Ann Elizabeth Kurth's additional information
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Publications
CARE+ user study: usability and attitudes towards a tablet pc computer counseling tool for HIV+ men and women.
AbstractSkeels, M. M., Kurth, A., Clausen, M., Severynen, A., & Garcia-Smith, H. (2006). AMIA . Annual Symposium Proceedings AMIA Symposium. AMIA Symposium, 729-733.AbstractCARE+ is a tablet PC-based computer counseling tool designed to support medication adherence and secondary HIV prevention for people living with HIV. Thirty HIV+ men and women participated in our user study to assess usability and attitudes towards CARE+. We observed them using CARE+ for the first time and conducted a semi-structured interview afterwards. Our findings suggest computer counseling may reduce social bias and encourage participants to answer questions honestly. Participants felt that discussing sensitive subjects with a computer instead of a person reduced feelings of embarrassment and being judged, and promoted privacy. Results also confirm that potential users think computers can provide helpful counseling, and that many also want human counseling interaction. Our study also revealed that tablet PC-based applications are usable by our population of mixed experience computer users. Computer counseling holds great potential for providing assessment and health promotion to individuals with chronic conditions such as HIV.Cell phones as a health care intervention in Peru: The Cell-PREVEN project
Kurth, A. (2006). Globalization and Health, 2(9).HIV-1 acquisition and disease progression are associated with decreased high-risk sexual behaviour among Kenyan female sex workers
AbstractMcClelland, R. S., Hassan, W. M., Lavreys, L., Richardson, B. A., Mandaliya, K., Ndinya-Achola, J., Jaoko, W., Kurth, A. E., & Baeten, J. M. (2006). AIDS, 20(15), 1969-1973. 10.1097/01.aids.0000247119.12327.e6AbstractBACKGROUND: Changes in sexual risk behaviour may occur following HIV-1 infection. OBJECTIVE: To test the hypothesis that HIV-1 seroconversion and disease progression are associated with changes in risk behaviours, using data from a cohort of Kenyan female sex workers (FSWs). METHODS: HIV-1-seronegative FSWs were enrolled in a prospective cohort study of risk factors for HIV-1 acquisition. At monthly visits, standardized interviews were conducted to assess sexual risk behaviour and HIV-1 serologic testing was performed. Seroconverters were invited to continue with follow-up. Between 1993 and 2004 (when antiretroviral therapy was introduced in the cohort), 265 women seroconverted for HIV-1 (incidence 7.7/100 person-years) and were included in this analysis. RESULTS: Unprotected intercourse was reported at 546/2037 (27%) pre-seroconversion visits versus 557/3732 (15%) post-seroconversion visits (P < 0.001). These findings remained significant after adjustment for potential confounding factors [adjusted odds ratio (AOR) 0.69; 95% confidence interval (CI), 0.55-0.86]. Compared with HIV-1-seronegative women, there was a progressive stepwise decrease in unprotected intercourse among HIV-1-seropositive women with CD4 cell counts ≥ 500 (AOR, 0.93; 95% CI, 0.62-1.39), 200-499 (AOR, 0.58; 95% CI, 0.41-0.82) and < 200 cells/μl (AOR, 0.45; 95% CI, 0.25-0.82). Decreases in unprotected intercourse reflected increases in both abstinence and 100% condom use. Women also reported fewer partners and fewer episodes of intercourse after HIV-1 seroconversion. CONCLUSIONS: HIV-1 seroconversion and disease progression were associated with decreases in sexual risk behaviour among Kenyan FSWs.A qualitative evaluation of computer assessment and risk reduction education (CARE) for sexually transmitted infections: Patient and staff perspective
Mackenzie, S. L. C., Kurth, A., & Spielberg, F. (2006). Journal of Adolescent Health, 38(2), 134-135.Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management
AbstractSimoni, J. M., Kurth, A. E., Pearson, C. R., Pantalone, D. W., Merrill, J. O., & Frick, P. A. (2006). AIDS and Behavior, 10(3), 227-245. 10.1007/s10461-006-9078-6AbstractA review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode=7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.Choosing HIV counseling and testing strategies for outreach settings: A randomized trial
