Browsing by Author "Elharrar 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; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.; FHI360, Durham, NC, USA.; University of Washington, Seattle, WA, USA.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. jmagidson@mgh.harvard.edu.; National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.; Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA.; Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil.; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Department of Psychology, University of Miami, Coral Gables, FL, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA.; Division of Infectious Diseases, Departments of Pathology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Harvard School of Public Health, Boston, MA, 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; Institute for Community Health Promotion, Brown University, Providence RI, USA.; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil.; Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.; FHI360, Durham, NC, USA.; Department of Psychology, University of Miami, Coral Gables, FL, USA; ssafren@miami.edu.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA.; School of Public Health, University of Washington, Seattle, WA, USA.; Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Department of Pathology, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.; The Fenway Institute, Fenway Health, Boston, MA, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; 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.
Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia.
(2015) Closson EF; Mimiaga MJ; Sherman SG; Tangmunkongvorakul A; Friedman RK; Limbada M; Moore AT; Srithanaviboonchai K; Alves CA; Roberts S; Oldenburg CE; Elharrar V; Mayer KH; Safren SA; National Institute of Allergy and Infectious Disease, Bethesda, Maryland, United States of America.; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America; Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.; FHI360, Durham, North Carolina, United States of America.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America.; Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.; Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.; Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America.; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America.; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.
Long-term follow-up of HIV seroconverters in microbicide trials - rationale, study design, and challenges in MTN-015.
(2016-Sep) Riddler SA; Husnik M; Gorbach PM; Levy L; Parikh U; Livant E; Pather A; Makanani B; Muhlanga F; Kasaro M; Martinson F; Elharrar V; Balkus JE; h UZ-UCSF Collaborative Research Programme , University of Zimbabwe , Harare , Zimbabwe.; b MTN Statistical and Data Management Center , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.; j UNC Project - Tidziwe Centre , Kamuzu Central Hospital , Lilongwe , Malawi.; g College of Medicine-John Hopkins University Research Project , Queen Elizabeth Central Hospital , Blantyre , Malawi.; k Division of AIDS , National Institutes of Health , Bethesda , MD , USA.; f HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa.; e Microbicide Trials Network , Magee-Womens Research Institute , Pittsburgh , PA , USA.; d FHI360 , Durham, NC , USA.; i Centre for Infectious Disease Research in Zambia , Lusaka , Zambia.; a Division of Infectious Diseases , University of Pittsburgh , Pittsburgh , PA , USA.; c Department of Epidemiology , University of California , Los Angeles , CA , USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: As the effect of biomedical prevention interventions on the natural history of HIV-1 infection in participants who seroconvert is unknown, the Microbicide Trials Network (MTN) established a longitudinal study (MTN-015) to monitor virologic, immunological, and clinical outcomes, as well as behavioral changes among women who become HIV-infected during MTN trials. We describe the rationale, study design, implementation, and enrollment of the initial group of participants in the MTN seroconverter cohort. METHODS: Initiated in 2008, MTN-015 is an ongoing observational cohort study enrolling participants who acquire HIV-1 infection during effectiveness studies of candidate microbicides. Eligible participants from recently completed and ongoing MTN trials are enrolled after seroconversion and return for regular follow-up visits with clinical and behavioral data collection. Biologic samples including blood and genital fluids are stored for future testing. RESULTS: MTN-015 was implemented initially at six African sites and enrolled 100/139 (72%) of eligible women who seroconverted in HIV Prevention Trials Network protocol 035 (HPTN 035, conducted by the MTN). The median time from seroconversion in HPTN 035 to enrollment in MTN-015 was 18 months. Retention was good with >70% of visits completed. Implementation challenges included regulatory reviews, translation, and testing of questionnaires, and site readiness. CONCLUSIONS: Enrollment of HIV-seroconverters into a longitudinal observational follow-up study is feasible and acceptable to participants. Data and samples collected in this protocol will be used to assess safety of investigational HIV microbicides and answer other important public health questions for HIV infected women.