Medicine and Health Sciences Commons^™

Contralateral Second Dose Improves Antibody Responses To A 2-Dose Mrna Vaccination Regimen, Sedigheh Fazli, Archana Thomas, Abram E. Estrada, Hiro A. P. Ross, David Xthona Lee, Steven Kazmierczak, Mark K. Slifka, David Montefiori, William B. Messer, Marcel E. Curlin

OHSU-PSU School of Public Health Faculty Publications and Presentations

BACKGROUND. Vaccination is typically administered without regard to site of prior vaccination, but this factor may substantially affect downstream immune responses. METHODS. We assessed serological responses to initial COVID-19 vaccination in baseline seronegative adults who received second-dose boosters in the ipsilateral or contralateral arm relative to initial vaccination. We measured serum SARSCoV-2 spike–specific Ig, receptor-binding domain–specific (RBD-specific) IgG, SARS-CoV-2 nucleocapsid–specific IgG, and neutralizing antibody titers against SARS-CoV-2.D614G (early strain) and SARS-CoV-2.B.1.1.529 (Omicron) at approximately 0.6, 8, and 14 months after boosting. RESULTS. In 947 individuals, contralateral boosting was associated with higher spike-specific serum Ig, and this effect increased over time, …

Incidence And Risk Factors For Clinically Confirmed Secondary Bacterial Infections In Patients Hospitalized For Coronavirus Disease 2019 (Covid-19), Hiromichi S. Park, Caitlin M. Mccracken, Noah Lininger, Cara D. Varley, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: The true incidence and risk factors for secondary bacterial infections in coronavirus disease 2019 (COVID-19) remains poorly understood. Knowledge of risk factors for secondary infections in hospitalized patients with COVID-19 is necessary to optimally guide selective use of empiric antimicrobial therapy. Design: Single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 from April 15, 2020, through June 30, 2021. Setting: Academic quaternary-care referral center in Portland, Oregon. Patients: The study included patients who were 18 years or older with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR test up to 10 days prior to admission. Methods: …

Adherence To Hiv Antiretroviral Therapy Among Pregnant And Postpartum Women During The Option B+ Era: 12-Month Cohort Study In Urban South Africa And Rural Uganda, Lynn T. Matthews, Catherine Orrell, Mwebesa B. Bwana, Alexander C. Tsai, Christina A. Psaros, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Kathleen Bell, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression …

Variability In State Regulations Pertaining To Infection Control And Pandemic Response In Us Assisted Living Communities, Taylor Bucy, Lindsey Smith, Paula C. Carder, Jaclyn Winfree, Kali Thomas

OHSU-PSU School of Public Health Faculty Publications and Presentations

At the end of 2019, international attention was drawn to an outbreak of zoonotic coronavirus SARS-CoV-2, formally named COVID-19, in Wuhan, China. The World Health Organization officially declared the outbreak a global pandemic on March 11, 2020, with the United States recording >1600 confirmed and presumptive travel-related and community-acquired cases at that time. As of April 10, 2020, all 50 US states and the District of Columbia, have reported cases, with the total number of US cases now totaling >400,000.2 Seattle, WA, is the US epicenter, with nursing facilities experiencing the greatest number of fatalities. Because of the communal living …

Potency And Breadth Of Human Primary Zikv Immune Sera Shows That Zika Viruses Cluster Antigenically As A Single Serotype, Chad M. Nix, Jonathan Salberg, Felicity J. Coulter, Bettie W. Kareko, Zoe L. Lyski, Brian L. Booty, William B. Messer

OHSU-PSU School of Public Health Faculty Publications and Presentations

The recent emergence of Zika virus as an important human pathogen has raised questions about the durability and breadth of Zika virus immunity following natural infection in humans. While global epidemic patterns suggest that Zika infection elicits a protective immune response that is likely to offer long-term protection against repeat infection by other Zika viruses, only one study to date has formally examined the ability of human Zika immune sera to neutralize different Zika viruses. That study was limited because it evaluated human immune sera no more than 13 weeks after Zika virus infection and tested a relatively small number …

Screening For Hepatitis C Virus Infection In Adolescents And Adults: Updated Evidence Report And Systematic Review For The Us Preventive Services Task Force, Roger Chou, Tracy Dana, Rongwei Fu, Bernadette Zahker, Jesse Wagner, Shaun Ramirez, Sara Grusing, Janice H. Jou

OHSU-PSU School of Public Health Faculty Publications and Presentations

IMPORTANCE: A 2013 review for the US Preventive Services Task Force (USPSTF) of hepatitis C virus (HCV) screening found interferon-based antiviral therapy associated with increased likelihood of sustained virologic response (SVR) and an association between achieving an SVR and improved clinical outcomes. New direct-acting antiviral (DAA) regimens are available.

