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Mancini C, Fu X, Zhang Y, Kuper K, Schulz L, Bohmick T, Postelnick M, Lee F, Walensky R. Penicillin Allergy Evaluation Access in US Hospitals: A Survey. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Blumenthal K, Fu X, Zhang Y, Kuper K, Schulz L, Bhowmick T, Postelnick M, Lee F, Walensky R. Association of Penicillin Allergy Documentation and Antibiotic Use: A National Inpatient Study. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mallampati D, MacLean RL, Shapiro R, Dabis F, Engelsmann B, Freedberg KA, Leroy V, Lockman S, Walensky R, Rollins N, Ciaranello A. Optimal breastfeeding durations for HIV-exposed infants: the impact of maternal ART use, infant mortality and replacement feeding risk. J Int AIDS Soc 2019; 21:e25107. [PMID: 29667336 PMCID: PMC5904528 DOI: 10.1002/jia2.25107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/16/2017] [Accepted: 03/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In 2010, the WHO recommended women living with HIV breastfeed for 12 months while taking antiretroviral therapy (ART) to balance breastfeeding benefits against HIV transmission risks. To inform the 2016 WHO guidelines, we updated prior research on the impact of breastfeeding duration on HIV-free infant survival (HFS) by incorporating maternal ART duration, infant/child mortality and mother-to-child transmission data. METHODS Using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Infant model, we simulated the impact of breastfeeding duration on 24-month HFS among HIV-exposed, uninfected infants. We defined "optimal" breastfeeding durations as those maximizing 24-month HFS. We varied maternal ART duration, mortality rates among breastfed infants/children, and relative risk of mortality associated with replacement feeding ("RRRF"), modelled as a multiplier on all-cause mortality for replacement-fed infants/children (range: 1 [no additional risk] to 6). The base-case simulated RRRF = 3, median infant mortality, and 24-month maternal ART duration. RESULTS In the base-case, HFS ranged from 83.1% (no breastfeeding) to 90.2% (12-months breastfeeding). Optimal breastfeeding durations increased with higher RRRF values and longer maternal ART durations, but did not change substantially with variation in infant mortality rates. Optimal breastfeeding durations often exceeded the previous WHO recommendation of 12 months. CONCLUSIONS In settings with high RRRF and long maternal ART durations, HFS is maximized when mothers breastfeed longer than the previously-recommended 12 months. In settings with low RRRF or short maternal ART durations, shorter breastfeeding durations optimize HFS. If mothers are supported to use ART for longer periods of time, it is possible to reduce transmission risks and gain the benefits of longer breastfeeding durations.
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Affiliation(s)
- Divya Mallampati
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Rachel L MacLean
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Divisions of General Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Roger Shapiro
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T.H, Chan School of Public Health, Boston, MA, USA.,The Botswana-Harvard School of Public Health AIDS Institute Partnership for HIV Research and Education, Gaborone, Botswana
| | - Francois Dabis
- Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Dévelopement (ISPED), Centre INSERM, U1219-Bordeaux Population Health, Bordeaux, France
| | - Barbara Engelsmann
- Organization for Public Health Interventions and Development, Harare, Zimbabwe
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Divisions of General Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Harvard University Center for AIDS Research Boston, MA, USA
| | | | - Shahin Lockman
- Department of Immunology and Infectious Diseases, Harvard T.H, Chan School of Public Health, Boston, MA, USA.,The Botswana-Harvard School of Public Health AIDS Institute Partnership for HIV Research and Education, Gaborone, Botswana.,Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Rochelle Walensky
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Divisions of General Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Harvard University Center for AIDS Research Boston, MA, USA.,Division of Infectious Disease, Brigham and Women's Hospital, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nigel Rollins
