022. A control group of PWH on metformin only will be compared to those on GLP-1RA at a later stage of analysis. Results Of 35 PWH on GLP-1RA, the mean age was 55.2 (standard deviation [SD] 10.0); 29 (83%) were Black/African American, 14 (40%) were assigned female at birth, 21 (60%) were assigned male at birth, and 2 were non-binary. Average BMI was 35.7 (SD 9.8) and average HbA1c was 9.5 (SD 2.6) at baseline. Integrase inhibitors were prescribed for 31 (89%) and metformin was prescribed for 20 (57%). Other baseline characteristics are shown in Figure 1. Mean duration of GLP-1RA therapy was 20.6 months (SD 14.0), and 20 (57%) had greater than 12 months of follow-up. Most (23, 66%) on GLP-1RA lost weight, 3 (9%) had a stable weight, and 9 (26%) gained weight. Five percent or more of body weight was lost by 11 (31%) of the total cohort (those with any amount of time on GLP-1RA) and by 9/20 (45%) of those on GLP-1RA for more than 12 months.
![]() Conclusion Our data show moderate weight loss among PWH on GLP-1RA. This study is limited by small sample size and limited follow-up time. Further research is needed to determine whether GLP-1RAs are an effective treatment option for obesity in PWH. Disclosures Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Roche: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant|Viiv Healthcare: Grant/Research Support.
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Affiliation(s)
- Lamiya Tauhid
- Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Mima Fondong
- Louisiana State University Health Science Center New Orleans, New Orleans, Louisiana
| | - Aish Lovett
- Louisiana State University Health Science Center–New Orleans, New Orleans, Louisiana
| | - Patricia J Kissinger
- Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana
| | - Yussef Bennani
- LSU Health Sciences Center New Orleans, New Orleans, Louisiana
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15
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Kumbhakar R, Neradilek M, Barnabas RV, Stewart J, Karita HCS, Landovitz RJ, Kissinger PJ, Jerome KR, Paasche-Orlow MK, Bershteyn A, Chu HY, Neuzil KM, Greninger AL, Luk A, Wald A, Brown ER, Johnston C. Using time-weighted average change from baseline of SARS-CoV-2 viral load to assess impact of hydroxychloroquine as postexposure prophylaxis and early treatment for COVID-19. J Med Virol 2022; 94:6091-6096. [PMID: 35940869 PMCID: PMC9538473 DOI: 10.1002/jmv.28054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023]
Abstract
Two randomized controlled trials demonstrated no clinical benefit of hydroxychloroquine (HCQ) for either postexposure prophylaxis or early treatment of SARS-CoV-2 infection. Using data from these studies, we calculated the time-weighted average change from baseline SARS-CoV-2 viral load and demonstrated that HCQ did not affect viral clearance.
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Affiliation(s)
- Raaka Kumbhakar
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
| | - Moni Neradilek
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
| | - Ruanne V. Barnabas
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington,
Seattle, WA, USA
| | - Jenell Stewart
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
- Department of Global Health, University of Washington,
Seattle, WA, USA
| | | | - Raphael J. Landovitz
- UCLA Center for Clinical AIDS Research & Education
(CARE), Division of Infectious Diseases, University of California, Los Angeles, CA,
USA
| | - Patricia J. Kissinger
- School of Public Health and Tropical Medicine, Tulane
University, New Orleans, LA, USA
| | - Keith R. Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, WA, USA
| | | | - Anna Bershteyn
- New York University Grossman School of Medicine, NY, NY,
USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington,
Seattle, WA, USA
- Department of Global Health, University of Washington,
Seattle, WA, USA
| | | | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
| | - Alfred Luk
- School of Medicine, Tulane University, New Orleans, LA,
USA
| | - Anna Wald
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington,
Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington,
Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer
Research Center, Seattle, WA, USA
| | - Christine Johnston
- Division of Allergy and Infectious Diseases, University of
Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University
of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson
Cancer Research Center, Seattle, WA, USA
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16
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Ratnayake A, Campbell MB, Jones A, Gomes G, Martin DH, Kissinger PJ. Anal and Oral Sex Behaviors Among Young Black Men Who Have Vaginal Sex: Evidence of the Need for Extragenital Testing for Chlamydia and Gonorrhea. Sex Transm Dis 2022; 49:826-830. [PMID: 36150068 PMCID: PMC9669138 DOI: 10.1097/olq.0000000000001709] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unprotected oral and anal sex may result in extragenital sexually transmitted infections. The purposes of this study were to describe sexual behaviors, barrier use, and chlamydia/gonorrhea (Ct/GC) positivity among young Black men who have sex with women, and to examine the potential influence of extragenital infections on genital infections. METHODS Young Black men who had vaginal sex were screened for Ct/GC in New Orleans, LA, from August 14, 2019, to February 29, 2020. Audio/computer-assisted self-interviews were used to collect data on demographics and sexual behaviors. χ2 /Fisher exact or t test/Wilcoxon rank tests were used to assess differences in behaviors by Ct/GC positivity. RESULTS Among 373 men studied, 619 female partnerships were reported in the past 2 months. Vaginal sex was reported in all partnerships per study protocol, receiving fellatio in 42.7%, performing cunnilingus in 35.7%, and penile-anal sex in 5.9%. Although 31.4% of the men consistently used condoms for vaginal sex with all partners, consistent barrier use was low during cunnilingus (0.5%) and fellatio (5.1%). Urethral infection rates among all men in the sample were 12.6% for Ct and 1.6% for GC. There was no significant difference in Ct/GC rates between those using and not using condoms consistently during vaginal sex ( P = 0.38). CONCLUSIONS Unprotected oral sex with female partners was common. The high rate of genital infection among men who used condoms consistently for vaginal sex suggests that oral infections could be serving as a reservoir of genital infection. Testing at all sites of exposure for youth who engage in heterosexual sex is merited.
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Affiliation(s)
- Aneeka Ratnayake
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mary Beth Campbell
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Austin Jones
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Gérard Gomes
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David H. Martin
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Louisiana State University – School of Medicine – Department of Infectious Diseases
| | - Patricia J. Kissinger
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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17
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Jones AT, Briones C, Tran T, Moreno-Walton L, Kissinger PJ. Closing the hepatitis C treatment gap: United States strategies to improve retention in care. J Viral Hepat 2022; 29:588-595. [PMID: 35545901 PMCID: PMC9276641 DOI: 10.1111/jvh.13685] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/10/2022] [Accepted: 04/05/2022] [Indexed: 12/09/2022]
Abstract
The hepatitis C virus (HCV) treatment landscape is shifting given the advent of direct-acting antivirals and a global call to action by the World Health Organization. Eliminating HCV is now an issue of healthcare delivery. Treatment is limited by the complexity of the HCV care continuum, expensive therapy and competing health burdens experienced by an underserved HCV population. The objective of this literature review was to assess strategies to improve retention in HCV care, with particular focus on those implemented in the United States. We identified barriers in HCV care retention and propose solutions to increase HCV treatment delivery. The following recommendations are herein described: improving the cohesion of health services through localized care and integrated case management, expanding the supply of non-specialist HCV treatment providers, leveraging patient navigators and care coordinators, improving adherence through directly observed therapy and reducing cost barriers through value-based payment and pharmaceutical subscription models.
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Affiliation(s)
- Austin T. Jones
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Christopher Briones
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Torrence Tran
- Department of Emergency Medicine, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Lisa Moreno-Walton
- Section of Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Patricia J. Kissinger
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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18
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Lindrose AR, Htet KZ, O'Connell S, Marsh J, Kissinger PJ. Burden of trichomoniasis among older adults in the United States: a systematic review. Sex Health 2022; 19:151-156. [PMID: 35667854 DOI: 10.1071/sh22009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022]
Abstract
Despite being one of the most common sexually transmitted infections (STIs) in the United States, the epidemiology of trichomoniasis remains understudied. One population that has been historically overlooked regarding STIs is that of older adults, despite many individuals remaining sexually active well into their older years. We investigated the reported prevalence and incidence of trichomoniasis in adults aged ≥45years in the United States using a systematic literature review. Twelve articles were included in the review, all assessing prevalence of trichomoniasis in this age group. Notably, no included articles assessed trichomoniasis incidence. Data collected encompassed several decades, from 1993 to 2016. Estimates of infection prevalence varied widely and ranged from 0.2% to 21.4% in included populations, with the highest prevalence typically seen among individuals seeking diagnostic testing for STIs. Several studies found increased risk for trichomoniasis in older patients compared to younger age groups. This is the first review to examine the risk of trichomoniasis in older adults, and the surprisingly high prevalence suggests that older adults may merit increased screening for trichomoniasis and sexual health education.
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Affiliation(s)
- Alyssa R Lindrose
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Kyaw Zin Htet
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Samantha O'Connell
- Office of Academic Affairs & Provost, Tulane University, New Orleans, LA, USA
| | - James Marsh
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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19
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Kissinger PJ, Gaydos CA, Seña AC, Scott McClelland R, Soper D, Secor WE, Legendre D, Workowski KA, Muzny CA. Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S152-S161. [PMID: 35416973 PMCID: PMC9006969 DOI: 10.1093/cid/ciac030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Trichomonas vaginalis is likely the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United States. Health disparities are prominent in the epidemiology of trichomoniasis, as African Americans are >4 times more likely to be infected than persons of other races. Since publication of the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines, additional data have bolstered the importance of T. vaginalis infection sequelae in women, including increased risk of human immunodeficiency virus (HIV) acquisition, cervical cancer, preterm birth, and other adverse pregnancy outcomes. Less is known about the clinical significance of infection in men. Newly available diagnostic methods, including point-of-care assays and multiple nucleic acid amplification tests, can be performed on a variety of genital specimens in women and men, including urine, allowing more accurate and convenient testing and screening of those at risk for infection. Repeat and persistent infections are common in women; thus, rescreening at 3 months after treatment is recommended. In vitro antibiotic resistance to 5-nitroimidazole in T. vaginalis remains low (4.3%) but should be monitored. High rates of T. vaginalis among sexual partners of infected persons suggest a role for expedited partner treatment. A randomized controlled trial in HIV-uninfected women demonstrated that multidose metronidazole 500 mg twice daily for 7 days reduced the proportion of women with Trichomonas infection at 1 month test of cure compared with women receiving single-dose therapy (2 g). The 2-g single-dose oral metronidazole regimen remains the preferred treatment in men.
