51 results on '"Nijhawan, Ank E."'
Search Results
2. A Multicomponent Intervention to Reduce Readmissions Among People With HIV.
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Nijhawan, Ank E., Zhang, Song, Chansard, Matthieu, Gao, Ang, Jain, Mamta K., and Halm, Ethan A.
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Background: Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH. Methods: Demographic, socioeconomic, and clinical variables were collected from the electronic health records of PWH or those with cellulitis (control group) hospitalized at an urban safety-net hospital before and after (from September 2012 to December 2016) the implementation of a multidisciplinary HIV transitional care team. After October 2014, hospitalized PWH could receive a medical HIV consultation ± a transitional care nurse intervention. The primary outcome was readmission to any hospital within 30 days of discharge. Multivariate logistic regression and propensity score analyses were conducted to compare readmissions before and after intervention implementation in PWH and people with cellulitis. Results: Overall, among PWH, 329 of the 2049 (16.1%) readmissions occurred before and 329 of the 2023 (16.3%) occurred after the transitional care team intervention. After including clinical and social predictors, the adjusted odds ratio of 30-day readmissions for postintervention for PWH was 0.81 (95% confidence interval: 0.66 to 0.99, P = 0.04), whereas little reduction was identified for those with cellulitis (adjusted odds ratio 0.91 (95% confidence interval: 0.81 to 1.02, P = 0.10). A dose–response effect was not observed for receipt of different HIV intervention components. Conclusions: A multicomponent intervention reduced the adjusted risk of 30-day readmissions in PWH, although no dose–response effect was detected. Additional efforts are needed to reduce overall hospitalizations and readmissions among PWH including increasing HIV prevention, early diagnosis and engagement in care, and expanding the availability and spectrum of transitional care services. [ABSTRACT FROM AUTHOR] more...
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- 2022
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Catalog
3. Study protocol of a randomized controlled trial comparing two linkage models for HIV prevention and treatment in justice-involved persons.
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Springer, Sandra A., Nijhawan, Ank E., Knight, Kevin, Kuo, Irene, Di Paola, Angela, Schlossberg, Esther, Frank, Cynthia A., Sanchez, Mark, Pankow, Jennifer, Proffitt, Randi P., Lehman, Wayne, Pulitzer, Zoe, Thompson, Kelly, Violette, Sandra, Harding, Kathleen K., ACTION Cooperative Group, Brooks, Ralph, Heimer, Robert, Schultheis, Alysse, and Van der Wyk, Brent more...
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PRE-exposure prophylaxis , *HIV prevention , *RANDOMIZED controlled trials , *OPIOID abuse , *SEXUALLY transmitted diseases , *HIV seroconversion , *DRUG overdose , *HIV infection epidemiology , *HEPATITIS C prevention , *HIV infections , *SUBSTANCE abuse , *CLINICAL trials , *HEPATITIS C , *ANTIRETROVIRAL agents , *PREVENTIVE health services , *RESEARCH funding , *OPIOID analgesics , *AIDS , *DISEASE complications - Abstract
Background: Persons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system.Methods: This is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities.Discussion: Results from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community.Trial Registration: Clincialtrials.gov NCT05286879 March 18, 2022. [ABSTRACT FROM AUTHOR] more...- Published
- 2022
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4. Hospitalization Rates Among Persons With HIV Who Gained Medicaid or Private Insurance After the Affordable Care Act in 2014.
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Chow, Jeremy Y., Nijhawan, Ank E., Mathews, W. Christopher, Raifman, Julia, Fleming, Julia, Gebo, Kelly A., Moore, Richard D., and Berry, Stephen A.
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Background: It is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014. Methods: Hospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate. Results: Among PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55-64, CD4, 200 cells/mL, viral load .400 copies/mL, and 2013 hospitalization rate. Conclusions: Acquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization. [ABSTRACT FROM AUTHOR] more...
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- 2021
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5. Clinical and Sociobehavioral Prediction Model of 30-Day Hospital Readmissions Among People With HIV and Substance Use Disorder: Beyond Electronic Health Record Data.
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Nijhawan, Ank E., Metsch, Lisa R., Zhang, Song, Feaster, Daniel J., Gooden, Lauren, Jain, Mamta K., Walker, Robrina, Huffaker, Shannon, Mugavero, Michael J., Jacobs, Petra, Armstrong, Wendy S., Daar, Eric S., Sullivan, Meg, del Rio, Carlos, and Halm, Ethan A. more...
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Supplemental Digital Content is Available in the Text. Background: Under the Affordable Care Act, hospitals receive reduced reimbursements for excessive 30-day readmissions. However, the Centers for Medicare and Medicaid Services does not consider social and behavioral variables in expected readmission rate calculations, which may unfairly penalize systems caring for socially disadvantaged patients, including patients with HIV. Setting: Randomized controlled trial of patient navigation with or without financial incentives in HIV-positive substance users recruited from the inpatient setting at 11 US hospitals. Methods: External validation of an existing 30-day readmission prediction model, using variables available in the electronic health record (EHR-only model), in a new multicenter cohort of HIV-positive substance users was assessed by C-statistic and Hosmer–Lemeshow testing. A second model evaluated sociobehavioral factors in improving the prediction model (EHR-plus model) using multivariable regression and C-statistic with cross-validation. Results: The mean age of the cohort was 44.1 years, and participants were predominantly males (67.4%), non-white (88.0%), and poor (62.8%, <$20,000/year). Overall, 17.5% individuals had a hospital readmission within 30 days of initial hospital discharge. The EHR-only model resulted in a C-statistic of 0.65 (95% confidence interval: 0.60 to 0.70). Inclusion of additional sociobehavioral variables, food insecurity and readiness for substance use treatment, in the EHR-plus model resulted in a C-statistic of 0.74 (0.71 after cross-validation, 95% confidence interval: 0.64 to 0.77). Conclusions: Incorporation of detailed social and behavioral variables substantially improved the performance of a 30-day readmission prediction model for hospitalized HIV-positive substance users. Our findings highlight the importance of social determinants in readmission risk and the need to ask about, adjust for, and address them. [ABSTRACT FROM AUTHOR] more...
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- 2019
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6. Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care.
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Nijhawan, Ank E., Liang, Yuanyuan, Vysyaraju, Kranthi, Muñoz, Jana, Ketchum, Norma, Saber, Julie, Buchberg, Meredith, Venegas, Yvonne, Bullock, Delia, Jain, Mamta K., Villarreal, Roberto, and Taylor, Barbara S. more...
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CONFIDENCE intervals , *HEALTH services accessibility , *HEALTH status indicators , *HIV infections , *MEDICAL appointments , *PATIENT compliance , *PATIENT dropouts , *ODDS ratio - Abstract
HIV disproportionately affects racial/ethnic minorities and individuals living in the southern United States, and missed clinic visits account for much of this disparity. We sought to evaluate: (1) predictors of missed initial HIV medical visits, (2) time to initial visit, and (3) the association between initial visit attendance and retention in HIV care. Chart reviews were conducted for 200 consecutive HIV-infected patients (100 in Dallas, 100 in San Antonio) completing case management (CM) intake. Of these, 52 (26%) missed their initial visit, with 22 (11%) never presenting for care. Mean age was 40 years, 85% were men, >70% were of minority race/ethnicity, and 28% had a new HIV diagnosis. Unemployment (OR [95% CI] = 2.33 [1.04-5.24], p = 0.04) and lower attendance of CM visits (OR = 3.08 [1.43-6.66], p = 0.004) were associated with missing the initial medical visit. A shorter time to visit completion was associated with CD4 ≤ 200 (HR 1.90 [1.25-2.88], p = 0.003), Dallas study site (HR = 1.48 [1.03-2.14], p = 0.04), and recent hospitalization (HR = 2.18 [1.38-3.43], p < 0.001). Patients who did not complete their initial medical visit within 90 days of intake were unlikely to engage in care. Initial medical visit attendance was associated with higher proportion of visits attended ( p = 0.04) and fewer gaps in care ( p = 0.01). Missed medical visits were common among HIV patients initiating or reinitiating care in Texas. Employment and CM involvement predicted initial medical visit attendance, which was associated with retention in care. New, early engagement strategies are needed to decrease missed visits and reduce HIV health disparities. [ABSTRACT FROM AUTHOR] more...
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- 2017
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7. Cost analysis of tuberculin skin test and the QuantiFERON-TB Gold In-tube test for tuberculosis screening in a correctional setting in Dallas, Texas, USA.
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Nijhawan, Ank E., Iroh, Princess A., Brown, Larry S., Winetsky, Daniel, and Porsa, Esmaeil
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HIV infections , *HIV , *HIV-positive persons , *TUBERCULOSIS , *MYCOBACTERIUM tuberculosis - Abstract
Background: Tuberculosis (TB) disproportionately affects immigrants, HIV-infected individuals, and those living in crowded settings such as homeless shelters and correctional facilities. Although the majority of jails and prisons use a tuberculin skin test (TST) for latent tuberculosis infection (LTBI) screening, limited data exist on the clinical performance and costs of the TST compared to interferon gamma release assays (IGRAs) in this setting. Methods: A prospective pilot study comparing cost between TST and an IGRA (QuantiFERON Gold In-tube, QFT-GIT) for the detection of LTBI in a convenience sample of inmates entering the Dallas County Jail (DCJ) was conducted June-October 2014. Participants completed a risk questionnaire, TST placement, QFT-GIT testing, and were offered opt-out HIV-Ab testing. LTBI prevalence based on TST and QFT-GIT results, an evaluation of discordant results and a cost analysis are presented. Results: A total of 529 subjects were enrolled. The majority were male (75 %), and 46 % were Black, 29 % White, and 24 % Hispanic. Most (85 %) had been previously incarcerated. Over 28 % of participants were released prior to TST reading, with paired QFT-GIT and TST results available for 351 subjects. Of these, nine (2.6 %) tested positive by TST and 47 (13.4 %) tested positive by QFT-GIT. It costs $23.27 more per inmate per year to screen with QFT-GIT than TST in this population, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT ($1247 v $460). Conclusions: We found a substantially higher rate of QFT-GIT positivity compared to TST in this sample of individuals entering the Dallas County Jail. Although no gold standard exists, this finding may indicate under-recognized LTBI in this setting. QFT-GIT as an initial screening tool was more time-efficient, had four-fold fewer labor costs and provided results on more individuals when compared with the TST. The overall cost of QFT-GIT was $23.27 more per inmate per year, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT. Further research is needed to determine the long-term performance of IGRA testing in the correctional setting and the public health implications of pairing QFT-GIT screening with other tests for communicable diseases. [ABSTRACT FROM AUTHOR] more...