OBJECTIVE: To update the 2013 review on HCV screening to inform the USPSTF.

DATA SOURCES: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through February 2019, with surveillance through September 2019.

STUDY SELECTION: Randomized clinical trials (RCTs) and nonrandomized treatment studies of HCV …

Hiv Care Continuum Characteristics Among People With Opioid Use Disorder And Hiv In Vietnam: Baseline Results From The Bravo Study, Caroline King, Le Minh Giang, Gavin Bart, Lynn Elizabeth Kunkel, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam.

Methods

We assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression.

Results

Among 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) …

Super Learner Analysis Of Real-Time Electronically Monitored Adherence To Antiretroviral Therapy Under Constrained Optimization And Comparison To Non-Differentiated Care Approaches For Persons Living With Hiv In Rural Uganda, Alejandra E. Benitez, Nicholas Musinguzi, David Bangsberg, Mwebesa B. Bwana, Conrad Muzoora, Peter Hunt, Jeffrey N. Martin, Jessica E. Haberer, Maya L. Petersen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction

Real‐time electronic adherence monitoring (EAM) systems could inform on‐going risk assessment for HIV viraemia and be used to personalize viral load testing schedules. We evaluated the potential of real‐time EAM (transferred via cellular signal) and standard EAM (downloaded via USB cable) in rural Uganda to inform individually differentiated viral load testing strategies by applying machine learning approaches.

Methods

We evaluated an observational cohort of persons living with HIV and treated with antiretroviral therapy (ART) who were monitored longitudinally with standard EAM from 2005 to 2011 and real‐time EAM from 2011 to 2015. Super learner, an ensemble machine learning method, …

Analysis Of Covid-19 Transmission: Low Risk Of Presymptomatic Spread?, Mark K. Slifka, William B. Messer, Ian J. Amanna

OHSU-PSU School of Public Health Faculty Publications and Presentations

More than 6 million confirmed cases of COVID-19 (coronavirus disease 2019) have been identified worldwide and a number of case reports1-5 have indicated that COVID-19 has the potential to be transmitted prior to disease onset. Studies have also shown that infectious virus can be isolated from presymptomatic COVID-19 cases6 and although it is unknown what level of infectious virus is needed to confer efficient transmission potential, detection of infectious virus in the upper respiratory tract indicates that presymptomatic transmission of COVID-19 is plausible. Fear of asymptomatic and presymptomatic transmission of COVID-19 has led to considerable concern among public health policy …

Rapid Deployment Of A Statewide Covid-19 Echo Program For Frontline Clinicians: Early Results And Lessons Learned, Anna Louise Steeves-Reece, Nancy Elder, Tuesday A. Graham, Miriam L. Wolf, Isabel Stock, Melinda M. Davis, Robert D. Stock

OHSU-PSU School of Public Health Faculty Publications and Presentations

In a pattern repeated around the country, Oregon reported its first coronavirus patient on February 28, 2020.1 A week later, the governor declared a state of emergency.2 While the media initially focused on efforts to address COVID-19 in large cities, many rural communities were working in parallel to prepare. In these rural areas, there was an increasing concern that the burden of COVID-19 may be particularly dire due to factors such as older populations, higher prevalence of chronic diseases and poverty, and less health care access.3-6 Rural clinicians, especially those working in outpatient settings, are caring for patients during the …

Molecular Analysis Of Lymphoid Tissue From Rhesus Macaque Rhadinovirus-Infected Monkeys Identifies Alterations In Host Genes Associated With Oncogenesis, Ryan D. Estep, Aparna N. Govindan, Minsha Manoharan, He Li, Suzanne S. Fei, Byung S. Park, Michael K. Axthelm, Scott Wong