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Affiliation(s)
- Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arlene C Seña
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - R Scott McClelland
- Departments of Medicine, Epidemiology, and Global Health, University of Washington, Seattle, Washington, USA
| | - David Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Davey Legendre
- Comprehensive Pharmacy Services, Woodstock, Georgia, USA
| | - Kimberly A Workowski
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Christina A Muzny
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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20
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Bershteyn A, Dahl AM, Dong TQ, Deming ME, Celum CL, Chu HY, Kottkamp AC, Greninger AL, Hoffman RM, Jerome KR, Johnston CM, Kissinger PJ, Landovitz RJ, Laufer MK, Luk A, Neuzil KM, Paasche-Orlow MK, Pitts RA, Schwartz MD, Stankiewicz Karita HC, Thorpe LE, Wald A, Zheng CY, Wener MH, Barnabas RV, Brown ER. Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study. Clin Infect Dis 2022; 75:e1180-e1183. [PMID: 35152299 PMCID: PMC8903379 DOI: 10.1093/cid/ciac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 01/19/2023] Open
Abstract
Coronavirus disease 2019 symptom definitions rarely include symptom severity. We collected daily nasal swab samples and symptom diaries from contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case patients. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (95% confidence interval [CI], 52.9%-66.7%) to 31.5% (95% CI, 25.7%- 38.0%) but increased specificity from 77.5% (95% CI, 75.3%-79.5%) to 93.8% (95% CI, 92.7%-94.8%).
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Affiliation(s)
- Anna Bershteyn
- Correspondence: A. Bershteyn, Department of Population Health, New York University Grossman School of Medicine, 227 E 30th St, New York, NY 10016 ()
| | | | - Tracy Q Dong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Meagan E Deming
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Connie L Celum
- International Clinical Research Center and Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Helen Y Chu
- Department of Medicine and Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Angelica C Kottkamp
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexander L Greninger
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Risa M Hoffman
- Department of Medicine and Division of Infectious Diseases, University of California, Los Angeles, California, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Christine M Johnston
- Department of Medicine and Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Raphael J Landovitz
- Center for Clinical AIDS Research & Education, University of California, Los Angeles, California, USA
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alfred Luk
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael K Paasche-Orlow
- Department of Medicine and Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Robert A Pitts
- Department of Medicine and Division of Infectious Diseases, NYC Health & Hospitals/Bellevue, New York, New York, USA
| | - Mark D Schwartz
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Anna Wald
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA,Department of Medicine, Department of Epidemiology, Seattle, Washington, USA
| | - Crystal Y Zheng
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mark H Wener
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ruanne V Barnabas
- Department of Global Health and Department of Medicine, University of Washington, Seattle, Washington, USA,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USAand
| | - Elizabeth R Brown
- Department of Biostatistics, University of Washington, Seattle, Washington, USA,Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, USA
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21
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Rietmeijer CA, Kissinger PJ, Guilamo-Ramos V, Gaydos CA, Hook EW, Mead A, Yang S, Geller A, Vermund SH. Report From the National Academies of Sciences, Engineering and Medicine-STI: Adopting a Sexual Health Paradigm-A Synopsis for Sexually Transmitted Infection Practitioners, Clinicians, and Researchers. Sex Transm Dis 2022; 49:169-175. [PMID: 34475355 PMCID: PMC9365299 DOI: 10.1097/olq.0000000000001552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/03/2023]
Abstract
ABSTRACT Despite decades of medical, diagnostic, and public health advances related to diagnosis and management of sexually transmitted infections (STIs), rates of reportable STIs continue to grow. A 2021 National Academies of Sciences, Engineering, and Medicine report on the current state of STI management and prevention in the United States, entitled Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, offers recommendations on future public health programs, policy, and research. This new report builds upon the 1997 Institute of Medicine report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, and provides 11 recommendations organized under 4 action areas: (1) adopt a sexual health paradigm, (2) broaden ownership and accountability for responding to STIs, (3) bolster existing systems and programs for responding to STIs, and (4) embrace innovation and policy change to improve sexual health. We present our interpretive synopsis of this report, highlighting elements of particular interest to STI and sexual health practitioners, including clinicians, researchers, disease intervention specialists, community outreach workers, and public health staff. The report asserts that it is possible to create a healthier and more equitable future where fewer adolescents and adults are infected, fewer babies are born with STIs, and people entering their sexual debut and continuing throughout the life span are taught the language and skills to conceptualize and enact their own vision for what it means to be sexually healthy.
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Affiliation(s)
- Cornelis A Rietmeijer
- From the Department of Community and Behavioral Health, Colorado School of Public Health and Rietmeijer Consulting LLC, Denver, CO
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Charlotte A Gaydos
- Division of Infectious Diseases, Medicine, Johns Hopkins University, Baltimore MD
| | | | - Aimee Mead
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Sophie Yang
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Amy Geller
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
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22
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Stankiewicz Karita HC, Dong TQ, Johnston C, Neuzil KM, Paasche-Orlow MK, Kissinger PJ, Bershteyn A, Thorpe LE, Deming M, Kottkamp A, Laufer M, Landovitz RJ, Luk A, Hoffman R, Roychoudhury P, Magaret CA, Greninger AL, Huang ML, Jerome KR, Wener M, Celum C, Chu HY, Baeten JM, Wald A, Barnabas RV, Brown ER. Trajectory of Viral RNA Load Among Persons With Incident SARS-CoV-2 G614 Infection (Wuhan Strain) in Association With COVID-19 Symptom Onset and Severity. JAMA Netw Open 2022; 5:e2142796. [PMID: 35006245 PMCID: PMC8749477 DOI: 10.1001/jamanetworkopen.2021.42796] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The SARS-CoV-2 viral trajectory has not been well characterized in incident infections. These data are needed to inform natural history, prevention practices, and therapeutic development. OBJECTIVE To characterize early SARS-CoV-2 viral RNA load (hereafter referred to as viral load) in individuals with incident infections in association with COVID-19 symptom onset and severity. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was a secondary data analysis of a remotely conducted study that enrolled 829 asymptomatic community-based participants recently exposed (<96 hours) to persons with SARS-CoV-2 from 41 US states from March 31 to August 21, 2020. Two cohorts were studied: (1) participants who were SARS-CoV-2 negative at baseline and tested positive during study follow-up, and (2) participants who had 2 or more positive swabs during follow-up, regardless of the initial (baseline) swab result. Participants collected daily midturbinate swab samples for SARS-CoV-2 RNA detection and maintained symptom diaries for 14 days. EXPOSURE Laboratory-confirmed SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES The observed SARS-CoV-2 viral load among incident infections was summarized, and piecewise linear mixed-effects models were used to estimate the characteristics of viral trajectories in association with COVID-19 symptom onset and severity. RESULTS A total of 97 participants (55 women [57%]; median age, 37 years [IQR, 27-52 years]) developed incident infections during follow-up. Forty-two participants (43%) had viral shedding for 1 day (median peak viral load cycle threshold [Ct] value, 38.5 [95% CI, 38.3-39.0]), 18 (19%) for 2 to 6 days (median Ct value, 36.7 [95% CI, 30.2-38.1]), and 31 (32%) for 7 days or more (median Ct value, 18.3 [95% CI, 17.4-22.0]). The cycle threshold value has an inverse association with viral load. Six participants (6%) had 1 to 6 days of viral shedding with censored duration. The peak mean (SD) viral load was observed on day 3 of shedding (Ct value, 33.8 [95% CI, 31.9-35.6]). Based on the statistical models fitted to 129 participants (60 men [47%]; median age, 38 years [IQR, 25-54 years]) with 2 or more SARS-CoV-2-positive swab samples, persons reporting moderate or severe symptoms tended to have a higher peak mean viral load than those who were asymptomatic (Ct value, 23.3 [95% CI, 22.6-24.0] vs 30.7 [95% CI, 29.8-31.4]). Mild symptoms generally started within 1 day of peak viral load, and moderate or severe symptoms 2 days after peak viral load. All 535 sequenced samples detected the G614 variant (Wuhan strain). CONCLUSIONS AND RELEVANCE This cohort study suggests that having incident SARS-CoV-2 G614 infection was associated with a rapid viral load peak followed by slower decay. COVID-19 symptom onset generally coincided with peak viral load, which correlated positively with symptom severity. This longitudinal evaluation of the SARS-CoV-2 G614 with frequent molecular testing serves as a reference for comparing emergent viral lineages to inform clinical trial designs and public health strategies to contain the spread of the virus.
