Ann Elizabeth Kurth

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Publications

Publications

Risk behaviors and reasons for not getting tested for HIV among men who have sex with men: An online survey in Peru

Blas, M. M., Alva, I. E., Cabello, R., Carcamo, C., & Kurth, A. E. (2011). PloS One, 6(11). 10.1371/journal.pone.0027334

Abstract

Abstract

Background: Men who have sex with men (MSM) account for the greatest burden of the HIV epidemic in Peru. Given that MSM are frequent users of the Internet, understanding the risk behaviors and the reasons for not getting tested among MSM who surf the Internet may improve the tailoring of future online behavioral interventions. Methods: From October 2007 to April 2008, we conducted an online survey among users of seven Peruvian gay websites. Results: We received 1,481 surveys, 1,301 of which were included in the analysis. The median age of the participants was 22.5 years (range 12 - 71), 67% were homosexual, and the remainder was bisexual. Of survey respondents, 49.4% had never been tested for HIV and only 11.3% were contacted in-person during the last year by peer health educators from the Peruvian Ministry of Health and NGOs. Additionally, 50.8% had unprotected anal or vaginal sex at last intercourse, and a significant percentage reported a condom broken (22.1%), slipped (16.4%) or sexual intercourse initiated without wearing a condom (39.1%). The most common reasons for not getting tested for HIV among high-risk MSM were "I fear the consequences of a positive test result" (n = 55, 34.4%), and "I don't know where I can get tested" (n = 50, 31.3%). Conclusions: A small percentage of Peruvian MSM who answered our online survey, were reached by traditional peer-based education programs. Given that among high-risk MSM, fear of a positive test result and lack of awareness of places where to get tested are the most important reasons for not taking an HIV test, Internet interventions aimed at motivating HIV testing should work to reduce fear of testing and increase awareness of places that offer free HIV testing services to MSM.

Understanding the context of HIV risk behavior among HIV-positive and HIV-negative female sex workers and male bar clients following antiretroviral therapy rollout in Mombasa, Kenya

McClelland, L., Wanje, G., Kashonga, F., Kibe, L., McClelland, R. S., Kiarie, J., Mandaliya, K., Peshu, N., & Kurth, A. (2011). AIDS Education and Prevention, 23(4), 299-312. 10.1521/aeap.2011.23.4.299

Abstract

Abstract

This study explored perceptions of HIV following local introduction of antiretroviral therapy (ART), among 30 HIV-positive and -negative female sex workers (FSWs) and 10 male bar patrons in Mombasa, Kenya. Semistructured interviews were analyzed qualitatively to identify determinants of sexual risk behaviors. ART was not perceived as a barrier to safer sex and in some cases led to decreased high-risk behaviors. Barriers to safer sex included economic pressure and sexual partnership types. Many women reported that negotiating condom use is more difficult in long-term partnerships. These women favored short-term partnerships to minimize risk through consistent condom use. For women living with HIV, concern about maintaining health and avoiding HIV super infection was a strong motivator of protective behaviors. For HIV-negative women, a negative HIV test was a powerful motivator. Incorporation of context- and serostatus-specific factors (e.g., self-protection for HIV-positive women) into tailored prevention counseling may support high-risk women to reduce risk behaviors.

Design preferences and characteristics of a website for monitoring HIV medication adherence in Peru

Curioso, W. H., Heitzinger, K., Quistberg, D. A., Cabello, R., Gozzer, E., Garcia, P. J., Kurth, A., & Pratt, W. (2010). In Studies in Health Technology and Informatics (Vols. 160). IOS Press.

Developing concurrency messages to reduce HIV/AIDS disparities in Black communities

Andrasik, M. P., Chapman, C., Foster, J., Kurth, A., & Morris, M. (2010). Annals of Behavioral Medicine, 39(217).

Effect of an online video-based intervention to increase HIV testing in men who have sex with men in Peru

Blas, M. M., Alva, I. E., Carcamo, C. P., Cabello, R., Goodreau, S. M., Kimball, A. M., & Kurth, A. E. (2010). PloS One, 5(5). 10.1371/journal.pone.0010448

Abstract

Abstract

Background: Although many men who have sex with men (MSM) in Peru are unaware of their HIV status, they are frequent users of the Internet, and can be approached by that medium for promotion of HIV testing. Methods: We conducted an online randomized controlled trial to compare the effect of HIV-testing motivational videos versus standard public health text, both offered through a gay website. The videos were customized for two audiences based on self-identification: either gay or non-gay men. The outcomes evaluated were 'intention to get tested' and 'HIV testing at the clinic.' Findings: In the non-gay identified group, 97 men were randomly assigned to the video-based intervention and 90 to the text-based intervention. Non-gay identified participants randomized to the video-based intervention were more likely to report their intention of getting tested for HIV within the next 30 days (62.5% vs. 15.4%, Relative Risk (RR): 2.77, 95% Confidence Interval (CI): 1.42-5.39). After a mean of 125.5 days of observation (range 42-209 days), 11 participants randomized to the video and none of the participants randomized to text attended our clinic requesting HIV testing (p = 0.001). In the gay-identified group, 142 men were randomized to the video-based intervention and 130 to the textbased intervention. Gay-identified participants randomized to the video were more likely to report intentions of getting an HIV test within 30 days, although not significantly (50% vs. 21.6%, RR: 1.54, 95% CI: 0.74-3.20). At the end of follow up, 8 participants who watched the video and 10 who read the text visited our clinic for HIV testing (Hazard Ratio: 1.07, 95% CI: 0.40-2.85). Conclusion: This study provides some evidence of the efficacy of a video-based online intervention in improving HIV testing among non-gay-identified MSM in Peru. This intervention may be adopted by institutions with websites oriented to motivate HIV testing among similar MSM populations.

