Ann Elizabeth Kurth's additional information
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Publications
Performance of a new, rapid assay for detection of Trichomonas vaginalis
AbstractKurth, A., Whittington, W. L., Golden, M. R., Thomas, K. K., Holmes, K. K., & Schwebke, J. R. (2004). Journal of Clinical Microbiology, 42(7), 2940-2943. 10.1128/JCM.42.7.2940-2943.2004AbstractTrichomonas vaginalis infection is highly prevalent, may have serious health consequence, and is readily treatable. However, screening has been limited by currently available tests, which tend to be insensitive, expensive, or require a delay before results are reported. The XenoStrip-Tv (Xenotope Diagnostics, Inc., San Antonio, Tex.) was evaluated on vaginal swab specimens from 936 women attending sexually transmitted disease clinics in Seattle, Wash. (n = 497), and Birmingham, Ala. (n = 439). T. vaginalis prevalence by culture (InPouch; Biomed) was 8.7% in Seattle and 21.0% in Birmingham. Compared to culture, the XenoStrip assay in Seattle was 76.7% (95% confidence interval [95% CI] = 61.4 to 88.2) sensitive and 99.8% (95% CI = 98.8 to 99.9) specific, and in Birmingham it was 79.4% (95% CI = 69.6 to 87.1) sensitive and 97.1% (95% CI = 94.8 to 98.6) specific. The positive predictive values were 97.1% in Seattle and 87.9% in Birmingham; the negative predictive values were 97.8 and 94.7%, respectively. Rapid test performance did not vary by vaginal symptoms or by the presence of other vaginal or cervical syndromes or infections. The sensitivity did vary by day of culture-positive result, with a 71% decline in XenoStrip sensitivity for every additional day delay until T. vaginalis was first detected in cultures (odds ratio = 0.29, 95% CI = 0.18 to 0.49). The rapid assay was more sensitive than wet preparation microscopy (78.5% versus 72.4% [P = 0.04]) but was less specific (98.6% versus 100% [P = 0.001]). The XenoStrip rapid assay is well suited for use in settings with a moderately high prevalence of T. vaginalis infection, particularly when microscopy is not practical.Designing an HIV counseling and testing program for bathhouses: The Seattle experience with strategies to improve acceptability
AbstractSpielberg, F., Branson, B. M., Goldbaum, G. M., Kurth, A., & Wood, R. W. (2003). Journal of Homosexuality, 44(3), 203-220. 10.1300/J082v44n03_09AbstractBathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively fcw bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.Overcoming barriers to HIV testing: Preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men
AbstractSpielberg, F., Branson, B. M., Goldbaum, G. M., Lockhart, D., Kurth, A., Celum, C. L., Rossini, A., Critchlow, C. W., & Wood, R. W. (2003). Journal of Acquired Immune Deficiency Syndromes, 32(3), 318-327. 10.1097/00126334-200303010-00012AbstractObjective: To determine strategies to overcome barriers to HIV testing among persons at risk. Methods: We developed a survey that elicited testing motivators, barriers, and preferences for new strategies among 460 participants at a needle exchange, three sex venues for men who have sex with men, and a sexually transmitted disease clinic. Results: Barriers to testing included factors influenced by individual concern (fear and discrimination); by programs, policies, and laws (named reporting and inability to afford treatment); and by counseling and testing strategies (dislike of counseling, anxiety waiting for results, and venipuncture). The largest proportions of participants preferred rapid testing strategies, including clinic-based testing (27%) and home selftesting (20%); roughly equal proportions preferred oral fluid testing (18%), urine testing (17%), and standard blood testing (17%). One percent preferred home specimen collection. Participants who had never tested before were significantly more likely to prefer home self-testing compared with other strategies. Blacks were significantly more likely to prefer urine testing. Conclusions: Strategies for improving acceptance of HIV counseling and testing include information about access to anonymous testing and early treatment. Expanding options for rapid testing, urine testing, and home self-testing; providing alternatives to venipuncture; making pretest counseling optional; and allowing telephone results disclosure may encourage more persons to learn their HIV status.Acceptance of alternative HIV counseling and testing strategies (rapid, oral fluid, counseling option vs. standard)
Spielberg, F., Goldbaum, G., Rossini, A., Lockhart, D., Kurth, A., Wood, R., & Branson, B. (2001). International Journal of STD and AIDS, 12(57).Moving from apprehension to action: HIV counseling and testing preferences in three at-risk populations