OHSU-PSU School of Public Health Faculty Publications and Presentations

Rhesus macaque (RM) rhadinovirus (RRV) is a simian gamma-2 herpesvirus closely related to human Kaposi’s sarcoma-associated herpesvirus (KSHV). RRV is associated with the development of diseases in simian immunodeficiency virus (SIV) co-infected RM that resemble KSHV-associated pathologies observed in HIV-infected humans, including B cell lymphoproliferative disorders (LPD) and lymphoma. Importantly, how de novo KSHV infection affects the expression of host genes in humans, and how these alterations in gene expression affect viral replication, latency, and disease is unknown. The utility of the RRV/RM infection model provides a novel approach to address these questions in vivo, and utilizing the RRV …

Art Adherence And Viral Suppression Are High Among Most Non-Pregnant Individuals With Early-Stage, Asymptomatic Hiv Infection: An Observational Study From Uganda And South Africa, Jessica E. Haberer, Bosco M. Bwana, Catherine Orrell, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Mark J. Siedner, Lynn T. Matthews, Alexander Tsai, Ingrid T. Katz, Kathleen Bell, Annet Kembabazi, Stephen Mugisha, Victoria Kibirige, Anna Cross, Nicola Kelly, Bethany Hedt-Gauthie, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction

The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS‐free generation depend on high adherence in individuals initiating ART during early‐stage HIV infection; however, adherence may be difficult in the absence of illness and associated support.

Methods

From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non‐pregnant women with early‐stage HIV infection (CD4 > 350 cells/μL), pregnant women with early‐stage HIV infection and men and non‐pregnant women with late‐stage HIV infection (CD4 < 200 cells/μL). Socio‐behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically.

Results

Adherence data were available for 869 participants: 322 (37%) early/non‐pregnant, …

Timing Of Antiretroviral Therapy And Systemic Inflammation In Sub-Saharan Africa: Results From The Meta Longitudinal Cohort Study, Mark J. Siedner, Bosco M. Bwana, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Jose R. Castillo-Mancilla, Russell P. Tracy, Ingrid T. Katz, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Chronic inflammation predicts complications in persons with human immunodeficiency virus infection. We compared D-dimer, soluble CD14, and interleukin 6 levels before and 12 months after antiretroviral therapy (ART) initiation, among individuals starting ART during earlier-stage (CD4 T-cell count >350/μL) or late-stage disease (CD4 T-cell count <200/ μL). Female sex, older age, viral load, and late-stage disease were associated with pre-ART biomarkers (n = 661; P < .05). However, there were no differences in biomarkers by disease stage after 12 months of ART (n = 438; P > .05), owing to loss from observation and greater declines in biomarkers in latestage initiators (P < .001). Earlier initiation of ART is associated with decreased inflammation, but levels seem to converge between earlier and later initiators surviving to 12 months.

Internalized Hiv Stigma, Art Initiation And Hiv-1 Rna Suppression In South Africa: Exploring Avoidant Coping As A Longitudinal Mediator, Valerie A. Earnshaw, Laura M. Bogart, Jean-Philippe Laurenceau, Brian T. Chan, Brendan G. Maughan-Brown, Janan Dietrich, Ingrid Courtney, Gugu Tshabalala, Catherine Orrell, Glenda E. Gray, David Bangsberg, Ingrid T. Katz

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction: Cross‐sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV‐1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.

Methods: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self‐report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and …

Hla-C Downregulation By Hiv-1 Adapts To Host Hla Genotype, Nathaniel D. Batchel, Gisele Umviligihozo, Suzanne Pickering, Talia Mota, Hua Liang, Gregory Q. Del Prete, Pramita Chatterjee, Guinevere Q. Lee, Rasmi Thomas, Mark A. Brockman, Stuart Neil, Mary Carrington, Bosco M. Bwana, David Bangsberg, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV-1 can downregulate HLA-C on infected cells, using the viral protein Vpu, and the magnitude of this downregulation varies widely between primary HIV-1 variants. The selection pressures that result in viral downregulation of HLA-C in some individuals, but preservation of surface HLA-C in others are not clear. To better understand viral immune evasion targeting HLA-C, we have characterized HLA-C downregulation by a range of primary HIV-1 viruses. 128 replication competent viral isolates from 19 individuals with effective anti-retroviral therapy, show that a substantial minority of individuals harbor latent reservoir virus which strongly downregulates HLA-C. Untreated infections display no change in …