- Department of Maternal Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
| | - Andrea Ciaranello
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Goldstein R, Sacks C, Walensky R. 1286. Evaluating Strategies to Reduce Risk of HIV Infection in the US Blood Supply. Open Forum Infect Dis 2018. [PMCID: PMC6252945 DOI: 10.1093/ofid/ofy210.1119] [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] [Indexed: 11/13/2022] Open
Abstract
Background Due to risk of HIV transmission, the FDA recommends a ban on blood donation from men who have sex with men (MSM). Revised in 2015, the current restriction applies to men who have had sex with a man in the year before donation. Given advances in HIV testing and the option of risk-based screening, the current approach may not represent the optimal strategy for ensuring a safe blood supply. Methods Using a decision tree, we compared three strategies: (1) the current standard: a deferral for MSM followed by fourth-generation HIV antibody/antigen (Ab/Ag) and viral load (VL) testing of all donated units; (2) test-only: no deferral, with Ab/Ag and VL testing; (3) risk-based: deferral for all male donors who report condomless anal intercourse in the past 6 weeks, followed by Ab/Ag and VL testing. The primary outcome was the expected number of accepted HIV+ donations per million units of donated blood. Key input parameters include MSM prevalence (3.6%), HIV testing sensitivity for chronic (99.96%) and acute (75%) infection, and false negative rate of the current MSM deferral question and the risk-based screening question (2.6% for each). In sensitivity analyses, we assessed the impact of variation in these parameters. Results In the base case, the current strategy resulted in 5.39 HIV+ accepted blood donations per million; the testing only strategy resulted in 7.10 HIV+ accepted blood donations per million; and the risk-based strategy resulted in 2.54 HIV+ accepted blood donations per million. In sensitivity analyses, the risk-based strategy was superior across plausible ranges of HIV test sensitivity and MSM prevalence. The risk-based strategy was superior when the false negative rate generated by the risk-based screening question was <10.4%; at higher rates, the current strategy was superior. The current strategy was superior when the MSM deferral question yielded <0.8% false negative rate; at higher rates, the risk-based strategy is superior. Compared with the current standard, a risk-based strategy could add 5 million low-risk MSM to the potential donor supply. Conclusion A risk-based screening question, combined with Ab/Ag and VL testing, may be more effective than the current strategy. The quality and ability of screening questions to accurately assess risk is key to any pre-donation screening strategy. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Robert Goldstein
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Chana Sacks
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rochelle Walensky
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
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Deeks SG, Lewin SR, Ross AL, Ananworanich J, Benkirane M, Cannon P, Chomont N, Douek D, Lifson JD, Lo YR, Kuritzkes D, Margolis D, Mellors J, Persaud D, Tucker JD, Barre-Sinoussi F, Alter G, Auerbach J, Autran B, Barouch DH, Behrens G, Cavazzana M, Chen Z, Cohen ÉA, Corbelli GM, Eholié S, Eyal N, Fidler S, Garcia L, Grossman C, Henderson G, Henrich TJ, Jefferys R, Kiem HP, McCune J, Moodley K, Newman PA, Nijhuis M, Nsubuga MS, Ott M, Palmer S, Richman D, Saez-Cirion A, Sharp M, Siliciano J, Silvestri G, Singh J, Spire B, Taylor J, Tolstrup M, Valente S, van Lunzen J, Walensky R, Wilson I, Zack J. International AIDS Society global scientific strategy: towards an HIV cure 2016. Nat Med 2016; 22:839-50. [PMID: 27400264 PMCID: PMC5322797 DOI: 10.1038/nm.4108] [Citation(s) in RCA: 358] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
Abstract
Antiretroviral therapy is not curative. Given the challenges in providing lifelong therapy to a global population of more than 35 million people living with HIV, there is intense interest in developing a cure for HIV infection. The International AIDS Society convened a group of international experts to develop a scientific strategy for research towards an HIV cure. This Perspective summarizes the group's strategy.
