Ann Elizabeth Kurth

Ann Elizabeth Kurth's additional information

Publications

Publications

Antiretroviral therapy in prevention of HIV and TB: Update on current research efforts

Kurth, A., & Al., . (2011). Current HIV Research, 9(6), 446-469.

Association between participant self-report and biological outcomes used to measure sexual risk behavior in human immunodeficiency virus-1-seropositive female sex workers in Mombasa, Kenya

McClelland, R. S., Richardson, B. A., Wanje, G. H., Graham, S. M., Mutunga, E., Peshu, N., Kiarie, J. N., Kurth, A. E., & Jaoko, W. (2011). Sexually Transmitted Diseases, 38(5), 429-433. 10.1097/OLQ.0b013e31820369f6

Abstract

Abstract

Background: Few studies have examined the association between self-reported sexual risk behaviors and biologic outcomes in human immunodeficiency virus (HIV)-1-seropositive African adults. Methods: We conducted a prospective cohort study in 898 HIV-1-seropositive women who reported engaging in transactional sex in Mombasa, Kenya. Primary outcome measures included detection of sperm in genital secretions, pregnancy, and sexually transmitted infections. Because 3 outcomes were evaluated, data are presented with odds ratios [OR] and 96.7% confidence intervals [CI] to reflect that we would reject a null hypothesis if a P-value was ≤0.033 (Simes' methodology). Results: During 2404 person-years of follow-up, self-reported unprotected intercourse was associated with significantly higher likelihood of detecting sperm in genital secretions (OR: 2.32, 96.7% CI: 1.93, 2.81), and pregnancy (OR: 2.78, 96.7% CI: 1.57, 4.92), but not with detection of sexually transmitted infections (OR: 1.20, 96.7% CI: 0.98, 1.48). At visits where women reported being sexually active, having >1 sex partner in the past week was associated with lower likelihood of detecting sperm in genital secretions (OR: 0.74, 96.7% CI: 0.56, 0.98). This association became nonsignificant after adjustment for reported condom use (adjusted OR: 0.81, 96.7% CI: 0.60, 1.08). Conclusions: Combining behavioral and biologic outcomes, which provide complementary information, is advantageous for understanding sexual risk behavior in populations at risk for transmitting HIV-1. The paradoxical relationship between higher numbers of sex partners and less frequent identification of sperm in genital secretions highlights the potential importance of context-specific behavior, such as condom use dependent on partner type, when evaluating sexual risk behavior.

Change in sexual activity 12 months after ART initiation among HIV-positive mozambicans

Pearson, C. R., Cassels, S., Kurth, A. E., Montoya, P., Micek, M. A., & Gloyd, S. S. (2011). AIDS and Behavior, 15(4), 778-787. 10.1007/s10461-010-9852-3

Abstract

Abstract

We assessed sexual behaviors before and 12-months after ART initiation among 277 Mozambicans attending an HIV clinic. Measured behaviors included the number of sexual partners, condom use, concurrent relationships, disclosure of HIV status, alcohol use, and partners' serostatus. Compared to before ART initiation, increases were seen 12 months after ART in the proportion of participants who were sexually active (48% vs. 64% respondents, P <0.001) and the proportion of participants with HIV-negative or unknown serostatus partners (45% vs. 80%, P < 0.001). Almost all (96%) concurrent partnerships reported at 12 months formed after ART initiation. Although reported correct and consist condom use increased, the number of unprotected sexual relationships remained the same (n = 45). Non-disclosure of HIV-serostatus to sexual partners was the only significant predictor of practicing unprotected sex with partners of HIV-negative or unknown serostatus. Sexual activity among HIV-positive persons on ART increased 12 months after ART initiation. Ongoing secondary transmission prevention programs addressing sexual activity with multiple partners, disclosure to partners and consistent condom use with serodisconcordant partners must be incorporated throughout HIV care programs.

Combination HIV prevention: Significance, challenges, and opportunities

Kurth, A. E., Celum, C., Baeten, J. M., Vermund, S. H., & Wasserheit, J. N. (2011). Current HIV AIDS Reports, 8(1), 62-72. 10.1007/s11904-010-0063-3

Abstract

Abstract

No single HIV prevention strategy will be sufficient to control the HIV pandemic. However, a growing number of interventions have shown promise in partially protecting against HIV transmission and acquisition, including knowledge of HIV serostatus, behavioral risk reduction, condoms, male circumcision, needle exchange, treatment of curable sexually transmitted infections, and use of systemic and topical antiretroviral medications by both HIV-infected and uninfected persons. Designing the optimal package of interventions that matches the epidemiologic profile of a target population, delivering that package at the population level, and evaluating safety, acceptability, coverage, and effectiveness, all involve methodological challenges. Nonetheless, there is an unprecedented opportunity to develop "prevention packages" that combine various arrays of evidence-based strategies, tailored to the needs of diverse subgroups and targeted to achieve high coverage for a measurable reduction in population-level HIV transmission. HIV prevention strategies that combine partially effective interventions should be scaled up and evaluated.

Computer-facilitated rapid HIV testing in emergency care settings: Provider and patient usability and acceptability

Spielberg, F., Kurth, A. E., Severynen, A., Hsieh, Y. H., Moring-Parris, D., Mackenzie, S., & Rothman, R. (2011). AIDS Education and Prevention, 23(3), 206-221. 10.1521/aeap.2011.23.3.206

Abstract

Abstract

Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, CARE, to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

HIV-related research in correctional populations: Now is the time

Kurth, A., & Al., . (2011). Current HIV AIDS Reports, 8(4), 288-296.

Is 60 seconds enough? Can talking pill bottles be used in the community pharmacy setting?

Lam, A., Wolpin, S., Nguyen, J., Berry, D. L., Kurth, A., & Morisky, D. E. (2011, January 1). In Journal of the American Pharmacists Association (Vols. 51, Issues 5, pp. 569-570). 10.1331/JAPhA.2011.10096

Iterative evaluation in a mobile counseling and testing program to reach people of color at risk for HIV-new strategies improve program acceptability, effectiveness, and evaluation capabilities

Spielberg, F., Kurth, A., Reidy, W., McKnight, T., Dikobe, W., & Wilson, C. (2011). AIDS Education and Prevention, 23(3), 110-116. 10.1521/aeap.2011.23.3_supp.110

Abstract

Abstract

This article highlights findings from an evaluation that explored the impact of mobile versus clinic-based testing, rapid versus central-lab based testing, incentives for testing, and the use of a computer counseling program to guide counseling and automate evaluation in a mobile program reaching people of color at risk for HIV. The program's results show that an increased focus on mobile outreach using rapid testing, incentives and health information technology tools may improve program acceptability, quality, productivity and timeliness of reports. This article describes program design decisions based on continuous quality assessment efforts. It also examines the impact of the Computer Assessment and Risk Reduction Education computer tool on HIV testing rates, staff perception of counseling quality, program productivity, and on the timeliness of evaluation reports. The article concludes with a discussion of implications for programmatic responses to the Centers for Disease Control and Prevention's HIV testing recommendations.

Operational methods of HIV testing in emergency departments: A systematic review

Kurth, A., & Al., . (2011). Annals of Emergency Medicine, 58, 96-103.

Public health and clinical impact of increasing emergency department-based HIV testing: Perspectives from the 2007 Conference of the National Emergency Department HIV Testing Consortium

Kurth, A., & Al., . (2011). Annals of Emergency Medicine, 58, 151-159.