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Affiliation(s)
| | - Tracy Q. Dong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christine Johnston
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Kathleen M. Neuzil
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Michael K. Paasche-Orlow
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | | | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Meagan Deming
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Angelica Kottkamp
- Department of Medicine, New York University Grossman School of Medicine, New York
| | - Miriam Laufer
- Department of Medicine, University of Maryland School of Medicine, Baltimore
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Alfred Luk
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Risa Hoffman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Pavitra Roychoudhury
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Craig A. Magaret
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Alexander L. Greninger
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Meei-Li Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Keith R. Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Mark Wener
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
- Division of Rheumatology, University of Washington, Seattle
| | - Connie Celum
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Jared M. Baeten
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Anna Wald
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Ruanne V. Barnabas
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Elizabeth R. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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23
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Schmidt N, Gomes G, Scott G, Wise B, Craig-Kuhn MC, Lederer AM, Martin DH, Kissinger PJ. Check It: A Community-Based Chlamydia Seek, Test, and Treat Program for Young Black Men Who Have Sex With Women in New Orleans, Louisiana. Sex Transm Dis 2022; 49:5-11. [PMID: 34310525 DOI: 10.1097/olq.0000000000001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/27/2022]
Abstract
BACKGROUND Check It is a novel, bundled, community-based seek, test, and treat Chlamydia trachomatis (Ct) screening program for 15- to 24-year-old Black men in New Orleans who have sex with women. The program design addressed barriers and facilitators to Ct screening/treatment by enlisting trusted community partners, incorporating participant input, providing free index/partner expedited treatment, developing relatable marketing materials and an educational Web site, encouraging peer referral, and providing a modest monetary incentive. METHODS Areas of high poverty were identified using census data; ethnographic/key informant interviews identified sites in those areas where the target population congregated. Black youth informed Web site design and social marketing. Content was inspirational/educational/amusing and endorsed recruitment and brand awareness. A community advisory board, participant interviews, community partner feedback, and recruitment staff involvement in the process evaluation helped refine the program in an ongoing manner. RESULTS During formative stages, 41 key informant/community advisory board members informed program refinement. Community partners provided venue locations (n = 65) and participant referrals. Between May 22, 2017, and February 28, 2020, 1890 men were enrolled (acceptance rate, 96.0%) with Ct infection rate of 10.2%. Overall study treatment was provided to 86.1% (71.4%-90.9%) of participants who tested positive and 28.5% (14.5%-41.5%) of their partners. Findings from in-depth interviews with participants (n = 43) led to increased treatment uptake. CONCLUSIONS C. trachomatis community screening of young Black men was successful through collaboration with trusted community partners, by tailoring implements/marketing with participant input, reducing barriers to treatment, and providing modest monetary incentives. The Check It program can serve as a roadmap for reducing health disparities in this population.
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Affiliation(s)
| | | | | | | | | | - Alyssa M Lederer
- Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
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Stoecker C, Shao Y, Schmidt N, Martin DH, Kissinger PJ. Impact of Check It: A Novel Community-Based Chlamydia Screening and Expedited Treatment Program for Young Black Men. Sex Transm Dis 2022; 49:1-4. [PMID: 34407010 PMCID: PMC8665060 DOI: 10.1097/olq.0000000000001526] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to estimate the impact of the Check It program, a novel community-based chlamydia seek, test, and treat program for young Black men who have sex with women, on test positivity rates for chlamydia in young Black women. METHODS We used a synthetic control model to compare chlamydia test positivity rates in Orleans Parish (intervention site) with other similar parishes (control sites) in Louisiana. We estimated a model that used all other parishes as potential contributors to a synthetic control for Louisiana as well as a sample limited to the 40 parishes in Louisiana with the largest Black populations. RESULTS The Check It program was associated with a 1.69-percentage-point decline in chlamydia positivity in the first full year of operation and a 2.44-percentage-point decline in chlamydia positivity in the second full year of operation compared with control sites with the largest Black populations (P = 0.05). Results were similar when the treatment site was compared with all other sites in Louisiana. CONCLUSIONS The Check It program was associated with a significant decline in chlamydia testing positivity rates among women in Orleans Parish compared with control sites. Screening of young Black men who have sex with women can decrease rates in women living in the same community. Future recommendations for chlamydia screening of young men should be considered.
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Affiliation(s)
- Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
| | - David H. Martin
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
- Louisiana State University School of Medicine – Department of Internal Medicine, Section of Infectious Diseases
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine
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25
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Stoecker C, Monnette A, Qu Z, Schmidt N, Craig-Kuhn MC, Kissinger PJ. Cost-effectiveness of Check It: A Novel Community-Based Chlamydia Screening and Expedited Treatment Program for Young Black Men. Clin Infect Dis 2021; 74:2166-2172. [PMID: 34864944 PMCID: PMC9258938 DOI: 10.1093/cid/ciab818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background We assessed the cost-effectiveness of the Check It program, a novel community-based chlamydia screening and expedited partner treatment program for young Black men conducted in New Orleans since 2017. Methods We implemented a probabilistic cost-effectiveness model using a synthetic cohort of 16 181 men and 13 419 women intended to simulate the size of the Black, sexually active population in New Orleans ages 15–24 years. Results The Check It program cost $196 838 (95% confidence interval [CI]: $117 320–$287 555) to implement, saved 10.2 quality-adjusted life-years (QALYs; 95% CI: 7.7–12.7 QALYs), and saved $140 950 (95% CI: −$197 018 to −$105 620) in medical costs per year. The program cost $5468 (95% CI: cost saving, $16 717) per QALY gained. All iterations of the probabilistic model returned cost-effectiveness ratios less than $50 000 per QALY gained. Conclusions The Check It program (a bundled seek, test, and treat chlamydia prevention program for young Black men) is cost-effective under base case assumptions. Communities where Chlamydia trachomatis rates have not declined could consider implementing a similar program.
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Affiliation(s)
- Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Zhuolin Qu
- Department of Mathematics, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Megan Clare Craig-Kuhn
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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26
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Lederer AM, Hindmarch G, Schmidt N, Gomes GR, Scott G, Watson S, Kissinger PJ. Facilitators and Barriers to Patient-Delivered Partner Therapy Acceptance for Chlamydia trachomatis Among Young African American Men Who Have Sex With Women in a Southern Urban Epicenter. Sex Transm Dis 2021; 48:823-827. [PMID: 33993165 PMCID: PMC9708115 DOI: 10.1097/olq.0000000000001470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chlamydia trachomatis (Ct) disproportionately affects African American young people living in the Southern United States and can have negative consequences if left untreated. Patient-delivered partner therapy (PDPT) is an evidence-based practice in which individuals diagnosed with Ct can provide treatment directly to their sex partners. However, PDPT acceptance rates need improvement. Although reasons for PDPT acceptance have been explored previously, the facilitators and barriers to expedited partner therapy acceptance among young southern African American men who have sex with women have not yet been examined. METHODS Twenty semistructured interviews were conducted as part of a community-based Ct screening and treatment intervention among African American men aged 15 to 25 years who had female sex partners. Participants were asked about why they did or did not accept PDPT for their sex partners. Data were transcribed and analyzed in NVivo qualitative software using an inductive thematic approach. RESULTS Participants' decision making was multifaceted. Facilitators for PDPT acceptance included being able to cure their partner, convenient access to treatment, believing it was the right thing to do, having a close relationship with a partner, concern for the partner's well-being, and the perceived severity of Ct. Barriers to PDPT acceptance were the belief that a partner did not need treatment, not having a close relationship with the partner, being unable to contact the partner, and fear of conflict. CONCLUSIONS Findings had similarities to other studies, indicating some universal messaging may be warranted alongside culturally tailored interventions for specific patient populations to increase PDPT acceptance. Implications for patient-provider communication are provided.
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Affiliation(s)
- Alyssa M. Lederer
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Grace Hindmarch
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gérard R. Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Glenis Scott
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shannon Watson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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27
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Cironi KA, Jones AT, Hauser EM, Olsen JW, Kissinger PJ. Human Immunodeficiency Virus and Hepatitis C Linkage-to-Care Initiative for New Orleans Residents Experiencing Homelessness During the COVID-19 Pandemic. Sex Transm Dis 2021; 48:595-600. [PMID: 34030154 DOI: 10.1097/olq.0000000000001484] [Citation(s) in RCA: 2] [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: 12/11/2022]
Abstract
BACKGROUND People experiencing homelessness are disproportionately infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). In response to COVID-19, cities nationwide temporarily housed people experiencing homelessness in unused hotels. One such initiative in New Orleans also enacted a screening, counseling, and linkage-to-care model for HIV and HCV treatment for this temporarily housed population between May and July 2020. METHODS A nonconcurrent cohort study was performed assessing follow up in the treatment of HIV and HCV for this population. Outcome data were collected on seropositive patients' electronic medical record to assess patient progression through the treatment cascade. RESULTS Of 102 unhoused residents, 25 (24.5%) tested HCV seropositive. Of the HCV positive 21/25 (84%) were connected to the associated clinic for follow up care and 10 (40%) obtained HCV treatment medication. Furthermore, all 3 patients who tested seropositive for HIV either started or re-initiated antiviral treatment. The greatest barrier to providing medication for the HCV seropositive patients, once care was initiated, was loss-to-follow-up. CONCLUSIONS Targeting homeless persons living in temporary residences for HCV and HIV screening can be effective at promoting access to care for those infected due to this population's high HCV seropositivity especially significant if the patient has a history of intravenous drug use or is older than 40 years. However, continued outreach strategies are needed to assist patients in retention of care.
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Affiliation(s)
| | | | | | | | - Patricia J Kissinger
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine
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28
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Craig-Kuhn MC, Schmidt N, Scott G, Gomes G, TatahMentan M, Enaholo O, Guzman S, Tannis A, Hall J, Triggs DR, Kissinger PJ. Changes in Sexual Behavior Related to the COVID-19 Stay-at-Home Orders Among Young Black Men Who Have Sex With Women in New Orleans, LA. Sex Transm Dis 2021; 48:589-594. [PMID: 33872224 PMCID: PMC8596751 DOI: 10.1097/olq.0000000000001444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND COVID-19 stay-at-home orders enacted in New Orleans, LA on March 16, 2020, may have caused changes in the way young men interacted with sex partners. METHODS An online substudy was conducted (May 21, 2020 to June 9, 2020) among Black men who have sex with women, 18 years and older, and who had previously enrolled in the parent study Check It (May 17, 2017 to March 6, 2020) to assess changes in sexual behavior during the stay-at-home orders. RESULTS Among 111 participants, from enrollment in Check It to during stay-at-home orders, recent vaginal sex declined from 96.4% to 47.8% (P < 0.0001), reports of multiple female sex partners declined from 45.0% to 14.4% (P < 0.0001), and sexual abstinence increased from 3.6% to 38.7% (P < 0.0001). Among those who did have vaginal sex, condomless sex rates did not change between enrollment in Check It and the substudy (64.5% vs 67.9%, P = 0.68). During stay-at-home orders oral sex, virtual sex, and pornography viewing were 40.5%, 42.3%, and 76.6%, respectively. Some (17.1%) acquired a new sex partner during stay-at-home orders, and 44.1% left their home to meet a partner for sex. Only 27.9% had seen information about safe sex during the pandemic. Income was diminished for 62.2% and 23.4% moved away from New Orleans when stay-at-home orders were enacted. CONCLUSIONS Although there was an overall reduction in physical sex, half of participants reported physical sex, with many leaving their home to have sex during stay-at-home orders and many not using condoms. Others adopted sexual abstinence, increased virtual sex, and/or pornography viewing, which may have protected them from both sexually transmitted infections and COVID-19.
