16 results on '"Elaine J. Abrams"'
Search Results
2. Distinct cord blood C-peptide, adipokine, and lipidomic signatures by in utero HIV exposure
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Lauren C. Balmert, Mitchell E. Geffner, Jennifer Jao, Irwin J. Kurland, Shan Sun, Rhoda S. Sperling, Brian Kirmse, Yunping Qiu, Elaine J. Abrams, Stephen Arpadi, Derek LeRoith, Thomas Kraus, and Landon Myer
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education.field_of_study ,Fetus ,Cord ,business.industry ,C-peptide ,Insulin ,medicine.medical_treatment ,Population ,Adipokine ,Physiology ,chemistry.chemical_compound ,chemistry ,In utero ,Cord blood ,Pediatrics, Perinatology and Child Health ,medicine ,education ,business - Abstract
BACKGROUND Early-life metabolic derangements in HIV-exposed uninfected (HEU) infants have been reported. METHODS Pregnant women with HIV and HIV-uninfected pregnant women were enrolled with their newborns in a US cohort from 2011 to 2015. We measured cord insulin, C-peptide, and metabolic cytokines of HEU and HIV-unexposed uninfected (HUU) newborns using ELISA and metabolites, lipid subspecies, and eicosanoids via liquid chromatography/mass spectrometry. Linear regression was employed to assess the association of intrauterine HIV/ART with insulin and C-peptide. Graphical lasso regression was used to identify differences between metabolite/lipid subspecies networks associated with C-peptide. RESULTS Of 118 infants, 56 were HEU, ART exposed. In adjusted analyses, mean cord insulin (β = 0.295, p = 0.03) and C-peptide (β = 0.522, p
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- 2021
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3. Construct Validity Supports Use of a Novel, Tablet-Based Neurocognitive Assessment for Adolescents and Young Adults Affected by Perinatal HIV from Vulnerable Communities in the United States
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Jeannette Raymond, S Espinel, Andrew Wiznia, Claude A. Mellins, Elaine J. Abrams, J Liu, Luke Kluisza, Curtis Dolezal, E Siegel, N Ngyuen, Reuben N. Robbins, and Anthony F. Santoro
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medicine.medical_specialty ,Longitudinal study ,Adolescent ,Social Psychology ,HIV Infections ,Article ,Executive Function ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Young adult ,030505 public health ,Working memory ,Public health ,Gold standard ,Public Health, Environmental and Occupational Health ,Construct validity ,Mental Status and Dementia Tests ,Infectious Disease Transmission, Vertical ,United States ,humanities ,Health psychology ,Infectious Diseases ,Female ,New York City ,0305 other medical science ,Psychology ,Neurocognitive ,Clinical psychology - Abstract
Construct validity of novel tablet-based neurocognitive tests (in the NeuroScreen app) measuring processing speed, working memory, and executive functioning in adolescents and young adults (AYA) living with perinatally-acquired HIV (PHIV) and perinatal HIV-exposure without infection (PHEU) was examined. Sixty-two AYA (33 PHIV, 29 PHEU) were recruited from an ongoing longitudinal study (CASAH) in New York City. Medium to large and statistically significant correlations were found between NeuroScreen and gold standard, paper-and-pencil tests of processing speed, working memory, and executive functioning. Results provide partial support for NeuroScreen as an alternative to cumbersome paper-and-pencil tests for assessing neurocognition among HIV-affected AYA.