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- 2016
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8. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable.
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Nijhawan, Ank E., Kitchell, Ellen, Etherton, Sarah Shelby, Duarte, Piper, Halm, Ethan A., and Jain, Mamta K.
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DRUGS , *EMERGENCY medical services , *HEALTH care teams , *HIV-positive persons , *MULTIVARIATE analysis , *PATIENT compliance , *PREVENTIVE health services , *RESEARCH funding , *STATISTICS , *RETROSPECTIVE studies , *PATIENT readmissions , *DATA analysis software , *DESCRIPTIVE statistics , *ODDS ratio - Abstract
Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4-14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population. [ABSTRACT FROM AUTHOR] more...
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- 2015
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9. Does Anything Work? Improving HIV Care Engagement for Individuals Transitioning out of Correctional Settings.
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Pluznik, Jacob A., Nijhawan, Ank E., and Spaulding, Anne C.
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- 2021
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10. An Electronic Medical Record-Based Model to Predict 30-Day Risk of Readmission and Death Among HIV-Infected Inpatients.
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Nijhawan, Ank E., Clark, Christopher, Kaplan, Richard, Moore, Billy, Halm, Ethan A., and Amarasingham, Ruben
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Readmission after hospitalization is costly, time-consuming, and remains common among HIV-infected individuals. We sought to use data from the Electronic Medical Record (EMR) to create a clinical, robust, multivariable model for predicting readmission risk in hospitalized HIV-infected patients.We extracted clinical and nonclinical data from the EMR of HIV-infected patients admitted to a large urban hospital between March 2006 and November 2008. These data were used to build automated predictive models for 30-day risk of readmission and death.We identified 2476 index admissions among HIV-infected inpatients who were 73% males, 57% African American, with a mean age of 43 years. One-quarter were readmitted, and 3% died within 30 days of discharge. Those with a primary diagnosis during the index admission of HIV/AIDS accounted for the largest proportion of readmissions (41%), followed by those initially admitted for other infections (10%) or for oncologic (6%), pulmonary (5%), gastrointestinal (4%), and renal (3%) causes. Factors associated with readmission risk include: AIDS defining illness, CD4 92, laboratory abnormalities, insurance status, homelessness, distance from the hospital, and prior emergency department visits and hospitalizations (c = 0.72; 95% confidence interval: 0.70 to 0.75). The multivariable predictors of death were CD4 < 132, abnormal liver function tests, creatinine >1.66, and hematocrit <30.8 (c = 0.79; 95% confidence interval: 0.74 to 0.84) for death.Readmission rates among HIV-infected patients were high. An automated model composed of factors accessible from the EMR in the first 48 hours of admission performed well in predicting the 30-day risk of readmission among HIV patients. Such a model could be used in real-time to identify HIV patients at highest risk so readmission prevention resources could be targeted most efficiently. [ABSTRACT FROM AUTHOR] more...
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- 2012
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11. The Association Between Trichomonas Infection and Incarceration in HIV-Seropositive and At-Risk HIV-Seronegative Women.
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Nijhawan, Ank E., DeLong, Alison K., Celentano, David D., Klein, Robert S., Sobel, Jack D., Jamieson, Denise J., and Cu-Uvin, Susan
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HIV , *HIV infections , *DISEASE prevalence , *HIV-positive persons , *CANDIDIASIS , *TRICHOMONAS vaginalis - Abstract
The article presents a study which determines whether the prevalence of Trichomonas vaginalis in incarcerated women has a relationship with HIV-seropositive and HIV-seronegative. The study uses a cohort study of 871 HIV-positive and 439 HIV-seronegative women in urban centers with interviews and physical examinations. Results show that the connection with incarceration is higher after adjusting for marital status, bacterial vaginosis, vaginal candidiasis, and health insurance. more...
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- 2011
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12. Preventive Healthcare for Underserved Women: Results of a Prison Survey.
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Nijhawan, Ank E., Salloway, Rachel, Nunn, Amy S., Poshkus, Michael, and Clarke, Jennifer G.
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PREVENTIVE health services , *WOMEN prisoners' health , *WOMEN'S health , *CERVICAL cancer , *BREAST cancer , *CANCER in women , *CANCER patients , *HEPATITIS C - Abstract
Objectives: We sought to determine the preventive healthcare needs of incarcerated women in the following areas: cervical cancer and breast cancer screening, sexually transmitted infection (STI) screening, hepatitis screening and vaccination, and smoking cessation. Methods: A cross-sectional interview survey of a random sample of 100 incarcerated women at the Rhode Island Department of Corrections (RIDOC) in Cranston, Rhode Island, was conducted. Results: Participants were 62% white, 11% African American, 13% Hispanic, and 14% of mixed race. Mean age was 35 years. Of those surveyed, 67% reported having had a Papanicolou (Pap) smear in the past year, the strongest predictor of which was having received a Pap smear while incarcerated. Of the inmates >40 years old, 58% reported having had a mammogram in the past 2 years. The majority (88%) reported testing for STIs in the past, and 39% desired testing during their current incarceration. As for hepatitis C, 70% had been tested previously and 37% of those reported testing positive. Hispanics were less likely than whites to have been tested for hepatitis C (OR 0.1). Over half (54%) of the women who reported testing positive for hepatitis C also reported having completed the hepatitis A and B vaccine series. Among smokers (80% of all survey participants), 61% were interested in quitting. Those who had been incarcerated multiple times were less likely to want to quit smoking (OR 0.1). Conclusions: Incarceration presents a unique opportunity to provide preventive healthcare to high-risk, medically underserved women. [ABSTRACT FROM AUTHOR] more...
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- 2010
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13. Using Machine Learning to Identify Patients at Risk of Acquiring HIV in an Urban Health System.
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Kumar Nethi, Arun, Karam, Albert George, Alvarez, Kristin S., Luque, Amneris Esther, Nijhawan, Ank E., Adhikari, Emily, and King, Helen Lynne
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Background: Effective measures exist to prevent the spread of HIV. However, the identification of patients who are candidates for these measures can be a challenge. A machine learning model to predict risk for HIV may enhance patient selection for proactive outreach. Setting: Using data from the electronic health record at Parkland Health, 1 of the largest public healthcare systems in the country, a machine learning model is created to predict incident HIV cases. The study cohort includes any patient aged 16 or older from 2015 to 2019 (n = 458,893). Methods: Implementing a 70:30 ratio random split of the data into training and validation sets with an incident rate <0.08% and stratified by incidence of HIV, the model is evaluated using a k-fold cross-validated (k = 5) area under the receiver operating characteristic curve leveraging Light Gradient Boosting Machine Algorithm, an ensemble classifier. Results: The light gradient boosting machine produces the strongest predictive power to identify good candidates for HIV PrEP. A gradient boosting classifier produced the best result with an AUC of 0.88 (95% confidence interval: 0.86 to 0.89) on the training set and 0.85 (95% confidence interval: 0.81 to 0.89) on the validation set for a sensitivity of 77.8% and specificity of 75.1%. Conclusions: A gradient boosting model using electronic health record data can be used to identify patients at risk of acquiring HIV and implemented in the clinical setting to build outreach for preventative interventions. [ABSTRACT FROM AUTHOR] more...
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- 2024
14. Long-Acting Injectable Antiretrovirals in Incarcerated Populations - Challenges and Opportunities.
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Akiyama, Matthew J., Spaulding, Anne C., and Nijhawan, Ank E.
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ANTI-HIV agents , *HIV infections , *PRISONERS , *ANTIRETROVIRAL agents , *CONTROLLED release preparations - Abstract
The article presents the discussion on long-acting antiretrovirals in carceral settings helping in ending the U.S. HIV epidemic. Topics include reduced by achieving and maintaining viral-load suppression in people with HIV and supporting HIV prevention; and rates of substance use and serious mental illness, competing social needs, stigma, and medical mistrust. more...
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- 2022
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15. Outcomes in Kaposi's sarcoma‐associated herpesvirus ‐associated primary effusion lymphoma and multicentric Castleman's disease in patients with human immunodeficiency virus (HIV) in a safety‐net hospital system.
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Lopez, Melanie, Kainthla, Radhika, Lazarte, Susana, Chen, Weina, Nijhawan, Ank E., and Knights, Sheena
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KAPOSI'S sarcoma-associated herpesvirus , *CASTLEMAN'S disease , *HIV , *HOSPITALS , *EXUDATES & transudates - Abstract
Objective: To describe cases of Kaposi's sarcoma‐associated herpesvirus (KSHV)‐associated multicentric Castleman's disease (MCD) and primary effusion lymphoma (PEL) in patients with HIV from a large, safety‐net hospital system in Dallas, Texas, USA. Methods: We conducted a retrospective review of patients with HIV‐associated PEL and/or MCD. Results: Twelve patients with PEL and 10 patients with MCD were identified. All patients were male and 17 of 20 were men who have sex with men; 66.7% of PEL patients and 50% of MCD patients had concurrent KS at the time of diagnosis; 42% of patients with PEL and 20% of patients with MCD died during the follow‐up period. We noted improved survival in our cohort compared to previous studies, particularly in our PEL patients with a median survival of 11.4 months compared to 3–6‐month median survival historically. Median follow‐up time for MCD patients was 17.5 months. This improved survival is despite suboptimal antiretroviral therapy (ART) adherence at diagnosis, with only 50% of patients on ART at the time of MCD/PEL diagnosis. Conclusion: These data highlight the importance of early recognition of PEL and MCD, and the larger‐scale efforts needed to better understand the pathogenetic drivers of clinical outcomes in patients affected by KSHV‐related diseases. [ABSTRACT FROM AUTHOR] more...