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Affiliation(s)
- Steven G Deeks
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Anna Laura Ross
- International and Scientific Relations Office, ANRS, Paris, France
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Monsef Benkirane
- Molecular Virology Lab, Institute of Human Genetics, CNRS UPR 1142, Université de Montpellier, Montpellier, France
| | - Paula Cannon
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Nicolas Chomont
- CRCHUM and Department of Microbiology, Infectiology, and Immunology, Université de Montréal, Faculty of Medicine, Montréal, Quebec, Canada
| | - Daniel Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey D Lifson
- AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory, Frederick, Maryland, USA
| | - Ying-Ru Lo
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - David Margolis
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - John Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deborah Persaud
- Johns Hopkins University School of Medicine &Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph D Tucker
- University of North Carolina-Project China, Guangzhou, China
| | | | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, USA
| | - Judith Auerbach
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brigitte Autran
- Sorbonne Universités, UPMC Univ Paris 06, CIMI-Paris, France
- Inserm U1135, CIMI-Paris, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Dan H Barouch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, USA
| | - Georg Behrens
- Clinic for Immunology and Rhematology, Hannover Medical School, Hanover, Germany
| | - Marina Cavazzana
- Centre d'Investigation Clinique en biothérapie, Hôpital Necker-Enfants Malades, Paris, France
| | - Zhiwei Chen
- AIDS Institute, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Éric A Cohen
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | | | - Serge Eholié
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Nir Eyal
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Cynthia Grossman
- National Institute of Mental Health, NIH, Bethesda, Maryland, USA
| | - Gail Henderson
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy J Henrich
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Brigham &Women's Hospital, Boston, Massachusetts, USA
| | | | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joseph McCune
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Department of Medicine, Stellenbosch University, Western Cape, South Africa
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Monique Nijhuis
- Department of Medical Microbiology, Virology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Melanie Ott
- Gladstone Institutes, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Palmer
- Westmead Millennium Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Douglas Richman
- Virginia San Diego Healthcare System and University of California, San Diego, San Diego, California, USA
| | | | - Matthew Sharp
- Independent HIV Education and Advocacy Consultant, San Francisco, California, USA
| | - Janet Siliciano
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guido Silvestri
- Yerkes National Primate Research Centre, Emory University, Atlanta, Georgia, USA
| | - Jerome Singh
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Jeffrey Taylor
- CARE Collaboratory Community Advisory Board, Palm Springs, California, USA
| | - Martin Tolstrup
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susana Valente
- Department of Immunology and Microbial Sciences, The Scripps Research Institute, Jupiter, Florida, USA
| | | | - Rochelle Walensky
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ira Wilson
- Department of Health Services, Policy &Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jerome Zack
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Hyle E, Rao S, Jentes E, Fiebelkorn AP, Hagmann S, Walensky R, Ryan E, Larocque R. Pretravel Assessment of Measles Immunity Status and Administration of Measles-Mumps-Rubella for Adult International Travelers Seen in Global TravEpiNet Sites. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Laughlin K, Kasozi J, Bassett I, Faustin Z, Parker R, Greenwald K, Omara Owino C, Walensky R. Predictors of HIV-infection during routine clinic-based HIV testing in
Nakivale Refugee settlement in SW Uganda. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ross E, Tanser F, Pei P, Newell ML, Losina E, Thiebaut R, Weinstein M, Freedberg K, Anglaret X, Scott C, Dabis F, Walensky R. The impact of the 2013 WHO antiretroviral therapy guidelines on the feasibility of HIV population prevention trials. HIV Clin Trials 2014; 15:185-98. [PMID: 25350957 PMCID: PMC4212337 DOI: 10.1310/hct1505-185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Several cluster-randomized HIV prevention trials aim to demonstrate the population-level preventive impact of antiretroviral therapy (ART). 2013 World Health Organization (WHO) guidelines raising the ART initiation threshold to CD4 <500/µL could attenuate these trials' effect size by increasing ART usage in control clusters. METHODS We used a computational model to simulate strategies from a hypothetical cluster-randomized HIV prevention trial. The primary model outcome was the relative reduction in 24-month HIV incidence between control (ART offered with CD4 below threshold) and intervention (ART offered to all) strategies. We assessed this incidence reduction using the revised (CD4 <500/µL) and prior (CD4 <350/µL) control ART initiation thresholds. Additionally, we evaluated changes to trial characteristics that could bolster the incidence reduction. RESULTS With a control ART initiation threshold of CD4 <350/µL, 24-month HIV incidence under control and intervention strategies was 2.46/100 person-years (PY) and 1.96/100 PY, a 21% reduction. Raising the threshold to CD4 <500/µL decreased the incidence reduction by more than one-third, to 12%. Using this higher threshold, moving to a 36-month horizon (vs 24-month), yearly control-strategy HIV screening (vs bian-nual), and intervention-strategy screening every 2 months (vs biannual), resulted in a 31% incidence reduction that was similar to effect size projections for ongoing trials. Alternate assumptions regarding cross-cluster contamination had the greatest influence on the incidence reduction. CONCLUSIONS Implementing the 2013 WHO HIV treatment threshold could substantially diminish the incidence reduction in HIV population prevention trials. Alternative HIV testing frequencies and trial horizons can bolster this incidence reduction, but they could be logistically and ethically challenging. The feasibility of HIV population prevention trials should be reassessed as the implementation of treatment guidelines evolves.