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- 2020
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4. 'This is My Life We are Talking About': Adaptive Strategies for HIV Care Retention and Treatment Adherence Among Postpartum Women Living with HIV in Cape Town, South Africa
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Kirsty Brittain, Tamsin K Phillips, Allison Zerbe, Jennifer A. Pellowski, Landon Myer, Elaine J. Abrams, Alison Z. Weber, and Abigail Harrison
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Adult ,medicine.medical_specialty ,Anti-HIV Agents ,Epidemiology ,media_common.quotation_subject ,Health Behavior ,HIV Infections ,Interpersonal communication ,Article ,03 medical and health sciences ,Interpersonal relationship ,0302 clinical medicine ,Pregnancy ,Intervention (counseling) ,Retention in Care ,medicine ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Empowerment ,media_common ,030219 obstetrics & reproductive medicine ,business.industry ,Public health ,Postpartum Period ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Patient Acceptance of Health Care ,Treatment Adherence and Compliance ,Family medicine ,Pediatrics, Perinatology and Child Health ,Female ,business ,Attitude to Health ,Psychosocial ,Postpartum period ,Dyad - Abstract
INTRODUCTION: Retaining postpartum women living with HIV in ongoing care is critical for the health of the mother-child dyad but low adherence to antiretroviral therapy (ART) and retention in HIV care are a global concern. This issue is particularly salient in South Africa, where approximately 50% of women fall out of the care cascade by 6 months postpartum. The purpose of this secondary analysis is to understand the strategies that women use to navigate HIV care during the postpartum period. METHODS: This study was conducted in Gugulethu, in Cape Town, South Africa. In-depth interviews were conducted with 21 study participants at 18-months postpartum. Participants were interviewed about their perceptions and experiences of their postpartum HIV care, and barriers and facilitators to their adherence and retention. RESULTS: All participants reported using care navigation strategies across a spectrum of individual, interpersonal and structural levels to remain retained in care and adherent to ART. Participants expressed the importance of individual empowerment and knowledge of treatment benefits for their HIV care. Interpersonal relationships were discussed as a pathway to access both psychosocial and tangible support. Participants described overcoming structural barriers to care through creative problem solving and identified opportunities for care delivery improvement. DISCUSSION: Participants described a wide range of overlapping and interconnected care navigation strategies. Consistent with the assets model, participants discussed their own capacity and that of their communities to engage in lifelong HIV care. Better understanding of potentially successful individual care navigation strategies should guide future intervention work. Trial registration: ClinicalTrials.gov NCT01933477.
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- 2020
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5. Correction to: The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial
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Phepo Mogoba, Maia Lesosky, Allison Zerbe, Joana Falcao, Claude Ann Mellins, Christopher Desmond, Carlos Arnaldo, Bill Kapogiannis, Landon Myer, and Elaine J. Abrams
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Adult ,Medicine (General) ,Adolescent ,Anti-HIV Agents ,Correction ,Medicine (miscellaneous) ,HIV Infections ,Viral Load ,Medication Adherence ,Young Adult ,R5-920 ,Anti-Retroviral Agents ,Humans ,Pharmacology (medical) ,Child ,Randomized Controlled Trials as Topic - Abstract
Adolescents and youth living with HIV (AYAHIV) have worse HIV outcomes than other age groups, particularly in sub-Saharan Africa (SSA). AYAHIV in SSA face formidable health system, interpersonal- and individual-level barriers to retention in HIV care, uptake of ART, and achievement of viral suppression (VS), underscoring an urgent need for multi-component interventions to address these challenges. This cluster-randomized control trial (cRCT) aims to evaluate the effectiveness and monitor implementation of a community-informed multi-component intervention ("CombinADO strategy") addressing individual-, facility-, and community-level factors to improve health outcomes for AYAHIV.This trial will be conducted in 12 clinics in Nampula Province, Northern Mozambique. All clinics will implement an optimized standard of care (control) including (1) billboards/posters and radio shows, (2) healthcare worker (HCW) training, (3) one-stop adolescent and youth-friendly services, (4) information/motivation walls, (5) pill containers, and (6) tools to be used by HCW during clinical visits. The CombinADO strategy (intervention) will be superadded to control conditions at 6 randomly selected clinics. It will include five additional components: (1) peer support, (2) informational/motivational video, (3) support groups for AYAHIV caregivers, (4) AYAHIV support groups, and (5) mental health screening and linkage to adolescent-focused mental health support. The study conditions will be in place for 12 months; all AYAHIV (ages 10-24 years, on ART) seeking care in the participating sites will be exposed to either the control or intervention condition based on the clinic they attend. The primary outcome is VS (viral load 50 copies/mL) at 12 months among AYAHIV attending participating clinics. Secondary outcomes include ART adherence (self-reported and TDF levels) and retention in care (engagement in the preceding 90 days). Uptake, feasibility, acceptability, and fidelity of the CombinADO strategy during implementation will be measured. Trial outcomes will be assessed in AYAHIV, caregivers, healthcare workers, and key informants. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cRCTs.The CombinADO study will provide evidence on effectiveness and inform implementation of a novel community-informed multi-component intervention to improve retention, adherence, and VS among AYAHIV. If found effective, results will strengthen the rationale for scale up in SSA.ClinicalTrials.gov NCT04930367 . Registered on 18 June 2021.