AbstractSpielberg, F., Branson, B. M., Goldbaum, G. M., Lockhart, D., Kurth, A., Rossini, A., & Wood, R. W. (2005). Journal of Acquired Immune Deficiency Syndromes, 38(3), 348-355.AbstractBackground: In surveys, clients have expressed preferences for alternatives to traditional HIV counseling and testing. Few data exist to document how offering such alternatives affects acceptance of HIV testing and receipt of test results. Objectives: This randomized controlled trial compared types of HIV tests and counseling at a needle exchange and 2 bathhouses to determine which types most effectively ensured that clients received test results. Methods: Four alternatives were offered on randomly determined days: (1) traditional test with standard counseling, (2) rapid test with standard counseling, (3) oral fluid test with standard counseling, and (4) traditional test with choice of written pretest materials or standard counseling. Results: Of 17,010 clients offered testing, 7014 (41%) were eligible; of those eligible, 761 (11%) were tested: 324 at the needle exchange and 437 at the bathhouses. At the needle exchange, more clients accepted testing (odds ratio [OR] = 2.3; P < 0.001) and received results (OR = 2.6; P < 0.001) on days when the oral fluid test was offered compared with the traditional test. At the bathhouses, more clients accepted oral fluid testing (OR = 1.6; P < 0.001), but more clients overall received results on days when the rapid test was offered (OR = 1.9; P = 0.01). Conclusions: Oral fluid testing and rapid blood testing at both outreach venues resulted in significantly more people receiving test results compared with traditional HIV testing. Making counseling optional increased testing at the needle exchange but not at the bathhouses.A national survey of clinic sexual histories for sexually transmitted infection and HIV screening
AbstractKurth, A. E., Holmes, K. K., Hawkins, R., & Golden, M. R. (2005). Sexually Transmitted Diseases, 32(6), 370-376. 10.1097/01.olq.0000154499.17511.0aAbstractBackground: Optimal elements of a sexual history for sexually transmitted infection (STI) and HIV risk assessment remain undefined. Goal: The goal of this study was to describe sexual histories in use at STI clinics across the United States. Study: This study consisted of a cross-sectional survey of facilities in cities with populations > 200,000 (n = 65). Within each city, a public health STI clinic (71% of the sample) or other STI care facility (29%) was randomly selected and sexual history forms were requested. Information was obtained from 48 clinics (74% response). Results: Most forms recorded information on symptoms and prior STI (96%), condom use (88%), other contraception (85%), and numbers and gender (83%) of sex partners. Common HIV risk questions were injecting drug use (IDU; 94%), sex for drugs or money (58%), and sex with an HIV-positive or IDU partner (52%). Ascertainment of time during which risks occurred (contact periods) varied from the past 14 days to the past 12 months, with only 38% of clinics using any 1 time period. Few histories (17%) incorporated questions for men who have sex with men (MSM). Only 2 (4%) had space to record Information about sexual behaviors by the HIV status of the sex partner. Condom use was infrequently assessed specifically for vaginal and anal sex (13%), and condom use problems were rarely explored (10%). Most forms documented STI/HIV counseling, although few (25%) included specific risk reduction plans. Conclusions: Sexual histories are highly variable. Although challenging to accomplish, STI/HIV care, surveillance, and prevention may be improved by developing consensus on core questions to be used in sexual histories.The benefit of health insurance coverage of contraceptives in a population-based sample