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Affiliation(s)
- Megan Clare Craig-Kuhn
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Norine Schmidt
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Glenis Scott
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Gérard Gomes
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Mom TatahMentan
- Environmental Health Sciences Department, Tulane University School of Public Health and Tropical Medicine
| | - Ososese Enaholo
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Stephanie Guzman
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Ayzsa Tannis
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Jacob Hall
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
| | - Daniel R. Triggs
- Health Policy and Management Department, Tulane University School of Public Health and Tropical Medicine
| | - Patricia J. Kissinger
- Epidemiology Department, Tulane University School of Public Health and Tropical Medicine
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29
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Van Gerwen OT, Camino AF, Sharma J, Kissinger PJ, Muzny CA. Epidemiology, natural history, diagnosis, and treatment of Trichomonas vaginalis in men. Clin Infect Dis 2021; 73:1119-1124. [PMID: 34079999 DOI: 10.1093/cid/ciab514] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
Trichomonas vaginalis infections in men are traditionally considered to be benign and consequently have been overlooked. However, men with this common sexually transmitted infection can experience urethritis, prostatitis, reduced fertility, and amplified HIV risk. In addition, men are often asymptomatic and can unknowingly spread the infection to their female sexual partners. With advances in T. vaginalis diagnostics, more men are being diagnosed, yet the optimal method of treatment in men remains unknown. The purpose of this review is to discuss the epidemiology, natural history, diagnosis, and treatment of T. vaginalis among men.
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Affiliation(s)
- Olivia T Van Gerwen
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres F Camino
- University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Jyoti Sharma
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Christina A Muzny
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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30
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Van Gerwen OT, Craig-Kuhn MC, Jones AT, Schroeder JA, Deaver J, Buekens P, Kissinger PJ, Muzny CA. Trichomoniasis and adverse birth outcomes: a systematic review and meta-analysis. BJOG 2021; 128:1907-1915. [PMID: 34036690 DOI: 10.1111/1471-0528.16774] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Trichomoniasis commonly affects women of childbearing age and has been linked to several adverse birth outcomes. OBJECTIVE To elucidate the association between trichomoniasis in pregnant women and adverse birth outcomes, including preterm delivery, prelabour rupture of membranes and low birthweight. SEARCH STRATEGY MEDLINE, EMBASE and ClinicalTrials.gov were systematically searched in December 2020 without time or language restrictions. SELECTION CRITERIA Original research studies were included if they assessed at least one of the specified adverse birth outcomes in pregnant women with laboratory-diagnosed trichomoniasis. DATA COLLECTION AND ANALYSIS Estimates from included articles were either extracted or calculated and then pooled to produce a combined estimate of the association of trichomoniasis with each adverse birth outcome using the random effects model. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. MAIN RESULTS Literature search produced 1658 publications after removal of duplicates (n = 770), with five additional publications identified by hand search. After screening titles and abstracts for relevance, full text of 84 studies was reviewed and 19 met inclusion criteria for meta-analysis. Significant associations were found between trichomoniasis and preterm delivery (OR 1.27; 95% CI 1.08-1.50), prelabour rupture of membranes (OR 1.87; 95% CI 1.53-2.29) and low birthweight (OR 2.12; 95% CI 1.15-3.91). CONCLUSIONS Trichomoniasis in pregnant women is associated with preterm delivery, prelabour rupture of membranes and low birthweight. Rigorous studies are needed to determine the impact of universal trichomoniasis screening and treatment during pregnancy on reducing perinatal morbidity. TWEETABLE ABSTRACT This systematic review and meta-analysis found that in the setting of pregnancy, trichomoniasis is significantly associated with multiple adverse birth outcomes, including preterm delivery, low birthweight, and prelabour rupture of membranes.
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Affiliation(s)
- O T Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M C Craig-Kuhn
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - A T Jones
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - J A Schroeder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Deaver
- Lister Hill Library of the Health Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - P Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - P J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - C A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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31
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Jones AT, Craig-Kuhn MC, Schmidt N, Gomes G, Scott G, Watson S, Hines P, Davis J, Lederer AM, Martin DH, Kissinger PJ. Adapting Index/Partner Services for the Treatment of Chlamydia Among Young African American Men in a Community Screening Program. Sex Transm Dis 2021; 48:323-328. [PMID: 33137012 PMCID: PMC8043978 DOI: 10.1097/olq.0000000000001325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Screening for asymptomatic Chlamydia trachomatis (Ct) among men has not been recommended because feasibility and efficacy are unknown. Check It is a seek-test-treat community-based Ct screening program for African American men who have sex with women and who are 15 to 24 years of age. This is an evaluation of adaptations made to the program aimed at improving index/partner notification and treatment rates. METHODS The original Check It intervention included free testing and treatment, contact tracing performed by a third party, expedited index therapy, and expedited partner therapy via pharmacy pickup. The intervention was adapted after a series of in-depth interviews eliciting information to refine the program. Changes included continuity of testing, notification, and treatment by the same staff; expanded hours; and patient-delivered partner therapy with a medication mail-delivery option. Rates of index male and partner treatment were compared using log-binomial models and generalized estimating equations. RESULTS Men in the adapted intervention (n = 85) were more likely than men in the original intervention (n = 99) to be contacted (relative risk [RR], 1.14; 95% confidence interval [CI], 1.02-1.27), make a treatment plan (RR, 1.14; 95% CI, 1.01-1.27), and complete treatment (RR, 1.45; 95% CI, 1.20-1.75). Female sexual partners were significantly more likely to complete treatment in postadaptation (n = 153) compared with preadaptation (n = 161; RR, 3.02; 95% CI, 1.81-5.05). CONCLUSIONS Compared with third-party notification and expedited index therapy/expedited partner therapy available by pharmacy pickup only, patient-delivered partner therapy with mail-delivery option, staff available at nontraditional hours, and staff continuity across testing, notification, and treatment significantly improved index and partner treatment completion.
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Affiliation(s)
- Austin T. Jones
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Megan Clare Craig-Kuhn
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gérard Gomes
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Glenis Scott
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Shannon Watson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Phazal Hines
- Louisiana Office of Public Health, STD/HIV Program, New Orleans, LA, USA
| | - Javone Davis
- Louisiana Office of Public Health, STD/HIV Program, New Orleans, LA, USA
| | - Alyssa M. Lederer
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David H. Martin
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Louisiana State University, New Orleans, LA, USA
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Barnabas RV, Brown ER, Bershteyn A, Stankiewicz Karita HC, Johnston C, Thorpe LE, Kottkamp A, Neuzil KM, Laufer MK, Deming M, Paasche-Orlow MK, Kissinger PJ, Luk A, Paolino K, Landovitz RJ, Hoffman R, Schaafsma TT, Krows ML, Thomas KK, Morrison S, Haugen HS, Kidoguchi L, Wener M, Greninger AL, Huang ML, Jerome KR, Wald A, Celum C, Chu HY, Baeten JM. Hydroxychloroquine as Postexposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 Infection : A Randomized Trial. Ann Intern Med 2021; 174:344-352. [PMID: 33284679 PMCID: PMC7732017 DOI: 10.7326/m20-6519] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective prevention against coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently limited to nonpharmaceutical strategies. Laboratory and observational data suggested that hydroxychloroquine had biological activity against SARS-CoV-2, potentially permitting its use for prevention. OBJECTIVE To test hydroxychloroquine as postexposure prophylaxis for SARS-CoV-2 infection. DESIGN Household-randomized, double-blind, controlled trial of hydroxychloroquine postexposure prophylaxis. (ClinicalTrials.gov: NCT04328961). SETTING National U.S. multicenter study. PARTICIPANTS Close contacts recently exposed (<96 hours) to persons with diagnosed SARS-CoV-2 infection. INTERVENTION Hydroxychloroquine (400 mg/d for 3 days followed by 200 mg/d for 11 days) or ascorbic acid (500 mg/d followed by 250 mg/d) as a placebo-equivalent control. MEASUREMENTS Participants self-collected mid-turbinate swabs daily (days 1 to 14) for SARS-CoV-2 polymerase chain reaction (PCR) testing. The primary outcome was PCR-confirmed incident SARS-CoV-2 infection among persons who were SARS-CoV-2 negative at enrollment. RESULTS Between March and August 2020, 671 households were randomly assigned: 337 (407 participants) to the hydroxychloroquine group and 334 (422 participants) to the control group. Retention at day 14 was 91%, and 10 724 of 11 606 (92%) expected swabs were tested. Among the 689 (89%) participants who were SARS-CoV-2 negative at baseline, there was no difference between the hydroxychloroquine and control groups in SARS-CoV-2 acquisition by day 14 (53 versus 45 events; adjusted hazard ratio, 1.10 [95% CI, 0.73 to 1.66]; P > 0.20). The frequency of participants experiencing adverse events was higher in the hydroxychloroquine group than the control group (66 [16.2%] versus 46 [10.9%], respectively; P = 0.026). LIMITATION The delay between exposure, and then baseline testing and the first dose of hydroxychloroquine or ascorbic acid, was a median of 2 days. CONCLUSION This rigorous randomized controlled trial among persons with recent exposure excluded a clinically meaningful effect of hydroxychloroquine as postexposure prophylaxis to prevent SARS-CoV-2 infection. PRIMARY FUNDING SOURCE Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ruanne V Barnabas
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Elizabeth R Brown
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Anna Bershteyn
- New York University Grossman School of Medicine, New York, New York (A.B., L.E.T., A.K.)
| | - Helen C Stankiewicz Karita
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Christine Johnston
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Lorna E Thorpe
- New York University Grossman School of Medicine, New York, New York (A.B., L.E.T., A.K.)
| | - Angelica Kottkamp
- New York University Grossman School of Medicine, New York, New York (A.B., L.E.T., A.K.)
| | - Kathleen M Neuzil
- University of Maryland School of Medicine, Baltimore, Maryland (K.M.N., M.K.L., M.D.)
| | - Miriam K Laufer
- University of Maryland School of Medicine, Baltimore, Maryland (K.M.N., M.K.L., M.D.)
| | - Meagan Deming
- University of Maryland School of Medicine, Baltimore, Maryland (K.M.N., M.K.L., M.D.)
| | - Michael K Paasche-Orlow
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts (M.K.P.)
| | - Patricia J Kissinger
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana (P.J.K.)
| | - Alfred Luk
- School of Medicine, Tulane University, New Orleans, Louisiana (A.L.)
| | - Kristopher Paolino
- State University of New York Upstate Medical University, Syracuse, New York (K.P.)
| | | | - Risa Hoffman
- University of California, Los Angeles, California (R.J.L., R.H.)
| | - Torin T Schaafsma
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Meighan L Krows
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Katherine K Thomas
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Susan Morrison
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Harald S Haugen
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Lara Kidoguchi
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Mark Wener
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Alexander L Greninger
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Meei-Li Huang
- Fred Hutchinson Cancer Research Center, Seattle, Washington (M.H.)
| | - Keith R Jerome
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Anna Wald
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington (R.V.B., E.R.B., C.J., A.L.G., K.R.J., A.W.)
| | - Connie Celum
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Helen Y Chu
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
| | - Jared M Baeten
- University of Washington, Seattle, Washington (H.C.S., T.T.S., M.L.K., K.K.T., S.M., H.S.H., L.K., M.W., C.C., H.Y.C., J.M.B.)