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- 2022
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6. The FANMI ('my FAMILY' in Creole) study to evaluate community-based cohort care for adolescent and young women living with HIV in Haiti: protocol for a randomized controlled trial
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Grace Seo, Lindsey K Reif, Vanessa Rivera, Rose Cardelle Riche, Esther Jean, Bruce R. Schackman, Joseph Marie Bajo Joseph, Alexandra Apollon, Heejung Bang, Elaine J. Abrams, Bianca Louis, Jean W. Pape, Tatiana Bell, Marie Elmase Belizaire, Daniel W. Fitzgerald, Vanessa Rouzier, Nancy Confident, and Margaret L. McNairy
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Pediatric AIDS ,and promotion of well-being ,HIV Infections ,030312 virology ,Peer support ,Cohort Studies ,Organizational ,Study Protocol ,0302 clinical medicine ,7.1 Individual care needs ,Models ,Health care ,Retention in Care ,Community Health Services ,030212 general & internal medicine ,Young adult ,10. No inequality ,Pediatric ,0303 health sciences ,lcsh:Public aspects of medicine ,1. No poverty ,Health services research ,3. Good health ,Mental Health ,Infectious Diseases ,Research Design ,Cohort ,Public Health and Health Services ,HIV/AIDS ,Female ,Health Services Research ,Public Health ,Infection ,Adolescent Sexual Activity ,Cohort study ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,Clinical Trials and Supportive Activities ,Young Adult ,03 medical and health sciences ,Social support ,Clinical Research ,Behavioral and Social Science ,medicine ,Humans ,business.industry ,Prevention ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Prevention of disease and conditions ,Haiti ,Good Health and Well Being ,Models, Organizational ,Family medicine ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Management of diseases and conditions ,business - Abstract
Background Adolescent girls and young women living with HIV in resource-limited settings have the poorest health outcomes of any age group, due in part to poor retention in care. Differentiated models of HIV care that target the specific challenges of young people living with HIV are urgently needed. Methods The FANMI study is an unblinded randomized controlled trial designed to evaluate the efficacy of an adolescent-specific model of HIV care in Port-au-Prince, Haiti. The FANMI intervention places newly young women living with HIV who are not currently on ART or on ART ≤ 3 months, in cohorts of 5–10 peers to receive monthly group HIV care in a community location. In contrast, participants in the standard care arm receive routine HIV care and individual counseling each month in GHESKIO’s Adolescent Clinic. A total of 160 participants ages 16–23 years old are being randomized on a 1:1 basis. The primary outcome is retention in HIV care defined as being alive and in care at 12 months after enrollment. Secondary outcomes include viral suppression at 12 months, sexual risk behaviors, acceptability of the FANMI intervention, and health care utilization and costs. Discussion The FANMI study evaluates a novel community-based cohort model of HIV care aimed at improving retention in care and reducing risk behaviors for HIV transmission among adolescent girls and young women living with HIV. Specifically, the FANMI model of care addresses social isolation by placing participants in cohorts of 5–10 peers to provide intensified peer support and makes HIV health management a group norm; reduces stigma and improves convenience by providing care in a community setting; and integrates clinical care and social support by the same providers to streamline care and promote long-term patient-provider relationships. If shown to be effective, the FANMI intervention may serve as a model of HIV care for improving retention among hard-to-reach adolescents and young adults in Haiti and could be adapted for other high-risk groups globally. Trial registration Identifier: NCT03286504, Registered September 18, 2017.
