Ann Elizabeth Kurth

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Publications

Publications

Usability evaluation of Personal Digital Assistants (PDAs) to support HIV treatment adherence and safer sex behavior in Peru.

Curioso, W. H., Kurth, A. E., Cabello, R., Segura, P., & Berry, D. L. (2008). AMIA . Annual Symposium Proceedings AMIA Symposium. AMIA Symposium, 918.

Abstract

Abstract

Colecta-PALM is a Web-based application delivered on PDAs that provides behavioral messaging based on risk assessment responses for HIV patients. Usability testing was undertaken with 15 people living with HIV.AIDS (PWLHA) in two clinics in Lima. Sixty percent (9/15) were somewhat/very satisfied with Colecta-PALM, with usefulness rated 3.7/5. Users found the tool innovative, interesting, easy to use, educational, trustworthy, private, and non-judgmental. Colecta-PALM was well-received and easily usable by most.

Access, use and perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru

Curioso, W. H., & Kurth, A. E. (2007). BMC Medical Informatics and Decision Making, 7. 10.1186/1472-6947-7-24

Abstract

Abstract

Background. Internet tools, cell phones, and other information and communication technologies are being used by HIV-positive people on their own initiative. Little is known about the perceptions of HIV-positive people towards these technologies in Peru. The purpose of this paper is to report on perceptions towards use of information and communication technologies as a means to support antiretroviral medication adherence and HIV transmission risk reduction. Methods. We conducted a qualitative study (in-depth interviews) among adult people living with HIV in two community-based clinics in Peru. Results. 31 HIV-positive individuals in Lima were interviewed (n = 28 men, 3 women). People living with HIV in Peru are using tools such as cell phones, and the Internet (via E-mail, chat, list-serves) to support their HIV care and to make social and sexual connections. In general, they have positive perceptions about using the Internet, cell phones and PDAs for HIV health promotion interventions. Conclusion. Health promotion interventions using information and communication technology tools among people living with HIV in resource-constrained settings may be acceptable and feasible, and can build on existing patterns of use.

Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues

Pearson, C. R., Simoni, J. M., Hoff, P., Kurth, A. E., & Martin, D. P. (2007). AIDS and Behavior, 11(2), 161-173. 10.1007/s10461-006-9133-3

Abstract

Abstract

We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R 2 = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1-3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.

Internet as a tool to access high-risk men who have sex with men from a resource-constrained setting: A study from Peru

Blas, M. M., Alva, I. E., Cabello, R., Garcia, P. J., Carcamo, C., Redmon, M., Kimball, A. M., Ryan, R., & Kurth, A. E. (2007). Sexually Transmitted Infections, 83(7), 567-570. 10.1136/sti.2007.027276

Abstract

Abstract

Objectives: In Peru, current interventions in high-risk men who have sex with men (MSM) reach a limited number of this population because they rely solely on peer education. The objective of this study was to assess the use of the internet as an alternative tool to access this population. Methods: Two nearly identical banner ads - both advertising an online survey but only one offering free HIV/syphilis tests and condoms - were displayed randomly on a Peruvian gay website. Results: The inclusion of the health incentive increased the frequency of completed surveys (5.8% vs 3.4% of delivered impressions; p<0.001), attracting high-risk MSM not previously tested for HIV but interested in a wide variety of preventive Web-based interventions. Eleven per cent (80/713) of participants who said they had completed the survey offering free testing visited our clinic: of those who attended, 6% had already been diagnosed as having HIV, while 5% tested positive for HIV. In addition, 8% tested positive for syphilis. Conclusions: The internet can be used as a tool to access MSM in Peru. The compensation of a free HIV/syphilis test increased the frequency of participation in our online survey, indicating that such incentives may be an effective means of reaching this population. However, as only a small percentage of participants actually reported for testing, future research should develop and assess tailored internet interventions to increase HIV/STI testing and delivery of other prevention services to Peruvian MSM.

