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Search Results: 1 - 10 of 278 matches for " Musick Beverly "
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Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya
Paul Ayuo,Beverly Musick,Hai Liu,Paula Braitstein
Journal of the International AIDS Society , 2013, DOI: 10.7448/ias.16.1.17994
Abstract: Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery. Methods: To address this objective, the electronic medical records of all antiretroviral-na ve adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis. Results: A total of 4284 antiretroviral-na ve pregnant women initiated CART between January 2006 and February 2009. The majority of women (89%) reported taking all of their medication at every visit. There were 18 (0.4%) deaths reported. Clinicians discontinued CART in 10 patients (0.7%) while 1367 (31.9%) women disengaged from care. Of those disengaging, 404 (29.6%) disengaged early and 963 (70.4%) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966–0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909–0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644–0.980) or tuberculosis medication (OR 0.457; CI 0.202–0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034–1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881–0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917–0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000–1001) and in married women (OR 1.297; CI 1.000–1.695) Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4%) of women remained engaged and received uninterrupted prenatal CART.
Short-term risk of anaemia following initiation of combination antiretroviral treatment in HIV-infected patients in countries in sub-Saharan Africa, Asia-Pacific, and central and South America
Zhou Jialun,Jaquet Antoine,Bissagnene Emmanuel,Musick Beverly
Journal of the International AIDS Society , 2012, DOI: 10.1186/1758-2652-15-5
Abstract: Background The objective was to examine the short-term risk and predictors of anaemia following initiation of combination antiretroviral therapy (cART) in HIV-infected patients from the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) collaboration. Methods Anaemia was defined as haemoglobin of < 10 g/dL. Patients were included if they started cART with three or more drugs, had prior haemoglobin of > = 10 g/dL, and had one or more follow-up haemoglobin tests. Factors associated with anaemia up to 12 months were examined using Cox proportional hazards models and stratified by IeDEA region. Results Between 1998 and 2008, 19,947 patients initiated cART with baseline and follow-up haemoglobin tests (7358, 7289, 2853, 471, 1550 and 426 in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian-Pacific, and Caribbean and Central and South America regions, respectively). At initiation, anaemia was found in 45% of Western Africa patients, 29% of Eastern Africa patients, 21% of Southern Africa patients, 36% of Central Africa patients, 15% of patients in Asian-Pacific and 14% of patients in Caribbean and Central and South America. Among patients with haemoglobin of > = 10 g/dL at baseline (13,445), the risks of anaemia were 18.2, 6.6, 9.7, 22.9, 11.8 and 19.5 per 100 person-years in the Western Africa, Eastern Africa, Southern Africa, Central Africa, Asian, and Caribbean and Central and South America regions, respectively. Factors associated with anaemia were female sex, low baseline haemoglobin level, low baseline CD4 count, more advanced disease stage, and initial cART containing zidovudine. Conclusions In data from 34 cohorts of HIV-infected patients from sub-Saharan Africa, Central and South America, and Asia, the risk of anaemia within 12 months of initiating cART was moderate. Routine haemoglobin monitoring was recommended in patients at risk of developing anaemia following cART initiation.
