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Comparison Of Self-Reported Alcohol Consumption To Phosphatidylethanol Measurement Among Hiv-Infected Patients Initiating Antiretroviral Treatment In Southwestern Uganda, Francis Bajunirwe, Jessica E. Haberer, Yap Boum Ii, Peter Hunt, Rain Mocello, Jeffrey Martin, David Bangsberg, Judith A. Hahn

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Alcohol consumption among HIV-infected patients may accelerate HIV disease progression or reduce antiretroviral therapy adherence. Self-reported alcohol use is frequently under-reported due to social desirability and recall bias. The aim of this study was to compare self-reported alcohol consumption to phosphatidylethanol (PEth), a biomarker of alcohol consumption, and to estimate the correlation between multiple measures of self-reported alcohol consumption with PEth.

Methods: The Uganda AIDS Rural Treatment Outcomes (UARTO) cohort is located in southwestern Uganda and follows patients on ART to measure treatment outcomes. Patients complete standardized questionnaires quarterly including questions on demographics, health status and alcohol consumption. Baseline …

Latino Men Managing Hiv: An Appraisal Analysis Of Intersubjective Relations In The Discourse Of Five Research Interviews, Will Caston

Dissertations and Theses

Latino men, particularly those who have sex with other men, have been disproportionately affected by HIV/AIDS. Scholars have sought for nearly two decades to understand how various social and cultural factors in the Latino community exacerbate HIV risk among these men. Although following the advent of life-sustaining medications in 1996, HIV is often regarded as a manageable chronic illness, as opposed to a death sentence, scant attention has been devoted to how HIV-positive Latino men experience managing the illness. Among studies that have focused on HIV-positive persons' illness management, few Latino men have participated.

Using the Appraisal framework from Hallidayan …

Antiretroviral Therapy Enrollment Characteristics And Outcomes Among Hiv-Infected Adolescents And Young Adults Compared With Older Adults — Seven African Countries, 2004–2013, Andrew F. Auld, Simon G. Agolory, Ray W. Shiraishi, Fred Wabwire-Mangen, Gideon Kwesigabo, Modest Mulenga, Sebastian Hachizovu, Emeka Asadu, Moise Zanga Tuho, Virginie Ettiegne-Traore, Francisco Mbofana, Velephi Okello, Charles Azih, Julie A. Denison, Sharon Tsui, Olivier Koole, Harrison Kamiru, Harriet Nuwagaba-Biribonwoha, Charity Alfredo, Kebba Jobarteh, Solomon Odafe, Dennis Onotu, Kunomboa A. Ekra, Joseph S. Kouakou, Peter Ehrenkranz, George Bicego, Kwasi Torpey, Ya Diul Mukadi, Eric Van Praag, Joris Menten, Timothy Mastro, Carol Dukes Hamilton, Mahesh Swaminathan, E. Kainne Dokubo, Andrew L. Baughman, Thomas Spira, Robert Colebunders, David R. Bangsberg, Richard Marlink, Aaron Zee, Jonathan Kaplan, Tedd V. Ellerbrock

OHSU-PSU School of Public Health Faculty Publications and Presentations

Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to a decline of about 30% in the global annual number of human immunodeficiency (HIV)–related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50%, and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15–24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this …

Understanding Adherence To Daily And Intermittent Regimens Of Oral Hiv Pre-Exposure Prophylaxis Among Men Who Have Sex With Men In Kenya, Peter Mwangi Mugo, Eduard J. Sanders, Gaudensia Mutua, Elisabeth Van Der Elst, Omu Anzala, Burc Barin, David Bangsberg, Frances H. Priddy, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV preexposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum1 dose/day)emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a ‘‘relaxed’’ definition (accounting for off-prescription dosing) and 40 % per a ‘‘strict’’ …

Understanding Treatment Refusal Among Adults Presenting For Hiv-Testing In Soweto, South Africa: A Qualitative Study, Ingrid T. Katz, Janan Dietrich, Gugu Tshabalala, Thandekile Essien, Kathryn Rough, Alexi A. Wright, David Bangsberg, Glenda E. Gray, Norma C. Ware

