bluuebunny/crossref_metadata_2025 huggingface dataset:
2018 National Magnet® Nurse of the Year Award Winners
Authors: Graystone Rebecca
Published: March 2019

In this month's Magnet® Perspectives column, the Vice President of the Magnet Recognition Program® and Pathway to Excellence® Program introduces the 5 nurses who were honored at the 2018 ANCC National Magnet Conference® for the National Magnet Nurse of the Year award. This award recognizes the outstanding contributions of clinical nurses to innovation, consultation, leadership, and professional risk-taking and are presented in each of the 5 Magnet Model components: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and Empirical Outcomes.
Capitalizing on an Existing Shared Governance Structure in Developing Leadership Succession Planning
Authors: Moreno Janette V. , Girard Anita S.
Published: March 2019

This evidence-based project in a large academic medical center presents the integration of a succession-planning framework into existing shared leadership councils to fill open formal leadership positions. The framework included assessment, planning, and outcome evaluation of 3 strategic interventions: 1) leadership development, 2) experiential learning, and 3) mentoring. Benefits included improved self-perception as a leader, improved leadership competency, increased talent bench strength, and 32 internal promotions of frontline staff to formal leadership positions within 1 year.
Cultural and Generational Considerations in RN Retention
Authors: Dols Jean Dowling , Chargualaf Katie A. , Martinez Kathryn S.
Published: March 2019

OBJECTIVE

The aim of this study was to identify evolving cultural and generational factors influencing nurse retention.

BACKGROUND

Multigenerational/culturally diverse workforces challenge the nurse leader's understanding of nurse satisfaction.

METHODS

A survey was designed to identify the RN's career intentions, desired leadership traits, and practice environment appraisal.

RESULTS

While generally satisfied with their current position, generational differences in the average number of years nurses intend to stay at their current employer exist with Millennials anticipating staying 3.03 years; Generation X, 5.83 years; and Boomers, 8.25 years. Perceived inability to meet patient needs, which varied by generation, was significantly related to nurse satisfaction (P < .01). Factors identified by the nurses that may improve retention, regardless of generation, were pay, staffing, and nursing leadership support. Preferred leader traits varied by generation and ethnicity. Hispanic nurses value hardworking, honest leaders, whereas non-Hispanic nurses value dependability.

CONCLUSION

Nurse leaders must individualize efforts to retain an ethnically diverse and multigenerational nursing workforce.
Clinical Training Innovation for Prelicensure Graduate Nursing Students to Expand Roles in Primary Care
Authors: Hooper-Arana Erica D. , Li Judy N. , Borges Wanda J. , Bodenheimer Thomas
Published: March 2019

Background

With the aging population, the prevalence of chronic disease is increasing, requiring a team-based approach to care with registered nurses (RNs) playing a vital role.

Problem

Nursing education generally prioritizes acute care rather than ambulatory care; however, nursing students should also be prepared to adequately respond to the population needs for longitudinal chronic care management.

Approach

To address the need for RNs to assume a role in chronic care management, a School of Nursing and Health Professions piloted a clinical option in which second-degree master of science in nursing students are prepared to function as health coaches on primary care teams at a local community health center.

Conclusions

Reshifting the focus of nursing education to integrate primary care nursing, it is important to embed nursing students into primary care practices where they can learn about the longitudinal care of patients with chronic conditions.
Sick Students
Authors: Critz Catharine , Feagai Hobie Etta , Akeo April , Tanaka Mieko , Shin Juh Hyun , Erickson Michael , Ikeda Mari , Moriya Haruyo , Ozaki Kyoko
Published: March 2019

Background

Presenteeism, the act of going to work while sick, is associated with increases in medication errors, patient falls, diminished quality of care, and higher costs. To date, presenteeism has not been described among nursing students.

Purpose

This study described presenteeism in nursing students from 3 different international nursing programs.

Method

A self-administered survey with open-ended responses was used.

Results

While nearly all student respondents believed going to class and clinical experiences put their classmates and patients at risk, the overall presenteeism rate was 85.5% for class and 69.5% for clinical experiences. Although there were significant differences between universities for reasons for presenteeism, a lack of opportunity for making up missed lecture or clinical time predominated.

Conclusion

Nursing students in 3 culturally different cities reported going to class and clinical experiences while sick despite recognizing the safety risk.
Nursing Students Who Fail and Repeat Courses
Authors: Lewis Lisa S.
Published: March 2019

Background

Nursing students who fail and are required to repeat courses experience personal consequences and have an impact on the academic institution and nursing profession because of delayed graduation or even attrition.

Purpose

The purpose was to summarize the literature on nursing students who fail and repeat courses and identify gaps in knowledge about this population.

Methods

This was a scoping review.

Results

Academic failure and course repetition have emotional, social, and financial consequences and impact the student, institution, and nursing profession. Nursing student repeaters are at increased risk for poor academic outcomes, but supportive interventions can be beneficial.