Prevalence And Correlates Of Physical And Sexual Intimate Partner Violence Among Women Living With Hiv In Uganda, Cynthia R. Young, Angela Kaida, Jerome Kabakyenga, Winnie R. Muyindike, Nicholas Musinguzi, Jeffrey N. Martin, Peter W. Hunt, David Bangsberg, Jessica E. Haberer, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Intimate partner violence (IPV) is a significant global health problem. Women who experience IPV have increased HIV incidence, reduced antiretroviral adherence, and a lower likelihood of viral load suppression. There is a lack of evidence regarding how to effectively identify and support women living with HIV (WLWH) experiencing IPV, including uncertainty whether universal or targeted screening is most appropriate for lower-resourced settings. We examined physical and sexual IPV prevalence and correlates among WLWH in Uganda to understand the burden of IPV and factors that could help identify women at risk.

Methods: We utilized data from women receiving …

Actual Vs. Perceived Hiv Testing Norms, And Personal Hiv Testing Uptake: A Cross-Sectional, Population-Based Study In Rural Uganda, Jessica M. Perkins, Viola N. Nyakato, Bernard Kakuhikire, Pamela K. Mbabazi, H. Wesley Perkins, Alexander C. Tsai, Sv Subramanian, Nicholas A. Christakis, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals’ perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence …

Diagnostic Performance Of Blood Inflammatory Markers For Tuberculosis Screening In People Living With Hiv, Katherine Farr, Resmi Ravindran, Luke Strnad, Emily Chang, Leah H. Chaisson, Christina Yoon, William Worodria, Alfred Andama, Irene Ayakaka, Priscilla Bbosa Nalwanga, Multiple Additional Authors

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy.

Methods

Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the …

Re-Inventing Adherence: Toward A Patient-Centered Model Of Care For Drug-Resistant Tuberculosis And Hiv, Max R. O'Donnell, A. Daftary, M. Frick, Y. Hirsch-Moverman, K. R. Amico, M. Senthilingam, A. Wolf, J. Z. Metcalfe, P. Isaakidis, J. L. Davis, J. R. Zelnick, J.C.M. Brust, N. Naidu, M. Garretson, David Bangsberg, N. Padayatchi, G. Friedland

OHSU-PSU School of Public Health Faculty Publications and Presentations

BACKGROUND—Despite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.

OBJECTIVE—To review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.

DISCUSSION—Current national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered …

Pitfalls Of Practicing Cancer Epidemiology In Resource-Limited Settings: The Case Of Survival And Loss To Follow-Up After A Diagnosis Of Kaposi’S Sarcoma In Five Countries Across Sub-Saharan Africa, Esther Freeman, Aggrey Semeere, Megan Wenger, Mwebesa B. Bwana, F. Chite Asirwa, Naftali Busakhala, Emmanuel Oga, Elima Jedy-Agba, Vivian Kwaghe, Kenneth Iregbu, Antoine Jaquet, Francois Dabis, Habakkuk Azinyui Yumo, Jean Claude Dusingize, David Bangsberg, Kathryn Anastos, Sam Phiri, Julia Bohlius, Matthias Egger, Constantin T. Yiannoutsos, Kara Wools-Kaloustian, Jeffrey Martin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Survival after diagnosis is a fundamental concern in cancer epidemiology. In resource-rich settings, ambient clinical databases, municipal data and cancer registries make survival estimation in real-world populations relatively straightforward. In resource-poor settings, given the deficiencies in a variety of health-related data systems, it is less clear how well we can determine cancer survival from ambient data.

Methods: We addressed this issue in sub-Saharan Africa for Kaposi’s sarcoma (KS), a cancer for which incidence has exploded with the HIV epidemic but for which survival in the region may be changing with the recent advent of antiretroviral therapy (ART). From 33 …

The Meanings In The Messages: How Sms Reminders And Real-Time Adherence Monitoring Improve Antiretroviral Therapy Adherence In Rural Uganda, Norma C. Ware, Emily A. Pisarski, Melanie Tam, Monique A. Wyatt, Esther Atukunda, Angella Musimenta, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

To understand how a pilot intervention combining SMS reminders with real-time adherence monitoring improved adherence to HIV antiretroviral therapy (ART) for adults initiating treatment in rural Uganda.

Design: Qualitative study, conducted with a pilot randomized controlled trial.