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Johnston C, Brown ER, Stewart J, Karita HC, Kissinger PJ, Dwyer J, Hosek S, Oyedele T, Paasche-Orlow MK, Paolino K, Heller KB, Leingang H, Haugen HS, Dong TQ, Bershteyn A, Sridhar AR, Poole J, Noseworthy PA, Ackerman MJ, Morrison S, Greninger AL, Huang ML, Jerome KR, Wener MH, Wald A, Schiffer JT, Celum C, Chu HY, Barnabas RV, Baeten JM. Hydroxychloroquine with or without azithromycin for treatment of early SARS-CoV-2 infection among high-risk outpatient adults: A randomized clinical trial. EClinicalMedicine 2021; 33:100773. [PMID: 33681731 PMCID: PMC7912360 DOI: 10.1016/j.eclinm.2021.100773] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment options for outpatients with COVID-19 could reduce morbidity and prevent SARS-CoV-2 transmission. METHODS In this randomized, double-blind, three-arm (1:1:1) placebo-equivalent controlled trial conducted remotely throughout the United States, adult outpatients with laboratory-confirmed SARS-CoV-2 infection were recruited. Participants were randomly assigned to receive hydroxychloroquine (HCQ) (400 mg BID x1day, followed by 200 mg BID x9days) with or without azithromycin (AZ) (500 mg, then 250 mg daily x4days) or placebo-equivalent (ascorbic acid (HCQ) and folic acid (AZ)), stratified by risk for progression to severe COVID-19 (high-risk vs. low-risk). Self-collected nasal swabs for SARS-CoV-2 PCR, FLUPro symptom surveys, EKGs and vital signs were collected daily. Primary endpoints were: (a) 14-day progression to lower respiratory tract infection (LRTI), 28-day COVID-19 related hospitalization, or death; (b) 14-day time to viral clearance; secondary endpoints included time to symptom resolution (ClinicalTrials.gov: NCT04354428). Due to the low rate of clinical outcomes, the study was terminated for operational futility. FINDINGS Between 15th April and 27th July 2020, 231 participants were enrolled and 219 initiated medication a median of 5.9 days after symptom onset. Among 129 high-risk participants, incident LRTI occurred in six (4.7%) participants (two control, four HCQ/AZ) and COVID-19 related hospitalization in seven (5.4%) (four control, one HCQ, two HCQ/AZ); no LRTI and two (2%) hospitalizations occurred in the 102 low-risk participants (one HCQ, one HCQ/AZ). There were no deaths. Among 152 participants with viral shedding at enrollment, median time to clearance was 5 days (95% CI=4-6) in HCQ, 6 days (95% CI=4-8) in HCQ/AZ, and 8 days (95% CI=6-10) in control. Viral clearance was faster in HCQ (HR=1.62, 95% CI=1.01-2.60, p = 0.047) but not HCQ/AZ (HR=1.25, p = 0.39) compared to control. Among 197 participants who met the COVID-19 definition at enrollment, time to symptom resolution did not differ by group (HCQ: HR=1.02, 95% CI-0.63-1.64, p = 0.95, HCQ/AZ: HR=0.91, 95% CI=0.57-1.45, p = 0.70). INTERPRETATION Neither HCQ nor HCQ/AZ shortened the clinical course of outpatients with COVID-19, and HCQ, but not HCQ/AZ, had only a modest effect on SARS-CoV-2 viral shedding. HCQ and HCQ/AZ are not effective therapies for outpatient treatment of SARV-CoV-2 infection. FUNDING The COVID-19 Early Treatment Study was funded by the Bill & Melinda Gates Foundation (INV-017062) through the COVID-19 Therapeutics Accelerator. University of Washington Institute of Translational Health Science (ITHS) grant support (UL1 TR002319), KL2 TR002317, and TL1 TR002318 from NCATS/NIH funded REDCap. The content is solely the responsibility of the authors and does not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. PAN and MJA were supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program.Trial registration ClinicalTrials.gov number NCT04354428.
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Affiliation(s)
- Christine Johnston
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth R. Brown
- Department of Biostatistics, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jenell Stewart
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Global Health, University of Washington, United States
| | | | - Patricia J. Kissinger
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - John Dwyer
- School of Medicine, Tulane University, New Orleans, LA, United States
| | - Sybil Hosek
- John H. Stroger, Jr., Hospital of Cook County, Chicago, IL, United States
- Rush University Medical Center, Chicago, IL, United States
| | - Temitope Oyedele
- John H. Stroger, Jr., Hospital of Cook County, Chicago, IL, United States
- Rush University Medical Center, Chicago, IL, United States
| | - Michael K. Paasche-Orlow
- Boston University School of Medicine, Boston, MA, United States
- Boston Medical Center, Boston, MA, United States
| | - Kristopher Paolino
- State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Kate B. Heller
- Department of Global Health, University of Washington, United States
| | - Hannah Leingang
- Department of Global Health, University of Washington, United States
| | - Harald S. Haugen
- Department of Global Health, University of Washington, United States
| | - Tracy Q. Dong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anna Bershteyn
- New York University Grossman School of Medicine, NY, NY, United States
| | - Arun R. Sridhar
- Division of Cardiology, University of Washington, United States
| | - Jeanne Poole
- Division of Cardiology, University of Washington, United States
| | | | | | - Susan Morrison
- Department of Global Health, University of Washington, United States
| | - Alexander L. Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Meei-Li Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith R. Jerome
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark H. Wener
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Division of Rheumatology, University of Washington, Seattle, WA, United States
| | - Anna Wald
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joshua T. Schiffer
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Connie Celum
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Department of Global Health, University of Washington, United States
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Department of Global Health, University of Washington, United States
| | - Ruanne V. Barnabas
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jared M. Baeten
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Department of Global Health, University of Washington, United States
| | - for the COVID-19 Early Treatment Study Team
- Division of Allergy and Infectious Diseases, University of Washington, United States
- Department of Laboratory Medicine and Pathology, University of Washington, United States
- Department of Biostatistics, University of Washington, United States
- Department of Epidemiology, University of Washington, United States
- Department of Global Health, University of Washington, United States
- Division of Cardiology, University of Washington, United States
- Division of Rheumatology, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- School of Medicine, Tulane University, New Orleans, LA, United States
- John H. Stroger, Jr., Hospital of Cook County, Chicago, IL, United States
- Rush University Medical Center, Chicago, IL, United States
- Boston University School of Medicine, Boston, MA, United States
- Boston Medical Center, Boston, MA, United States
- State University of New York Upstate Medical University, Syracuse, NY, United States
- New York University Grossman School of Medicine, NY, NY, United States
- Mayo Clinic, Rochester, MN, United States
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Walker EM, Slisarenko N, Gerrets GL, Grasperge BF, Mattison JA, Kissinger PJ, Welsh DA, Veazey RS, Jazwinski SM, Rout N. Dysregulation of IL-17/IL-22 Effector Functions in Blood and Gut Mucosal Gamma Delta T Cells Correlates With Increase in Circulating Leaky Gut and Inflammatory Markers During cART-Treated Chronic SIV Infection in Macaques. Front Immunol 2021; 12:647398. [PMID: 33717202 PMCID: PMC7946846 DOI: 10.3389/fimmu.2021.647398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
HIV-associated inflammation has been implicated in the premature aging and increased risk of age-associated comorbidities in cART-treated individuals. However, the immune mechanisms underlying the chronic inflammatory state of cART-suppressed HIV infection remain unclear. Here, we investigated the role of γδT cells, a group of innate IL-17 producing T lymphocytes, in the development of systemic inflammation and leaky gut phenotype during cART-suppressed SIV infection of macaques. Plasma levels of inflammatory mediators, intestinal epithelial barrier disruption (IEBD) and microbial translocation (MT) biomarkers, and Th1/Th17-type cytokine functions were longitudinally assessed in blood and gut mucosa of SIV-infected, cART-suppressed macaques. Among the various gut mucosal IL-17/IL-22-producing T lymphocyte subsets including Th17, γδT, CD161+ CD8+ T, and MAIT cells, a specific decline in the Vδ2 subset of γδT cells and impaired IL-17/IL-22 production in γδT cells significantly correlated with the subsequent increase in plasma IEBD/MT markers (IFABP, LPS-binding protein, and sCD14) and pro-inflammatory cytokines (IL-6, IL-1β, IP10, etc.) despite continued viral suppression during long-term cART. Further, the plasma inflammatory cytokine signature during long-term cART was distinct from acute SIV infection and resembled the inflammatory cytokine profile of uninfected aging (inflammaging) macaques. Overall, our data suggest that during cART-suppressed chronic SIV infection, dysregulation of IL-17/IL-22 cytokine effector functions and decline of Vδ2 γδT cell subsets may contribute to gut epithelial barrier disruption and development of a distinct plasma inflammatory signature characteristic of inflammaging. Our results advance the current understanding of the impact of chronic HIV/SIV infection on γδT cell functions and demonstrate that in the setting of long-term cART, the loss of epithelial barrier-protective functions of Vδ2 T cells and ensuing IEBD/MT occurs before the hallmark expansion of Vδ1 subsets and skewed Vδ2/Vδ1 ratio. Thus, our work suggests that novel therapeutic approaches toward restoring IL-17/IL-22 cytokine functions of intestinal Vδ2 T cells may be beneficial in preserving gut epithelial barrier function and reducing chronic inflammation in HIV-infected individuals.