Conclusions

The literature lacks a comprehensive description of nursing school progression policies, the incidence of nursing student repeaters, the financial implications of course repetition, and effective interventions to support the academic success of nursing students who repeat courses.
Characteristics of Gay, Bisexual and Other Men Who Have Sex With Men With Multiple Diagnoses of Infectious Syphilis in British Columbia, Canada, 2005–2014
Authors: Konrad Stephanie , Mak Donna B. , Grennan Troy , Zakher Bernadette , Brownrigg Bobbi , Ogilvie Gina , Morshed Muhammad , Tyndall Mark , Gilbert Mark , Krajden Mel , Wong Jason
Published: March 2019

Background

Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community.

Methods

A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network.

Results

Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and 29 (96%) were human immunodeficiency virus–positive. Of the 139 diagnoses, 65% occurred in the early latent stage of infection, 22% in the secondary stage, and 14% in the primary stage. The median number of sexual partners per diagnosis was 5 (range, 1–50). Among the 838 partners reported, 79% were notifiable, 53% were notified, and 23% were reported to be tested or treated. Sexual network mapping showed that almost half of the members of this group could be linked to one another either directly or indirectly via partners over 10 years. Social network mapping demonstrated high connectivity, with 4 venues associated with almost two thirds of the study population.

Conclusions

The connectivity and recurrent diagnoses in this study population suggest potential benefits of targeted interventions to individuals with multiple diagnoses and their partners. Our study highlights the need for enhanced care, increased syphilis testing frequency, and exploring alternative preventative methods among individuals with syphilis rediagnoses to reduce syphilis incidence.
Assessment of Usability and Task Load Demand Using a Robot-Assisted Transfer Device Compared With a Hoyer Advance for Dependent Wheelchair Transfers
Authors: Greenhalgh Mark , Landis James Matthew , Brown Joshua , Kulich Hailee , Bass Sarah , Alqahtani Saleh , Deepak Nikitha , Cryzter Theresa Marie , Grindle Garrett G. , Koontz Alicia M. , Cooper Rory A.
Published: March 2019

Objective

Manual lifting can be burdensome for people who care for power wheelchair users. Although technologies used for dependent transfers are helpful, they have shortcomings of their own. This study compares the usability and task load demand of a novel robot-assisted transfer device to a clinical standard when performing dependent transfers.

Design

A cross-sectional study was conducted to assess caregivers (N = 21) transferring a 56-kg mannequin with the Strong Arm and Hoyer Advance at three transfer locations. Feedback was gathered through qualitative surveys.

Results

Usability was significant in multiple areas important for transfers. Caregiver fatigue and discomfort intensity were reduced, and the Strong Arm was preferred at the three transfer locations. Device ease and efficiency favored Strong Arm at two stations as was discomfort frequency. In addition, physical demand, frustration, and effort were significantly lower using Strong Arm compared with the Hoyer Advance.

Conclusions

Compared with the Hoyer, participants favored Strong Arm for transfer usability and task load demand. However, further Strong Arm developments are needed.
The Association Between Complications, Incidents, and Patient Experience: Retrospective Linkage of Routine Patient Experience Surveys and Safety Data
Authors: de Vos Marit S. , Hamming Jaap F. , Boosman Hileen , Marang-van de Mheen Perla J.
Published: March 2019

Objectives

Linkage of safety data to patient experience data may provide information to improve surgical care. This retrospective observational study aimed to assess associations between complications, incidents, patient-reported problems, and overall patient experience.

Methods

Routinely collected data from safety reporting on complications and incidents, as well as patient-reported problems and experience on the Picker Patient Experience Questionnaire 15, covering seven experience dimensions, were linked for 4236 surgical inpatients from an academic center (April 2014–December 2015, 41% response). Associations between complication and/or incident occurrence and patient-reported problems, regarding risk of nonpositive experience (i.e., grade of 1–5 of 10), were studied using multivariable logistic regression.

Results

Patient-reported problems were associated with occurrence of complications/incidents among patients with nonpositive experiences (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.6–4.9), but not among patients with positive experiences (OR = 1.0, 95% CI = 0.6–1.5). For each experience dimension, presence of patient-reported problems increased risk of nonpositive experience (OR range = 2.7–4.4). Patients with complications or incidents without patient-reported problems were at lower risk of a nonpositive experience than patients with neither complications/incidents nor reported problems (OR = 0.5; 95% CI = 0.3–0.9). Occurrence of complications/incidents only increased risk of nonpositive experience when patients also had problems on “continuity and transition” or “respect for patient preferences” dimensions.