AbstractKurth, A., Weaver, M., Lockhart, D., & Bielinski, L. (2004). American Journal of Public Health, 94(8), 1330-1332. 10.2105/AJPH.94.8.1330AbstractThis study estimated the value of contraceptives, through a random-digit-dialed survey of willingness to pay for health insurance coverage of contraceptives among 659 Washington State adults. People valued contraceptives at 5 times the actuarial cost; in general, women and reproductive-aged persons were willing to pay more, but low-income men highly valued contraceptives. Most respondents (85%) said that contraceptives should be covered by health insurance plans. The full benefit of contraceptives exceeds their cost.A comparison between audio computer-assisted self-interviews and clinician interviews for obtaining the sexual history
AbstractKurth, A. E., Martin, D. P., Golden, M. R., Weiss, N. S., Heagerty, P. J., Spielberg, F., Handsfield, H. H., & Holmes, K. K. (2004). Sexually Transmitted Diseases, 31(12), 719-726. 10.1097/01.olq.0000145855.36181.13AbstractObjective: The objective of this study was to compare reporting between audio computer-assisted self-interview (ACASI) and clinician-administered sexual histories. Goal: The goal of this study was to explore the usefulness of ACASI in sexually transmitted disease (STD) clinics. Study: The authors conducted a cross-sectional study of ACASI followed by a clinician history (CH) among 609 patients (52% male, 59% white) in an urban, public STD clinic. We assessed completeness of data, item prevalence, and report concordance for sexual history and patient characteristic variables classified as socially neutral (n = 5), sensitive (n = 11), or rewarded (n = 4). Results: Women more often reported by ACASI than during CH same-sex behavior (19.6% vs. 11.5%), oral sex (67.3% vs. 50.0%), transactional sex (20.7% vs. 9.8%), and amphetamine use (4.9% vs. 0.7%) but were less likely to report STD symptoms (55.4% vs. 63.7%; all McNemar chi-squared P values <0.003). Men's reporting was similar between interviews, except for ever having had sex with another man (36.9% ACASI vs. 28.7% CH, P <0.001). Reporting agreement as measured by kappas and intraclass correlation coefficients was only moderate for socially sensitive and rewarded variables but was substantial or almost perfect for socially neutral variables. ACASI data tended to be more complete. ACASI was acceptable to 89% of participants. Conclusions: ACASI sexual histories may help to identify persons at risk for STDs.Importance of sex partner HIV status in HIV risk assessment among men who have sex with men
AbstractGolden, M. R., Brewer, D. D., Kurth, A., Holmes, K. K., & Handsfield, H. H. (2004). Journal of Acquired Immune Deficiency Syndromes, 36(2), 734-742. 10.1097/00126334-200406010-00011AbstractClinical HIV risk assessments have not typically integrated questions about sex partners' HIV status with questions about condom use and type of sex. Since 2001, we have asked all men who have sex with men (MSM) evaluated in an urban sexually transmitted disease (STD) clinic how often in the preceding 12 months they used condoms for anal sex with partners who were HIV-positive, HIV-negative, and of unknown HIV status. Overall, MSM displayed a pattern of assortative mixing by HIV status, particularly for unprotected anal intercourse (UAI). Nevertheless, 433 (27%) of 1580 MSM who denied knowing they were HIV-positive and 93 (43%) of 217 HIV-positive MSM reported having UAI with a partner of opposite or unknown HIV status. Among men who denied previously knowing they were HIV-positive, 24 (9.6%) of 251 MSM who reported having UAI with an HIV-positive partner or partner of unknown HIV status compared with 11 (1.7%) of 620 MSM who denied such exposure tested HIV-positive (odds ratio = 5.8, 95% confidence interval: 2.8-12.1). UAI with an HIV-positive partner or partner with unknown HIV status was 69% sensitive and 73% specific in identifying men with previously undiagnosed HIV infection; UAI regardless of partner HIV status was 80% sensitive but only 45% specific. The positive predictive value was highest for risk assessments that included partner HIV status. Integrating questions about anal sex partner HIV status and condom use identifies MSM at greatest risk for HIV acquisition and transmission. These risk criteria might be effectively used to triage MSM into more intensive prevention interventions.