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- 2024
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16. A Call for Youth Voice to Support Engagement in Care for 18- to 29-Year Olds Living with HIV in the US South.
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Johnson, Catherine, Chidester, Autumn, Chandramohan, Divya, Lin, Hueylie, Ho, Nhat Minh, Taranova, Anna, Nijhawan, Ank E., Kools, Susan, Ingersoll, Karen, Dillingham, Rebecca, and Taylor, Barbara S.
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ADOLESCENT development , *HEALTH services administration , *FEAR , *LIFESTYLES , *FOCUS groups , *SELF-efficacy , *STEREOTYPES , *QUALITATIVE research , *RESEARCH funding , *HIV-positive persons , *PLANNED behavior theory , *INTERVIEWING , *HEALTH insurance , *HIV infections , *DESCRIPTIVE statistics , *THEMATIC analysis , *TRANSPORTATION , *RESEARCH methodology , *DRUG abuse , *SOCIAL support , *GRIEF - Abstract
Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH. [ABSTRACT FROM AUTHOR] more...
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- 2024
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17. HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail.
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Jui Desai, Krakower, Douglas, Harris, Barry-Lewis, Culp, Sophia, and Nijhawan, Ank E.
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Background: Incarcerated women experience high rates of HIVand sexually transmitted infections (STIs); few are offered HIV preexposure prophylaxis (PrEP).We aimed to examine HIV/STI screening rates in this population and identify PrEP eligibility. Methods: Results of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/syphilis screening in cisgender women in the Dallas County Jail were compiled from January to October 2020. An electronic health record review was conducted for a subgroup in March 2020 to identify PrEP eligibility. Results: Overall, 4398 of 13,292 women were screened for CT and 4389 of 13,292 for GC, and among them, 479 (11%) screened for HIVand 562 (13%) for syphilis. Furthermore, 462 of 4398 (11%) were positive for CT, 323 of 4389 (7%) were positive for GC, 10 of 479 (2%) had positive HIV test results, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma reagin test. In March 2020, of 541 women screened, 90 tested positive for CTor GC. Of these 90, 70 (78%) did not receive HIVor syphilis screening, including women with these risk factors: 10 (14%) were homeless, 11 (16%) reported heroin use, and 10 (14%) reported methamphetamine use. Based on the presence of an acute bacterial STI, 17% (96 of 541) were PrEP eligible. Conclusions: Incarcerated women had high STI rates and other risk factors for HIVacquisition, although only 1 in 5 with acute STIs (11%overall) was also screened for HIV or syphilis. HIV prevention efforts should include comprehensive STI/HIV screening, linkage to treatment, and identification of PrEP candidates. [ABSTRACT FROM AUTHOR] more...
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- 2023
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18. The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis.
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Iroh, Princess A., Mayo, Helen, and Nijhawan, Ank E.
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HIV prevention , *THERAPEUTICS , *HIV infections , *CORRECTIONAL institutions , *DATABASES , *INFORMATION storage & retrieval systems , *MEDICAL databases , *MEDLINE , *TIME , *SYSTEMATIC reviews - Abstract
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity. [ABSTRACT FROM AUTHOR] more...
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- 2018
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19. Opt-out HIV and Hepatitis C Testing at the Dallas County Jail: Uptake, Prevalence, and Demographic Characteristics of Testers.
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de la Flor, Carolina, Porsa, Esmaeil, and Nijhawan, Ank E.
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HEPATITIS C diagnosis , *DIAGNOSIS of HIV infections , *BABY boom generation , *CORRECTIONAL institutions , *PRISONERS , *PHLEBOTOMY , *RACE , *VIRAL antibodies , *DISEASE prevalence - Abstract
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection are common in the criminal justice system. We offered opt-out HIV/HCV testing at the Dallas County Jail during intake from June 2015 to November 2016, after which testing was integrated into routine phlebotomy processes. The uptake of testing increased from 12.9% (118/915) in June 2015 to 80.5% (269/334) in January 2016. HIV was confirmed in 1.0% (30/3155) of inmates; 6 were new diagnoses and all were linked to care. HCV antibody positivity was found in 16.4% (500/4042) of inmates. Sixty percent (155/258) of HCV-positive inmates born between 1945 and 1965 (ie, baby boomers) were non-Hispanic black, whereas 56.2% (136/242) born after 1965 were non-Hispanic white. Testing only baby boomers would have missed approximately half of HCV infections, predominantly among young, non-Hispanic white people. Future efforts should expand HIV and HCV testing in jails, as it is feasible, acceptable, and increases prevention and engagement in care for a high-prevalence, hard-to-reach population. [ABSTRACT FROM AUTHOR] more...
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- 2017
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20. Hepatitis C Epidemiology in a Large Urban Jail: A Changing Demographic.
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Hoff, Emily, Warden, Andrea, Taylor, Ruby, and Nijhawan, Ank E.
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HEPATITIS C prevention , *STATISTICS , *CORRECTIONAL institutions , *MULTIVARIATE analysis , *HEPATITIS C , *MEDICAL screening , *RACE , *RESEARCH funding , *METROPOLITAN areas , *ELECTRONIC health records , *SOCIODEMOGRAPHIC factors - Abstract
Objectives: Nearly 1 in 3 people with hepatitis C virus (HCV) infection pass through the criminal justice system annually; the system is a crucial location for HCV screening, education, and linkage to care. We aimed to (1) determine the prevalence and incidence of HCV antibody positivity and (2) evaluate the demographic characteristics of people with HCV in a large urban jail. Methods: We offered universal opt-out HCV testing to any person undergoing a routine blood test at the Dallas County Jail from June 2015 through December 2019 (N = 14 490). We extracted data on demographic characteristics from the electronic medical record and collected data on risk factors from people with HCV antibody positivity. We performed univariate and multivariate analyses. Results: The prevalence of HCV antibody positivity was 16.7%; the incidence was 13.5 cases per 1000 person-years. HCV antibody positivity was significantly associated with older age (P <.001), female sex (P =.004), non-Hispanic White race versus non-Hispanic Black race (P <.001), and being released to prison versus not (P <.001). Among people born after 1965, those who were HCV antibody–positive were more frequently non-Hispanic White and Hispanic women, whereas among those born in 1965 or before, those who were HCV antibody–positive were more frequently non-Hispanic Black men. Conclusions: The high prevalence and incidence of HCV antibody positivity in a large county jail argue for routine, universal HCV testing and prevention counseling in criminal justice settings. Changing demographic characteristics mirror those of the national injection drug use epidemic and shed insight into designing interventions for risk reduction, education, linkage to care, and treatment. [ABSTRACT FROM AUTHOR] more...
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- 2023
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21. The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis.
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Iroh, Princess A., Mayo, Helen, and Nijhawan, Ank E.
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- 2015
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22. Toward Ending the HIV Epidemic: Temporal Trends and Disparities in Early ART Initiation and Early Viral Suppression Among People Newly Entering HIV Care in the United States, 2012–2018.
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Li, Jun, Humes, Elizabeth, Lee, Jennifer S, Althoff, Keri N, Colasanti, Jonathan A, Bosch, Ronald J, Horberg, Michael, Rebeiro, Peter F, Silverberg, Michael J, Nijhawan, Ank E, Parcesepe, Angela, Gill, John, Shah, Sarita, Crane, Heidi, Moore, Richard, Lang, Raynell, Thorne, Jennifer, Sterling, Timothy, Hanna, David B, and Buchacz, Kate more...
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DRUG abuse , *HIV , *NEEDLE exchange programs , *SOCIAL determinants of health , *EPIDEMICS , *CD4 lymphocyte count - Abstract
Background In 2012, the US Department of Health and Human Services updated their HIV treatment guidelines to recommend antiretroviral therapy (ART) for all people with HIV (PWH) regardless of CD4 count. We investigated recent trends and disparities in early receipt of ART prescription and subsequent viral suppression (VS). Methods We examined data from ART-naïve PWH newly presenting to HIV care at 13 North American AIDS Cohort Collaboration on Research and Design clinical cohorts in the United States during 2012–2018. We calculated the cumulative incidence of early ART (within 30 days of entry into care) and early VS (within 6 months of ART initiation) using the Kaplan-Meier survival function. Discrete time-to-event models were fit to estimate unadjusted and adjusted associations of early ART and VS with sociodemographic and clinical factors. Results Among 11 853 eligible ART-naïve PWH, the cumulative incidence of early ART increased from 42% in 2012 to 82% in 2018. The cumulative incidence of early VS among the 8613 PWH who initiated ART increased from 83% in 2012 to 93% in 2018. In multivariable models, factors independently associated with delayed ART and VS included non-Hispanic/Latino Black race, residence in the South census region, being a male with injection drug use acquisition risk, and history of substance use disorder (SUD; all P ≤.05). Conclusions Early ART initiation and VS have substantially improved in the United States since the release of universal treatment guidelines. Disparities by factors related to social determinants of health and SUD demand focused attention on and services for some subpopulations. [ABSTRACT FROM AUTHOR] more...
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- 2022
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23. Prevalence and Management of Sexually Transmitted Infections in Correctional Settings: A Systematic Review.
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Spaulding, Anne C, Rabeeah, Zainab, González-Montalvo, Myrna del Mar, Akiyama, Matthew J, Baker, Brenda J, Bauer, Heidi M, Gibson, Brent R, Nijhawan, Ank E, Parvez, Farah, Wangu, Zoon, Chan, Philip A, and Corrections, Rollins Investigational Team on STIs in more...