Conclusions

Linking safety data to patient experience data can reveal ways to optimize care. Staff seem able to ensure positive patient experiences despite complications or incidents. Increased attention should be paid to respecting patient preferences, continuity, and transition, particularly when complications or incidents occur.
Error Detection and Cost Savings With an Image-Based Workflow Management System Connected to a Computerized Prescription Order Entry Program for Antineoplastic Compounding
Authors: Marzal-Alfaro Maria Belén , Escudero-Vilaplana Vicente , Rodríguez-González Carmen Guadalupe , González-Haba Eva , Calvo Aitana , Osorio Santiago , Iglesias-Peinado Irene , Herranz Ana , Sanjurjo María
Published: March 2019

Objective

The aim of the study was to analyze both the prevalence of errors with the implementation of an image-based workflow management system during the antineoplastic compounding process, and the estimated costs associated with the negative clinical outcome if the errors had not been intercepted.

Methods

Three months after the implementation of Phocus Rx system at a hospital pharmacy department, the identification, classification (type, preparation stage, and cause), and potential severity degree (from negligible to catastrophic) of the errors intercepted were determined. The probability of an error causing an adverse event if it had reached the patient (from nil [0] to high [0.6]) and its consequences was estimated by a team of clinical pharmacists and physicians. Cost-effectiveness analysis from the hospital’s perspective was performed.

Results

Overall, 9872 antineoplastic medications were prepared using Phocus Rx. The total compounding error rate was 0.8% (n = 78, 56 [69.2%] were related to incorrect dose, 20 [28.2%] to incorrect drug preparation or conditioning technique, and 2 [2.6%] were wrong drugs). Approximately 70% of the detected errors were classified as undetectable via the previous verification practice, with 11.55% judged to be potentially severe (n = 9) and 51.3% moderate (n = 29). Likelihood of occurrence of an adverse event was medium (0.4) to high (0.6) for 37.2% of the errors. Estimated cost ratio and return on investment were €4.21 and 321%, respectively.

Conclusions

The implementation of Phocus Rx prevented antineoplastic preparation errors that would have reached the patient otherwise. In addition, acquisition of this technology was estimated to be cost-effective.
Factors Influencing Falls in High- and Low-Risk Patients in a Tertiary Hospital in Korea
Authors: Lee Young-Shin , Choi Eun-Ju , Kim Yeon-Hee , Park Hyeoun-Ae
Published: March 2019

Objective

The purpose of this study was to explore the characteristics and predictors of falls in high- and low-risk inpatients in a tertiary hospital in Korea.

Methods

Fallers' data were extracted from quality improvement reports and electronic health records from June 1, 2014, to May 31, 2015. Data on nonfallers matched by the length of hospitalization and medical departments of fallers were extracted from electronic health records. Participants were classified into a high- or a low-risk group based on their Morse Fall Scale score, fall risk–related symptoms, and medications known to increase fall risk. Characteristics of falls and risk factors were analyzed using descriptive statistics and logistic regression analysis, respectively.

Results

In the high-risk group, education, surgery, department, impaired mobility, intravenous catheter placement, use of ambulatory aid, gait disturbance, and some medications were significantly different between the fallers and nonfallers. From these variables, education, operation, department, intravenous catheter placement, gait disturbance, and use of narcotics, vasodilators, antiarrhythmics, and hypnotics were statistically significant factors for falls. In the low-risk group, sex, age, length of hospitalization, surgery, department, diagnosis, and mental status were significantly different between the fallers and nonfallers. From these, sex, age, length of hospitalization, surgery, and liver-digestive diseases were statistically significant factors for falls.

Conclusions

Characteristics and risk factors for falls differed between the risk groups. Fall prevention strategies need to be tailored to the risk groups and fall risk assessment tools need to be revised accordingly.
Predicting Virological Response to HIV Treatment Over Time: A Tool for Settings With Different Definitions of Virological Response
Authors: Revell Andrew D. , Wang Dechao , Perez-Elias Maria-Jesus , Wood Robin , Tempelman Hugo , Clotet Bonaventura , Reiss Peter , van Sighem Ard I. , Alvarez-Uria Gerardo , Nelson Mark , Montaner Julio S. G. , Lane H. Clifford , Larder Brendan A. ,   on behalf of the RDI study group
Published: March 2019

Objective:

Definitions of virological response vary from <50 up to 1000 copies of HIV-RNA/mL. Our previous models estimate the probability of HIV drug combinations reducing the viral load to <50 copies/mL, with no indication of whether higher thresholds of response may be achieved. Here, we describe the development of models that predict absolute viral load over time.

Methods:

Two sets of random forest models were developed using 50,270 treatment change episodes from more than 20 countries. The models estimated viral load at different time points following the introduction of a new regimen from variables including baseline viral load, CD4 count, and treatment history. One set also used genotypes in their predictions. Independent data sets were used for evaluation.

Results:

Both models achieved highly significant correlations between predicted and actual viral load changes (r = 0.67–0.68, mean absolute error of 0.73–0.74 log10 copies/mL). The models produced curves of virological response over time. Using failure definitions of <100, 400, or 1000 copies/mL, but not 50 copies/mL, both models were able to identify alternative regimens they predicted to be effective for the majority of cases where the new regimen prescribed in the clinic failed.