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- 2019
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7. Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa
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Robert H. Remien, Stephanie Shiau, Landon Myer, Tamsin K Phillips, Elaine J. Abrams, Marcia Wong, Greg Petro, Kirsty Brittain, Allison Zerbe, and Claude A. Mellins
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Adult ,0301 basic medicine ,medicine.medical_specialty ,Adolescent ,Alcohol Drinking ,Anti-HIV Agents ,Social Stigma ,Population ,Alcohol abuse ,HIV Infections ,Article ,Cohort Studies ,South Africa ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Antiretroviral Therapy, Highly Active ,Humans ,Medicine ,030212 general & internal medicine ,Psychiatry ,education ,education.field_of_study ,Alcohol Use Disorders Identification Test ,Depression ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,030112 virology ,Mental health ,Psychiatry and Mental health ,Socioeconomic Factors ,Edinburgh Postnatal Depression Scale ,Domestic violence ,Female ,Pregnant Women ,business ,Psychosocial - Abstract
HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. We compared younger (18-24 years old) and older (≥25 years old) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test and the Edinburgh Postnatal Depression Scale (EPDS). Among 625 women initiating ART, 16 % reported risky alcohol use and 21 % alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37 % of 18-21 years old versus 20 % of 22-24 years old reported alcohol-related harm (p = 0.02). Overall, 11 % of women had EPDS scores suggesting probable depression, and 6 % reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11 % in younger and 4 % in older women (p = 0.002). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women, and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma and intimate partner violence may be moderating factors. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population.
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- 2016
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8. Sexual Risk and Intravaginal Practice Behavior Changes During Pregnancy
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Mary Ann Chiasson, Jessica Justman, Elaine J. Abrams, Heidi E. Jones, Chloe A. Teasdale, and Kelly Blanchard
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Zimbabwe ,medicine.medical_specialty ,Sexual Behavior ,Sexually Transmitted Diseases ,HIV Infections ,law.invention ,South Africa ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,Condom ,Pregnancy ,law ,medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,Pregnancy Complications, Infectious ,General Psychology ,Reproductive health ,030219 obstetrics & reproductive medicine ,Unsafe Sex ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Public health ,Behavior change ,medicine.disease ,Sexual Partners ,Relative risk ,symbols ,Female ,business - Abstract
Data suggest that pregnant women in some settings have high prevalence of HIV and other sexually transmitted infections (STI). We examined changes in sexual risk behaviors and intravaginal practices during pregnancy that may contribute to HIV and STI incidence using data from the Methods for Improved Reproductive Health in Africa study conducted in South Africa and Zimbabwe 2003–2006. We used a crossover design and modified Poisson regression to compare behaviors among HIV negative women 18–45 years during pregnant and non-pregnant periods. Among the 4802 women
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- 2016
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9. Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa
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Robert H. Remien, Allison Zerbe, Claude A. Mellins, Kirsty Brittain, Elaine J. Abrams, Tamsin K Phillips, and Landon Myer
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Adult ,medicine.medical_specialty ,Social Psychology ,Social stigma ,Social Stigma ,Psychological intervention ,HIV Infections ,Article ,South Africa ,Young Adult ,03 medical and health sciences ,Social support ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Young adult ,Psychiatry ,Depressive Disorder ,030505 public health ,Depression ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Social Support ,medicine.disease ,Pregnancy Complications ,Health psychology ,Infectious Diseases ,Anti-Retroviral Agents ,Edinburgh Postnatal Depression Scale ,Linear Models ,Antenatal depression ,Female ,Pregnant Women ,0305 other medical science ,business ,Clinical psychology - Abstract
Depression, HIV-related stigma and low levels of social support may be particularly prevalent and adversely affect health and treatment outcomes among HIV-infected pregnant women. We examined factors associated with social support and stigma among pregnant women initiating antiretroviral therapy in the Western Cape, South Africa; and explored associations with depressive symptoms (Edinburgh Postnatal Depression Scale; EPDS) in linear regression models. Among 623 participants, 11 and 19 % had elevated EPDS scores using thresholds described in the original development of the scale (scores ≥13 and ≥10, respectively). Social support and stigma were highly interrelated and were associated with depressive symptoms. Stigma was observed to moderate the association between social support and depression scores; when levels of stigma were high, no association between social support and depression scores was observed. Elevated depression scores are prevalent in this setting, and interventions to reduce stigma and to address risk factors for depressive symptoms are needed.