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Affiliation(s)
- Edith M. Walker
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Nadia Slisarenko
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Giovanni L. Gerrets
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
| | - Brooke F. Grasperge
- Veterinary Medicine, Tulane National Primate Research Center, Covington, LA, United States
| | - Julie A. Mattison
- Translational Gerontology Branch, National Institute on Aging, NIH, Poolesville, MD, United States
| | - Patricia J. Kissinger
- School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - David A. Welsh
- Department of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine, New Orleans, LA, United States
| | - Ronald S. Veazey
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, United States
| | - S. Michal Jazwinski
- Tulane Center for Aging, Tulane University School of Medicine, New Orleans, LA, United States
| | - Namita Rout
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, United States
- Tulane Center for Aging, Tulane University School of Medicine, New Orleans, LA, United States
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Qu Z, Azizi A, Schmidt N, Craig-Kuhn MC, Stoecker C, Hyman JM, Kissinger PJ. Effect of screening young men for Chlamydia trachomatis on the rates among women: a network modelling study for high-prevalence communities. BMJ Open 2021; 11:e040789. [PMID: 33483442 PMCID: PMC7831743 DOI: 10.1136/bmjopen-2020-040789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Chlamydia trachomatis (Ct) is the most commonly reported sexually transmitted infection in the USA and causes important reproductive morbidity in women. The Centers for Disease Control and Prevention recommend routine screening of sexually active women under age 25 but not among men. Despite three decades of screening women, chlamydia prevalence in women remains high. Untested and untreated men can serve as a reservoir of infection in women, and male-screening based intervention can be an effective strategy to reduce infection in women. We assessed the impact of screening men on the Ct prevalence in women. DESIGN We created an individual-based network model to simulate a realistic chlamydia epidemic on sexual contact networks for a synthetic population (n=5000). The model is calibrated to the ongoing routine screening among African American (AA) women in the USA and detailed a male-screening programme, Check It, that bundles best practices for Ct control. We used sensitivity analysis to quantify the relative importance of each intervention component. SETTING Community-based venues in New Orleans, Louisiana, USA. PARTICIPANTS Heterosexual AA men, aged 15 to 24, who had sex with women in the past 2 months. INTERVENTION Venue-based screening, expedited index treatment, expedited partner treatment and rescreening. RESULTS We estimate that by annually screening 7.5% of the AA male population in the age-range, the chlamydia prevalence would be reduced relatively by 8.1% (95% CI 5.9% to 10.4%) in AA women and 8.8% (95% CI 6.9% to 10.8%) in AA men. Each man screened could prevent 0.062 (95% CI 0.030 to 0.094) cases in men and 0.204 (95% CI 0.143 to 0.267) cases in women. The model suggested the importance of intervention components ranked from high to low as venue-based screening, expedited index treatment, expedited partner treatment and rescreening. CONCLUSION The findings indicated that male-screening has the potential to substantially reduce the prevalence among women in high-prevalence communities.
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Affiliation(s)
- Zhuolin Qu
- Department of Mathematics, Tulane University, New Orleans, Louisiana, USA
- Department of Mathematics, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Asma Azizi
- Simon A Levin Mathematical Computational Modeling Science Center, Arizona State University, Tempe, Arizona, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University, New Orleans, Louisiana, USA
| | | | - Charles Stoecker
- Department of Health Policy and Management, Tulane University, New Orleans, Louisiana, USA
| | - James Mac Hyman
- Department of Mathematics, Tulane University, New Orleans, Louisiana, USA
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Brown ER, Bershteyn A, Karita HCS, Johnston C, Thorpe L, Kottkamp A, Neuzil K, Laufer MK, Deming M, Paasche-Orlow MK, Kissinger PJ, Luk A, Paolino KM, Paolino KM, Landovitz RJ, Hoffman R, Schaafsma T, Krows ML, Thomas K, Morrison S, Kidoguchi L, Wener MH, Greninger AL, Huang ML, Jerome K, Wald A, Wald A, Celum C, Chu HY, Baeten JM. LB-17. Efficacy of Hydroxychloroquine (HCQ) for Post-exposure Prophylaxis to Prevent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Blinded, Randomized, Controlled Trial. Open Forum Infect Dis 2020. [PMCID: PMC7776476 DOI: 10.1093/ofid/ofaa515.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prevention interventions for coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), are currently limited to non-pharmaceutical strategies. Observational and laboratory data suggested that hydroxychloroquine (HCQ) had biologic activity against SARS-CoV-2. A blinded trial of HCQ in persons with confirmed exposure and virologic and clinical endpoints is needed.
Methods
We conducted a national, householdrandomized, double-blind, controlled trial of HCQ post-exposure prophylaxis, with entirely remote study procedures. We enrolled close contacts exposed to persons with SARS-CoV-2 infection in the past 96 hours. Participants were randomized to either HCQ (400 mg daily for three days followed by 200 mg daily for eleven days) or ascorbic acid (500 mg followed by 250 mg daily), as a placebo-equivalent control. Participants self-collected mid-turbinate swabs daily (days 1–14) for SARS-CoV-2 PCR testing. The primary outcome was PCR-confirmed, incident SARS-CoV-2 infection among persons SARS-CoV-2 negative at enrollment. Symptoms were assessed using criteria from the US CDC.
Results
From March-August 2020, 623 households were randomized; 311 households (381 participants) to the HCQ group and 312 households (400 participants) to the control group. Ninety- one percent of participants were retained up to day 14 and 9,595 of 10,588 (91%) of swabs were tested. Among participants who were SARS-CoV-2 negative at baseline (n=626/781, 80%), the cumulative incidence of SARS-CoV-2 was 14.5% (95% CI: 11.6–17.4) and the cumulative incidence of COVID-19 symptoms was 11.6% (95% CI: 8.9–14.2) at day 14. By day 14, there was no difference between the HCQ group and control group in SARS-CoV-2 acquisition (46 vs. 43 events, aHR= 0.99, 95% CI 0.64–1.52, p=0.95) or symptomatic disease (40 vs. 32 events, aHR= 1.23, 95% CI: 0.76–1.99, p=0.40). The adverse event frequency was similar between groups (59 [15.5%] participants in the HCQ and 45 [11.3%] in the control group, p=0.092).
Cumulative incidence of RT-PCR-confirmed SARS-CoV-2 infection among close contacts of diagnosed cases, by study group
Conclusion
This randomized, double-blind, controlled trial among persons with recent exposure and high incidence of SAR-CoV2 provides strong evidence that HCQ post-exposure prophylaxis did not prevent SARS-CoV-2 infection or modify clinical disease.
Disclosures
Anna Bershteyn, PhD, Bill and Melinda Gates Foundation (Grant/Research Support)Gates Ventures (Consultant)National Institutes of Health (Grant/Research Support) Kristopher M. Paolino, MD, MTM&H, Nothing to disclose Raphael J. Landovitz, MD, MSc, Gilead (Advisor or Review Panel member)Merck (Advisor or Review Panel member)Roche (Other Financial or Material Support, Speaker Honoraria) Anna Wald, MD, MPH, Aicuris (Individual(s) Involved: Self): Consultant; Gilead (Individual(s) Involved: Self): Consultant; GlaxoSmithKline (Individual(s) Involved: Self): Scientific Research Study Investigator; Merck (Individual(s) Involved: Self): DSMB participation; provision of vaccine for a study, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Scientific Research Study Investigator; X-Vax (Individual(s) Involved: Self): Consultant Helen Y. Chu, MD MPH, Cepheid (Grant/Research Support)Ellume (Grant/Research Support)Glaxo Smith Kline (Consultant)Merck (Consultant)Sanofi-Pasteur (Grant/Research Support)
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Affiliation(s)
| | - Anna Bershteyn
- New York University Grossman School of Medicine, New York, New York
| | | | | | - Lorna Thorpe
- New York University Grossman School of Medicine, New York, New York
| | | | - Kathleen Neuzil
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Miriam K Laufer
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Meagan Deming
- Center for Vaccine Development, University of Maryland Medical Center, Baltimore, Maryland
| | | | | | | | | | | | | | - Risa Hoffman
- University of California, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | - Anna Wald
- University of Washington, Seattle, Washington
| | - Anna Wald
- University of Washington, Seattle, Washington
| | | | - Helen Y Chu
- University of Washington, Seattle, Washington
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Graves KJ, Ghosh AP, Schmidt N, Augostini P, Secor WE, Schwebke JR, Martin DH, Kissinger PJ, Muzny CA. Trichomonas vaginalis Virus Among Women With Trichomoniasis and Associations With Demographics, Clinical Outcomes, and Metronidazole Resistance. Clin Infect Dis 2020; 69:2170-2176. [PMID: 30768180 DOI: 10.1093/cid/ciz146] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trichomonas vaginalis virus (TVV) is a non-segmented, 4.5-5.5 kilo-base pair (kbp), double-stranded RNA virus infecting T. vaginalis. The objectives of this study were to examine the TVV prevalence in US Trichomonas vaginalis isolates and TVV's associations with patient demographics, clinical outcomes, and metronidazole resistance. METHODS Archived T. vaginalis isolates from the enrollment visits of 355 women participating in a T. vaginalis treatment trial in Birmingham, Alabama, were thawed and grown in culture. Their total RNA was extracted using a Trizol reagent. Contaminating, single-stranded RNA was precipitated using 4.0 M Lithium Chloride and centrifugation. The samples were analyzed by gel electrophoresis to visualize a 4.5 kbp band representative of TVV. In vitro testing for metronidazole resistance was also performed on 25/47 isolates obtained from the women's test of cure visits. RESULTS TVV was detected in 142/355 (40%) isolates at the enrollment visit. Women with TVV-positive (TVV+) isolates were significantly older (P = .01), more likely to smoke (P = .04), and less likely to report a history of gonorrhea (P = .04). There was no association between the presence of clinical symptoms or repeat T. vaginalis infections with TVV+ isolates (P = .14 and P = .44, respectively). Of 25 test of cure isolates tested for metronidazole resistance, 0/10 TVV+ isolates demonstrated resistance, while 2/15 TVV-negative isolates demonstrated mild to moderate resistance (P = .23). CONCLUSIONS Of 355 T. vaginalis isolates tested for TVV, T. vaginalis isolates tested for TVV, the prevalence was 40%. However, there was no association of TVV+ isolates with clinical symptoms, repeat infections, or metronidazole resistance. These results suggest that TVV may be commensal to T. vaginalis.