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DIAGNOSIS of HIV infections , *SEXUALLY transmitted disease treatment , *EPIDEMIOLOGY of sexually transmitted diseases , *IMMIGRANTS , *CORRECTIONAL institutions , *HEALTH services accessibility , *SYSTEMATIC reviews , *TRICHOMONIASIS , *MEDICAL screening , *RACE , *JUVENILE offenders , *DISEASE management - Abstract
Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions—managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)—can counteract structural racism in healthcare. [ABSTRACT FROM AUTHOR] more...
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- 2022
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24. Tetanus: A Rare Complication of Black Tar Heroin Use.
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Pichlinski, Elisa M, Hoff, Emily, Epperson, Lindsey Claire, Morley, Elizabeth, Cao, James Dazhe, Thoppil, Joby, Field, Steven, Mehta, Prayag, Good, Daniel, and Nijhawan, Ank E
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TETANUS , *HEROIN , *TETANUS vaccines , *HEROIN abuse , *HIGH-income countries - Abstract
Tetanus is associated with high morbidity and mortality, although this is rarely encountered in high-income countries. We present a case of tetanus in an unvaccinated patient secondary to black tar heroin use that highlights the importance of considering tetanus in appropriate clinical contexts, harm reduction interventions, and universal tetanus vaccination campaigns. [ABSTRACT FROM AUTHOR] more...
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- 2022
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25. Association of the VACS Index With Hospitalization Among People With HIV in the NA-ACCORD.
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Qian, Yuhang, Moore, Richard D., Coburn, Sally B., Davy-Mendez, Thibaut, Akgün, Kathleen M., McGinnis, Kathleen A., Silverberg, Michael J., Colasanti, Jonathan A., Cachay, Edward R., Horberg, Michael A., Rabkin, Charles S., Jacobson, Jeffrey M., Gill, M. John, Mayor, Angel M., Kirk, Gregory D., Gebo, Kelly A., Nijhawan, Ank E., and Althoff, Keri N. more...
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Supplemental Digital Content is Available in the Text. Background: People with HIV (PWH) have a higher hospitalization rate than the general population. The Veterans Aging Cohort Study (VACS) Index at study entry well predicts hospitalization in PWH, but it is unknown if the time-updated parameter improves hospitalization prediction. We assessed the association of parameterizations of the VACS Index 2.0 with the 5-year risk of hospitalization. Setting: PWH ≥30 years old with at least 12 months of antiretroviral therapy (ART) use and contributing hospitalization data from 2000 to 2016 in North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Three parameterizations of the VACS Index 2.0 were assessed and categorized by quartile: (1) "baseline" measurement at study entry; (2) time-updated measurements; and (3) cumulative scores calculated using the trapezoidal rule. Methods: Discrete-time proportional hazard models estimated the crude and adjusted associations (and 95% confidence intervals [CIs]) of the VACS Index parameterizations and all-cause hospitalizations. The Akaike information criterion (AIC) assessed the model fit with each of the VACS Index parameters. Results: Among 7289 patients, 1537 were hospitalized. Time-updated VACS Index fitted hospitalization best with a more distinct dose–response relationship [score <43: reference; score 43–55: aHR = 1.93 (95% CI: 1.66 to 2.23); score 55–68: aHR = 3.63 (95% CI: 3.12 to 4.23); score ≥68: aHR = 9.98 (95% CI: 8.52 to 11.69)] than study entry and cumulative VACS Index after adjusting for known risk factors. Conclusions: Time-updated VACS Index 2.0 had the strongest association with hospitalization and best fit to the data. Health care providers should consider using it when assessing hospitalization risk among PWH. [ABSTRACT FROM AUTHOR] more...
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- 2022
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26. Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064).
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Metsch, Lisa R, Feaster, Daniel J, Gooden, Lauren K, Masson, Carmen, Perlman, David C, Jain, Mamta K, Matheson, Tim, Nelson, C Mindy, Jacobs, Petra, Tross, Susan, Haynes, Louise, Lucas, Gregory M, Colasanti, Jonathan A, Rodriguez, Allan, Drainoni, Mari-Lynn, Osorio, Georgina, Nijhawan, Ank E, Jacobson, Jeffrey M, Sullivan, Meg, and Metzger, David more...
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SUBSTANCE abuse , *HIV , *HEPATITIS C , *CLINICAL trials , *CONTINUUM of care , *CLINICAL trial registries - Abstract
Background Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment. Methods In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018. Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization. Results Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group. Conclusions The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination. Clinical Trials Registration NCT02641158. [ABSTRACT FROM AUTHOR] more...
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- 2021
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27. Paired Testing of Sexually Transmitted Infections With Urine Pregnancy Tests in Incarcerated Women.
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Dang, Christine M., Pao, Julie, Taherzadeh, Dena, and Nijhawan, Ank E.
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Pairing gonorrhea/chlamydia with urine pregnancy tests in a large urban jail led to a nearly 5-fold increase in completed tests and a corresponding increase in positive test results. Background: In correctional facilities, sexually transmitted infections (STIs) are common, are often asymptomatic, and may lead to adverse outcomes such as infertility and increased HIV acquisition. In January 2020, testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) was paired with routine urine pregnancy tests among women entering a large county jail to increase testing and detection of STIs. Methods: The results of all GC/CT urine tests in the Dallas County Jail were collected from October 2019 to February 2020. Medical records were reviewed to collect demographic factors and to determine the positivity of GC/CT infections, time to results, and time to treatment. Results: With paired testing, monthly testing rates increased 4.7-fold among incarcerated females from 125 to 589 tests without substantial change for males (174 to 163). The number of infections detected in females increased from 25 (7%) of 359 to 62 (5.3%) of 1171 for GC and 42 (11.2%) of 374 to 129 (11%) of 1177 for CT without a significant difference in GC (P = 0.23) or CT positivity (P = 0.66). Younger women (≤25 years) had the highest rates of CT (18.8% [66/350]), whereas GC was highest among women aged 31 to 35 years (9.9% [32/321]). Average time to results and treatment were 5.8 and 1.8 days, respectively. Conclusions: Pairing GC/CT testing with routine urine pregnancy tests resulted in a large (4.7-fold) increase in the number of STI tests and a comparable increase (3.7- to 4.6-fold) in the number of infections detected. Future efforts should focus on incorporating STI testing into routine jail practices and expediting treatment to further improve outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR] more...
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- 2021
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28. Paired Testing of Sexually Transmitted Infections With Urine Pregnancy Tests in Incarcerated Women.
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Dang, Christine M, Pao, Julie, Taherzadeh, Dena, and Nijhawan, Ank E
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Background: In correctional facilities, sexually transmitted infections (STIs) are common, are often asymptomatic, and may lead to adverse outcomes such as infertility and increased HIV acquisition. In January 2020, testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) was paired with routine urine pregnancy tests among women entering a large county jail to increase testing and detection of STIs.Methods: The results of all GC/CT urine tests in the Dallas County Jail were collected from October 2019 to February 2020. Medical records were reviewed to collect demographic factors and to determine the positivity of GC/CT infections, time to results, and time to treatment.Results: With paired testing, monthly testing rates increased 4.7-fold among incarcerated females from 125 to 589 tests without substantial change for males (174 to 163). The number of infections detected in females increased from 25 (7%) of 359 to 62 (5.3%) of 1171 for GC and 42 (11.2%) of 374 to 129 (11%) of 1177 for CT without a significant difference in GC (P = 0.23) or CT positivity (P = 0.66). Younger women (≤25 years) had the highest rates of CT (18.8% [66/350]), whereas GC was highest among women aged 31 to 35 years (9.9% [32/321]). Average time to results and treatment were 5.8 and 1.8 days, respectively.Conclusions: Pairing GC/CT testing with routine urine pregnancy tests resulted in a large (4.7-fold) increase in the number of STI tests and a comparable increase (3.7- to 4.6-fold) in the number of infections detected. Future efforts should focus on incorporating STI testing into routine jail practices and expediting treatment to further improve outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR] more...- Published
- 2021
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29. The risk of depression among racially diverse people living with HIV: the impact of HIV viral suppression.
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Jain, Mamta K., Li, Xilong, Adams-Huet, Beverley, Tiruneh, Yordanos M., Luque, Amneris E., Duarte, Piper, Trombello, Joseph M., and Nijhawan, Ank E.
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MENTAL depression risk factors , *HIV-positive persons , *CROSS-sectional method , *VIRAL load , *MULTIVARIATE analysis , *MULTIPLE regression analysis , *INTRAVENOUS drug abuse , *RETROSPECTIVE studies , *RACE , *RISK assessment , *SEX distribution , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *MEN who have sex with men - Abstract
Understanding the correlates of depression in HIV patients can help identify groups whose members are at increased risk for depression. We conducted a cross-sectional retrospective study among racially diverse, indigent patients living with HIV (PLWH) who were obtaining care in an urban safety-net hospital system and had completed a Patient Health Questionnaire-9 (PHQ-9) in 2014 or 2015. We collected demographics, HIV risk factors, HIV viral loads, CD4 counts, missed visits, and emergency department (ED) visits. Data from the Substance Abuse and Mental Illness Symptoms Screener (SAMISS) were abstracted. Missing data on substance use and CD4 cell counts were imputed to examine the odds of depression (PHQ-9 ≥ 10) by multivariable analysis for a complete case and sensitivity analysis. Stratified analysis by HIV viral suppression (VS) was used to determine the odds of depression among subgroups. Of the 5126 HIV patients (70.8% male,56.3% Black, 44.6% MSM, 6.0% IDU), 1271 (24.8%) experienced depression (PHQ ≥ 10). In a multivariable logistic model female gender, White race, injection drug use (IDU) or men who have sex with men (MSM) as an HIV risk factor, making ≥1 ED visit, having missed any HIV visit, having AIDS, and having a positive drug screen by SAMISS increased the odds for depression. Those who had achieved HIV VS or received efavirenz had lower odds of depression. Even among those with AIDS, those failing to achieve VS were at increased odds for depression, whereas those achieving VS were not. Moderate to severe depression is prevalent among PLWH. Among those with AIDS, HIV VS modifies the odds of depression. [ABSTRACT FROM AUTHOR] more...