AbstractSpielberg, F., Kurth, A., Gorbach, P. M., & Goldbaum, G. (2001). AIDS Education and Prevention, 13(6), 524-540. 10.1521/aeap.13.6.524.21436AbstractThis study sought to identify factors influencing HIV testing decisions among clients at a sexually transmitted disease clinic, gay men, and injection drug users. Focus group and intensive interview data were collected from 100 individuals. The AIDS Risk Reduction Model was adapted to describe factors that affect test decisions. Testing barriers and facilitators were grouped as factors affected by "Individual" beliefs, "System" policies and programs, "Testing" technology, and "Counseling" options. Individual factors (fear of death and change), system factors (anonymous test availability, convenience), and counseling and testing factors (rapid results, counseling alternatives) interact to determine whether an individual does not test ("apprehension") or does test ("action"), and ultimately, tests routinely ("integration"). In conclusion, traditional HIV testing presents barriers to some populations at risk for HIV. These findings suggest several strategies to improve HIV test acceptance: acknowledge fears, address system barriers, utilize available test technologies, and expand counseling options.Reproductive and sexual health benefits in private health insurance plans in Washington State
AbstractKurth, A., Bielinski, L., Graap, K., Conniff, J., & Connell, F. A. (2001). Family Planning Perspectives, 33(4), 153-160+179. 10.2307/2673718AbstractContext: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. Methods: A survey administered to a market-representative sample of 12 health insurance carders in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, and sterilization, as well as for the existence of confidentiality policies. "Core" services in each category were defined based on U.S. Preventive Services Task Force and other recommendations. Results: Of the 91 top-selling plans on which data were collected, 8% were indemnity plans, 14% were point-of-service plans, 21% were preferred-provider organization plans and 57% were health maintenance organization (HMO)-type products; they had a combined enrollment of 1.4 million individuals. Coverage of core services varied widely by type of plan. While a high proportion of plans covered core gynecologic, maternity, reproductive cancer screening, STD and HIV and AIDS services, nearly half of plans did not cover any kind of contraceptive method. Approximately 13% of female enrollees did not have core coverage for gynecologic services, 19% for maternity services, 75% for contraception, 37% for sterilization and 53% for pregnancy termination; 98% of women and men were not covered for infertility treatment. Most carriers did not have specific policies for maintaining privacy of sensitive health information. Overall, benefit coverage was lower for indemnity, preferred-provider organization and HMO plans in Washington State than has previously been seen nationally. Conclusions: A sizable proportion of women and men in Washington State who rely on private-sector health insurance lack comprehensive coverage for key reproductive and sexual health services.STD/HIV risk: What should we measure, and how should we measure it?
Kurth, A., Spielberg, F., & Rossini, A. (2001). International Journal of STD and AIDS, 12(171).The needs of special populations
Kurth, A. (1998). In J. Flaskerud & P. Ungvarski (Eds.), HIV/AIDS: Women, pregnant women, lesbians, and transgender/transsexual persons (4th eds., 1–, pp. 308-321). WB Saunders.Promoting sexual health in the age of HIV/AIDS
AbstractKurth, A. (1998). Journal of Nurse-Midwifery, 43(3), 162-181. 10.1016/S0091-2182(98)00004-4AbstractIdentifying, managing, and preventing HIV infection and other sexually transmitted diseases (STDs) are essential components of women's health care. Biological, sociocultural, and epidemiological risks, including STDs, increase the likelihood that a woman will become infected with HIV. Infection with a STD facilitates the likelihood of infection with HIV, and many of the same risk behaviors and interventions are relevant. Promoting sexual health in the age of HIV/AIDS necessitates the acknowledgment of behavioral and social aspects of sexuality, as well as clinical approaches and skills that support safer and satisfying sexual lives for women. This article reviews the use of sexual and substance use risk assessment, individualized counseling, and risk-reduction strategies for women to improve sexual health.Clinical and psychological needs of HIV-positive women living outside of HIV epicenters
Kurth, A., & Jones, C. (1996). In HIV/AIDS education in rural settings (1–, pp. 16-23). Eta Sigma Gamma.