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Affiliation(s)
- Keonte J Graves
- Division of Infectious Diseases, University of Alabama at Birmingham
| | - Arindam P Ghosh
- Division of Infectious Diseases, University of Alabama at Birmingham
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Peter Augostini
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - W Evan Secor
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, Georgia
| | - Jane R Schwebke
- Division of Infectious Diseases, University of Alabama at Birmingham
| | - David H Martin
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.,Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham
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Walker EM, Slisarenko N, Gerrets GL, Kissinger PJ, Didier ES, Kuroda MJ, Veazey RS, Jazwinski SM, Rout N. Correction to: Inflammaging phenotype in rhesus macaques is associated with a decline in epithelial barrier-protective functions and increased pro-inflammatory function in CD161-expressing cells. GeroScience 2019; 42:375. [PMID: 31884556 DOI: 10.1007/s11357-019-00144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Unfortunately, the original version of this article was published with error in the materials and methods section.
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Affiliation(s)
- Edith M Walker
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Nadia Slisarenko
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Giovanni L Gerrets
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Patricia J Kissinger
- School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Elizabeth S Didier
- Center for ComparativeMedicine and California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Marcelo J Kuroda
- Center for ComparativeMedicine and California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Ronald S Veazey
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, USA
| | | | - Namita Rout
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA. .,Tulane Center for Aging, Tulane University, New Orleans, LA, USA.
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Walker EM, Slisarenko N, Gerrets GL, Kissinger PJ, Didier ES, Kuroda MJ, Veazey RS, Jazwinski SM, Rout N. Inflammaging phenotype in rhesus macaques is associated with a decline in epithelial barrier-protective functions and increased pro-inflammatory function in CD161-expressing cells. GeroScience 2019; 41:739-757. [PMID: 31713098 PMCID: PMC6925095 DOI: 10.1007/s11357-019-00099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 07/17/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023] Open
Abstract
The development of chronic inflammation, called inflammaging, contributes to the pathogenesis of age-related diseases. Although it is known that both B and T lymphocyte compartments of the adaptive immune system deteriorate with advancing age, the impact of aging on immune functions of Th17-type CD161-expressing innate immune cells and their role in inflammaging remain incompletely understood. Here, utilizing the nonhuman primate model of rhesus macaques, we report that a dysregulated Th17-type effector function of CD161+ immune cells is associated with leaky gut and inflammatory phenotype of aging. Higher plasma levels of inflammatory cytokines IL-6, TNF-α, IL-1β, GM-CSF, IL-12, and Eotaxin correlated with elevated markers of gut permeability including LPS-binding protein (LBP), intestinal fatty acid binding protein (I-FABP), and sCD14 in aging macaques. Further, older macaques displayed significantly lower frequencies of circulating Th17-type immune cells comprised of CD161+ T cell subsets, NK cells, and innate lymphoid cells. Corresponding with the increased markers of gut permeability, production of the type-17 cytokines IL-17 and IL-22 was impaired in CD161+ T cell subsets and NK cells, along with a skewing towards IFN-γ cytokine production. These findings suggest that reduced frequencies of CD161+ immune cells along with a specific loss in Th17-type effector functions contribute to impaired gut barrier integrity and systemic inflammation in aging macaques. Modulating type-17 immune cell functions via cytokine therapy or dietary interventions towards reducing chronic inflammation in inflammaging individuals may have the potential to prevent or delay age-related chronic diseases and improve immune responses in the elderly population.
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Affiliation(s)
- Edith M Walker
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Nadia Slisarenko
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Giovanni L Gerrets
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA
| | - Patricia J Kissinger
- School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Elizabeth S Didier
- Center for Comparative Medicine and California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Marcelo J Kuroda
- Center for Comparative Medicine and California National Primate Research Center, University of California Davis, Davis, CA, USA
| | - Ronald S Veazey
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, USA
| | | | - Namita Rout
- Division of Microbiology, Tulane National Primate Research Center, Covington, LA, USA.
- Tulane Center for Aging, Tulane University, New Orleans, LA, USA.
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Abstract
Trichomonas vaginalis (TV) is a parasitic protozoan responsible for the sexually transmitted infection trichomoniasis. Trichomonas vaginalis virus (TVV) is a nonsegmented, 4.5-5 kbp, double-stranded RNA virus, from the Totiviridae family, which inhabits TV. A capsid protein consisting of 120 subunits is covered in channels aiding in RNA release. TVV is closely associated with the Golgi complex and is transmitted vertically. TVV has four subspecies, TVV1, TVV2, TVV3, and TVV4. The clinical significance of TVV and its effect on the pathogenicity of TV is not well known. We performed a systematic review of the literature on TVV to better understand its clinical significance and its role in the pathogenesis of TV.
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Affiliation(s)
- K J Graves
- 1 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A P Ghosh
- 1 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - P J Kissinger
- 2 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - C A Muzny
- 1 Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Belafsky PC, Amedee R, Moore B, Kissinger PJ. The Association between Sinusitis and Survival among Individuals Infected with the Human Immunodeficiency Virus. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240101500510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine the association between sinusitis and survival among human immunodeficiency virus (HIV)–infected persons. All patients enrolled in the adult spectrum of disease data base from November 1, 1990 to November 1, 1999 were included. Patients were followed until death, loss to follow-up, or the end of the study on January 10, 2000. A Cox proportional hazard regression analysis was conducted to evaluate the association between sinusitis, various other cofactors, and survival. Of the 7513 HIV-infected patients followed, 57% were <35 years old, 59.5% were black, 78.5% were male, and 20.8% had an opportunistic infection (OI) at entry. The incidence of one or more diagnoses of sinusitis in the cohort was 14.5%. The mean entry CD4 count for the entire cohort was 347.8 (SD, 298.9) and the mean follow-up time was 33.2 months (SD, 25.7). The mean CD4 count at the time of sinusitis diagnosis was 391 (SD, 316). In the multivariate analysis, older age and lower CD4 cell count were associated with death. Sinusitis, gender, and race were not associated with survival. Sinusitis is frequent in individuals infected with HIV. After adjusting for level of immunodeficiency, age, gender, and race, sinusitis is not associated with an increased hazard of death. This may have implications for treatment, because a diagnosis of sinusitis does not portend a poor prognosis in individuals infected with HIV.
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Affiliation(s)
- Peter C. Belafsky
- Department of Otolaryngology-HNS, Wake Forest University, Winston-Salem, North Carolina
| | - Ronald Amedee
- Department of Otolaryngology-HNS, Tulane University, New Orleans, Louisiana
| | - Brian Moore
- Department of Otolaryngology-HNS, Vanderbilt University, Nashville, Tennessee
| | - Patricia J. Kissinger
- Department of Epidemiology, Tulane University School of Public Health, New Orleans, Louisiana
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Randolph TC, Kissinger PJ, Clark RA, Lacour N, Amedee AM. A predominance of R5-like HIV genotypes in vaginal secretions is associated with elevated plasma HIV-1 RNA levels and the absence of anti-retroviral therapy. Virol J 2008; 5:87. [PMID: 18664290 PMCID: PMC2515106 DOI: 10.1186/1743-422x-5-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 07/29/2008] [Indexed: 11/10/2022] Open
Abstract
HIV expressed in genital secretions provides the inoculum from which transmitting variants are selected, both in sexual transmission and mother-to-infant transmission during partuition. Characterization of HIV levels and genotypes found in vaginal secretions and the impact of anti-retroviral therapy (ART) on this virus can provide valuable insight for the prevention of HIV transmission. Vaginal HIV was evaluated in a cohort of 43 women attending a New Orleans HIV outpatient clinic. Predominant vaginal genotypes were characterized as R5- or X4-like by heteroduplex tracking analyses of the envelope V3 region. Most women (67.4%) shed R5-like genotypes in vaginal secretions which was associated with elevated plasma HIV levels (≥ 10,000 copies HIV-RNA/mL) and absence of ART. Because R5-like genotypes are more frequently associated with transmission, these observations suggest that the majority of women shedding HIV in genital secretions present a transmission risk. The levels of vaginal virus were similar between both groups, but shedding of X4-like genotypes was associated with lower plasma viral loads and the use of ART, suggesting that ART use may impact the genotypes of virus found in the female genital compartment.
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Affiliation(s)
- Tara C Randolph
- Department of Microbiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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Abstract
OBJECTIVE To determine the prevalence of douching among a cohort of HIV-infected women and to examine clinical outcomes associated with frequent douching-namely bacterial vaginosis, presence of a sexually-transmitted infections, and genital tract HIV-1 RNA shedding. STUDY DESIGN Participants included a concurrent cohort of 187 women attending an HIV outpatient clinic in New Orleans, LA. Subjects underwent clinical examinations and answered questions in a computer-assisted survey at each visit. RESULTS At baseline, 1-, and 3-month follow-ups, 64.2%, 56.5%, and 54.7% of women, respectively, indicated that they douched. In multivariable analyses, douching >1 time a month was independently associated with the outcomes of bacterial vaginosis and presence of a selected sexually transmitted infection (Trichomonas vaginalis, Neisseria gonorrhea, or Chlamydia trachomatis). Although not significant, women who douched >1 time a month were also twice as likely to have genital tract HIV-1 RNA shedding as nondouchers. CONCLUSIONS This is the first study performed in women infected with HIV to link a significant dose-response relationship between douching and the clinical outcomes of bacterial vaginosis and presence of a sexually transmitted infection, and to examine the association between douching and genital tract HIV-1 RNA shedding.
