Ann Elizabeth Kurth

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Publications

Publications

Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 161(8), 587-93.

Computerized counseling reduces HIV-1 Viral load and sexual transmission risk: Findings from a randomized controlled trial

Kurth, A. E., Spielberg, F., Cleland, C. M., Lambdin, B., Bangsberg, D. R., Frick, P. A., Severynen, A. O., Clausen, M., Norman, R. G., Lockhart, D., Simoni, J. M., & Holmes, K. K. (2014). Journal of Acquired Immune Deficiency Syndromes, 65(5), 611-620. 10.1097/QAI.0000000000000100

Abstract

Abstract

Objective: Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. Design: Longitudinal randomized controlled trial. Settings: An academic HIV clinic and a community-based organization in Seattle. Subjects: In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). Intervention: Randomization to computerized counseling or assessment only, 4 sessions over 9 months. Main Outcome Measures: HIV-1 viral suppression, and selfreported ART adherence and transmission risks, compared using generalized estimating equations. Results: Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (<30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. Conclusions: Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.

An effective intervention to reduce intravaginal practices among HIV-1 uninfected Kenyan women

Sivapalasingam, S., McClelland, R. S., Ravel, J., Ahmed, A., Cleland, C. M., Gajer, P., Mwamzaka, M., Marshed, F., Shafi, J., Masese, L., Fajans, M., Anderson, M. E., Jaoko, W., & Kurth, A. E. (2014). AIDS Research and Human Retroviruses, 30(11), 1046-1054. 10.1089/aid.2013.0251

Abstract

Abstract

Intravaginal practices (IVP) are common among African women and are associated with HIV acquisition. A behavioral intervention to reduce IVP is a potential new HIV risk-reduction strategy. Fifty-eight HIV-1-uninfected Kenyan women reporting IVP and 42 women who denied IVP were followed for 3 months. Women using IVP attended a skill-building, theory-based group intervention occurring weekly for 3 weeks to encourage IVP cessation. Vaginal swabs at each visit were used to detect yeast, to detect bacterial vaginosis, and to characterize the vaginal microbiota. Intravaginal insertion of soapy water (59%) and lemon juice (45%) was most common among 58 IVP women. The group-counseling intervention led to a decrease in IVP from 95% (54/58) at baseline to 0% (0/39) at month 3 (p=0.001). After 3 months of cessation, there was a reduction in yeast on vaginal wet preparation (22% to 7%, p=0.011). Women in the IVP group were more likely to have a Lactobacillus iners-dominated vaginal microbiota at baseline compared to controls [odds ratio (OR), 6.4, p=0.006] without significant change in the microbiota after IVP cessation. The group counseling intervention was effective in reducing IVP for 3 months. Reducing IVP may be important in itself, as well as to support effective use of vaginal microbicides, to prevent HIV acquisition.

Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: Opportunities and challenges

McMahon, J. M., Myers, J. E., Kurth, A. E., Cohen, S. E., Mannheimer, S. B., Simmons, J., Pouget, E. R., Trabold, N., & Haberer, J. E. (2014). AIDS Patient Care and STDs, 28(9), 462-474. 10.1089/apc.2013.0302

Abstract

Abstract

Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP - injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.

Preferences for daily or intermittent pre-exposure prophylaxis regimens and ability to anticipate sex among HIV uninfected members of Kenyan HIV serodiscordant couples

Roberts, S. T., Heffron, R., Ngure, K., Celum, C., Kurth, A., Curran, K., Mugo, N., & Baeten, J. M. (2014). AIDS and Behavior, 18(9), 1701-1711. 10.1007/s10461-014-0804-1

Abstract

Abstract

Intermittent dosing for pre-exposure prophylaxis (PrEP) has been proposed as an alternative to daily PrEP to reduce cost and patient drug exposure and to improve adherence. One possible dosing regimen is pre-intercourse PrEP, which requires anticipating sex in advance. We examined preferences for daily versus pre-intercourse PrEP and ability to anticipate sex among 310 HIV uninfected members of HIV serodiscordant heterosexual couples in Thika, Kenya, with high HIV knowledge and experience with daily PrEP use in a clinical trial setting. Preferences were evenly split between daily PrEP (47.4 %) and pre-intercourse PrEP (50.7 %). Participants were more likely to prefer daily PrEP if they reported unprotected sex during the prior month (adjusted prevalence ratio [aPR] 1.48, 95 % CI 1.20-1.81) or <80 % adherence to study drug (aPR 1.50, 95 % CI 1.25-1.79), and were less likely to prefer daily PrEP if sex was usually planned, versus spontaneous (aPR 0.76, 95 % CI 0.61-0.96). A minority (24.2 %) reported anticipating sex >3 h in advance, with younger participants being less likely to do so (aPR 0.43, 95 % CI 0.23-0.83 for ages 18-29 vs. ≥40). Findings suggest that intermittent PrEP could be a popular option in this population, but that optimal adherence and sufficient drug levels might be challenging with a pre-intercourse regimen.

Screening for abdominal aortic aneurysm: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 161(4), 281-290.

Screening for asymptomatic cartoid artery stenosis: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 161(5), 356-362.

Screening for chlamydia and gonorrhea: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 161(12), 902-910.

Screening for Hepatitus B virus infection in nonpregnant adolescents and adults: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 161(1), 58-66.

Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventative Services Task Force recommendation statement

LeFevre, M. L., & Kurth, A. (2014). Annals of Internal Medicine, 160(10), 719-726.