Methods: Sixty-two pilot intervention study participants took part in qualitative interviews on: preferences for content; frequency and timing of SMS adherence reminders; understandings and experiences of SMS reminders; and understandings and experiences of real-time adherence monitoring. Analysis of interview data was inductive and derived categories describing how participants experienced the intervention, and what it meant to them.

Results: SMS reminders prompted taking individual …

Short Message Service (Sms) Reminders And Real-Time Adherence Monitoring Improve Antiretroviral Therapy Adherence In Rural Uganda, Jessica E. Haberer, Angella Musimenta, Esther Atukunda, Nicholas Musinguzi, Monique A. Wyatt, Norma C. Ware, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To explore the effects of four types of short message service (SMS) plus realtime adherence monitoring on antiretroviral therapy (ART) adherence: daily reminders, weekly reminders, reminders triggered after a late or missed dose (delivered to patients), and notifications triggered by sustained adherence lapses (delivered to patient-nominated social supporters).

Design: Pilot randomized controlled trial.

Methods: Sixty-three individuals initiating ART received a real-time adherence monitor and were randomized (1 : 1 : 1): (1) Scheduled SMS reminders (daily for 1 month, weekly for 2 months), then SMS reminders triggered by a late or missed dose (no monitoring signal within 2 h …

"I Always Worry About What Might Happen Ahead" : Implementing Safer Conception Services In The Current Environment Of Reproductive Counseling For Hiv-Affected Men And Women In Uganda, Lynn T. Matthews, Francis Bajunirwe, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, Courtney Ng, Rachel Rifkin, Cecilia Milford, Lizzie Moore, Ira B. Wilson, David Bangsberg, Jennifer A. Smit, Angela Kaida

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background. We explored healthcare provider perspectives and practices regarding safer conception counseling for HIV-affected clients. Methods.We conducted semistructured interviews with 38 providers (medical and clinical officers, nurses, peer counselors, and village health workers) delivering care to HIV-infected clients across 5 healthcare centres in Mbarara District, Uganda. Interview transcripts were analyzed using content analysis. Results. Of 38 providers, 76% were women with median age 34 years (range 24–57). First, we discuss providers’ reproductive counseling practices. Emergent themes include that providers (1) assess reproductive goals of HIV-infected female clients frequently, but infrequently for male clients; (2) offer counseling focused on “family planning” …

Reasons For Missing Antiretroviral Therapy: Results From A Multi-Country Study In Tanzania, Uganda, And Zambia, Olivier Koole, Julie A. Denison, Joris Menten, Sharon Tsui, Fred Wabwire-Mangen, Gideon Kwesigabo, Modest Mulenga, Andrew F. Auld, Simon G. Agolory, Ya Diul Mukadi, Eric Van Praag, Kwasi Torpey, Seymour Williams, Jonathan Kaplan, Aaron Zee, David Bangsberg, Robert Colebunders

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objectives To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence.

Methods Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients’ medical, pharmacy, and laboratory records. Incomplete adherence was defined as …

Time Preferences Predict Mortality Among Hiv-Infected Adults Receiving Antiretroviral Therapy In Kenya, Harsha Thirumurthy, Kami Hayashi, Sebastian Linnemayr, Rachel C. Vreeman, Irwin P. Levin, David Bangsberg, Noel T. Brewer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Identifying characteristics of HIV-infected adults likely to have poor treatment outcomes can be useful for targeting interventions efficiently. Research in economics and psychology suggests that individuals’ intertemporal time preferences, which indicate the extent to which they trade-off immediate vs. future cost and benefits, can influence various health behaviors. While there is empirical support for the association between time preferences and various non-HIV health behaviors and outcomes, the extent to which time preferences predict outcomes of those receiving antiretroviral therapy (ART) has not been examined previously.

HIV-infected adults initiating ART were enrolled at a health facility in Kenya. Participants’ time preferences …

The Kynurenine Pathway Of Tryptophan Catabolism And Aids-Associated Kaposi's Sarcoma In Africa, Helen Byakwaga, Peter W. Hunt, Miriam Laker-Oketta, David V. Glidden, Yong Huang, Bosco M. Bwana, Rain Mocello, John Bennett, Victoria Walusansa, Sheila C. Dollard, David R. Bangsberg, Edward K. Mbidde, Jeffrey N. Martin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—Other than Kaposi's sarcoma (KS)-associated herpesvirus and CD4+ T cell lymphopenia, the mechanisms responsible for KS in the context of HIV are poorly understood. One recently explored pathway of HIV pathogenesis involves induction of the enzyme indoleamine 2,3 dioxygenase-1 (IDO), which catabolizes tryptophan into kynurenine and several other immunologically active metabolites that suppress T cell proliferation. We investigated the role of IDO in the development of KS in HIV disease.