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV treatment initiatives have focused on increasing access to antiretroviral therapy (ART). There is growing evidence, however, that treatment availability alone is insufficient to stop the epidemic. In South Africa, only one third of individuals living with HIV are actually on treatment. Treatment refusal has been identified as a phenomenon among people who are asymptomatic, however, factors driving refusal remain poorly understood. We interviewed 50 purposively sampled participants who presented for voluntary counseling and testing in Soweto to elicit a broad range of detailed perspectives on ART refusal. We then integrated our core findings into an explanatory framework. Participants described …

Delayed Switch Of Antiretroviral Therapy After Virologic Failure Associated With Elevated Mortality Among Hiv-Infected Adults In Africa, Maya L. Petersen, Linh Tran, Elvin H. Geng, Steven J. Reynolds, Andrew Kambugu, Robin Wood, David Bangsberg, Constantin T. Yiannoutsos, Steven G. Deeks, Jeffrey N. Martin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Routine monitoring of plasma HIV RNA among HIV-infected patients on antiretroviral therapy (ART) is unavailable in many resource-limited settings. Alternative monitoring approaches correlate poorly with virologic failure and can substantially delay switch to second-line therapy. We evaluated the impact of delayed switch on mortality among patients with virologic failure in Africa.

Design—A cohort.

Methods—We examined patients with confirmed virologic failure on first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens from four cohorts with serial HIV RNA monitoring in Uganda and South Africa. Marginal structural models aimed to estimate the effect of delayed switch on mortality in a hypothetical trial in which …

High Medication Adherence During Periconception Periods Among Hiv-1–Uninfected Women Participating In A Clinical Trial Of Antiretroviral Pre-Exposure Prophylaxis, Lynn T. Matthews, Renee Heffron, Nelly R. Mugo, Craig R. Cohen, Craig W. Hendrix, Connie Celum, David Bangsberg, Jared M. Baten

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Pre-exposure prophylaxis (PrEP) may be an important safer conception strategy for HIV-1–uninfected women with HIV-1–infected partners. Understanding medication adherence in this population may inform whether PrEP is a feasible safer conception strategy.

Methods: We evaluated predictors of pregnancy and adherence to study medication among HIV-1–uninfected women enrolled in a randomized placebo-controlled trial of PrEP among African HIV-1– serodiscordant couples. Participants were counseled on HIV-1 risk reduction, contraception, and adherence and tested for pregnancy at monthly study visits. Pill counts of dispensed drug were performed and, at a subset of visits, plasma was collected to measure active drug concentration.

Results: …

Persistent Hiv-Related Stigma In Rural Uganda During A Period Of Increasing Hiv Incidence Despite Treatment Expansion, Brian T. Chan, Sheri D. Weiser, Yap Boum Ii, Mark J. Siedner, Rain Mocello, Jessica E. Haberer, Peter Hunt, Jeffrey N. Martin, Kenneth H. Mayer, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion.

Design—Serial cross-sectional surveys.

Methods—We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We …

Empiric Deworming And Cd4 Count Recovery In Hiv-Infected Ugandans Initiating Antiretroviral Therapy, Alexander J. Lankowski, Alexander C. Tsai, Michael Kanyesigye, Mwebesa B. Bwana, Jessica E. Haberer, Megan Wenger, Jeffrey N. Martin, David Bangsberg, Peter W. Hunt, Mark J. Siedner

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naive individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received …

South Africans With Recent Pregnancy Rarely Know Partner’S Hiv Serostatus: Implications For Serodiscordant Couples Interventions, Lynn T. Matthews, Lizzie Moore, Tamaryn L. Crankshaw, Cecilia Milford, Fortunate N. Mosery, Ross Greener, Christina Psaros, Steven A, Safren, David Bangsberg, Jennifer A. Smit

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Implementation of safer conception strategies requires knowledge of partner HIV-serostatus. We recruited women and men in a high HIV-prevalence setting for a study to assess periconception risk behavior among individuals reporting HIV-serodiscordant partnerships. We report screening data from that study with the objective of estimating the proportion of individuals who are aware that they are in an HIV-serodiscordant relationship at the time of conception.