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- 2016
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10. Patterns and Correlates of Serostatus Disclosure to Sexual Partners by Perinatally-Infected Adolescents and Young Adults
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Mahrukh Bamji, Elaine J. Abrams, Katherine S. Elkington, Claude A. Mellins, Amy Weintraub, Andrew Wiznia, Amelia Bucek, Curtis Dolezal, Patricia Warne, and Cheng-Shiun Leu
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Adult ,Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Self Disclosure ,Adolescent ,Social Psychology ,Casual ,Sexual Behavior ,Human immunodeficiency virus (HIV) ,HIV Infections ,Disclosure ,Intention ,medicine.disease_cause ,Article ,Developmental psychology ,Condoms ,Young Adult ,03 medical and health sciences ,Sexually active ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Parent-Child Relations ,Young adult ,030505 public health ,Communication ,Public health ,Public Health, Environmental and Occupational Health ,Infectious Disease Transmission, Vertical ,Health psychology ,Sexual Partners ,Infectious Diseases ,Self-disclosure ,Regression Analysis ,Female ,New York City ,0305 other medical science ,Psychology ,Serostatus - Abstract
Similar to same-age peers, perinatally HIV-infected (PHIV+) youth in the US are engaging in sex, including condomless sex. Understanding decisions about serostatus disclosure to sexual partners is important to domestic and global HIV prevention efforts, since large numbers of PHIV+ children are entering adolescence and becoming sexually active. Using Social Action Theory (SAT) to inform variable selection, we examined correlates of disclosure among 98 PHIV+ adolescents/young adults in New York City. Over half of these youth reported not disclosing to any casual partners (59%) and to any partners when using condoms (55%). In simple regression analyses, increased disclosure was associated with older age; being female; earlier age of learning one’s serostatus; and increased STD knowledge, disclosure intentions, and parent-child communication. Multiple regression analyses revealed a strong fit with the SAT model. As with adults, disclosure to sexual partners is difficult for PHIV+ youth and challenges prevention efforts. Effective interventions that help youth with disclosure decisions are needed to curb the epidemic.