Conclusions:

These models could be useful for selecting the optimum combination therapy for patients requiring a change in therapy in settings using any definition of virological response. They also give an idea of the likely response curve over time. Given that genotypes are not required, these models could be a useful addition to the HIV-TRePS system for those in resource-limited settings.
Characterizing the Influence of Structural Determinants of HIV Risk on Consistent Condom Use Among Female Sex Workers in Senegal
Authors: Twahirwa Rwema Jean Olivier , Lyons Carrie E. , Ketende Sosthenes , Bowring Anna L. , Rao Amrita , Comins Carly , Diouf Daouda , Drame Fatou M. , Liestman Benjamin , Coly Karleen , Ndour Cheikh , Turpin Gnilane , Mboup Souleymane , Toure-Kane Coumba , Castor Delivette , Leye-Diouf Nafissatou , Diop-Ndiaye Halimatou , Baral Stefan
Published: March 2019

Background:

Female sex workers (FSWs) are disproportionately affected by HIV even in the most generalized HIV epidemics. Although structural HIV risks have been understood to affect condom negotiation among FSWs globally, there remain limited data on the relationship between structural determinants of HIV risk, including violence and socioeconomic status, and condom use among FSWs across sub-Saharan Africa. Here, we describe the prevalence of structural determinants and their associations with condom use among FSWs in Senegal.

Methods:

In 2015, 758 FSWs >18 years of age were recruited using respondent driven sampling in Senegal. Data on individual, community, network, and structural-level risks were collected through an interviewer-administered questionnaire. Poisson regression with robust variance estimation was used to model the associations of consistent condom use (CCU) and selected structural determinants.

Results:

The respondent driven sampling–adjusted prevalence of CCU in the last 10 sexual acts was 76.8% [95% confidence interval (CI): 70.8 to 82.8]. Structural determinants that were significantly associated with lower CCU were as follows: physical violence [adjusted prevalence ratio (aPR): 0.71; 95% CI: 0.52 to 0.98]; working primarily in a hotel or guest house (aPR: 0.85; 95% CI: 0.73 to 0.99); and difficultly accessing condoms (aPR: 0.72; 95% CI: 0.52 to 0.96). High income from sex work (aPR: 1.23; 95% CI: 1.04 to 1.46) was significantly associated with higher CCU.

Conclusions:

Taken together, these data highlight the role of structural risk determinants on condom use among FSWs in Senegal. Moreover, these results highlight the need for structural interventions, including safe working spaces and violence mitigation programs, to support condom negotiation and access. Combined with condom distribution programs, structural interventions could ultimately increase condom use among FSWs in Senegal.
Effect of HIV Subtype and Antiretroviral Therapy on HIV-Associated Neurocognitive Disorder Stage in Rakai, Uganda
Authors: Sacktor Ned , Saylor Deanna , Nakigozi Gertrude , Nakasujja Noeline , Robertson Kevin , Grabowski M. Kate , Kisakye Alice , Batte James , Mayanja Richard , Anok Aggrey , Gray Ronald H. , Wawer Maria J.
Published: March 2019

Background:

Combination antiretroviral therapy (ART) improves HIV-associated neurocognitive disorder (HAND) stage in the United States where subtype B predominates, but the effect of ART and subtype on HAND stage in individuals in Uganda with subtypes D and A is largely unknown.

Setting:

A community-based cohort of participants residing in Rakai, Uganda.

Methods:

Three hundred ninety-nine initially ART-naive HIV-seropositive (HIV+) individuals were followed up over 2 years. Neurological and neuropsychological tests and functional assessments were used to determine HAND stage. Frequency and predictors of HAND and HIV-associated dementia (HAD) were assessed at baseline and at follow-up after ART initiation in 312 HIV+ individuals. HIV subtype was determined from gag and env sequences.

Results:

At 2-year follow-up, HAD frequency among HIV+ individuals on ART (n = 312) decreased from 13% to 5% (P < 0.001), but the overall frequency of HAND remained unchanged (56%–51%). Subtype D was associated with higher rates of impaired cognition (global deficit score ≥ 0.5) compared with HIV+ individuals with subtype A (55% vs. 24%) (P = 0.008). Factors associated with HAD at baseline were older age, depression, and plasma HIV viral load >100,000 copies/mL. At follow-up, age and depression remained significantly associated with HAD.

Conclusions:

HIV+ individuals on ART in rural Uganda had a significant decrease in the frequency of HAD, but HAND persists after 2 years on ART. The current guideline of immediate ART initiation after HIV diagnosis is likely to greatly reduce HAD in sub-Saharan Africa. Further studies of the effect of HIV subtype and neurocognitive performance are warranted.
Measuring Adherence to Antiretroviral Therapy via Hair Concentrations in India
Authors: Gandhi Monica , Devi Sarita , Bacchetti Peter , Chandy Sara , Heylen Elsa , Phung Nhi , Kuncze Karen , Okochi Hideaki , Kumar Ravi , Kurpad Anura V. , Ekstrand Maria L.
Published: March 2019

Background:

Objective adherence measures are of increasing interest in antiretroviral treatment (ART) monitoring. Hair ART levels predict virologic suppression, and hair is easy to collect and store. No previous study has examined hair levels in an India-based cohort or laboratory.