Methods—In a case-control study among untreated HIV-infected Ugandans, cases were adults with KS and controls were without KS. IDO activity was assessed by the ratio of plasma kynurenine to tryptophan …

A Combination Sms And Transportation Reimbursement Intervention To Improve Hiv Care Following Abnormal Cd4 Test Results In Rural Uganda: A Prospective Observational Cohort Study, Mark J. Siedner, Data Santorino, Alexander J. Lankowski, Michael Kanyesigye, Mwebesa B. Bwana, Jessica E. Haberer, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Up to 50 % of HIV-infected persons in sub-Saharan Africa are lost from care between HIV diagnosis and antiretroviral therapy (ART) initiation. Structural barriers, including cost of transportation to clinic and poor communication systems, are major contributors.

Methods: We conducted a prospective, pragmatic, before-and-after clinical trial to evaluate a combination mobile health and transportation reimbursement intervention to improve care at a publicly operated HIV clinic in Uganda. Patients undergoing CD4 count testing were enrolled, and clinicians selected a result threshold that would prompt early return for ART initiation or further care. Participants enrolled in the pre-intervention period (January – …

Sexual Relationships Outside Primary Partnerships And Abstinence Are Associated With Lower Adherence And Adherence Gaps: Data From The Partners Prep Ancillary Adherence Study, Alexander Kintu, Susan E. Hankinson, Raji Balasubramanian, Karen Ertel, Elioda Tumwesigye, David Bangsberg, Jessica E. Haberer

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—To assess the role of sexual relationships on levels and patterns of adherence to medication for pre-exposure prophylaxis (PrEP) against HIV.

Methods—We enrolled 1,147 HIV-negative individuals in long-term serodiscordant relationships at three sites in Uganda from the Partners PrEP Study- a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir. We used generalized estimation equations to assess the effects of sexual relationships on low adherence (

Results—Fifty-three percent were male, 51% were 18-34 years and 24% were polygamous. Participants who reported sex in the past month with someone other than their primary partner and with

Conclusions—Risk of low overall adherence …

Super Learner Analysis Of Electronic Adherence Data Improves Viral Prediction And May Provide Strategies For Selective Hiv Rna Monitoring, Maya L. Petersen, Erin Ledell, Joshua Schwab, Varada Sarovar, Robert Gross, Nancy Reynolds, Jessica E. Haberer, Kathy Goggin, Carol E. Golin, Julia Arnsten, Marc Rosen, Robert H. Remien, David Etoori, Ira B. Wilson, Jane M. Simoni, Judith A. Erlen, Mark J. Van Der Laan, Honghu Liu, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective—Regular HIV RNA testing for all HIV positive patients on antiretroviral therapy (ART) is expensive and has low yield since most tests are undetectable. Selective testing of those at higher risk of failure may improve efficiency. We investigated whether a novel analysis of adherence data could correctly classify virological failure and potentially inform a selective testing strategy.

Design—Multisite prospective cohort consortium.

Methods—We evaluated longitudinal data on 1478 adult patients treated with ART and monitored using the Medication Event Monitoring System (MEMS) in 16 United States cohorts contributing to the MACH14 consortium. Since the relationship between adherence and virological failure is …

Assessing Usual Care In Clinical Trials, Judith A. Erlen, Lisa K. Tamres, Nancy Reynolds, Carol E. Golin, Marc I. Rosen, Robert H. Remien, Julie W. Banderas, Neil Schneiderman, Glenn Wagner, David Bangsberg, Honghu Liu

OHSU-PSU School of Public Health Faculty Publications and Presentations

Researchers designing clinical trials often specify usual care received by participants as the control condition expecting that all participants receive usual care regardless of group assignment. The assumption is that the groups in the study are affected similarly. We describe the assessment of usual care within the 16 studies in MACH 14, a multi-site collaboration on adherence to antiretroviral therapy. Only five of the studies in MACH 14 assessed usual care. Assessment protocols varied as did the timing and frequency of assessments. All usual care assessments addressed patient education focused on HIV, HIV medications, and medication adherence. Our findings support …