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- 2016
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11. Experiences of HIV-positive postpartum women and health workers involved with community-based antiretroviral therapy adherence clubs in Cape Town, South Africa
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Tamsin K Phillips, Landon Myer, Allison Zerbe, Christopher J. Colvin, Zara Trafford, Elaine J. Abrams, Yolanda Gomba, Kirsty Brittain, Victoria Iyun, Division of Public Health, and Faculty of Health Sciences
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Adult ,Postpartum women ,0301 basic medicine ,Postnatal Care ,medicine.medical_specialty ,Referral ,Anti-HIV Agents ,Health Personnel ,Differentiated care ,Breastfeeding ,HIV Infections ,Pilot Projects ,Health workers ,Adherence clubs ,Medication Adherence ,Cohort Studies ,South Africa ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,reproductive and urinary physiology ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Postpartum Period ,Public Health, Environmental and Occupational Health ,HIV ,Prenatal Care ,lcsh:RA1-1270 ,030112 virology ,Antiretroviral therapy ,3. Good health ,Breast Feeding ,Family medicine ,Feasibility Studies ,Female ,Club ,Biostatistics ,business ,Inclusion (education) ,Research Article ,Program Evaluation - Abstract
Background The rollout of universal, lifelong treatment for all HIV-positive pregnant and breastfeeding women (“Option B+”) has rapidly increased the number of women initiating antiretroviral treatment (ART) and requiring ART care postpartum. In a pilot project in South Africa, eligible postpartum women were offered the choice of referral to the standard of care, a local primary health care clinic, or a community-based model of differentiated ART services, the adherence club (AC). ACs have typically enrolled only non-pregnant and non-postpartum adults; postpartum women had not previously been referred directly from antenatal care. There is little evidence regarding postpartum women’s preferences for and experiences of differentiated models of care, or the capacity of this particular model to cater to their specific needs. This qualitative paper reports on feedback from both postpartum women and health workers who care for them on their respective experiences of the AC. Methods One-on-one in-depth qualitative interviews were conducted with 19 (23%) of the 84 postpartum women who selected the AC and were retained at approximately 12 months postpartum, and 9 health workers who staff the AC. Data were transcribed and thematically analysed using NVivo 11. Results Postpartum women’s inclusion in the AC was acceptable for both participants and health workers. Health workers were welcoming of postpartum women but expressed concerns about prospects for longer term adherence and retention, and raised logistical issues they felt might compromise trust with AC members in general. Conclusions Enrolling postpartum women in mixed groups with the general adult population is feasible and acceptable. Preliminary recommendations are offered and may assist in supporting the specific needs of postpartum women transitioning from antenatal ART care. Trial registration Number NCT02417675 clinicaltrials.gov/ct2/show/record/NCT02417675 (retrospective reg.)
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- 2018
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12. Pediatric HIV: Progress on Prevention, Treatment, and Cure
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Saeed Ahmed, Maria H. Kim, and Elaine J. Abrams
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medicine.medical_specialty ,Pediatrics ,Pediatric hiv ,business.industry ,medicine ,General Earth and Planetary Sciences ,Case finding ,Treatment options ,Intensive care medicine ,business ,Article ,General Environmental Science - Abstract
This review provides an update on current developments with prevention, treatment, and cure strategies in the field of pediatric HIV. There has been tremendous progress in the prevention and treatment of pediatric HIV infection. With new strategies for prevention of mother-to-child transmission, we are growing ever closer toward elimination of pediatric HIV, though challenges with retention of pregnant woman and their HIV-exposed infants remain. Ongoing vigilance regarding the potential hazards of in utero ART exposure to infants continues with no significant alarms yet identified. Though cure has not been achieved, evidence of the impact of early treatment on reducing HIV-1 reservoir size with subsequent prolonged remission has enlivened efforts to rapidly identify and treat HIV-infected newborns. There is an increasing array of treatment options for pediatric patients and reassuring evidence regarding long-term complications of ART. Unfortunately, despite evidence suggesting the benefit of early treatment, timely identification and treatment of children remains a challenge. Better strategies for effective case finding and engagement in care are urgently needed in addition to an improved understanding of how to retain HIV-positive children and adolescents on treatment. However, further emboldened by recent international commitments and robust global support, the future is hopeful.