Methods: We screened women and men attending antenatal and antiretroviral clinics in Durban, South Africa for enrollment in a study of periconception risk behavior among individuals with serodiscordant partners. Screening questionnaires assessed for study eligibility …

Decreases In Self-Reported Alcohol Consumption Following Hiv Counseling And Testing At Mulago Hospital, Kampala, Uganda, Judith A. Hahn, Robin Fatch, Rhoda K. Wanyenze, Steven Baveewo, Moses R. Kamya, David Bangsberg, Thomas J. Coates

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Alcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. HIV counseling and testing (HCT) may provide a contact opportunity to intervene with hazardous alcohol use; however, little is known about how alcohol consumption changes following HCT.

Methods: We utilized data from 2056 participants of a randomized controlled trial comparing two methods of HCT and subsequent linkage to HIV care conducted at Mulago Hospital in Kampala, Uganda. Those who had not previously tested positive for HIV and whose last HIV test was at least one year in the past were eligible. Participants were asked at …

Using Radiation Therapy For Mesothelioma, Samira Rezaei

Student Research Symposium

This poster details research that shows that patients who suffer from mesothelioma cancer and choose Immune Therapy treatment have a longer survival rate in comparison with other methods of treatment.

Tobacco Use Among Adults Initiating Treatment For Hiv Infection In Rural Uganda, Gina R. Kruse, David Bangsberg, Judith A. Hahn, Jessica E. Haberer, Peter Hunt, Conrad Muzoora, John P. Bennett, Jeffrey N. Martin, Nancy A, Rigotti

OHSU-PSU School of Public Health Faculty Publications and Presentations

We conducted a longitudinal study of tobacco use among adults initiating antiretroviral therapy (ART) in Mbarara, Uganda where 11% of men and 3% of women use tobacco according to the 2011 Demographic and Health Survey. In a prospective cohort, self-reported tobacco use was assessed before starting ART and reassessed every 3–4 months. Plasma cotinine, a nicotine metabolite, was measured in a subset of adults pre-ART to verify self-report. Among 496 subjects, 50 (10%) reported current tobacco use (20% of men, 6% of women). Most (53%) adults with elevated cotinine levels (>15 ng/mL) reported no tobacco use. By 6 months …

Impact Of Hiv On Cd8+ T Cell Cd57 Expression Is Distinct From That Of Cmv And Aging, Sulggi A. Lee, Elizabeth Sinclair, Hiroyu Hatano, Priscilla Y. Hsue, Lorrie Epling, Frederick M. Hecht, David Bangsberg, Jeffrey N. Martin, Joseph M. Mccune, Steven G. Deeks, Peter Hunt

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Chronic antigenic stimulation by cytomegalovirus (CMV) is thought to increase ‘‘immunosenesence’’ of aging, characterized by accumulation of terminally differentiated CD28- CD8+ T cells and increased CD57, a marker of proliferative history. Whether chronic HIV infection causes similar effects is currently unclear.

Methods: We compared markers of CD8+ T cell differentiation (e.g., CD28, CD27, CCR7, CD45RA) and CD57 expression on CD28- CD8+ T cells in healthy HIV-uninfected adults with and without CMV infection and in both untreated and antiretroviral therapy (ART)-suppressed HIV-infected adults with asymptomatic CMV infection.

Results: Compared to HIV-uninfected adults without CMV (n = 12), those with asymptomatic …

The Dynamic Relationship Between Social Support And Hiv-Related Stigma In Rural Uganda, Sae Takada, Sheri D. Weiser, Elias Kumbakumba, Conrad Muzoora, Jeffrey N. Martin, Peter Hunt, Jessica E. Haberer, Annet Kawuma, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.

Purpose—The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.

Methods—We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.

Results—Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and …