Browsing by Author "Cummings V"

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Antiretroviral Medication Adherence and Amplified HIV Transmission Risk Among Sexually Active HIV-Infected Individuals in Three Diverse International Settings.
(2016-Apr) Magidson JF; Li X; Mimiaga MJ; Moore AT; Srithanaviboonchai K; Friedman RK; Limbada M; Hughes JP; Cummings V; Gaydos CA; Elharrar V; Celentano D; Mayer KH; Safren SA; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. jmagidson@mgh.harvard.edu.; University of Washington, Seattle, WA, USA.; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Department of Psychology, University of Miami, Coral Gables, FL, USA.; FHI360, Durham, NC, USA.; Harvard School of Public Health, Boston, MA, USA.; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.; Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.; Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
Successful biomedical prevention/treatment-as-prevention (TasP) requires identifying individuals at greatest risk for transmitting HIV, including those with antiretroviral therapy (ART) nonadherence and/or 'amplified HIV transmission risk,' defined as condomless sex with HIV-uninfected/unknown-status partners when infectious (i.e., with detectable viremia or STI diagnosis according to Swiss criteria for infectiousness). This study recruited sexually-active, HIV-infected patients in Brazil, Thailand, and Zambia to examine correlates of ART nonadherence and 'amplified HIV transmission risk'. Lower alcohol use (OR = .71, p < .01) and higher health-related quality of life (OR = 1.10, p < .01) were associated with greater odds of ART adherence over and above region. Of those with viral load data available (in Brazil and Thailand only), 40 % met Swiss criteria for infectiousness, and 29 % had 'amplified HIV transmission risk.' MSM had almost three-fold (OR = 2.89, p < .001) increased odds of 'amplified HIV transmission risk' (vs. heterosexual men) over and above region. TasP efforts should consider psychosocial and contextual needs, particularly among MSM with detectable viremia.
Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents.
(2016) Safren SA; Hughes JP; Mimiaga MJ; Moore AT; Friedman RK; Srithanaviboonchai K; Limbada M; Williamson BD; Elharrar V; Cummings V; Magidson JF; Gaydos CA; Celentano DD; Mayer KH; School of Public Health, University of Washington, Seattle, WA, USA.; Department of Psychology, University of Miami, Coral Gables, FL, USA; ssafren@miami.edu.; FHI360, Durham, NC, USA.; Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; Institute for Community Health Promotion, Brown University, Providence RI, USA.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Pathology, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
INTRODUCTION: Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings. METHODS: HIV-positive individuals ( RESULTS: An estimated 3.81 (standard error, (SE)=0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, CONCLUSIONS: These data help to estimate the potential number of HIV infections transmitted and bacterial STIs acquired over time in patients established in care, a group typically considered at lower transmission risk, and found substantial numbers of estimated HIV transmissions. These findings provide an approach for evaluating the impact (in phase 2 studies) and potentially cost-effectiveness of global TasP efforts.