Ann Elizabeth Kurth's additional information
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Publications
The gender context of HIV risk and pregnancy goals in western Kenya
Kurth, A., Inwani, I. W., Wangombe, A., Nduati, R., Owuor, M., Njiri, F., Akinyi, P., Cherutich, P., Osoti, A., Kinuthia, J., Chhun, N., & Kiarie, J. (2015). East African Medical Journal.HIV prevalence, estimated incidence, and risk behaviors among people who inject drugs in Kenya
AbstractKurth, A. E., Cleland, C. M., Des Jarlais, D. C., Musyoki, H., Lizcano, J. A., Chhun, N., & Cherutich, P. (2015). Journal of Acquired Immune Deficiency Syndromes, 70(4), 420-427. 10.1097/QAI.0000000000000769AbstractObjective: HIV infection in sub-Saharan Africa increasingly occurs among people who inject drugs (PWID). Kenya is one of the first to implement a national needle and syringe program. Our study undertook a baseline assessment as part of evaluating needle and syringe program in a seek, test, treat, and retain approach. Methods: Participants enrolled between May and December 2012 from 10 sites. Respondent-driven sampling was used to reach 1785 PWID for HIV-1 prevalence and viral load determination and survey data. Results: Estimated HIV prevalence, adjusted for differential network size and recruitment relationships, was 14.5% in Nairobi (95% CI: 10.8 to 18.2) and 20.5% in the Coast region (95% CI: 17.3 to 23.6). Viral load (log10 transformed) in Nairobi ranged from 1.71 to 6.12 (median: 4.41; interquartile range: 3.51-4.94) and in the Coast from 1.71 to 5.88 (median: 4.01; interquartile range: 3.44- 4.72). Using log10 viral load 2.6 as a threshold for HIV viral suppression, the percentage of HIV-infected participants with viral suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most commonly injected drug in both regions, used by 93% of participants in the past month, typically injecting 2-3 times/day. Receptive needle/syringe sharing at last injection was more common in Nairobi (23%) than in the Coast (4%). Estimated incidence among new injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in the Coast. Conclusions: The HIV epidemic is well established among PWID in both Nairobi and Coast regions. Public health scale implementation of combination HIV prevention has the potential to greatly limit the epidemic in this vulnerable and bridging population.HIV self-testing: Strategies to enhance and measure linkage to care
Cherutich, P., Kurth, A., Musyoki, H., Kilonzo, N., & Maina, W. (2015). Retrovirology: Research and Treatment.HIV testing and linkage to services for youth
AbstractKurth, A. E., Lally, M. A., Choko, A. T., Inwani, I. W., & Fortenberry, J. D. (2015). Journal of the International AIDS Society, 18(2), 23-28. 10.7448/IAS.18.2.19433AbstractIntroduction: HIV testing is the portal to serostatus knowledge that can empower linkage to care for HIV treatment and HIV prevention. However, young people's access to HIV testing is uneven worldwide. The objective of this paper is to review the context and concerns faced by youth around HIV testing in low- as well as high-income country settings. Discussion: HIV testing is a critical entry point for primary and secondary prevention as well as care and treatment for young people including key populations of vulnerable youth.We provide a framework for thinking about the role of testing in the continuum of prevention and care for young people. Brief case study examples from Kenya and the US illustrate some of the common barriers and issues involved for young people. Conclusions: Young people worldwide need more routine access to HIV testing services that effectively address the developmental, socio-political and other issues faced by young women and men.IAPAC guidelines for optimizing the HIV care continuum for adults and adolescents
AbstractBekker, L. G., Montaner, J., Ramos, C., Sherer, R., Celletti, F., Cutler, B., Dabis, F., Granich, R., Greenberg, A., Goldenberg, S., Hull, M., Kerr, T., Kurth, A., Mayer, K., Metsch, L., Mugo, N. R., Munderi, P., Nachega, J., Nosyk, B., … Zorrilla, C. (2015). Journal of the International Association of Providers of AIDS Care, 14, S3-S34. 10.1177/2325957415613442AbstractBackground: An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. Methods: A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. Recommendations: Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study