Reduced renal function is associated with progression to AIDS but not with overall mortality in HIV-infected kenyan adults not initially requiring combination antiretroviral therapy
Gupta Samir K,Ong'or Willis,Shen Changyu,Musick Beverly
Journal of the International AIDS Society , 2011, DOI: 10.1186/1758-2652-14-31
Abstract: Background The World Health Organization (WHO) has recently recommended that antiretrovirals be initiated in all individuals with CD4 counts of less than 350 cells/mm3. For countries with resources too limited to expand care to all such patients, it would be of value to able to identify and target populations at highest risk of HIV progression. Renal disease has been identified as a risk factor for disease progression or death in some populations. Methods Times to meeting combination antiretroviral therapy (cART) initiation criteria (developing either a CD4 count < 200 cells/mm3 or WHO stage 3 or 4 disease) and overall mortality were evaluated in cART-na ve, HIV-infected Kenyan adults with CD4 cell counts ≥200/mm3 and with WHO stage 1 or 2 disease. Cox proportional hazard regression models were used to evaluate the associations between renal function and these endpoints. Results We analyzed data of 7383 subjects with a median follow-up time of 59 (interquartile range, 27-97) weeks. In Cox regression analyses adjusted for age, sex, WHO disease stage, CD4 cell count and haemoglobin, estimated creatinine clearance (CrCl) < 60 mL/min was significantly associated with shorter times to meeting cART initiation criteria (HR 1.34; 95% CI, 1.23-1.52) and overall mortality (HR 1.73; 95% CI, 1.19-2.51) compared with CrCl ≥60 mL/min. Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 was associated with shorter times to meeting cART initiation criteria (HR 1.39; 95% CI, 1.22-1.58), but not with overall mortality. CrCl and eGFR remained associated with shorter times to cART initiation criteria, but neither was associated with mortality, in weight-adjusted analyses. Conclusions In this large natural history study, reduced renal function was strongly associated with faster HIV disease progression in adult Kenyans not initially meeting cART initiation criteria. As such, renal function measurement in resource-limited settings may be an inexpensive method to identify those most in need of cART to prevent progression to AIDS. The initial association between reduced CrCl, but not reduced eGFR, and greater mortality was explained by the low weights in this population.
Impact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in western Kenya
Rachel C Vreeman, Winstone M Nyandiko, Edwin Sang, Beverly S Musick, Paula Braitstein, Sarah E Wiehe
Conflict and Health , 2009, DOI: 10.1186/1752-1505-3-5
Abstract: We conducted a mixed methods analysis that included a retrospective cohort analysis, as well as key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infected children, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and 25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre- and post-conflict antiretroviral therapy (ART) adherence and post-election return to clinic for this cohort. ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We used multivariable logistic regression to assess factors associated with not returning to clinic. Interview dialogue from was analyzed using constant comparison, progressive coding and triangulation.Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642 on ART) were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398) returned to care. At their first visit after the election, 95% of children on ART (N = 1,408) reported perfect ART adherence, a significant drop from 98% pre-election (p < 0.001). Children on ART were significantly more likely to return to clinic than those not on ART. Members of tribes targeted by violence and members of minority tribes were less likely to return. In qualitative analysis of 9 key informant interviews, prominent barriers to return to clinic and adherence included concerns for personal safety, shortages of resources, hanging priorities, and hopelessness.During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population had disruptions in clinical care and in medication adherence, putting children at risk for viral resistance and increased morbidity. However, unique program strengths may have minimized these disruptions.Conflicts, population displacement, and the economic consequences of disasters affect children disproportionately.[1] Children are more vulnerable to communicable
Alternative antiretroviral monitoring strategies for HIV-infected patients in east Africa: opportunities to save more lives?
Braithwaite R Scott,Nucifora Kimberly A,Yiannoutsos Constantin T,Musick Beverly
Journal of the International AIDS Society , 2011, DOI: 10.1186/1758-2652-14-38
Abstract: Background Updated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection. Methods Using a validated HIV computer simulation based on resource-limited data (USAID and AMPATH) and circumstances (east Africa), we compared alternative monitoring strategies for HIV-infected persons newly started on cART. We evaluated clinical, immunologic and virologic monitoring strategies, including combinations and conditional logic (e.g., only perform virologic testing if immunologic testing is positive). We calculated incremental cost-effectiveness ratios (ICER) in units of cost per quality-adjusted life year (QALY), using a societal perspective and a lifetime horizon. Costs were measured in 2008 US dollars, and costs and benefits were discounted at 3%. We compared the ICER of monitoring strategies with those of other resource-constrained decisions, in particular earlier cART initiation (at CD4 counts of 350 cells/mm3 rather than 200 cells/mm3). Results Monitoring strategies employing routine CD4 testing without virologic testing never maximized health benefits, regardless of budget or societal willingness to pay for additional health benefits. Monitoring strategies employing virologic testing conditional upon particular CD4 results delivered the most benefit at willingness-to-pay levels similar to the cost of earlier cART initiation (approximately $2600/QALY). Monitoring strategies employing routine virologic testing alone only maximized health benefits at willingness-to-pay levels (> $4400/QALY) that greatly exceeded the ICER of earlier cART initiation. Conclusions CD4 testing alone never maximized health benefits regardless of resource limitations. Programmes routinely performing virologic testing but deferring cART initiation may increase health benefits by reallocating monitoring resources towards earlier cART initiation.