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Affiliation(s)
- Eric Ross
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Pamela Pei
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marie-Louise Newell
- Faculty of Medicine and Faculty of Social and Human Sciences, University of Southampton, Southampton, England
| | - Elena Losina
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts Harvard University Center for AIDS Research, Cambridge, Massachusetts Harvard Medical School, Boston, Massachusetts
| | - Rodolphe Thiebaut
- Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France Institut de Santé Publique, d'Épidémiologie, et de Développement (ISPED), University of Bordeaux, Bordeaux, France
| | - Milton Weinstein
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Kenneth Freedberg
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts Harvard University Center for AIDS Research, Cambridge, Massachusetts Harvard Medical School, Boston, Massachusetts Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Xavier Anglaret
- Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France Institut de Santé Publique, d'Épidémiologie, et de Développement (ISPED), University of Bordeaux, Bordeaux, France Programme PAC-CI/ANRS, Abidjan, Côte d'Ivoire
| | - Callie Scott
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Francois Dabis
- Centre INSERM U897 for Epidemiology and Biostatistics, Bordeaux, France Institut de Santé Publique, d'Épidémiologie, et de Développement (ISPED), University of Bordeaux, Bordeaux, France Programme PAC-CI/ANRS, Abidjan, Côte d'Ivoire Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Rochelle Walensky
- Medical Practice Evaluation Center, Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts Harvard University Center for AIDS Research, Cambridge, Massachusetts Harvard Medical School, Boston, Massachusetts Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
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Shenoy ES, Lee H, Hou T, Ryan E, Cotter J, Ware W, Hooper D, Walensky R. 319A discrete event simulation (DES) model of patient flow incorporating infection control policy for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Blumenthal K, Parker R, Shenoy ES, Walensky R. 290Optimizing clinical outcomes in patients with methicillin-sensitive Staphylococcus aureus bacteremia and reported penicillin allergy. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Metsch LR, Feaster DJ, Gooden L, Matheson T, Mandler RN, Haynes L, Tross S, Kyle T, Gallup D, Kosinski AS, Douaihy A, Schackman BR, Das M, Lindblad R, Erickson S, Korthuis PT, Martino S, Sorensen JL, Szapocznik J, Walensky R, Branson B, Colfax GN. Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial. Am J Public Health 2012; 102:1160-7. [PMID: 22515871 DOI: 10.2105/ajph.2011.300460] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. METHODS Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing. RESULTS We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P<.001; Mantel-Haenszel risk ratio=4.52; 97.5% confidence interval [CI]=3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P=.39; incidence rate ratio [IRR]=1.04; 97.5% CI=0.95, 1.14) or the 2 on-site testing arms (P=.81; IRR=1.03; 97.5% CI=0.84, 1.26). CONCLUSIONS This study demonstrated on-site rapid HIV testing's value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.