Methods:

Small hair samples were collected from HIV-positive participants on either efavirenz (EFV)-based or nevirapine (NVP)-based ART in a South India–based study. Hair samples were split and analyzed for EFV or NVP in the University of California, San Francisco –based Hair Analytical Laboratory and the analytic laboratory of the Division of Nutrition at St. John's Research Institute, Bangalore, India, using liquid chromatography/tandem mass spectrometry. Agreement (using Bland–Altman methods) and rank correlation between the 2 laboratories' hair levels were calculated. Rank correlation between self-reported adherence (SRA) over the previous month using a visual analog scale and hair ART levels was calculated.

Results:

Among 75 participants (38 on NVP; 37 on EFV), the correlation between NVP levels generated by the 2 laboratories was 0.66 (P < 0.0001) and between EFV levels was 0.87 (P < 0.0001). Measurements from St. John's Research Institute were usually within 20% of those from the University of California, San Francisco Hair Analytical Laboratory. SRA was essentially uncorrelated with hair antiretroviral levels for either drug (all correlations < 0.04). Hair levels showed variability in adherence although SRA was >85% in all participants.

Conclusions:

Hair ART levels measured by both an India-based laboratory and the standard U.S.-based laboratory showed generally high agreement and correlation, demonstrating local capacity. As in many other cohorts, hair ART levels and SRA were not well-correlated, likely indicating limitations in self-report and the need for objective adherence monitoring in resource-limited settings.
Factors Associated With Excess Myocardial Infarction Risk in HIV-Infected Adults: A Systematic Review and Meta-analysis
Authors: Rao Shreya G. , Galaviz Karla I. , Gay Hawkins C. , Wei Jingkai , Armstrong Wendy S. , del Rio Carlos , Narayan K.M. Venkat , Ali Mohammed K.
Published: March 2019

Objectives:

To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors.

Background:

Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies.

Methods:

We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk.

Results:

Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5–2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14–1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12–1.27)], dyslipidemia [OR = 1.09 (1.07–1.11)], and smoking [OR = 1.09 (1.05–1.13)] were independently associated with increased AMI risk in HIV-infected adults.

Conclusions and Relevance:

Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.
Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain
Authors: Merlin Jessica S. , Long Dustin , Becker William C. , Cachay Edward R. , Christopolous Katerina A. , Claborn Kasey R. , Crane Heidi M. , Edelman Eva Jennifer , Lovejoy Travis I. , Mathews William Christopher , Morasco Benjamin J. , Napravnik Sonia , O'Cleirigh Connall , Saag Michael S. , Starrels Joanna L. , Gross Robert , Liebschutz Jane M.
Published: March 2019

Background:

People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

Methods:

Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed up for 1 year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.

Results:

Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (interquartile range 4.7–8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity, and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.

Conclusions:

We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana.
Brief Report: Kidney Dysfunction Does Not Contribute Significantly to Antiretroviral Therapy Modification in Treatment-Naive PLWH Receiving Initial ART
Authors: Eaton Ellen F. , Tamhane Ashutosh , Davy-Mendez Thibaut , Moore Richard D. , Mathews W. Christopher , Saag Michael S. , Mugavero Michael J. , Wyatt Christina M. , Gutierrez Orlando M.
Published: March 2019

Background:

Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The study objective was to determine whether kidney dysfunction is contributing to reduced durability.

Methods:

This retrospective follow-up study of CNICS evaluated treatment-naive PLWH initiating ART between 2007 and 2014. Regimen modification was defined as cessation/modification of any part of the 3-drug ART regimen. We evaluated the role of kidney dysfunction in initial regimen modification as both a mediator and effect measure modifier. Associations of the variables with the ART modification were examined using univariable and multivariable Cox proportional hazard models.

Results:

Of 4515 PLWH included in the analysis, 1967 modified their ART. Of those receiving TDF-based ART (n = 3888), 1580 (41%) modified their regimen compared with 387 (62%) receiving other regimens. Overall, the median eGFR decreased by 5 mL/min/1.73 m2 (quartiles: first = −16, third = 0) from baseline to follow-up. Of the 128 patients with low baseline eGFR (<60 mL/min/1.73 m2), the final eGFR remained low in 73% while it increased to above 60 mL/min/1.73 m2 in 27%. Of the 4387 with normal baseline eGFR, only 135 (3%) had a final eGFR <60 mL/min/1.73 m2. Those with low eGFR at the baseline and/or final visits were more likely to modify ART than others (hazards ratio = 1.75, 95% confidence interval: 1.39 to 2.19, P < 0.001). Relative to other regimens, TDF-based ART was less likely to be modified when accounting for numerous clinical and demographic traits.