Cohabitation, nonmarital childbearing, and the marriage process
Kelly Musick
Demographic Research , 2007,
Abstract: Past work on the relationship between cohabitation and childbearing shows that cohabitation increases fertility compared to being single, and does so more for intended than unintended births. Most work in this area, however, does not address concerns that fertility and union formation are joint processes, and that failing to account for the joint nature of these decisions can bias estimates of cohabitation on childbearing. For example, cohabitors may be more likely to plan births because they see cohabitation as an acceptable context for childbearing; alternatively, they may be more likely to marry than their single counterparts. In this paper, I use a modeling approach that accounts for the stable, unobserved characteristics of women common to nonmarital fertility and union formation as a way of estimating the effect of cohabitation on nonmarital fertility net of cohabitors' potentially greater likelihood of marriage. I distinguish between intended and unintended fertility to better understand variation in the perceived acceptability of cohabitation as a setting for childbearing. I find that accounting for unmeasured heterogeneity reduces the estimated effect of cohabitation on intended childbearing outside of marriage by up to 50%, depending on race/ethnicity. These results speak to cohabitation's evolving place in the family system, suggesting that cohabitation may be a step on the way to marriage for some, but an end in itself for others.
Recognizing trivial links in polynomial time
Chad Musick
Mathematics , 2011,
Abstract: Trivial links are unique up to number of link components, but they can be hard to recognize from arbitrary diagrams. We define a new measure of the complexity of a link embedding, the crumple, and show how this may be used to measure progress toward a trivial embedding. In conjunction with a modified form of arc presentations of links, we obtain a strictly monotonic, deterministic algorithm that recognizes triviality in links within polynomial time and space.
Minimal bridge projections for 11-crossing prime knots
Chad Musick
Mathematics , 2012,
Abstract: We give the bridge indices for 11-crossing prime knots and give a minimal bridge projection for each of these knots. The results on the indices may be easily summarized: all of these knots that are not rational knots or Montesinos knots have bridge index three.
A method of encoding generalized link diagrams
Chad Musick
Mathematics , 2012, DOI: 10.1142/S0218216513500211
Abstract: We describe a method of encoding various types of link diagrams, including those with classical, flat, rigid, welded, and virtual crossings. We show that this method may be used to encode link diagrams, up to equivalence, in a notation whose length is a cubic function of the number of 'riser marks'. For classical knots, the minimal number of such marks is twice the bridge index, and a classical knot diagram in minimal bridge form with bridge index $b$ may be encoded in space $\mathcal{O}(b^2)$. A set of moves on the notation is defined. As a demonstration of the utility of the notation we give another proof that the Kishino virtual knot is non-classical.
Minimal Assumption Distribution Propagation in Belief Networks
Ron Musick
Computer Science , 2013,
Abstract: As belief networks are used to model increasingly complex situations, the need to automatically construct them from large databases will become paramount. This paper concentrates on solving a part of the belief network induction problem: that of learning the quantitative structure (the conditional probabilities), given the qualitative structure. In particular, a theory is presented that shows how to propagate inference distributions in a belief network, with the only assumption being that the given qualitative structure is correct. Most inference algorithms must make at least this assumption. The theory is based on four network transformations that are sufficient for any inference in a belief network. Furthermore, the claim is made that contrary to popular belief, error will not necessarily grow as the inference chain grows. Instead, for QBN belief nets induced from large enough samples, the error is more likely to decrease as the size of the inference chain increases.
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