Ann Elizabeth Kurth's additional information
-
-
Publications
Why the wait? Delayed HIV diagnosis among men who have sex with men
AbstractNelson, K. M., Thiede, H., Hawes, S. E., Golden, M. R., Hutcheson, R., Carey, J. W., Kurth, A., & Jenkins, R. A. (2010). Journal of Urban Health, 87(4), 642-655. 10.1007/s11524-010-9434-8AbstractWe sought to identify factors associated with delayed diagnosis of human immunodeficiency virus (HIV; testing HIV-seropositive 6 months or more after HIV seroconversion), by comparing delayed testers to non-delayed testers (persons who were diagnosed within 6 months of HIV seroconversion), in King County, Washington among men who have sex with men (MSM). Participants were recruited from HIV testing sites in the Seattle area. Delayed testing status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion or a self-reported previous HIV- negative test. Quantitative data on sociodemographic characteristics, health history, and drug-use and sexual behaviors were collected via computer-assisted self-interviews. Qualitative semi-structured interviews regarding testing and risk behaviors were also conducted. Multivariate analysis was used to identify factors associated with delayed diagnosis. Content analysis was used to establish themes in the qualitative data. Out of the 77 HIV-seropositive MSM in this sample, 39 (51%) had evidence of delayed diagnosis. Factors associated with delayed testing included being African-American, homeless, "out" to 50% or less people about male-male sex, and having only one sex partner in the past 6 months. Delayed testers often cited HIV-related sickness as their reason for testing and fear and wanting to be in denial of their HIV status as reasons for not testing. Delayed testers frequently did not identify as part of the MSM community, did not recognize that they were at risk for HIV acquisition, and did not feel a responsibility to themselves or others to disclose their HIV status. This study illustrates the need to further explore circumstances around delayed diagnosis in MSM and develop outreach methods and prevention messages targeted specifically to this potentially highly marginalized population in order to detect HIV infections earlier, provide HIV care, and prevent new infections.Concurrent partnerships and HIV prevalence disparities by race: Linking science and public health practice
AbstractMorris, M., Kurth, A. E., Hamilton, D. T., Moody, J., & Wakefield, S. (2009). American Journal of Public Health, 99(6), 1023-1031. 10.2105/AJPH.2008.147835AbstractConcurrent sexual partnerships may help to explain the disproportionately high prevalence of HIV and other sexually transmitted infections among African Americans. The persistence of such disparities would also require strong assortative mixing by race. We examined descriptive evidence from 4 nationally representative US surveys and found consistent support for both elements of this hypothesis. Using a data-driven network simulation model, we found that the levels of concurrency and assortative mixing observed produced a 2.6-fold racial disparity in the epidemic potential among young African American adults.Discussion and revision of the mathematical modeling tool described in the previously published article Modeling HIV Transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy
AbstractCassels, S., Pearson, C. R., Kurth, A. E., Martin, D. P., Simoni, J. M., Matediana, E., & Gloyd, S. (2009). AIDS Care - Psychological and Socio-Medical Aspects of AIDS HIV, 21(7), 858-862. 10.1080/09540120802626204AbstractMathematical models are increasingly used in social and behavioral studies of HIV transmission; however, model structures must be chosen carefully to best answer the question at hand and conclusions must be interpreted cautiously. In Pearson et al. (2007), we presented a simple analytically tractable deterministic model to estimate the number of secondary HIV infections stemming from a population of HIV-positive Mozambicans and to evaluate how the estimate would change under different treatment and behavioral scenarios. In a subsequent application of the model with a different data set, we observed that the model produced an unduly conservative estimate of the number of new HIV-1 infections. In this brief report, our first aim is to describe a revision of the model to correct for this underestimation. Specifically, we recommend adjusting the population-level sexually transmitted infection (STI) parameters to be applicable to the individual-level model specification by accounting for the proportion of individuals uninfected with an STI. In applying the revised model to the original data, we noted an estimated 40 infections/1000 HIV-positive persons per year (versus the original 23 infections/1000 HIV-positive persons per year). In addition, the revised model estimated that highly active antiretroviral therapy (HAART) along with syphilis and herpes simplex virus type 2 (HSV-2) treatments combined could reduce HIV-1 transmission by 72% (versus 86% according to the original model). The second aim of this report is to discuss the advantages and disadvantages of mathematical models in the field and the implications of model interpretation. We caution that simple models should be used for heuristic purposes only. Since these models do not account for heterogeneity in the population and significantly simplify HIV transmission dynamics, they should be used to describe general characteristics of the epidemic and demonstrate the importance or sensitivity of parameters in the model."It's time for your life": How should we remind patients to take medicines using short text messages?