Conclusions:

For patients in our study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction is not a major factor leading to regimen modification.
Brief Report: Real-World Performance and Interobserver Agreement of Urine Lipoarabinomannan in Diagnosing HIV-Associated Tuberculosis in an Emergency Center
Authors: Van Hoving Daniël J. , Lahri Sa'ad , Lategan Hendrick J. , Nicol Mark P. , Maartens Gary , Meintjes Graeme
Published: March 2019

Background:

The urine lipoarabinomannan (LAM) lateral flow assay is a point-of-care test to diagnose HIV-associated tuberculosis (TB). We assessed the performance of urine LAM in HIV-positive patients presenting to the emergency center and evaluated the interobserver agreement between emergency center physicians and laboratory technologists.

Setting:

A cross-sectional diagnostic study was performed at the emergency center of a district hospital in a high HIV-prevalence community in South Africa.

Methods:

Consecutive HIV-positive adults presenting with ≥1 WHO TB symptom were enrolled over a 16-month period. A urine LAM test was performed at point-of-care by an emergency physician and interpreted independently by 2 physicians. A second test was performed in the laboratory and interpreted independently by 2 laboratory technologists. The reference standard was a positive TB culture or Xpert MTB/RIF test on sputum or appropriate extrapulmonary samples. We compared diagnostic accuracy and reproducibility of urine LAM between point-of-care readers and laboratory readers.

Results:

One thousand three hundred eighty-eight samples (median, 3 samples/participant) were sent for TB microbiology tests in 411 participants; 170 had confirmed TB (41.4%). Point-of-care and laboratory-performed urine LAM had similar sensitivity (41.8% vs 42.0%, P = 1.0) and specificity (90.5% vs 87.5%, P = 0.23). Moderate agreement was found between point-of-care and laboratory testing (κ = 0.62), but there was strong agreement between point-of-care readers (κ = 0.95) and between laboratory readers (κ = 0.94). Positive percent agreement between point-of-care and laboratory readers was 68% and negative percent agreement 92%.

Conclusion:

There is no diagnostic accuracy advantage in laboratory-performed versus point-of-care–performed urine LAM tests in emergency care centers in high-burden settings.
Brief Report: Assessing the Impact of Race on HIV/STI Risk Perceptions Among Young Men Who Have Sex With Men Using an Experimental Approach
Authors: Hill Brandon J. , Rosentel Kris , Hebert Luciana
Published: March 2019

Background:

This study explores how character race may influence HIV/sexually transmitted infection (STI) risk perceptions of young men who have sex with men (MSM), using a social experimental study design.

Methods:

A sample of 134 MSM were recruited to participate in a 30- to 45-minute, in-person laboratory study at 3 Midwest universities. Data were collected from July 2015 to June 2016. Participants were randomly assigned to 1 of 3 experimental conditions. Each participant read and listened to 9 behaviorally specific vignettes describing sexual encounters between 2 male-identified characters. Vignettes were identical across all conditions with only the race and character name manipulated for condition. Participants were asked to rate the likelihood of HIV/STI transmission for each vignette using a 5-point Likert scale (1 = very unlikely and 5 = very likely).

Results:

Across all 9 vignettes, HIV/STI transmission risk was rated significantly higher in vignettes in which both characters were identified as Black compared with vignettes where both characters were White. For 8 of the vignettes, participants rated HIV/STI risk significantly higher among interracial character vignettes compared with vignettes in which both characters were identified as White. Overall, significant differences had medium effect sizes for each statistical comparison (0.065 ≤ η2 ≤ 0.124).

Conclusions:

MSM may associate character race with HIV/STI risk even when behaviorally specific information is available. More specifically, MSM may be more likely to associate Black/African American men with higher HIV/STI risk compared with White men, regardless of sexual behavior (eg, oral sex and condomless anal sex) or engagement with HIV/STI prevention strategies (eg, condoms, pre-exposure prophylaxis, and antiretroviral therapy use).
Brief Report: Short-Term Adherence Marker to PrEP Predicts Future Nonretention in a Large PrEP Demo Project: Implications for Point-of-Care Adherence Testing
Authors: Spinelli Matthew A. , Glidden David V. , Anderson Peter L. , Gandhi Monica , Cohen Stephanie , Vittinghoff Eric , Coleman Megan E. , Scott Hyman , Bacon Oliver , Elion Richard , Kolber Michael A. , Buchbinder Susan P. , Liu Albert Y.
Published: March 2019

Background:

Objective adherence metrics for tenofovir (TFV) disoproxil fumarate/emtricitabine (FTC)-based pre-exposure prophylaxis (PrEP) were critical for interpretation of efficacy in PrEP clinical trials, and there is increasing interest in using drug levels to tailor interventions for reengagement and adherence. Point-of-care immunoassays for TFV, which examine short-term adherence, are in development. However, the ability of poor short-term and long-term adherence to predict future PrEP nonretention is unknown.