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- 2021
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30. Extragenital Testing for Neisseria gonorrhoeae and Chlamydia trachomatis in a Large HIV Clinic in the US South: Implementation and Epidemiology.
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Pottorff, Alexandra, Duarte, Piper, Chow, Jeremy, Luque, Amneris, and Nijhawan, Ank E.
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Background: Rectal and oral Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infections are common among people with HIV, especially men who have sex with men (MSM); however, GC/CT testing rates remain low in many HIV clinics. We evaluated the real-world implementation and results of extragenital nucleic acid amplification testing for GC/CT in an urban HIV clinic.Methods: Electronic health records were reviewed for all patients 18 years or older with ≥1 outpatient visit to an HIV clinic in Dallas, TX, from February 2016 to May 2019. Extragenital nucleic acid amplification testing became available in February 2017, which was followed by active interventions to increase testing.Results: Overall, 5564 individual patients were included in the preintervention period (February 2016-January 2017), 5067 in the intervention period (February 2017-August 2017), and 7030 in the postintervention period (September 2017-May 2018). Tailored education was provided to patients, and nursing and medical providers, and a self-collection protocol was implemented beginning in spring 2017. A sustained increase in extragenital GC/CT testing among MSM patients, from 70% to 87% (P < 0.01), was observed. Among MSM, overall GC positivity increased from 3.2% to 8.5% and CT positivity increased from 3.9% to 8.3%. N. gonorrhoeae/C. trachomatis infections were highest among young (<35 years) MSM, and approximately 50% of GC/CT infections diagnosed were detected by oral and rectal tests.Conclusions: Clinic-wide education and self-collection of extragenital specimens were associated with increased GC/CT testing and detection in a large HIV clinic. [ABSTRACT FROM AUTHOR] more...- Published
- 2021
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31. Hepatitis C Virus Infection in the Dallas County Jail: Implications for Screening, Prevention, and Linkage to Care.
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Abe, Caroline M., Aguwa, Merilyne, Zhao, Michelle, Sullivan, Jacqueline, Porsa, Esmaeil, and Nijhawan, Ank E.
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HEPATITIS C prevention , *HEPATITIS C risk factors , *HEPATITIS C transmission , *HEPATITIS C treatment , *INFECTIOUS disease transmission , *CORRECTIONAL institutions , *HEALTH status indicators , *HEPATITIS C , *HEALTH insurance , *LONGITUDINAL method , *MEDICAL screening , *NURSES' attitudes , *PATIENT education , *RNA , *SELF-evaluation , *TATTOOING , *VIRAL antibodies , *HUMAN services programs , *DISEASE prevalence , *RETROSPECTIVE studies , *PATIENT-centered care , *ELECTRONIC health records - Abstract
Objectives: Screening for hepatitis C virus (HCV) infection in jail provides an opportunity to educate and offer care to a high-risk population. We aimed to (1) estimate the prevalence of HCV infection in jail; (2) describe the demographic characteristics, risk factors, and pre-incarceration health insurance status associated with HCV infection; and (3) examine the implementation of HCV screening in jail. Methods: We conducted a retrospective analysis of an opt-out HCV screening program with HCV RNA confirmation and patient education at the Dallas County Jail from April 1 through November 2, 2017. We extracted data on test results, demographic characteristics, and release destination from electronic medical records. A nurse navigator recorded data on patient self-reported risk factors and pre-incarceration health insurance status. Results: Of 4089 incarcerated persons screened, 708 (17.3%) had a positive HCV antibody result. Of these, 641 (90.5%) had an HCV RNA test ordered; 576 (89.9%) had RNA tests completed, of whom 413 (71.7%) had a positive HCV RNA result. Of these 413, 352 (85.2%) received patient education. Half of HCV RNA-positive incarcerated persons (n = 207, 50.1%) were born outside the birth cohort (1945-1965). Among those with HCV infection, commonly reported risk factors were injection drug use (168 of 352; 47.8%) and tattoos (82 of 352; 23.4%). Most incarcerated persons with HCV infection (284 of 350; 81.1%) did not have health insurance. HCV antibody prevalence was higher among incarcerated persons released to prison (232 of 961; 24.1%) than to outside agencies (38 of 403; 9.4%) or the community (178 of 1026; 17.4%). Conclusions: Screening for HCV with RNA confirmation in jail provides an opportunity for disease education, transmission prevention, and navigation to HCV treatment. Future efforts should examine post-incarceration linkage to care. [ABSTRACT FROM AUTHOR] more...
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- 2019
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32. Sexually Transmitted Infections Detected During and After Incarceration Among People with Human Immunodeficiency Virus: Prevalence and Implications for Screening and Prevention.
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Krieger, Demi, Abe, Caroline, Pottorff, Alexandra, Li, Xilong, Rich, Josiah, and Nijhawan, Ank E.
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Background: Incarceration and human immunodeficiency virus (HIV) are associated with sexually transmitted infections (STIs); however, little is known about STI prevalence among people living with HIV (PLWH) during and after incarceration.Methods: Electronic medical records from the Dallas County Jail and community HIV clinics were reviewed to determine the frequency and results of testing for gonorrhea, chlamydia, syphilis, and hepatitis B virus (HBV) among PLWH incarcerated in Dallas County Jail between 2010 and 2013. HIV viral loads (VL) and evidence of STI symptoms and treatment were also collected.Results: During 2473 incarcerations, 6 (3%) of 190 tests were positive for gonorrhea, 7 (4%) of 190 for chlamydia, 231 (21%) of 1082 for syphilis, of which 53 (23%) were new diagnoses, and 48 (5%) of 1005 for HBV surface antigen. Among 1631 releases to the community, 808 followed up in community clinics, where 21 (4%) 553 tests were positive for gonorrhea, 23 (4%) of 555 for chlamydia, 150 (19%) of 808 for syphilis, of which 31 (21%) were new diagnoses, and 24 (6%) of 421 for HBV surface antigen. The majority of new STI cases, 51 (80%) of 64 in jail and 43 (77%)of 56 in the community, had a concurrent detectable (>200 copies/mL) HIV VL.Conclusions: Testing for gonorrhea and chlamydia was low, particularly in jail, which was attributed to testing protocols. High proportions of PLWH tested positive for syphilis and HBV infection in both settings. The majority of patients with active STIs had a detectable HIV VL. Routine, opt-out screening for STIs for PLWH during and after incarceration has the potential to identify a high proportion of STIs and improve secondary HIV prevention. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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33. Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making.
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Taylor, Barbara S., Fornos, Laura, Tarbutton, Jesse, Muñoz, Jana, Saber, Julie A., Bullock, Delia, Villarreal, Roberto, and Nijhawan, Ank E.
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GROUNDED theory , *HEALTH facilities , *PSYCHOLOGY of HIV-positive persons , *INTERVIEWING , *RESEARCH methodology , *MEDICAL care , *MEDICAL cooperation , *RESEARCH , *SOCIAL stigma , *SOCIAL support , *PLANNED behavior theory , *PATIENTS' attitudes , *PHYSICIANS' attitudes - Abstract
Initial linkage to medical care is a critical step in the HIV care continuum leading to improved health outcomes, reduced morbidity and mortality, and decreased HIV transmission risk. We explored differences in perspectives on engagement in HIV care between people living with HIV who attended (Arrived) their initial medical provider visit (IMV) and those who did not (Missed), and between patients and providers. The study was conducted in two large majority/minority HIV treatment centers in the United States (US) south, a geographical region disproportionately impacted by HIV. The Theory of Planned Behavior informed semistructured interviews eliciting facilitators and barriers to engagement in care from 53 participants: 40 patients in a structured sample of 20 Missed and 20 Arrived, and 13 care providers. Using Grounded Theory to frame analysis, we found similar perspectives for all groups, including beliefs in the following: patients' control over care engagement, a lack of knowledge regarding HIV within the community, and the impact of structural barriers to HIV care such as paperwork, transportation, housing, and substance use treatment. Differences were noted by care engagement status. Missed described HIV-related discrimination, depression, and lack of social support. Arrived worried what others think about their HIV status. Providers focused on structural barriers and process, while patients focused on relational aspects of HIV care and personal connection with clinics. Participants proposed peer navigation and increased contact from clinics as interventions to reduce missed IMV. Context-appropriate interventions informed by these perspectives are needed to address the expanding southern HIV epidemic. [ABSTRACT FROM AUTHOR] more...
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- 2018
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34. Psychosocial Factors Associated with Problem Drinking Among Substance Users with Poorly Controlled HIV Infection.
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Elliott, Jennifer C, Brincks, Ahnalee M, Feaster, Daniel J, Hasin, Deborah S, Rio, Carlos del, Lucas, Gregory M, Rodriguez, Allan E, Nijhawan, Ank E, and Metsch, Lisa R
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HIV prevention , *ANXIETY , *CONFLICT (Psychology) , *MENTAL depression , *DRINKING behavior , *INTERPERSONAL relations , *MENTAL health , *PATIENT satisfaction , *PHYSICIAN-patient relations , *SELF-evaluation , *SOMATOFORM disorders , *URBAN hospitals , *PSYCHOLOGY of Black people , *DISABILITIES , *SECONDARY analysis , *BINGE drinking , *STRUCTURAL equation modeling , *PSYCHOLOGY of drug abusers - Abstract
Aims We aimed to identify psychosocial factors related to problem drinking among patients with poorly controlled human immunodeficiency virus (HIV) infection. Short Summary We aimed to identify psychosocial factors related to problem drinking among those with poorly controlled HIV infection. Increased levels of interpersonal conflict were associated with greater severity of alcohol problems. Poorer mental health, medical mistrust and less satisfaction with one’s physician related to excessive drinking. Methods This secondary analysis used baseline data from a large multisite randomized controlled trial of substance users whose HIV infection was currently poorly controlled, from 11 urban hospitals across the USA. Participants were HIV-infected adult inpatients (n = 801; 67% male, 75% African American) with substance use histories. Participants self-reported on their drinking, perceived health, mental health, social relationships and patient–provider relationship. Structural equation models examined psychosocial factors associated with problem drinking, controlling for demographic covariates. Results Increased levels of interpersonal conflict were associated with greater severity of alcohol problems. Poorer mental health, medical mistrust and less satisfaction with one’s physician were associated with excessive drinking. Conclusions Several psychosocial factors, including interpersonal conflict, poor mental health (i.e. anxiety, depression and somatization), medical mistrust and less satisfaction with one’s provider, were associated with problem drinking among HIV-infected substance users with poorly controlled HIV infection. The co-occurrence of these concerns highlights the need for comprehensive services (including attention to problem drinking, social services, mental health and quality medical care) in this at-risk group. [ABSTRACT FROM AUTHOR] more...