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Affiliation(s)
- Rebecca A Clark
- Department of Medicine, Louisiana State University Health Science Center, USA.
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Clark RA, Theall KP, Amedee AM, Dumestre J, Wenthold L, Kissinger PJ. Lack of Association Between Genital Tract HIV-1 RNA Shedding and Hormonal Contraceptive Use in a Cohort of Louisiana Women. Sex Transm Dis 2007; 34:870-2. [PMID: 17565332 DOI: 10.1097/olq.0b013e3180ca9633] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Rebecca A Clark
- Louisiana State University Health Science Center, New Orleans, LA 70112, USA.
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Beilke MA, Traina-Dorge VL, Sirois M, Bhuiyan A, Murphy EL, Walls JM, Fagan R, Winsor EL, Kissinger PJ. Relationship between Human T Lymphotropic Virus (HTLV) Type 1/2 Viral Burden and Clinical and Treatment Parameters among Patients with HIV Type 1 and HTLV-1/2 Coinfection. Clin Infect Dis 2007; 44:1229-34. [PMID: 17407044 DOI: 10.1086/513428] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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] [Received: 10/16/2006] [Accepted: 01/15/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Human T lymphotropic virus types 1 (HTLV-1) and 2 (HTLV-2) are frequent copathogens among individuals infected with human immunodeficiency virus type 1 (HIV-1). The long-term effects of coinfection are unknown, and little information exists regarding how levels of HTLV-1/2 viral burden are affected by antiretroviral medications. METHODS Factors associated with HTLV-1/2 viral burden were examined in patients with HIV-HTLV-1/2 coinfection. A total of 72 subjects were evaluated. The variables analyzed included HTLV-1/2 proviral load, HTLV-1/2 tax/rex mRNA expression, HIV load, HTLV-1/2 viral antigen detection in peripheral blood mononuclear cell (PBMC) cultures, T cell subsets, demographic variables (age, race, sex, and reported use of injection drugs), and administration of highly active antiretroviral therapy. RESULTS An HTLV-1/2 proviral DNA copy number >20,000 copies/10(6) PBMCs was significantly associated with the following variables: (1) a positive HTLV-1 Western blot test result, (2) a positive HTLV-1/2 PBMC culture result, (3) a positive tax/rex mRNA result, (4) an HIV load <10,000 copies/mL, and (5) higher CD4 cell counts among subjects with HIV-HTLV-1 coinfection. There was no correlation between HTLV-1/2 proviral copy number or HTLV-1/2 tax/rex mRNA detection and administration of antiretroviral therapy. CONCLUSIONS HTLV-1/2 proviral burden was significantly higher among patients with HIV-HTLV-1 coinfection than among patients with HIV-HTLV-2 coinfection. Highly active antiretroviral therapy may be of limited value in controlling virus expression of HTLV-1/2 in patients with HIV-HTLV-1/2 coinfection.
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Affiliation(s)
- Mark A Beilke
- Tulane University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA.
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46
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Clark RA, Theall K, Kissinger PJ. Reply to: Microscopy and culture for Trichomonas vaginalis: Are both required? Int J STD AIDS 2007; 18:220. [PMID: 17362561 DOI: 10.1258/095646207780132424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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47
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Chaturvedi AK, Myers L, Hammons AF, Clark RA, Dunlap K, Kissinger PJ, Hagensee ME. Prevalence and Clustering Patterns of Human Papillomavirus Genotypes in Multiple Infections. Cancer Epidemiol Biomarkers Prev 2005; 14:2439-45. [PMID: 16214929 DOI: 10.1158/1055-9965.epi-05-0465] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [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: 11/16/2022] Open
Abstract
Prevalence of multiple human papillomavirus (HPV) infections, involvement of specific HPV phylogenetic clades in multiple infections, and clustering patterns of multiple infections at the clade level were assessed in 854 HIV (-) and 275 HIV (+) women cross-sectionally. Reverse line blot assay was used to detect 27 HPV genotypes. Involvement of specific clades in coinfections and clustering patterns were assessed using HPV clade/genotype as the unit of analyses. Expected frequencies assuming independence for all possible clade combinations in two-genotype infections were derived using a multinomial expansion and comparisons of observed and expected frequencies were done using a composite goodness-of-fit test. In all, 100 two-genotype infections were detected; 61 in HIV (-) and 39 in HIV (+) women. Clade A9 (HPV types 16, 31, 33, 35, 52, and 58) was significantly less likely to be involved in multiple infections compared with all other clades (55.2% versus 64.6%; adjusted odds ratios, 0.68; 95% confidence interval, 0.48-0.95). Observed patterns for all possible clade combinations (among HPV clades A3, A5, A6, A7, A9, and A10) in two-genotype infections did not significantly differ from those expected in the entire sample, across HIV, Pap smear, and age strata (all goodness-of-fit exact P > 0.20). These results indicate that clade A9 is less likely to be involved in multiple infections and that HPV genotypes predominantly establish multiple infections at random, with little positive/negative clustering for either phylogenetically related or unrelated types. The current method of analysis affords the opportunity to test clustering of a large number of HPV genotype/clade combinations at nominal alpha levels.
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Affiliation(s)
- Anil K Chaturvedi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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Kissinger PJ, Dumestre J, Clark RA, Wenthold L, Mohammed H, Hagensee ME, Martin DH. Vaginal swabs versus lavage for detection of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women. Sex Transm Dis 2005; 32:227-30. [PMID: 15788920 DOI: 10.1097/01.olq.0000151416.56717.7d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. GOAL The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). STUDY CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel's criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent's criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. RESULTS The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P <0.05). Sensitivities for Amsel's versus Nugent's criteria for BV were 36.2 for CVL and 34.0 for vaginal swab (P <0.80). Kappa scores of agreement between CVL and vaginal swabs for BV and TV were excellent for both. CONCLUSION CVL was comparable to vaginal swabs as a specimen collection method for these 2 lower genital tract infections and may be superior for the diagnosis of TV.
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Affiliation(s)
- Patricia J Kissinger
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
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Beilke MA, Theall KP, O'Brien M, Clayton JL, Benjamin SM, Winsor EL, Kissinger PJ. Clinical Outcomes and Disease Progression among Patients Coinfected with HIV and Human T Lymphotropic Virus Types 1 and 2. Clin Infect Dis 2004; 39:256-63. [PMID: 15307036 DOI: 10.1086/422146] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [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] [Received: 01/12/2004] [Accepted: 03/07/2004] [Indexed: 11/03/2022] Open
Abstract
The goal of this study was to investigate clinical outcomes and survival probabilities among persons coinfected with human immunodeficiency virus (HIV) and human T lymphotropic viruses types 1 and 2 (HTLV-I/II). A nonconcurrent cohort study of 1033 HIV-infected individuals was also conducted. Sixty-two patients were coinfected with HTLV-I, and 141 patients were coinfected with HTLV-II. HTLV-I/II coinfection was highly associated with African-American race/ethnicity, age of >36 years, higher CD4(+) T cell count at baseline and over time, and history of injection drug use. Coinfected patients were more likely to have neurologic complications, thrombocytopenia, respiratory and urinary tract infections, and hepatitis C. Despite having higher CD4(+) T cell counts over time, there was no difference in the incidence of opportunistic infections. Progression to both acquired immunodeficiency syndrome (AIDS; adjusted hazard ratio [aHR], 0.50; 95% confidence interval [CI], 0.25-0.98) and death (aHR, 0.57, 95% CI, 0.37-0.89) were slower among HTLV-II-coinfected patients, compared with time-entry- and CD4(+) T cell count-matched control subjects. In conclusion, HIV-HTLV-I/II coinfection may result in improved survival and delayed progression to AIDS, but this happens at the expense of an increased frequency of other of clinical complications.
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Affiliation(s)
- Mark A Beilke
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
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Chaturvedi AK, Brinkman JA, Gaffga AM, Dumestre J, Clark RA, Braly PS, Dunlap K, Kissinger PJ, Hagensee ME. Distribution of human papillomavirus type 16 variants in human immunodeficiency virus type 1-positive and -negative women. J Gen Virol 2004; 85:1237-1241. [PMID: 15105540 DOI: 10.1099/vir.0.19694-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The prevalence of human papillomavirus type 16 E6 variant lineages was characterized in a cross-sectional study of 24 human immunodeficiency virus type 1 (HIV)-positive and 33 HIV-negative women in New Orleans. The European prototype was the predominant variant in the HIV-negative women (39·4 %), while in the HIV-positive women the European 350G variant was predominant (29·1 %). In exact logistic regression models, HIV-positive women were significantly more likely to harbour any variant with a nucleotide G-350 mutation compared with HIV-negative women [58·3 % vs 21·1 %; adjusted odds ratio (AOR)=6·28, 95 % confidence interval (CI)=1·19–46·54]. Models also revealed a trend towards increased prevalence of Asian–American lineage in HIV-positive women compared with HIV-negative women (25·0 % vs 6·0 %; AOR=6·35, 95 % CI=0·77–84·97). No association was observed between any variant and cytology or CD4 cell counts or HIV-1 viral loads. These observations reflect a difference in the distribution of HPV-16 variants among HIV-positive and -negative women, indicating that HIV-positive status may lead to increased prevalence of a subset of variants.
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Affiliation(s)
- Anil K Chaturvedi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Joeli A Brinkman
- Department of Microbiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Ann M Gaffga
- Department of Microbiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Jeanne Dumestre
- Department of Microbiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Rebecca A Clark
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Patricia S Braly
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Kathleen Dunlap
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA
| | - Michael E Hagensee
- Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
- Department of Microbiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
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