Modeling HIV transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy

Pearson, C. R., Kurth, A. E., Cassels, S., Martin, D. P., Simoni, J. M., Hoff, P., Matediana, E., & Gloyd, S. (2007). AIDS Care - Psychological and Socio-Medical Aspects of AIDS HIV, 19(5), 594-604. 10.1080/09540120701203337

Abstract

Abstract

Understanding sexual behavior and assessing transmission risk among people living with HIV-1 is crucial for effective HIV-1 prevention. We describe sexual behavior among HIV-positive persons initiating highly active antiretroviral therapy (HAART) in Beira, Mozambique. We present a Bernoulli process model (tool available online) to estimate the number of sexual partners who would acquire HIV-1 as a consequence of sexual contact with study participants within the prior three months. Baseline data were collected on 350 HAART-naive individuals 18-70 years of age from October 2004 to February 2005. In the three months prior to initiating HAART, 45% (n = 157) of participants had sexual relationships with 191 partners. Unprotected sex occurred in 70% of partnerships, with evidence suggesting unprotected sex was less likely with partners believed to be HIV-negative. Only 26% of the participants disclosed their serostatus to partners with a negative or unknown serostatus. Women were less likely to report concurrent relationships than were men (21 versus 66%; OR 0.13; 95%CI: 0.06, 0.26). Given baseline behaviors, the model estimated 23.2 infections/1,000 HIV-positive persons per year. The model demonstrated HAART along with syphilis and herpes simplex virus type 2 (HSV-2) treatment combined could reduce HIV-1 transmission by 87%; increasing condom use could reduce HIV-1 transmission by 67%.

Modeling transmission risk among HIV-positive Mozambicans initiating HAART

Pearson, C. R., Kurth, A., Cassels, S., Martin, D. P., Simoni, J. M., Hoff, P., Matediana, E., & Gloyd, S. (2007). Annals of Behavioral Medicine, 33.

Opportunities for providing Web-based interventions to prevent sexually transmitted infections in Peru

Curioso, W. H., Blas, M. M., Nodell, B., Alva, I. E., & Kurth, A. E. (2007). PLoS Medicine, 4(2), 248-251. 10.1371/journal.pmed.0040011

Patient and Staff Perspectives on the Use of a Computer Counseling Tool for HIV and Sexually Transmitted Infection Risk Reduction

Mackenzie, S. L., Kurth, A. E., Spielberg, F., Severynen, A., Malotte, C. K., St. Lawrence, J., & Fortenberry, J. D. (2007). Journal of Adolescent Health, 40(6), 572.e9-572.e16. 10.1016/j.jadohealth.2007.01.013

Abstract

Abstract

Purpose: To explore use of an interactive health communication tool- "Computer Assessment and Risk Reduction Education (CARE) for STIs/HIV.". Methods: This was a mixed method study utilizing participant observation and in-depth interviews with patients (n = 43), and focus groups with staff (5 focus groups, n = 41) from 5 clinics in 3 states (1 Planned Parenthood, 1 Teen, 2 STD, and 1 mobile van clinic). Data were managed using Atlas.ti. Inter-rater reliability of qualitative coding was .90. Results: Users were 58% nonwhite with mean age 24.7 years (74% < 25). Patients could use CARE with minimal to no assistance. Time for session completion averaged 29.6 minutes. CARE usefulness was rated an average of 8.2 on an ascending utility scale of 0 to 10. Patient themes raised as strengths were novelty, simplicity, confidentiality, personalization, and plan development, increased willingness to be honest, lack of judgment, and a unique opportunity for self-evaluation. Staff themes raised as strengths were enhanced data collection, handout customization, education standardization, behavioral priming, and expansion of services. Patient limitation themes included limited responses and lack of personal touch. Staff limitation themes were selecting users, cost, patient-provider role, privacy, and time for use. Conclusions: CARE was well-received and easily usable by most (especially 18-25-year-olds). Patient and staff perceptions support the use of CARE as an adjunct to usual practice and as a method to expand services. Honesty, reduced time constraints, and lack of judgment associated with CARE appeared to enhance self-evaluation, which may prove an important component in moving patients forward in the behavior change process.

Personal digital assistants for HIV treatment adherence, safer sex behavior support, and provider training in resource-constrained settings.

Kurth, A. E., Curioso, W. H., Ngugi, E., McClelland, L., Segura, P., Cabello, R., & Berry, D. L. (2007). AMIA . Annual Symposium Proceedings AMIA Symposium. AMIA Symposium, 1018.

Abstract

Abstract

We developed a Web-based application delivered on PDAs (Colecta-PALM in Peru, Pambazuko-PALM in Kenya), to collect data from HIV patients and to facilitate HIV provider training. Colecta-PALM provides tailored feedback (behavioral messaging) based on risk assessment responses for HIV patients. Pambazuko-PALM collects patient risk assessment data, and delivers counseling protocol training and evaluation to nurses involved in HIV care.

Tecnologias de informacion y comunicacion para la prevencion y control de la infeccion por el VIH y otras ITS

Curioso, W., Blas, M., Kurth, A., & Klausner, J. D. (2007). Revista Peruana De Medicina Experimental Y Salud Publica, 24(3), 262-271.