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- 2018
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35. HIV Care After Jail: Low Rates of Engagement in a Vulnerable Population.
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Ammon, Benjamin, Iroh, Princess, Tiruneh, Yordanos, Li, Xilong, Montague, Brian T., Rich, Josiah D., and Nijhawan, Ank E.
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CRIMINAL justice system , *SUBSTANCE-induced disorders , *HIV infections , *IMPRISONMENT , *MENTAL illness , *STATISTICS on Hispanic Americans , *BLACK people , *COMPARATIVE studies , *PRISONERS , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *WHITE people , *SOCIOECONOMIC factors , *EVALUATION research , *AT-risk people , *PATIENTS' attitudes - Abstract
The criminal justice system is a critical area of focus to improve HIV outcomes and reduce health disparities. We analyzed demographic, incarceration, socioeconomic, and clinical data for HIV-positive persons released to the community from the Dallas County Jail (1450 incarcerations, 1111 unique individuals) between January 2011 and November 2013. The study population was 68% black and 14% Hispanic; overall linkage to care within 90 days of release was 34%. In adjusted analyses, Hispanics were more likely to link than whites (aOR 2.33 [95% CI: 1.55-3.50]), and blacks were as likely to link as whites (aOR 1.14 [95% CI: 0.84-1.56]). The majority of HIV-positive jail releases did not re-engage in HIV care after release, though Hispanics were twice as likely as other groups to link to care. Further efforts are needed to improve the transition from jail to community HIV care with particular attention to issues of housing, mental illness, and substance use. [ABSTRACT FROM AUTHOR] more...
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- 2018
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36. A randomized control trial of a combined community health worker and re-entry intervention for people with HIV recently released from jail who use substances.
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Hoff, Emily, Hansen, Laura, Pulitzer, Zoe, Campalans, Nicholas, Salyards, Maverick, Muquith, Maishara, Shavit, Shira, Nguyen, Hue, Crain, Christina, Walker, Robrina, and Nijhawan, Ank E.
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SUBSTANCE abuse treatment , *HIV infection prognosis , *SUBSTANCE abuse risk factors , *HIV-positive persons , *PILOT projects , *CORRECTIONAL institutions , *SUBSTANCE abuse , *TREATMENT effectiveness , *RANDOMIZED controlled trials , *RISK assessment , *DESCRIPTIVE statistics , *EMPLOYMENT reentry , *METROPOLITAN areas , *STATISTICAL sampling , *URINALYSIS , *DRUG abusers , *CRIMINAL justice system , *LONGITUDINAL method - Abstract
People with human immunodeficiency virus (HIV; PWH) who use substances are disproportionately involved in the criminal justice system. While HIV viral suppression typically improves during incarceration, these gains are frequently lost after release. We evaluated the impact of a combined intervention (formerly incarcerated community health workers [CHW] plus a re-entry organization; CHW+) on postrelease HIV- and substance use–related outcomes. We conducted a pilot randomized controlled trial of a CHW+ for PWH who use substances, within 30 days of release from a large southern, urban jail. Between February 2019 and August 2021, participants were recruited, enrolled, and randomized to treatment as usual (TAU; passive referral to care) or CHW+. Follow up study visits occurred at 3, 6, and 12 months. The primary outcome was HIV VL at 6 months; secondary outcomes included 6-month urinary toxicology and high-risk substance use at 12 months. A total of 31 participants were enrolled who were primarily male (n = 24; 77 %), Black (n = 22; 71 %), unemployed (n = 23; 74.2 %), had unstable housing (n = 18; 58 %), had food insecurity (n = 14; 45 %), and reported their drug of choice was stimulants (n = 24; 77 %). The study identified no significant difference in HIV VL suppression at 6 months (20 % v. 37 %; [CHW+ v. TAU], p = 0.61). We observed improved substance use outcomes in CHW+ v. TAU, including fewer positive urinary toxicology screens for stimulants (40 % v. 100 %; p = 0.01) and a trend toward less high-risk substance use (30 % v. 43 %). The CHW+ group met more basic needs, such as food security [+32 % v. +11 %], housing security [+52 % v. −7 %] and full-time employment [+20 % v. +5 %] compared to TAU. PWH who use substances assigned to a combined intervention of CHW+ after jail release did not achieve higher rates of HIV VL suppression than TAU; however, they had improved substance use outcomes and met more basic subsistence needs. Results highlight the potential of culturally informed interventions to address the competing needs of PWH who use substances after release from jail and call for further development of innovative solutions to successfully bridge to HIV care in the community. • People with HIV who use substances and are recently released from jail often do not reengage in care. • A community health worker plus re-entry organization intervention aimed to improve HIV outcomes. • Results demonstrated improved substance use outcomes, but no difference in HIV outcomes. • There were high rates of mortality (10 %) and recidivism (39 %). [ABSTRACT FROM AUTHOR] more...
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- 2023
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37. Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014.
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Raifman, Julia R., Gebo, Kelly A., Mathews, William Christopher, Korthuis, Philip Todd, Ghanem, Khalil G., Aberg, Judith A., Moore, Richard D., Nijhawan, Ank E., Monroe, Anne K., and Berry, Stephen A. more...
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Objectives: Annual screening for gonorrhea [Neisseria gonorrhoeae (NG)] and chlamydia [Chlamydia trachomatis (CT)] is recommended for all sexually active persons living with HIV but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004–2014, a period of expanding testing. Methods: We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women, and women. Results: Among 15,614 patients (50% MSM, 26% men who have sex exclusively with women, and 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 [adjusted odds ratio (AOR) per year 1.22 (1.21–1.22)]. Despite the increase in testing, test positivity also increased [AOR per year 1.10 (1.07– 1.12)], and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 [AOR per year 1.20 (1.17–1.22)]. Case detection was highest among MSM but increased over time among all 3 groups. Conclusions: NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among persons living with HIV to decrease transmission and complications of NG/CT and of HIV. [ABSTRACT FROM AUTHOR] more...
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- 2017
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38. Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data.
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Monroe, Anne K., Fleishman, John A., Voss, Cindy C., Keruly, Jeanne C., Nijhawan, Ank E., Agwu, Allison L., Aberg, Judith A., Rutstein, Richard M., Moore, Richard D., and Gebo, Kelly A.
- Abstract
Background: Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (埅180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days. Setting: HIV Research Network data from 5 sites and Medicaid Analytic Extract eligibility and pharmacy data were combined. Methods: Factors associated with having both an HIV primary care gap and a new (ie, nonrefill) ART prescription during a gap were evaluated with multinomial logistic regression. Results: Of 6892 HIV Research Network patients, 6196 (90%) were linked to Medicaid data, and 4275 had any Medicaid ART prescription. Over half (54%) had occasional gaps in HIV primary care. Women, older people, and those with suppressed viral load were less likely to have a gap. Among those with occasional gaps (n = 2282), 51% received a new ART prescription in a gap. Viral load suppression before gap was associated with receiving a new ART prescription in a gap (odds ratio = 1.91, 95% confidence interval: 1.57 to 2.32), as was number of days in a gap (odds ratio = 1.04, 95% confidence interval: 1.02 to 1.05), and the proportion of months in the gap enrolled in Medicaid. Conclusions: Medicaid-insured individuals commonly receive ART during gaps in HIV primary care, but almost half do not. Retention measures based on visit frequency data that do not incorporate receipt of ART and/or viral suppression may misclassify individuals who remain suppressed on ART as not retained. [ABSTRACT FROM AUTHOR] more...
- Published
- 2017
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39. Healthcare Coverage for HIV Provider Visits Before and After Implementation of the Affordable Care Act.
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Berry, Stephen A., Fleishman, John A., Yehia, Baligh R., Cheever, Laura W., Hauck, Heather, Korthuis, P. Todd, Mathews, W. Christopher, Keruly, Jeanne, Nijhawan, Ank E., Agwu, Allison L., Somboonwit, Charurut, Moore, Richard D., and Gebo, Kelly A. more...
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MEDICAL care of HIV-positive persons , *CHARITIES , *UNCOMPENSATED medical care , *MEDICAID , *HEALTH insurance ,PATIENT Protection & Affordable Care Act - Abstract
Background. Before implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, 100 000 persons living with human immunodeficiency virus (HIV) (PLWH) lacked healthcare coverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to cover visits to HIV providers. We compared HIV provider coverage before (2011-2013) versus after (first half of 2014) ACA implementation among a total of 28 374 PLWH followed up in 4 sites in Medicaid expansion states (California, Oregon, and Maryland), 4 in a state (New York) that expanded Medicaid in 2001, and 2 in nonexpansion states (Texas and Florida). Methods. Multivariate multinomial logistic models were used to assess changes in RWHAP/Uncomp, Medicaid, and private insurance coverage, using Medicare as a referent. Results. In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% before and 13% after ACA; adjusted relative risk ratio [ARRR], 0.44; 95% confidence interval [CI], .40-.48). Medicaid coverage increased (23% and 38%; ARRR, 1.82; 95% CI, 1.70-1.94), and private coverage was unchanged (21% and 19%; 0.96; .89-1.03). In New York sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) coverage were unchanged, while private coverage decreased (13% and 12%; ARRR, 0.86; 95% CI, .80-.92). In nonexpansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) coverage were unchanged, while private coverage increased (4% and 7%; ARRR, 1.79; 95% CI, 1.62-1.99). Conclusions. In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage. [ABSTRACT FROM AUTHOR] more...