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- 2015
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13. Case report: Severe central nervous system manifestations associated with aberrant efavirenz metabolism in children: the role of CYP2B6 genetic variation
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Louise Kuhn, Renate Strehlau, Ashraf Coovadia, Marelize Swart, Collet Dandara, Elaine J. Abrams, Francoise Pinillos, and Faeezah Patel
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Central Nervous System ,Cyclopropanes ,Male ,Paediatric HIV ,0301 basic medicine ,medicine.medical_specialty ,Efavirenz ,CYP2B6 ,Anti-HIV Agents ,030106 microbiology ,Central nervous system ,Case Report ,Single-nucleotide polymorphism ,Polymorphism, Single Nucleotide ,Pediatrics ,Biochemistry ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Medical microbiology ,Seizures ,Cerebellum ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Adverse effect ,business.industry ,Haplotype ,HIV ,Paediatrics ,Benzoxazines ,Cytochrome P-450 CYP2B6 ,Antiretroviral treatment ,Infectious Diseases ,medicine.anatomical_structure ,Haplotypes ,chemistry ,Alkynes ,Child, Preschool ,Immunology ,Female ,CNS ,business ,HIV infections - Abstract
Background Efavirenz, widely used as part of antiretroviral drug regimens in the treatment of paediatric human immunodeficiency virus infection, has central nervous system side effects. We describe four children presenting with serious, persistent central nervous system adverse events who were found to have elevated plasma efavirenz concentrations as a result of carrying CYP2B6 single nucleotide polymorphisms, known to play a role in the metabolism of EFV. None of the children had a CYP2B6 wildtype haplotype. We believe this is the first case of cerebellar dysfunction associated with efavirenz use to be described in children. Case presentation Four black African children, between the ages of 4 and 8 years presenting between 1 and 20 months post-efavirenz initiation, are described. Cerebellar dysfunction, generalised seizures and absence seizures were the range of presenting abnormalities. Plasma efavirenz levels ranged from 20-60 mg/L, 5–15 times the upper limit of the suggested reference range. All abnormal central nervous system manifestations abated after efavirenz discontinuation. Conclusion Efavirenz toxicity should always be considered in human immunodeficiency virus-infected children with unexplained central nervous system abnormalities. Our findings further our understanding of the impact of genetic variants on antiretroviral pharmacokinetics in children across various ethnic groups. Screening for potential EFV-toxicity based on the CYP2B6 c.516 SNP alone, may not be adequate.
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- 2015
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14. Systemic delays in the initiation of antiretroviral therapy during pregnancy do not improve outcomes of HIV-positive mothers: a cohort study
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Rose Zulliger, Linda-Gail Bekker, Elaine J. Abrams, Landon Myer, Desmond Tutu HIV Centre, and Faculty of Health Sciences
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Counseling ,Prevention of mother-to-child transmission (PMTCT) ,medicine.medical_specialty ,Pediatrics ,Time Factors ,Population ,Reproductive medicine ,Patient preparation ,lcsh:Gynecology and obstetrics ,Cohort Studies ,South Africa ,Patient Education as Topic ,Acquired immunodeficiency syndrome (AIDS) ,Pregnancy ,Obstetrics and Gynaecology ,HIV Seropositivity ,medicine ,Humans ,Pregnancy Complications, Infectious ,education ,lcsh:RG1-991 ,Public health ,education.field_of_study ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,medicine.disease ,Infectious Disease Transmission, Vertical ,Antiretroviral therapy ,Anti-Retroviral Agents ,HIV/AIDS ,Female ,business ,Research Article ,Patient education ,Cohort study - Abstract
Background Antiretroviral therapy (ART) initiation in eligible HIV-infected pregnant women is an important intervention to promote maternal and child health. Increasing the duration of ART received before delivery plays a major role in preventing vertical HIV transmission, but pregnant women across Africa experience significant delays in starting ART, partly due the perceived need to deliver ART counseling and patient education before ART initiation. We examined whether delaying ART to provide pre-ART counseling was associated with improved outcomes among HIV-infected women in Cape Town, South Africa. Methods We undertook a retrospective cohort study of 490 HIV-infected pregnant women referred to initiate treatment at an urban ART clinic. At this clinic all patients including pregnant women are screened by a clinician and then undergo three sessions of counseling and patient education prior to starting treatment, commonly introducing delays of 2–4 weeks before ART initiation. Data on viral suppression and retention in care after ART initiation were taken from routine clinic records. Results A total of 382 women initiated ART before delivery (78%); ART initiation before delivery was associated with earlier gestational age at presentation to the ART service (p Conclusions A substantial proportion of eligible pregnant women referred for ART do not begin treatment before delivery in this setting. Among women who do initiate ART, delaying initiation for patient preparation is not associated with improved maternal outcomes. Given the need to maximize the duration of ART before delivery for prevention of mother-to-child HIV transmission, there is an urgent need for new strategies to help expedite ART initiation in eligible pregnant women.