Setting:

Secondary data analysis of a large, prospective multi-site U.S. PrEP demonstration project.

Methods:

An adjusted Cox-proportional hazards model examined the relationship of dried blood spot (DBS) levels of FTC-triphosphate (FTC-TP) or TFV-diphosphate (TFV-DP), measures of short-term and long-term PrEP adherence, respectively, with future study nonretention.

Results:

Overall, 294 individuals (median age 33 years) contributed drug levels within the U.S. PrEP demonstration project. By the end of study, 27% were lost to follow-up, 25% had at least one undetectable FTC-TP level indicating poor short-term adherence, and 29% had a drug level indicating suboptimal long-term adherence (TFV-DP <700 fmol/punch). The strongest factor associated with future study nonretention using a binary drug-level cut-off was an undetectable DBS FTC-TP level (adjusted hazard ratio 6.3; 95% confidence interval 3.8 to 10.2). The suboptimal long-term adherence based on low DBS TFV-DP levels was also associated with nonretention (adjusted hazard ratio 4.3; 95% confidence interval: 2.4 to 7.6).

Conclusions:

Both short- and long-term metrics of PrEP adherence are strongly associated with future loss to follow-up in a U.S. demonstration project study. Short-term metrics of adherence, once available at the point-of-care, could be used to direct real-time tailored retention and adherence interventions.
Religiosity, Social Support, and Ethnic Identity: Exploring “Resilience Resources” for African-American Women Experiencing HIV-Related Stigma
Authors: Lipira Lauren , Williams Emily C. , Nevin Paul E. , Kemp Christopher G. , Cohn Susan E. , Turan Janet M. , Simoni Jane M. , Andrasik Michele P. , French Audrey L. , Unger Joseph M. , Heagerty Patrick , Rao Deepa
Published: March 2019

Introduction:

African-American women living with HIV report substantial HIV-related stigma and depression. Resilience resources are strength-based resources that may moderate the effects of HIV-related stigma on poor psychosocial outcomes such as depression.

Objective:

To evaluate whether religiosity, social support, and ethnic identity moderate the effects of HIV-related stigma on depression among African-American women living with HIV.

Methods:

We used baseline data (May 2013–October 2015) from a randomized controlled trial testing the efficacy of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago, IL, and Birmingham, AL, who were older than 18 years and currently receiving HIV services. To assess whether religiosity (7-item Religious Beliefs and Behaviors survey), social support (select subscales from the Medical Outcomes Study Social Support Survey), and ethnic identity (Commitment subscale from the Multigroup Ethnic Identity Measure) modified the relationship between HIV-related stigma (Stigma Scale for Chronic Illness) and depression (8-item Patient Health Questionnaire), we conducted 3 separate moderation analyses using linear regression with interactions between HIV-related stigma and each moderator of interest, adjusted for study site, age, time since diagnosis, and education.

Results:

Among 226 African-American women living with HIV, greater levels of HIV-related stigma were associated with greater depression in all 3 models (P < 0.05). Only religiosity modified this association (P = 0.04), with a weaker association among women reporting higher levels of religiosity.

Conclusions:

The protective effects of religiosity may be leveraged in interventions for African-American women living with HIV struggling with HIV-related stigma.
Markers of Bone Mineral Metabolism and Cardiac Structure and Function in Perinatally HIV-Infected and HIV-Exposed but Uninfected Children and Adolescents
Authors: Margossian Renee , Williams Paige L. , Yu Wendy , Jacobson Denise L. , Geffner Mitchell E. , DiMeglio Linda A. , Van Dyke Russell B. , Spector Stephen A. , Schuster Gertrud U. , Stephensen Charles B. , Miller Tracie L. , Lipshultz Steven E. ,   for the Pediatric HIV/AIDS Cohort Study (PHACS)
Published: March 2019

Background:

Disordered bone mineral metabolism and low vitamin D concentrations are associated with cardiovascular abnormalities; few studies have evaluated this relationship in HIV-infected youth.

Setting:

The Adolescent Master Protocol is a Pediatric HIV/AIDS Cohort Study network study conducted across 14 US sites.

Methods:

Among perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected (PHEU) youth enrolled in the Adolescent Master Protocol, we evaluated associations of vitamin D [measured as 25-hydroxy-vitamin D (25-OHD)], parathyroid hormone (PTH), calcium, phosphate, and fibroblast growth factor-23 (FGF-23) concentrations with echocardiographic measures of left ventricular (LV) structure, function, and concentrations of NT-proBNP, a biomarker of cardiac damage.