AbstractRhodes, T., Guise, A., Ndimbii, J., Strathdee, S., Ngugi, E., Platt, L., Kurth, A., Cleland, C., & Vickerman, P. (2015). BMJ Open, 5(3). 10.1136/bmjopen-2014-007198AbstractBackground and objectives: Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. Methods, setting and participants: We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. Results: The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of 'rationed expectation' in relation to access to care and a 'poverty of drug treatment opportunity'. In this context, the promise of methadone may be narrated as a symbol of hope - both for individuals and community - in relation to addiction recovery. Conclusions: Methadone offers HIV prevention potential, but there is a need to better model the effects of sexual HIV transmission in mediating the impact of OST among PWID in settings characterised by a combination of generalised and concentrated epidemics. We find that individual and community narratives of methadone as hope for recovery coexist with policy narratives positioning methadone primarily in relation to HIV prevention. Our analyses show the value of mixed methods approaches to investigating newly-introduced interventions.Knowledge, beliefs and practices regarding antiretroviral medications for HIV prevention: Results from a survey of healthcare providers in New England
AbstractKrakower, D. S., Oldenburg, C. E., Mitty, J. A., Wilson, I. B., Kurth, A. E., Maloney, K. M., Gallagher, D., & Mayer, K. H. (2015). PloS One, 10(7). 10.1371/journal.pone.0132398AbstractBackground: Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and preexposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods: Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results: Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01-1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98-11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34), whereas female gender (aOR 0.26, 95% CI 0.10-0.71) was associated with having not prescribed PrEP. Conclusions: These findings suggest many clinicians have shifted towards routinely recommending early ART, but not PrEP, so interventions to facilitate PrEP provision are needed.Lessons learned
Kurth, A., Squires, A., Shedlin, M., & Kiarie, J. (2015). In . Corliss Et Al. (Ed.), Global health nursing in the 21st century: Interdisciplinary collaborations in global health research (1–, pp. 547-563).A pilot study of rapid Hepatitus C virus testing in the Rhode Island Department of Corrections
Beckwith, C. G., Kurth, A., Bazerman, L., Patry, E., Tran, L., Cates, A., Trezza, C., Chapin, K., Vohr, F., Flanigan, T., Larney, S., & Kuo, I. (2015). Journal of Public Health, 1-8.Rethinking HIV prevention to prepare for oral PrEP implementation for young African women
AbstractCelum, C. L., Delany-Moretlwe, S., McConnell, M., Van Rooyen, H., Bekker, L. G., Kurth, A., Bukusi, E., Desmond, C., Morton, J., & Baeten, J. M. (2015). Journal of the International AIDS Society, 18. 10.7448/IAS.18.4.20227AbstractIntroduction: HIV incidence remains high among young women in sub-Saharan Africa in spite of scale-up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence-based HIV prevention strategies, particularly emerging interventions such as pre-exposure prophylaxis (PrEP). Discussion: Women in sub-Saharan Africa are at increased risk of HIV during adolescence and into their 20s, in part due to contextual factors including gender norms and relationship dynamics, and limited access to reproductive and sexual health services. We reviewed behavioural, behavioural economic and biomedical approaches to HIV prevention for young African women, with a particular focus on the barriers, opportunities and implications for implementing PrEP in this group. Behavioural interventions have had limited impact in part due to not effectively addressing the context, broader sexual norms and expectations, and structural factors that increase risk and vulnerability. Of biomedical HIV prevention strategies that have been tested, daily oral PrEP has the greatest evidence for protection, although adherence was low in two placebo-controlled trials in young African women. Given high efficacy and effectiveness in other populations, demonstration projects of open-label PrEP in young African women are needed to determine the most effective delivery models and whether women at substantial risk are motivated and able to use oral PrEP with sufficient adherence to achieve HIV prevention benefits. Conclusions: Social marketing, adherence support and behavioural economic interventions should be evaluated as part of PrEP demonstration projects among young African women in terms of their effectiveness in increasing demand and optimizing uptake and effective use of PrEP. Lessons learned through evaluations of implementation strategies for delivering oral PrEP, a firstgeneration biomedical HIV prevention product, will inform development of new and less user-dependent PrEP formulations and delivery of an expanding choice of prevention options in HIV prevention programmes for young African women.