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- 2016
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40. Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial.
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Metsch, Lisa R., Feaster, Daniel J., Gooden, Lauren, Matheson, Tim, Stitzer, Maxine, Das, Moupali, Jain, Mamta K., Rodriguez, Allan E., Armstrong, Wendy S., Lucas, Gregory M., Nijhawan, Ank E., Drainoni, Mari-Lynn, Herrera, Patricia, Vergara-Rodriguez, Pamela, Jacobson, Jeffrey M., Mugavero, Michael J., Sullivan, Meg, Daar, Eric S., McMahon, Deborah K., and Ferris, David C. more...
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HIV infection risk factors , *HIV-positive persons , *HOSPITAL patients , *VIRAL load , *MEDICAL case management , *RANDOMIZED controlled trials , *DISEASES , *SUBSTANCE abuse , *HIV infection complications , *HIV infection epidemiology , *COMPARATIVE studies , *ECONOMICS , *HIV , *HIV infections , *RESEARCH methodology , *MEDICAL cooperation , *MOTIVATION (Psychology) , *RESEARCH , *RESEARCH funding , *EVALUATION research , *SOCIAL services case management , *MOTIVATIONAL interviewing , *TREATMENT effectiveness , *PATIENT-centered care , *ANTI-HIV agents , *DISEASE complications - Abstract
Importance: Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates.Objective: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients.Design, Setting, and Participants: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months.Interventions: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment.Main Outcomes and Measures: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up.Results: Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68).Conclusions and Relevance: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.Trial Registration: clinicaltrials.gov Identifier: NCT01612169. [ABSTRACT FROM AUTHOR] more...- Published
- 2016
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41. The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth.
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Lee, Lana, Yehia, Baligh R., Gaur, Aditya H., Rutstein, Richard, Gebo, Kelly, Keruly, Jeanne C., Moore, Richard D., Nijhawan, Ank E., and Agwu, Allison L.
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OUTPATIENT medical care , *CHI-squared test , *COMMUNICATION , *CONFIDENCE intervals , *HEALTH facilities , *HEALTH services accessibility , *HIV-positive persons , *RESEARCH methodology , *MEDICAL care use , *MEDICAL cooperation , *PATIENT-professional relations , *MEDICAL records , *PATIENT compliance , *RESEARCH , *RESEARCH funding , *STATISTICS , *MULTIPLE regression analysis , *WAITING rooms , *CROSS-sectional method , *DESCRIPTIVE statistics , *ODDS ratio - Abstract
Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area (AOR 2.47, 95% CI [1.11-5.52]), evening clinic hours (AOR 1.94; 95% CI [1.13-3.33]), and providers with adolescent health training (AOR 1.98; 95% CI [1.01-3.86]). Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care. [ABSTRACT FROM AUTHOR] more...
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- 2016
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42. Use and Predictors of End-of-Life Care Among HIV Patients in a Safety Net Health System.
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Rhodes, Ramona L., Nazir, Fiza, Lopez, Sonya, Xuan, Lei, Nijhawan, Ank E., Alexander-Scott, Nicole E., and Halm, Ethan A.
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TERMINAL care , *HIV infections , *THERAPEUTICS , *HIGHLY active antiretroviral therapy , *PALLIATIVE treatment , *HOSPICE care , *ELECTRONIC health records , *DIAGNOSIS of HIV infections , *HIV infection epidemiology , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *CITY dwellers , *ADVANCE directives (Medical care) , *LOGISTIC regression analysis , *SOCIOECONOMIC factors , *EVALUATION research , *ALBUMINS , *RETROSPECTIVE studies ,TERMINAL care statistics - Abstract
Context: Although highly active antiretroviral therapy has improved survival among many HIV patients, there are still those with advanced illness and limited access to care who may benefit from palliative care and hospice.Objectives: To examine completion of advance directives, use of palliative care, and enrollment in hospice among HIV patients who receive care at an urban safety net hospital.Methods: This was a retrospective cohort study of HIV patients in a large, urban safety net hospital in 2010. Physicians abstracted data from the electronic medical record on patient and clinical factors and end-of-life care use. Logistic regression examined predictors of hospice use.Results: Overall, 367 HIV patients identified electronically by International Classification of Disease (ICD)-9 code were hospitalized in 2010. The mean age was 42 years, and 57% were African American. Although 28% died, only 6% of the sample received palliative care consultation, and 6% of the sample enrolled in hospice. Those who received hospice had lower albumin levels (adjusted odds ratio [AOR] 4.53, 95% CI 1.19-17.34) had received palliative care (AOR 9.73, 95% CI 2.10-45.09) and completed an advance directive (AOR 16.33, 95% CI 4.23-61.68). Of those patients who received hospice, the mean time to death after enrollment was 11 days.Conclusion: Among an urban cohort of HIV patients, the rates of advance directive completion, palliative care use, and hospice use were low. Despite advancements in the treatment of HIV, many patients with advanced illness may benefit from palliative care and hospice services. Advances should be made in identifying those patients earlier in their disease trajectories. [ABSTRACT FROM AUTHOR] more...- Published
- 2016
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43. Hospitalization Rates and Reasons Among HIV Elite Controllers and Persons With Medically Controlled HIV Infection.
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Crowell, Trevor A., Gebo, Kelly A., Blankson, Joel N., Korthuis, P. Todd, Yehia, Baligh R., Rutstein, Richard M., Moore, Richard D., Sharp, Victoria, Nijhawan, Ank E., Mathews, W. Christopher, Hanau, Lawrence H., Corales, Roberto B., Beil, Robert, Somboonwit, Charurut, Edelstein, Howard, Allen, Sara L., and Berry, Stephen A. more...
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HIV infections , *HOSPITAL care , *ANTIRETROVIRAL agents , *INFLAMMATION , *PATHOLOGICAL psychology , *IMMUNE system - Abstract
Background. Elite controllers spontaneously suppress human immunodeficiency virus (HIV) viremia but also demonstrate chronic inflammation that may increase risk of comorbid conditions. We compared hospitalization rates and causes among elite controllers to those of immunologically intact persons with medically controlled HIV. Methods. For adults in care at 11 sites from 2005 to 2011, person-years with CD4 T-cell counts ⩾350 cells/mm2 were categorized as medical control, elite control, low viremia, or high viremia. All-cause and diagnostic categoryspecific hospitalization rates were compared between groups using negative binomial regression. Results. We identified 149 elite controllers (0.4%) among 34 354 persons in care. Unadjusted hospitalization rates among the medical control, elite control, low-viremia, and high-viremia groups were 10.5, 23.3, 12.6, and 16.9 per 100 person-years, respectively. After adjustment for demographic and clinical factors, elite control was associated with higher rates of all-cause (adjusted incidence rate ratio, 1.77 [95% confidence interval, 1.21-2.60]), cardiovascular (3.19 [1.50-6.79]) and psychiatric (3.98 [1.54-10.28]) hospitalization than was medical control. Non- AIDS-defining infections were the most common reason for admission overall (24.1% of hospitalizations) but were rare among elite controllers (2.7%), in whom cardiovascular hospitalizations were most common (31.1%). Conclusions. Elite controllers are hospitalized more frequently than persons with medically controlled HIV and cardiovascular hospitalizations are an important contributor. [ABSTRACT FROM AUTHOR] more...
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- 2015
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44. Histoplasmosis-Induced Hemophagocytic Syndrome: A Case Series and Review of the Literature.
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Leigh Townsend, Jennifer, Shanbhag, Satish, Hancock, John, Bowman, Kathryn, and Nijhawan, Ank E.
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HISTOPLASMOSIS , *KIDNEY transplantation - Abstract
Background. Histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) is a relatively rare disorder for which data are limited regarding optimal treatment and clinical outcomes in adults. We describe the clinical features, treatment, and outcomes of patients with histoplasmosis-associated HLH at our institution. Methods. We performed a retrospective chart review of all inpatients at Parkland Hospital diagnosed with HLH associated with Histoplasma capsulatum from 2003 to 2013. Results. Eleven cases of histoplasmosis-associated HLH over this time period were identified. Nine of eleven cases were males (82%). Nine of these patients had human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), 1 was a renal transplant patient on immunosuppressants, and the other had no documented immunocompromise. The most common HLH criteria were splenomegaly (n = 10), fever (n = 10), and ferritin >500 ng/dL (n = 9). Urine Histoplasma antigen was positive in every patient tested (n = 9 of 9), and most antibodies for Histoplasma were positive if checked (n = 4 of 5). A majority of patients received liposomal amphotericin B (n = 9) with an average treatment duration of 11 days, and 5 patients also received prednisone, intravenous immunoglobulin (IVIG), or both. Overall, 5 patients died within 30 days (45.5%), and 7 patients died within 90 days (63.6%). Of the 5 patients that received immunosuppression, 4 died (80%), whereas in the group not given additional immunosuppression (n = 5), 2 died (40%). Conclusions. Histoplasmosis-associated HLH among adults is a lethal disease of highly immunocompromised patients, especially patients with HIV/AIDS. Clinical features such as splenomegaly, elevated ferritin, and cytopenias should prompt evaluation for HLH in this population. Further data are needed to define the role of immunosuppression, IVIG, and highly active antiretroviral therapy in treating this condition. [ABSTRACT FROM AUTHOR] more...
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- 2015
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45. Impact of Hepatitis Coinfection on Healthcare Utilization Among Persons Living With HIV.
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Crowell, Trevor A., Berry, Stephen A., Fleishman, John A., LaRue, Richard W., Korthuis, Philip T., Nijhawan, Ank E., Moore, Richard D., and Gebo, Kelly A.
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- 2015
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46. Prevalence and predictors of trichomonas infection in newly incarcerated women.