Results:

Among 485 participants (305 PHIV and 180 PHEU) with echocardiograms and bone mineralization measures, low 25-OHD (<20 ng/mL) was common among all participants (48% PHIV and 44% PHEU), but elevated PTH (>65 pg/mL) was identified more often among PHIV participants than PHEU participants (9% vs 3%, P = 0.02). After adjusting for HIV status and demographic covariates, both low 25-OHD and elevated PTH were associated with lower mean LV mass z-scores, whereas elevated PTH was associated with higher mean fractional shortening z-scores. Participants with low 25-OHD also had slightly higher mean LV end-systolic wall stress z-scores, but differences were more pronounced in PHEU participants than in PHIV participants. FGF-23 was inversely related to end-diastolic septal thickness, both overall and among PHIV participants.

Conclusions:

In this cohort of PHIV and PHEU youth, we observed associations of 25-OHD, PTH, and FGF-23 with both structural and functional cardiac parameters, supporting links between bone mineral metabolism and cardiac status.
A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living With HIV in Asia
Authors: Ross Jeremy L. , Teeraananchai Sirinya , Lumbiganon Pagakrong , Hansudewechakul Rawiwan , Chokephaibulkit Kulkanya , Khanh Truong Huu , Van Nguyen Lam , Mohamed Thahira A Jamal , Yusoff Nik Khairulddin Nik , Fong Moy Siew , Prasitsuebsai Wasana , Sohn Annette H. , Kerr Stephen J. ,   on behalf of the TApHOD ACASI study group of IeDEA Asia-Pacific
Published: March 2019

Background:

Adolescents living with HIV (ALHIV) have poorer adherence and clinical outcomes than adults. We conducted a study to assess behavioral risks and antiretroviral therapy outcomes among ALHIV in Asia.

Methods:

A prospective cohort study among ALHIV and matched HIV-uninfected controls aged 12–18 years was conducted at 9 sites in Malaysia, Thailand, and Vietnam from July 2013 to March 2017. Participants completed an audio computer-assisted self-interview at weeks 0, 48, 96, and 144. Virologic failure (VF) was defined as ≥1 viral load (VL) measurement >1000 copies/mL. Generalized estimating equations were used to identify predictors for VF.

Results:

Of 250 ALHIV and 59 HIV-uninfected controls, 58% were Thai and 51% females. The median age was 14 years at enrollment; 93% of ALHIV were perinatally infected. At week 144, 66% of ALHIV were orphans vs. 28% of controls (P < 0.01); similar proportions of ALHIV and controls drank alcohol (58% vs. 65%), used inhalants (1% vs. 2%), had been sexually active (31% vs. 21%), and consistently used condoms (42% vs. 44%). Of the 73% of ALHIV with week 144 VL testing, median log VL was 1.60 (interquartile range 1.30–1.70) and 19% had VF. Over 70% of ALHIV had not disclosed their HIV status. Self-reported adherence ≥95% was 60% at week 144. Smoking cigarettes, >1 sexual partner, and living with nonparent relatives, a partner or alone, were associated with VF at any time.

Conclusions:

The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.
Pulmonary Insufficiency
Authors: Secchi Francesco , Chessa Massimo , Petrini Marcello , Monti Caterina B. , Alì Marco , Cannaò Paola M. , Di Leo Giovanni , Sardanelli Francesco
Published: March 2019

Objective:

The objective of this study was to compare the use of pulmonary regurgitation volume (PRV) or indexed PRV (PRVi) with that of pulmonary regurgitation fraction (PRF) in the assessment of patients with pulmonary regurgitation (PR) undergoing cardiac magnetic resonance (CMR) imaging.

Materials and Methods:

CMR of 176 patients with PR were retrospectively evaluated. Their right ventricular diastolic (end-diastolic volume index [EDVi]) and systolic (end-systolic volume index) volume indexes, stroke volume, and ejection fraction were obtained from cine CMR sequences, whereas phase-contrast flow sequences were analyzed to obtain PRV, PRVi, and PRF. Patients were divided into subgroups, according to underlying pathology and according to PR severity. Correlations between PRV or PRF and RV parameters were studied through Spearman ρ, both in the main group and subgroups. Follow-up examinations were analyzed, and correlations between PRV or PRF from the first CMR examination and volume data from the second were calculated.

Results:

Tetralogy of Fallot was the main setting of PR (98/179). Overall, EDVi strongly correlates with PRV (ρ=0.592, P<0.001) than with PRF (ρ=0.522, P<0.001), and end-systolic volume index strongly correlates with PRV (ρ=0.454, P<0.001) and PRF (ρ=0.406, P <0.001). As regards subgroup analysis, in moderate or severe PR patients, EDVi strongly correlates (P=0.043) with PRV (ρ=0.499, P<0.001) than with PRF (ρ=0.317, P<0.001). Follow-up EDVi correlates with PRV (ρ=0.450, P=0.031), but not with PRF.

Conclusions:

Especially when assessing moderate to severe PR, PRV and PRVi may be better indicators of right ventricular dysfunction than PRF. Moreover, PRV may be a predictor of worsening RV dilation.