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- 2012
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15. Population genetic estimation of the loss of genetic diversity during horizontal transmission of HIV-1
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Elaine J. Abrams, Daniel J. Wilson, Raphael P. Viscidi, Edward C. Holmes, Rodney E. Phillips, Charles T. T. Edwards, and Alexei J. Drummond
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Male ,Time Factors ,Evolution ,Population ,HIV Core Protein p24 ,HIV Infections ,HIV Envelope Protein gp120 ,Biology ,Models, Biological ,Coalescent theory ,law.invention ,Evolution, Molecular ,03 medical and health sciences ,Genetic drift ,law ,QH359-425 ,Disease Transmission, Infectious ,Humans ,Genetic variability ,education ,Phylogeny ,Ecology, Evolution, Behavior and Systematics ,030304 developmental biology ,Genetics ,0303 health sciences ,education.field_of_study ,Genetic diversity ,030306 microbiology ,Infant, Newborn ,Genetic Variation ,Bayes Theorem ,Homosexuality ,Infectious Disease Transmission, Vertical ,3. Good health ,Population bottleneck ,Transmission (mechanics) ,Evolutionary biology ,HIV-1 ,Female ,human activities ,Horizontal transmission ,Research Article - Abstract
BackgroundGenetic diversity of the human immunodeficiency virus type 1 (HIV-1) population within an individual is lost during transmission to a new host. The demography of transmission is an important determinant of evolutionary dynamics, particularly the relative impact of natural selection and genetic drift immediately following HIV-1 infection. Despite this, the magnitude of this population bottleneck is unclear.ResultsWe use coalescent methods to quantify the bottleneck in a single case of homosexual transmission and find that over 99% of theenvandgagdiversity present in the donor is lost. This was consistent with the diversity present at seroconversion in nine other horizontally infected individuals. Furthermore, we estimated viral diversity at birth in 27 infants infected through vertical transmission and found there to be no difference between the two modes of transmission.ConclusionAssuming the bottleneck at transmission is selectively neutral, such a severe reduction in genetic diversity has important implications for adaptation in HIV-1, since beneficial mutations have a reduced chance of transmission.
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- 2006
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16. The art and science of preventing and treating HIV disease in children: a life cycle approach
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Elaine J. Abrams
- Subjects
lcsh:Immunologic diseases. Allergy ,Gerontology ,medicine.medical_specialty ,Sociology of scientific knowledge ,Pediatric hiv ,Epidemiology ,business.industry ,Vulnerability ,Medical sciences ,Social issues ,Affect (psychology) ,Pediatrics ,Infectious Diseases ,Virology ,Immunology ,medicine ,lcsh:RC581-607 ,business ,HIV infections ,Hiv disease ,Biomedical sciences - Abstract
Dr Abrams will review current scientific knowledge in the area of pediatric HIV infection from infancy through adolescence and will identify critical gaps that significantly impact successful care of children with HIV disease. She will explore three interconnected themes: evolution of physical and psychological development throughout childhood; the relationship between the child and her family; and importance of psychological, behavioral, and social issues as they affect successful treatment of the HIV infected child as well as vulnerability of the uninfected adolescent to acquisition of HIV infection. Combining experiences from HIV programs in resource rich and resource constrained settings, Dr. Abrams will highlight a number of pressing questions warranting urgent scientific inquiry.
- Published
- 2009
- Full Text
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