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Nijhawan AE, Chapin KC, Salloway R, Andrea S, Champion J, Roberts M, Clarke JG, Nijhawan, Ank E, Chapin, Kimberle C, Salloway, Rachel, Andrea, Sarah, Champion, Jessi, Roberts, Mary, and Clarke, Jennifer G more...
- Abstract
Background: Trichomonas vaginalis is the most prevalent curable sexually transmitted infection in the United States and may lead to preterm delivery, infertility, and increased HIV transmission. Incarcerated women may be at especially high risk for infection, although few studies have examined routine screening for Trichomonas infection in this population.Methods: Women older than 18 years entering the Rhode Island Department of Corrections between September 2009 and May 2011 were recruited to participate. All women submitted a self-collected vaginal swab for APTIMA transcription-mediated amplification testing. Each participant completed a survey addressing demographics, symptoms, sexual behavior, and substance use by audio computer-assisted self-interview. Data analysis was completed using multivariate logistic regression in SAS.Results: Data for 387 women were analyzed. The mean age was 30 years, 60% were white, 18% were Hispanic, 10% were black, and 12% had other race/ethnicity. Forty-four percent reported vaginal symptoms, and 77% reported illicit drug and/or heavy alcohol use in the 30 days before incarceration. The prevalence of Trichomonas was 14% by APTIMA. The strongest predictors of infection included black race (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.9-13.4; P < 0.01), more than 1 year since last Papanicolaou test (OR, 2.5; 95% CI, 1.3-4.8; P < 0.01) and presence of vaginal symptoms (OR, 2.3; 95% CI, 1.2-4.7; P = 0.02).Conclusions: Trichomonas infection is common in incarcerated women, especially among black women, women with vaginal symptoms, and those not receiving routine gynecologic care. Screening for Trichomonas infection in high-risk populations, particularly if using highly sensitive methods such as transcription-mediated amplification, may lead to increased detection and treatment. [ABSTRACT FROM AUTHOR] more...- Published
- 2012
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47. Erratum to: An Outbreak of Brucellosis: An Adult and Pediatric Case Series.
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Hassouneh, Linda, Quadri, Syeda, Reto, Patricia Pichilingue, Chaisavaneeyakorn, Sujittra, Cutrell, James B, Wetzel, Dawn M, and Nijhawan, Ank E
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BRUCELLOSIS , *FORUMS - Published
- 2019
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48. 764. Patients with Substance Use Disorder Discharged from Safety Net Hospital to Skilled Nursing Facility for OPAT: Baseline Characteristics and Clinical Outcomes.
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Bird, Cylaina, Collins, Ryan, Mang, Norman, Nijhawan, Ank E, and Bhavan, Kavita
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NURSING care facilities , *SUBSTANCE-induced disorders , *ELECTRONIC health records , *HOSPITAL personnel , *PARENTERAL therapy - Abstract
Background Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) is offered at Parkland Memorial Hospital for uninsured patients requiring an extended course of intravenous (IV) antibiotics to complete treatment at home.1 At Parkland, S-OPAT has been demonstrated to be safe and effective with >70,000 inpatient bed days avoided to date, lower 30-day readmission rates, and significant cost savings.1 Patients with a history of substance use are not eligible for S-OPAT and are discharged to skilled nursing facilities (SNF) to complete IV antibiotic therapy. This study aims to describe clinical outcomes of a patient population with history of substance use discharged to SNF for OPAT. Methods The electronic medical record was used to identify patients with substance use discharged to an SNF for OPAT between January 1, 2017 and April 30, 2018. Data were retrospectively reviewed for demographics, substance use history, treatment plan and clinical outcomes. Results 76 patients with history of substance use were discharged to SNFs for OPAT in the study period. 62% of patients reported non-IV drug use and 38% reported IV drug use (IVDU). The mean age for patients with non-IV drug use was 47 (83% male) vs. 43 years for patients with IVDU (86% male). Of patients with non-IV drug use, 30% reported cocaine use, 11% methamphetamine use and 59% polysubstance use or other. Of patients with IVDU, 38% reported heroin use, 10% methamphetamine use and 52% polysubstance use or other. When comparing outcomes of IVDU vs. non-IV drug use patients, 34% vs. 21% did not complete the prescribed treatment course, 28% vs. 11% left against medical advice (AMA), and 20% vs. 15% were readmitted to the hospital within 30 days. Conclusion The majority of patients with substance use, 74%, completed their prescribed IV antibiotic course when sent to an SNF. However, a subset of these patients is at risk for poor clinical outcomes. A greater proportion of patients with prior IVDU compared with patients with prior non-IV drug use left treatment AMA and were readmitted to our hospital within 30 days of discharge. Future efforts to identify patients with substance use disorder who may be appropriate for S-OPAT with integration of addiction medicine services may improve clinical outcomes. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant. [ABSTRACT FROM AUTHOR] more...
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- 2019
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49. 329. Health Disparities Among HIV-Positive Patients with Kaposi's Sarcoma.
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Knights, Sheena, Lazarte, Susana, Kainthla, Radhika, Krieger, Demi, Bhattatiry, Mitu, Chiao, Elizabeth, and Nijhawan, Ank E
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KAPOSI'S sarcoma , *HEALTH equity , *PROPORTIONAL hazards models , *ELECTRONIC health records , *VIRAL load - Abstract
Background Kaposi's sarcoma (KS) is an AIDS-related condition that is mediated by HHV-8. Although incidence and mortality of KS in the United States have decreased over time since the advent of HAART, there may be disparities in mortality based on geographic location and race/ethnicity, particularly African-American men in the South. Methods A retrospective electronic medical record review was conducted using integrated inpatient and outpatient data in EPIC from PHHS. We included all individuals with a diagnosis of HIV and Kaposi's sarcoma between January 1, 2009 and December 31, 2018 based on ICD-9/10 codes. We collected demographic information, HIV history, variables related to HIV and KS diagnosis, treatment and outcomes data for each patient. We calculated hazard ratios using Cox proportional hazards modeling. Results We identified 252 patients with KS. 95% of patients were male, and the majority were MSM (men who have sex with men; 77% of all patients). 35% of patients were Hispanic, 34% were African-American and 31% were Caucasian. Over half (56%) of patients were funded through Ryan White or were uninsured. The median CD4 count and viral load at the time of cancer diagnosis were 44 and 73,450, respectively. 24% of patients were confirmed to have died by the end of the study time frame. However, due to loss to follow-up, 35% of the cohort had an unknown vital status at the time of the final chart review. Variables most strongly associated with mortality were >2 hospitalizations in the first 6 months of cancer diagnosis (aHR=4.93, P = 0.0003), IV drug use (aHR=3.61, P = 0.0009), and T1 stage of KS (aHR= 2.13, P = 0.0264). African American patients had lower survival than Caucasian or Hispanic patients, with a 5-year survival of 69%, 81% and 80% respectively, although this did not reach statistical significance (aHR 1.77, P = 0.1396). Conclusion We describe a large cohort of patients with HIV and HHV-8-related disease, who are predominantly of minority race/ethnicity, uninsured, and have advanced HIV disease. Factors associated with mortality include Black/African-American ethnicity, number of hospitalizations, IV drug use and T1 stage of KS. Our mortality analysis is limited due to high lost to follow-up rates, so we suspect overall mortality in our cohort is higher than currently reported. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant. [ABSTRACT FROM AUTHOR] more...
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- 2019
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50. 1947. Educational Impact of a Hybrid Infectious Diseases Rotation for Internal Medicine Residents.
- Author
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Cutrell, James B, Le, Binh-Minh, Wolfe, Heather R, King, Helen, Arasaratnam, Reuben J, Nijhawan, Ank E, McKenna, Megan, and Lee, Francesca
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RESIDENTS (Medicine) , *COURSE evaluation (Education) , *COMMUNICABLE diseases , *ROTATIONAL motion , *INTERNAL medicine , *LIKERT scale - Abstract
Background Traditional infectious diseases (ID) rotations for internal medicine (IM) residents focus on inpatient consultation, potentially skewing trainees' perspectives on ID. We report our experience with a hybrid inpatient–outpatient ID rotation which provides broader ID clinical exposure and an effective venue for educational innovation. Methods We included all IM residents completing an assigned ID rotation in the UT Southwestern IM residency since July 2013. From July 2013 to June 2017, a 4-week ambulatory ID (Amb ID) rotation, consisting of general and subspecialty ID clinics and weekly teaching sessions focused on ID board review, was offered in parallel to traditional inpatient ID consult rotations. From July 2017 to present, all assigned residents complete up to a 4-week ID hybrid rotation, consisting of 2 weeks of ambulatory ID and 2 weeks of inpatient ID consults, with all residents receiving weekly teaching sessions; in some cases, the 4 weeks were not completed sequentially. Data were collected on resident numbers and training level, quantitative and qualitative course evaluations, and program in-training examination scores in ID content areas. Results From July 2013 to June 2019, IM residents completed a total of 626 ID rotations, an average of 104 per year (Table 1). A sample ID hybrid schedule is shown in Table 2. Overall resident satisfaction with the ID hybrid rotation was 4.7 (std. dev. 0.7) on a 5-point Likert scale. This rotation has consistently been among the highest rated rotations by residents. In-training examination ID scores increased significantly with creation of the Amb ID rotation in 2013 and further increased since 2017 with creation of the ID hybrid, in which both inpatient and ambulatory residents receive the weekly teaching sessions (Figure 1). Pilot educational innovations through this rotation include an online web-based antibiotic stewardship curriculum (2014–2015) and a mobile app-based ID board review platform utilizing spaced interval learning (2018–2019). Conclusion A hybrid inpatient–outpatient ID rotation for IM residents has proven to be a highly effective platform for ID education and curriculum innovation at our institution. This concept could be exported to other institutions and increase IM resident interest and breadth of clinical exposure in ID. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant. [ABSTRACT FROM AUTHOR] more...
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- 2019
- Full Text
- View/download PDF
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