Improving health literacy: A web application for evaluating text-to-speech engines

Wolpin, S., Berry, D. L., Kurth, A., & Lober, W. B. (2010). CIN - Computers Informatics Nursing, 28(4), 198-204. 10.1097/NCN.0b013e3181e1ddca

Abstract

Abstract

The Internet is increasingly used as a medium for gathering and exchanging health information exchange. Healthcare professionals and organizations need to consider barriers that may exist within their patient-oriented Web applications. One approach to making the Web more accessible for those with lower health literacy may be to supplement textual content with audio annotation using text-to-speech engines, allowing for the creation of a virtual surrogate reader. One challenge is that with numerous text-to-speech engines on the market, objective measures of quality are difficult to obtain. To facilitate comparisons of text-to-speech engines, we developed an open-source Web application that measures user reaction times, subjective quality ratings, and accuracy in completing tasks across different audio files created by text-to-speech engines. Our research endeavor was successful in building and piloting this Web application; significant differences were found for subjective ratings of quality across three text-to-speech engines priced at different levels. However, no significant differences were found with reaction times or accuracy between these text-to-speech engines. Future avenues of research include exploring more complex tasks, usability issues related to implementing text-to-speech features, and applied health promotion and education opportunities among vulnerable populations.

Treatment with antiretroviral therapy is not associated with increased sexual risk behavior in Kenyan female sex workers

McClelland, R. S., Graham, S. M., Richardson, B. A., Peshu, N., Masese, L. N., Wanje, G. H., Mandaliya, K. N., Kurth, A. E., Jaoko, W., & Ndinya-Achola, J. O. (2010). AIDS, 24(6), 891-897. 10.1097/QAD.0b013e32833616c7

Abstract

Abstract

Objective: The objective of this study was to test the hypothesis that sexual risk behavior would increase following initiation of antiretroviral therapy (ART) in Kenyan female sex workers (FSWs). Design: Prospective cohort study. Setting: FSW cohort in Mombasa, Kenya, 1993-2008. Subjects: Eight hundred and ninety-eight women contributed HIV-1-seropositive follow-up visits, of whom 129 initiated ART. Intervention: Beginning in March 2004, ART was provided to women qualifying for treatment according to Kenyan National Guidelines. Participants received sexual risk reduction education and free condoms at every visit. Main Outcome Measures: Main outcome measures included unprotected intercourse, abstinence, 100% condom use, number of sexual partners, and frequency of sex. Outcomes were evaluated at monthly follow-up visits using a 1-week recall interval. Results: Compared with non-ART-exposed follow-up, visits following ART initiation were not associated with an increase in unprotected sex [adjusted odds ratio (AOR) 0.86, 95% confidence interval (CI) 0.62-1.19, P = 0.4]. There was a nonsignificant decrease in abstinence (AOR 0.81, 95% CI 0.65-1.01, P = 0.07), which was offset by a substantial increase in 100% condom use (AOR 1.54, 95% CI 1.07-2.20, P = 0.02). Numbers of sex partners and frequency of sex were similar before versus after starting ART. A trend for decreased sexually transmitted infections following ART initiation provides additional support for the validity of the self-reported behavioral outcomes (AOR 0.67, 95% CI 0.44-1.02, P = 0.06). Conclusion: In the setting of ongoing risk reduction education and provision of free condoms, initiation of ART was not associated with increased sexual risk behavior in this cohort of Kenyan FSWs.

Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

Curioso, W. H., Kepka, D., Cabello, R., Segura, P., & Kurth, A. E. (2010). BMC Public Health, 10. 10.1186/1471-2458-10-13

Abstract

Abstract

Background. Antiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood. Methods. At two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data. Results. Among the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment. Conclusions. Overall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.

Usability of PDAs to deliver multi-language health worker training and patient behavioral assessment in Kenya

Kurth, A., McClelland, L., Kamau, V., & Curioso, W. H. (2010). In Studies in Health Technology and Informatics (Vols. 160). IOS Press.

Utilizing information and communication technology tools in STD clinics: Has the time come to go digital

Kurth, A. E. (2010). Sexually Transmitted Diseases, 37(11), 669-671. 10.1097/OLQ.0b013e3181f90503