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Affiliation(s)
- Lisa R Metsch
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Lyons MS, Lindsell CJ, Haukoos JS, Almond G, Brown J, Calderon Y, Couture E, Merchant RC, White DAE, Rothman RE, Aldridge C, Almond G, Andrade G, Arbelaez C, Archinard TM, Aronin SI, Barrera S, Bateganya M, Bell-Merriam J, Bongiovanni B, Brady K, Branson B, Brosgart C, Brown J, Cadoff E, Calderon Y, Chaille-Arnold L, Cheng B, Chiang W, Copeland B, Cousar RL, Couture E, Czarnogorski M, Delgado K, Erbelding E, Feldman J, Garcia O, Gaydos CA, Glick N, Gripshover B, Haukoos J, Hayes A, Heffelfinger J, Herrera L, Hilley A, Holtgrave D, Hoots B, Hopkins E, Houry D, Howell D, Hsieh YH, Hutchinson AB, Jackson B, Jaker M, Jones K, Jung J, Kampe L, Kan V, Kass N, Kelen GD, Kroc K, Kurth A, Lampe MA, Leider J, Lemanski M, Lindsell CJ, Lyons M, McGovern S, Mercer S, Merchant R, Miertschin N, Miller J, Mitchell P, Nelson S, Onaga L, Paltiel D, Paul S, Pollack H, Raffanti S, Randall L, Rothman R, Sabreen A, Sankoff J, Sasso V, Saylor NB, Schechter E, Schechtman B, Schrantz S, Scribner A, Shahan J, Skiest D, Spielberg F, Stennett IS, Sullivan P, Teahan C, Thompson S, Torres G, Totten V, Wagner K, Walensky R, Waxman M, Weddle A, White D, Widell T, Wilde JA, Wrenn K, Yonek J. Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: report from the 2007 conference of the National Emergency Department HIV Testing Consortium. Acad Emerg Med 2009; 16:168-77. [PMID: 19076107 PMCID: PMC3173973 DOI: 10.1111/j.1553-2712.2008.00300.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.
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Affiliation(s)
- Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Waisbren SE, Bowles H, Hasan T, Zou KH, Emans SJ, Goldberg C, Gould S, Levine D, Lieberman E, Loeken M, Longtine J, Nadelson C, Patenaude AF, Quinn D, Randolph AG, Solet JM, Ullrich N, Walensky R, Weitzman P, Christou H. Gender differences in research grant applications and funding outcomes for medical school faculty. J Womens Health (Larchmt) 2008; 17:207-14. [PMID: 18321172 DOI: 10.1089/jwh.2007.0412] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate whether there were differences in acquisition of research grant support between male and female faculty at eight Harvard Medical School-affiliated institutions. METHODS Data were obtained from the participating institutions on all research grant applications submitted by full-time faculty from 2001 through 2003. Data were analyzed by gender and faculty rank of applicant, source of support (federal or nonfederal), funding outcome, amount of funding requested, and amount of funding awarded. RESULTS Data on 6319 grant applications submitted by 2480 faculty applicants were analyzed. Women represented 29% of investigators and submitted 26% of all grant requests. There were significant gender differences in the mean number of submissions per applicant (women 2.3, men 2.7), success rate (women 41%, men 45%), number of years requested (women 3.1, men 3.4), median annual amount requested (women $115,325, men $150,000), mean number of years awarded (women 2.9, men 3.2), and median annual amount awarded (women $98,094, men $125,000). After controlling for academic rank, grant success rates were not significantly different between women and men, although submission rates by women were significantly lower at the lowest faculty rank. Although there was no difference in the proportion of money awarded to money requested, women were awarded significantly less money than men at the ranks of instructor and associate professor. More men than women applied to the National Institutes of Health, which awarded higher dollar amounts than other funding sources. CONCLUSIONS Gender disparity in grant funding is largely explained by gender disparities in academic rank. Controlling for rank, women and men were equally successful in acquiring grants. However, gender differences in grant application behavior at lower academic ranks also contribute to gender disparity in grant funding for medical science.
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Arbelaez C, Losina E, Wright E, Millen J, Dooley M, Reichman B, Mikulinsky R, Walensky R. 376: The Barriers Affecting Health Care Providers’ Willingness to Perform Routine HIV Testing in the Emergency Department. Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wertheimer B, Freedberg K, Walensky R, Yazdan Y, Losina E. Therapeutic Drug Monitoring in HIV Treatment: A Literature Review. HIV Clinical Trials 2006. [DOI: 10.1310/4ccj-kt1t-h6pv-nlfc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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