AbstractCurioso, W. H., Quistberg, D. A., Cabello, R., Gozzer, E., Garcia, P. J., Holmes, K. K., & Kurth, A. E. (2009). AMIA . Annual Symposium Proceedings AMIA Symposium. AMIA Symposium, 2009, 129-133.AbstractThe objective of this paper is to characterize effective patient care reminder strategies for people living with HIV/AIDS (PLWHA) to improve antiretroviral therapy (ART) adherence) using short message service (SMS) based on patient perspectives. We conducted a qualitative study with adult PLWHA in a community-based clinic in Lima, Peru using focus groups. 26 HIV-positive individuals participated in four focus groups (20 men, 6 women). The participants expressed positive perceptions towards receiving reminders via SMS, but specified certain characteristics they wanted them to have (such as being simple and concise). It was also important that the messages maintained confidentiality and privacy by using coded words or phrases ("Remember, it is the time of your life") instead of "sensitive" words (HIV or antiretroviral). This study suggests that patients want healthcare SMS that appropriately notify them, deliver a careful crafted message, and assess the context in which they are received.Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: Report from the 2007 Conference of the National Emergency Department HIV Testing Consortium
Kurth, A., & Al., . (2009). Academic Emergency Medicine, 16(2), 168-177.Reducing at-risk adolescents' display of risk behavior on a social networking web site a randomized controlled pilot intervention trial
AbstractMoreno, M. A., Vanderstoep, A., Parks, M. R., Zimmerman, F. J., Kurth, A., & Christakis, D. A. (2009). Archives of Pediatrics and Adolescent Medicine, 163(1), 35-41. 10.1001/archpediatrics.2008.502AbstractObjective: To determine whether an online intervention reduces references to sex and substance abuse on social networking Web sites among at-risk adolescents. Design: Randomized controlled intervention trial. Setting: www.MySpace.com. Participants: Self-described 18- to 20-year-olds with public MySpace profiles who met our criteria for being at risk (N = 190). Intervention: Single physician e-mail. Main Outcome Measures: Web profiles were evaluated for references to sex and substance use and for security settings before and 3 months after the intervention. Results: Of 190 subjects, 58.4% were male. At baseline, 54.2% of subjects referenced sex and 85.3% referenced substance use on their social networking site profiles. The proportion of profiles in which references decreased to 0 was 13.7% in the intervention group vs 5.3% in the control group for sex (P = .05) and 26.0% vs 22% for substance use (P = .61). The proportion of profiles set to "private" at follow-up was 10.5% in the intervention group and 7.4% in the control group (P = .45). The proportion of profiles in which any of these 3 protective changes were made was 42.1% in the intervention group and 29.5% in the control group (P =.07). Conclusions: A brief e-mail intervention using social networking sites shows promise in reducing sexual references in the online profiles of at-risk adolescents. Further study should assess how adolescents view different risk behavior disclosures to promote safe use of the Internet.Counseling and testing for HIV infection
Spielberg, F., & Kurth, A. (2008). In K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, M. Cohen, & H. Watts (Eds.), Sexually transmitted diseases (4th eds., 1–). McGraw-Hill.Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: Results of a randomized trial
AbstractMcClelland, R. S., Richardson, B. A., Hassan, W. M., Chohan, V., Lavreys, L., Mandaliya, K., Kiarie, J., Jaoko, W., Ndinya-Achola, J. O., Baeten, J. M., Kurth, A. E., & Holmes, K. K. (2008). Journal of Infectious Diseases, 197(10), 1361-1368. 10.1086/587490AbstractBackground. Vaginal infections are common and have been associated with increased risk for acquisition of human immunodeficiency virus type 1 (HIV-1). Methods. We conducted a randomized trial of directly observed oral treatment administered monthly to reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was compared with metronidazole placebo plus fluconazole placebo. The primary end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus organisms. Results. Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were included in the primary end points analysis. A median of 12 follow-up visits per subject were recorded in both study arms (P = .8). Compared with control subjects, women receiving the intervention had fewer episodes of BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19 -1.80) and H2O 2-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16 -2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among control subjects, but the differences were not statistically significant. Conclusions. Periodic presumptive treatment reduced the incidence of BV and promoted colonization with normal vaginal flora. Vaginal health interventions have the potential to provide simple, female-controlled approaches for reducing the risk of HIV-1 acquisition.Individual-level risk assessment for STD/HIV infection
Kurth, A., & Spielberg, F. (2008). In K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, M. Cohen, & H. Watts (Eds.), Sexually transmitted diseases (4th eds., 1–). McGraw-Hill.Information technologies and STD/HIV
Curioso, W., Kurth, A., Blas, M., & Klausner, J. (2008). In K. Holmes, P. Sparling, W. Stamm, P. Piot, J. Wasserheit, L. Corey, M. Cohen, & H. Watts (Eds.), Sexually transmitted diseases (4th eds., 1–). McGraw-Hill.